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EXTRACTS FROM OTHER JOURNALS RELATING TO CHILDREN, YOUTH AND FAMILIES — IN THE FIELDS OF HEALTH, SUBSTANCE ABUSE, EDUCATION, PSYCHOLOGY, SCIENCE

February 2002

Prevention Programs Work for High-Risk Youth
Addiction-prevention programs for high-risk youth led to lower use of alcohol and other drugs, according to a new study from the Substance Abuse & Mental Health Services Administration (SAMHSA). The National Cross-Site Evaluation of the High-Risk Youth Demonstration Program study found that high-risk youth enrolled in federally funded prevention programs had a 12-percent lower rate of first-time use of cigarettes, alcohol, and marijuana, than youth who were not in a program.
In addition, compared to their peers outside of programs, alcohol and other drug use by youth who had already begun to use was 10 percent lower by the time they exited treatment.
The study included more than 10,500 youth in 48 communities that were defined as high-risk based on such factors as poverty, crime rate, and overall substance use.
The study identified six program components that can help reduce the likelihood of alcohol and other drug use. Among the successful programs were those emphasizing life-skills development, connectedness to constructive peers and adults, and self-examination.
The study further found that the best programs had a clear purpose and evidenced-based strategy, maintained intensive participant contact, and were offered in after-school settings at times when youth are most at risk for alcohol and other drug use.
In addition, the study indicated that gender plays an important role in risk, protection, and alcohol, tobacco, and illicit-drug use. For instance, boys participating in study programs used alcohol and other drugs at a 29-percent lower rate than a comparison group. Use rates for girls participating in the study program were 3 percent lower than a control group.
Noted SAMHSA's prevention program director, Ruth Sanchez-Way, Ph.D.: "The research clearly shows that adolescent males tend to change their behavior as long as the necessary prevention supports are in place. Females, inversely, seem to better internalize the lessons learned from prevention programs than do males."

One in 10 North Carolina Kids Given ADHD Status
As many as 10% of North Carolina school children have been diagnosed with attention-deficit/hyperactivity disorder (ADHD) and many of those youngsters are taking medication for the condition, researchers report. This percentage is significantly higher than national estimates of 3% to 5%. Yet the new report, as well as a handful of other regional studies, indicate that ADHD diagnosis and treatment may be much more common than previously thought, the investigators note.
"We found that 10% of elementary school children...had received a diagnosis of ADHD by a doctor or psychologist and 7% of the children were being treated for ADHD with medication," study author Dr. Andrew Rowland told Reuters Health.
The new findings "make me question whether the 3% to 5% figure could possibly be valid," said Rowland, an epidemiologist at the University of New Mexico in Albuquerque, who conducted the study while at the National Institute of Environmental Health Sciences in Research Triangle Park, North Carolina.
The results add fuel to ongoing concerns that too many youngsters are being treated for the disorder.
"Medication treatment often is very helpful for children who have ADHD," Rowland said. "But on the other hand, if it's not followed up well and the diagnosis is not made according to standardized criteria, that's when you start to have problems."
Symptoms of ADHD include inattention, hyperactivity and impulsivity that can lead to academic underachievement and troubled family relationships.
In the study, conducted from 1997 to 1999, parents of 6,099 children in grades 1 through 5 at 17 public elementary schools in Johnston County, North Carolina, completed a survey asking them whether their children had ever been diagnosed with ADHD and whether they were currently taking medication to treat the disorder.
Results published in the February issue of the American Journal of Public Health, journal of the American Public Health Association, showed that 607 children, or 10%, had been diagnosed with ADHD and 434, or 7%, were taking Ritalin or other treatment medication.
Boys were three times more likely to be diagnosed with ADHD than girls, and both sexes were about equally likely to receive medication after diagnosis. However, black and Hispanic children received fewer prescriptions than white youngsters, perhaps because they had less access to healthcare, the researchers suggest.
Johnston County has both rural and urban areas, and its ethnic population is similar to that of most of North Carolina, according to Rowland. As a result, he said, the findings probably apply to the rest of the state and perhaps neighboring states in the South as well.
He said his findings are in line with other regional studies, such as a 1995 Virginia study showing that 8% to 10% of young school children were taking medication for ADHD.
However, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), a book widely used by doctors to diagnose mental illnesses, estimates the prevalence of ADHD at 3% to 5%, Rowland noted.
The problem, he said, is that solid national data on ADHD do not exist.
"We really need other studies like ours and national monitoring data to know whether the experience we saw is unusual," Rowland said. "Having that information is important for understanding the dimensions of the impact of ADHD."
SOURCE: American Journal of Public Health 2002;92:231-234.

