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

January 2002

Developed World Sees Rise in Youth Suicide, Murder

 Since the mid-1950s, an analysis of data from 26 industrialized nations reveals, the rate of death among adolescents and young adults has decreased by almost 50%.
 But death rates in this group from motor vehicle accidents, homicide and suicide combined have risen by 17%, according to the analysis.
And among 15- to 34-year-olds in the sampled countries, the US had the second highest rate of death from homicide, and the third highest rate of death due to motor vehicle accidents, the researchers found.
The findings come from a World Health Organization (news - web sites) (WHO) mortality database of information submitted by each country on the annual number of deaths by cause and age group. The report, published in the January issue of the Journal of Adolescent Health, analyzes data from 1955 to 1994.
Dr. Patrick Heuveline of the University of Chicago, Illinois, the study's lead author, said that he was surprised to see that a larger percentage of young people were dying from these three common causes today than in 1955, given the overall decrease in death rates.
``We hope we are making improvements against mortality all the time, and those (three causes) seem to be causes that are sort of resistant to the change,'' he told Reuters Health.
The next step, Heuveline explained, is to examine the reasons behind these data. Since death rates from these causes have increased across entire countries, Heuveline suspects the driving forces may relate to a country's social or cultural environment.
``What this suggests is that there are different social, environmental factors that apply to everyone, explaining the difference,'' he said. ``And those are, by definition, sort of at the core of your social fabric, (therefore) much more difficult to change.''
Heuveline suggested that, in the US, the relatively high death rates from these three causes could relate, in part, to American cultural products like music and movies, which some say praise violence and risk-taking behavior.
Furthermore, Heuveline mentioned an article in a recent New York Review of Books that attributed America's higher-than-average death rate from homicide--as well as relatively higher rates of teen pregnancy and drug use--to the country's ``laissez-faire culture,'' which tends to impose fewer restrictions on behavior than other industrialized countries.
Heuveline explained that increased personal freedom can stem from American families choosing to place fewer rules or restrictions on their children than families from other industrialized countries. Or from the state itself, which allows people to carry guns and other dangerous weapons that are not permitted in other nations.
``People are freer here, but to some extent, they are also freer to hurt themselves, or put themselves at risk,'' Heuveline stated.
SOURCE: Journal of Adolescent Health 2002;30:29-34.

Female Genital Mutilation Declines in Egypt
The rate of female genital mutilation has dipped in recent years in Egypt, as more girls seem to be rejecting the idea that the practice is necessary, researchers report.
Female genital mutilation, also called female circumcision, typically involves removing the clitoris and parts of the labia minora in girls and young teens. In the Nile valley and parts of sub-Saharan Africa, the practice is a long-standing tradition believed to be necessary to control female sexuality and ensure a girl's "marriageability."
But in Egypt and elsewhere, the practice has become highly controversial, as women's health advocates and others are now pushing for its eradication, researchers note in the current issue of the journal Social Science & Medicine.
To see whether the practice and attitudes toward this practice have changed in Egypt, researchers at the Population Council in Cairo and New York City examined national health survey data on women and girls.
The investigators found that while most Egyptian girls continue to be circumcised, they are about 10% less likely than their mothers were to undergo the procedure. According to Barbara S. Mensch and her colleagues, there are "hints" that decline followed the 1994 International Conference on Population and Development in Cairo -- "a time when the campaign against circumcision gained momentum."
The research team also found that maternal education was a key factor in whether the daughter underwent genital mutilation. Girls whose mothers had vocational training were one third less likely to be circumcised than girls with uneducated mothers. When a mother had been to secondary school, her daughter was nearly two thirds less likely to be circumcised.
Mensch and her colleagues suggest that community campaigns to reduce female circumcision enlist more-educated mothers as "peer educators."
"Interestingly," Mensch's team notes, the "father's education does not significantly reduce the likelihood of circumcision."
Girls living in urban areas were also less likely to be circumcised, according to the report. In addition, girls living in urban areas, as well as those with more schooling, were more likely to believe circumcision was unnecessary. "Even among circumcised girls," the authors write, "belief in the necessity of the practice may be waning."
Fourteen percent of circumcised girls said the procedure was unnecessary, while another 28% had mixed feelings. On the other hand, the researchers point out, evidence shows that boys continue to support the practice.
Mensch and colleagues note that as education efforts seek to reduce female genital mutilation, "men and boys should not be overlooked."
Soc Sci Med 2002;54:205-220.