Abdominal Fat May Raise Boys' Blood Pressure
Excess fat around the middle is linked to an increased risk of heart disease in adults, and now research suggests that it may also contribute to high blood pressure in boys.
New York researchers found that among the 920 healthy children and teens they studied, blood pressure rose in tandem with abdominal fat for boys of all ages and races. The relationship was not found among girls, they reported Monday in the advance online edition of Circulation: Journal of the American Heart Association.
Previous research has found body-fat distribution to be important in both boys' and girls' cardiovascular health. This study, according to the researchers, is the first to find a sex difference in the link between fat distribution and blood pressure in children and teens.
The reasons for the difference are unclear, according to the study's lead author, Dr. Dympna Gallagher of St. Luke's-Roosevelt Hospital.
But, Gallagher told Reuters Health, sex differences in cardiovascular health are nothing new. "In adults," the researcher noted, "abdominal fat is associated with greater cardiovascular risk in males than females."
With children, it is important to know what factors might elevate blood pressure because blood pressure is known to "track" from childhood to adulthood, according to Gallagher's team. High blood pressure is a major risk factor for heart disease, stroke and kidney disease.
In addition, teens diagnosed with high blood pressure have been found to have a high prevalence of left ventricular hypertrophy, an enlargement of the heart's main pumping chamber that raises the risk of heart attack and stroke.
None of the boys in the current study had high blood pressure, which is relatively uncommon in children. However, Gallagher said, boys with higher amounts of abdominal fat had blood pressure in the high range of "normal."
"We consider this to be important as we know that blood pressure tracks from childhood to adulthood, and childhood blood pressure is predictive of later (disease)," the researcher explained.
The findings, according to Gallagher, suggest that it is especially important to annually monitor blood pressure changes in children who are overweight or obese.
In the study, the researchers measured the children's body fat with tests of skinfold thickness and a special x-ray technique that gauges the density of tissue. They found that the amount of fat in the trunk was related to boys' blood pressure, independent of the amount of fat elsewhere in the body.
Among girls, black participants had a slightly higher average blood pressure than whites. The same was true of black boys compared with Asian boys.
SOURCE: Circulation 2002;105.

Parents Overtreat Harmless Fevers in Kids: Survey
A survey comparing attitudes of doctors, nurses and parents towards treating fevers in children reveals that parents tend to treat high temperatures much more aggressively than health professionals do.
A low fever can actually benefit a sick child, and the researchers attributed parental tendencies to "fever phobia"--a fear that fever is harmful--which they say originated after the introduction of anti-fever drugs like Tylenol.
A group of Israeli researchers obtained their results from a questionnaire sent to more than 2,000 parents, doctors and nurses regarding fevers in children older than 3 months. The researchers defined fever as 1.8 degrees Fahrenheit above normal body temperature, which is around 98.6 degrees. The survey included questions on risks of fever, dosages of anti-fever drugs and when children should be treated.
Dr. Michael Sarrell and colleagues from the IPROS Network of the Israel Ambulatory Pediatric Association in Tel Aviv published their survey results in the January issue of Patient Education and Counseling.
The investigators found that only 43% of parents knew that a fever below 100.4 degrees can be beneficial to a child, in contrast to 86% of the doctors and 64% of the nurses who responded to the survey. The majority of parents also said they would treat a fever below 100.4 even if the child has no other symptoms, something with which only 11% of doctors agreed.
Dr. Donna D'Alessandro from the department of pediatrics at the University of Iowa Hospitals and Clinics, who reviewed the paper for Reuters Health, said these results are consistent with what she sees in her practice. "It seems to me there is a general feeling that many, many parents are worried about fevers," she said.
A fever can actually help sick children, she explained. "The body, basically, is trying to do the right thing," she said. "Bugs like to live at body temperature. So if you raise the temperature, you kill them off." And contrary to what parents may believe, she pointed out, the body can function very efficiently at temperatures as high as 100.5 degrees.
D'Alessandro added that some parents may overtreat fever because they mistake it for a problem, and not just a symptom.
Twenty percent of parents responding to the study questionnaire reported the only reason they treat their child's fever is to reduce the risk of seizure associated with high temperatures, called febrile seizure. D'Alessandro agreed that febrile seizures are possible, but only in children with temperatures around 108 degrees. And at that point, she said, parents should be concerned about more than just the child's fever.
"Well, what's really causing the fever? It's not the fever itself, it's the underlying cause that's the problem," she said.
As a general rule, D'Alessandro said she tends to treat fevers when the high temperature makes the child uncomfortable and thus less likely to drink often and eat.
In their report, Sarrell and colleagues included a series of recommendations on how to improve fever management in children, which included educating parents and the public, and adopting standardized guidelines for when and how to treat fevers. D'Alessandro agreed with this idea, but was unsure whether these initiatives were possible.
"The question is, who's going to spend the money for all of this? Is this significant enough a problem to go after spending a large amount of money?" she asked.
SOURCE: Patient Education and Counseling 2002;46:61-65.

Parents Should Spur Kids' Activity From Cradle On
New guidelines released Wednesday encourage US parents and caregivers to foster physical activity in children beginning in infancy in an effort to combat the nation's growing obesity epidemic.
Experts now suggest that parents stimulate their children's physical skill development just as they commonly encourage cognitive skills such as uttering 'mama' or reciting the alphabet. The guidelines call on parents to foster movement and motor skill development in their children early on as a way to avoid the pattern of sedentary living and weight gain plaguing millions of Americans.
More than 60% of American adults and 13% of children are classified as overweight or obese, according to a recent US Surgeon General report. The same report charted a doubling of childhood obesity rates over the last 20 years.
Obesity, along with smoking, is a leading risk factor for some of the nation's most pervasive health problems, including diabetes, heart disease and high blood pressure.
"We know that adults who are inactive were also inactive in their youth," said Dr. Judith C. Young, executive director of the National Association for Sport and Physical Education. The nonprofit group released the recommendations, drawing on some 40 research studies.
Parents should minimize the time preschoolers spend vegetating in front of the TV and computers and instead make sure that 3-, 4- and 5-year-olds accumulate at least one hour of structured physical activity per day, according to the report. Kids can benefit from almost any activity that encourages them to walk, run, balance, throw, roll or kick.
"They're not going to be doing push-ups and sit-ups," Young said.
Experts suggested mixing physically stimulating activity into the day-to-day routine of a child's life. When walking with a child, "walk the curb. It's a balancing activity," said Dr. Jane Clark, a professor of kinesiology at the University of Maryland and chair of the task force that authored the recommendations.
Toddlers between the ages of 1 and 3 should get at least 30 minutes of similar activity each day, and neither age group should be sedentary more than an hour at a time unless asleep, the report states.
Experts stressed that even infants can be spurred to use their motor skills. Parents can make a habit of letting infants lounge on a blanket that allows rolling and crawling rather than confining them to a seat. Early development of hand-eye coordination may also make it more likely that infants will appreciate physical activity as they grow, Clark said.
"Although it may appear that sitting up, rolling over and crawling emerge naturally, these behaviors are clearly influenced by the parent and/or caregiver and the environmental stimulation available to the infant," the report indicates.
Motor skills for an infant can be as simple as "getting your Cheerios off of your high-chair," Clark said.
Washington pediatrician Dr. Nazrat Mirza blamed the nation's growing childhood obesity problem on a high-fat American diet, low emphasis on physical education and the thousands of television hours logged yearly by the average American child.
As many as one quarter of all overweight toddlers wind up obese as adults, Mirza pointed out. Meanwhile, obese children are themselves at risk of physical and psychological damage.
"There is victimization of those children, there is discrimination, there is low self-esteem," she said.

Body Image Doesn't Change After Facelift, Nose Job
While getting a nose job or a tummy tuck may make a female patient feel better about her nose or stomach, it may not lead to increased satisfaction with her overall body image, according to recent study findings.
"The findings do suggest that improvements in body image may be limited to the feature altered by surgery," lead study author Dr. David B. Sarwer of the University of Pennsylvania Medical Center in Philadelphia told Reuters Health. "Cosmetic surgery is not a panacea for someone who is dissatisfied with his or her overall appearance."
To investigate, Sarwer and his colleagues surveyed 45 female cosmetic surgery patients, both before their operation and afterwards. On average, the patients were about 40 years old and had been considering surgery for nearly 5 years. The most common procedures were blepharoplasty (eyelid surgery), rhinoplasty (nose jobs) and breast augmentation, followed by rhytidectomy (facelift), breast reduction and liposuction.
Almost 90% of the patients said they were "extremely" or "somewhat" satisfied with the results of their operation, and most rated the feature that they had the operation performed on as significantly more attractive than it was before their operation.
The patients reported being less embarrassed about the part of their body altered by surgery and less emotionally upset when people commented about the body part. They also spent less time feeling upset about the feature operated on and fewer days per month trying to camouflage the feature with either clothes or makeup.
But the patients' overall body image did not change after surgery, the researchers report in the January issue of the journal Plastic and Reconstructive Surgery.
Overall, these findings "suggest that cosmetic surgery may help some people feel better about aspects of their appearance," Sarwer said.
SOURCE: Plastic and Reconstructive Surgery 2002;109:363-369.

Kids Say No to Smoking if Parents Set Good Example
Children living with nonsmoking parents-and particularly those youngsters who also have mothers with a strong antismoking attitude--are 50% less likely to take up the tobacco habit compared with their peers, researchers report.
Not surprisingly, the study also revealed that when parents encourage children to "do as I say and not as I do," children are apt to dismiss the good advice, and view the parents as hypocritical.
While previous studies have clearly established that parents' smoking behavior influences their child's subsequent cigarette use, the role of a mother's attitudes and concerns about smoking on cigarette use is largely unknown.
To investigate, lead author Dr. M. Robyn Andersen of the Fred Hutchinson Cancer Research Center in Seattle, Washington and her team looked at the smoking habits of 2,736 students in 12th grade and the smoking habits and attitudes of their mothers.
Initially, all of the mothers responded to a questionnaire when the students were approximately 8 years old and in the 3rd grade--before the time most children begin smoking.
The children were interviewed about their smoking habits 9 years later when they were in the 12th grade.
According to the report in the February issue of the journal Preventive Medicine, children in households where neither parent smoked and the mother had strong antismoking beliefs were 50% less likely to take up the habit than other children.
"In contrast, in households in which one or both parents are current smokers, there was no reduction in adolescent smoking associated with mothers' antismoking attitudes," Andersen and colleagues write.
"This joint effect of parental attitudes and behaviors suggests that mothers' attitudes have a substantial influence on children and adolescents, but that this influence occurs only when the attitudes are strongly held and both parents behave in a manner consistent with those attitudes and do not smoke," they add.
SOURCE: Preventive Medicine 2002;34:198-206.

Stimulants turn U.S. teens on to risky sex
Almost one in four U.S. teens and young adults has reported having unprotected sex while using alcohol or drugs, a new national survey has found.
Twenty-three percent of sexually active people surveyed, aged 15 to 24, representing about 5.6 million nationwide, reported mixing unsafe sex with drinking or drugs, the survey conducted by the Kaiser Family Foundation found on Thursday.
Even more -- 29 percent of the 1,200 people interviewed -- said they "did more sexually than they had planned" because alcohol or drugs were in the picture.
The Kaiser foundation and The National Center of Addiction and Substance Abuse, or CASA, at New York's Columbia University said the survey was among the first to look at sexual activity as it relates to drugs and alcohol and reduced inhibitions.
According to the U.S. Centres for Disease Control and Prevention, about half of all high school students have had sexual intercourse.
Seventy-nine percent of high school students had experimented with alcohol at least once, and a quarter reported frequent drug use, the CDC said.
The new survey found that teens 15 and older who drank alcohol were seven times more likely to have intercourse than those who did not drink, while those who took drugs were five times more likely. Those who drank or used drugs were also prone to have more sexual partners.
"Those are big differences and this is really dangerous activity," said Joseph Califano Jr., president of CASA and former U.S. secretary of health, education and welfare. "Kids do not understand this.
"When you mix drinking and drugs and sex, you then move into the world of the danger of getting AIDS, which is life threatening, or sexually transmitted diseases, teen pregnancy and rape," Califano said in a telephone interview.
Most rapes involved drinking or drug use by the attacker or victim, he said.
Sex education and drug prevention programs must drive home to teens the increased dangers of unsafe sex when combined with alcohol and drug use, Califano added.
Half of those in the survey said their peers mixed alcohol or drugs and sex "a lot," while 73 percent thought their peers often did not use condoms when they were under the influence.
The survey was to be presented at a conference at Columbia University -- "Dangerous Liaisons: Substance Abuse and Sexual Behaviour" - sponsored by CAS, Kaiser and the National Institute of Drug Abuse.

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