Learning Disability Linked With Increased Risk of Affective Disorder
Individuals with mild learning disabilities have a long-term risk of affective disorder, according to a report in the December issue of the British Journal of Psychiatry.
In a large, population-based, prospective study, Dr. Marcus Richards, of University College London, UK, and colleagues examined the risk of affective disorder in subjects with mild learning disability and also evaluated the potential role of adverse social or material circumstances in childhood and adulthood.
Participants were drawn from members of the British 1946 birth cohort. The final sample consisted of 41 individuals with mild learning disability (defined as the equivalent of an IQ of 69 or less at age 15 years) and 2119 controls. "The Present State Examination at age 36 years and the Psychiatric Symptom Frequency Scale at age 13 years provided psychiatric outcome measures," the team explains.
They found that people with learning disabilities were significantly more likely to be rated by a teacher as having a behavioral problem than those in the comparison group (p < 0.001). These individuals also had a fourfold increased risk of affective disorder in mid-life.
The risk of affective disorder was "not accounted for by social and material disadvantage or by medical disorder," Dr. Richards and colleagues report.
Based on these findings, they conclude that the "continued assessment of affective state in individuals with learning disability as they progress through mid-life into old age is therefore of considerable importance."
Br J Psychiatry 2001;179:523-527.

Most Adult Male Sexual Perpetrators Were Not Molested in Childhood
A "cycle" of child sexual abuse seems to exist for only a minority of adult male perpetrators, investigators at the Tavistock and Portman NHS Trust in London report. Dr. I. Kolvin and colleagues conducted a clinical case note review of 843 randomly selected subjects attending a forensic psychotherapy clinic for sexual deviants and offenders. Two women and 225 men were found to be child abusers, out of a total of 96 women and 747 men.
Forty-one of the women were victims of sexual abuse, one of whom became a perpetrator, the investigators report in the British Journal of Psychiatry for December. Seventy-nine of 135 male victims became perpetrators.
Homosexual men and transvestites were significantly less likely to be perpetrators than were heterosexual men and men who were not transvestites (p < 0.001 for both). The authors observed no significant associations between status as a child molester and voyeurism, fetishism, obscene phone calls, or other sexually deviant acts.
Ten perpetrators and eight nonperpetrators used pornography compulsively, suggesting this as a possible risk factor. In addition, 19 of 24 men molested by a female became perpetrators compared with 60 of 111 molested by males. Thus, victimization by a female may contribute more to a male becoming an abuser than victimization by a male. However, the authors caution that the numbers may be too small to establish causation.
"Although the data do not provide strong support for a cycle of sexual abuse encompassing a substantial proportion of male perpetrators, prior victimisation may have some effect in a minority of perpetrators, and can be viewed as one mediating factor which enhances the probability of subsequent perpetrator behaviour," the authors summarize.
Two invited commentaries accompany the report by Dr. Kolvin's team. Dr. Mary Cannon, of the Institute of Psychiatry in London, cautions against blaming the victim, which could lead to further stigmatization and stress for individuals who have been molested in childhood. She does praise the study for exposing "psychoanalytic theory to epidemiological scrutiny."
Dr. Susan Bailey, of Mental Health Services of Salford in Manchester, UK, notes that "for each individual, dispositions conditioned by childhood abuse are subject to many different kinds of combinations of motivating and mediating factors that ultimately determine whether or not and in what circumstances being abused can lead on to abusing."
She maintains that the real challenge for society is to develop treatment programs that are then evaluated by long-term follow-up.
Br J Psychiatry 2001;179:482-497.

Number of US Adolescents Treated for Addiction on the Rise
During the late 1990s, the number of people between the ages of 12 and 17 in the US who were admitted to substance abuse treatment increased 20%, federal health officials reported Thursday.
The numbers come from the latest Treatment Episode Data Set, which tracks US admissions to state-approved facilities for substance abuse treatment. These centers see an estimated 1.6 million admissions each year.
Among all Americans treated in 1999, four drugs of abuse accounted for nearly all admissions: alcohol (47%), opiates such as heroin (16%), cocaine (14%) and marijuana (14%).
Marijuana abuse accounted for a growing proportion of these admissions, increasing from 43% in 1994 to 60% in 1999, according to data released by the US Department of Health and Human Services (HHS). Many who entered treatment for marijuana were referred through the criminal justice system.
"While we can all be thankful that people who need help are getting it, this report shows some of the real-life consequences of marijuana use," John P. Walters, director of the White House's Office of National Drug Control Policy, said in a statement releasing the statistics.
"In recent years," he added, "too many people have said that marijuana is a 'harmless' drug. That is a lie."

Childhood Abuse, Family Dysfunction Strongly Associated With Suicide Attempts
Adverse childhood events, from abuse to incarceration of a family member, strongly influence the risk of suicide attempts throughout a person's life span, according to study results reported in the December 26th issue of The Journal of the American Medical Association.
Subjects of the study included 9367 female and 7970 male members of Kaiser Permanente's Health Appraisal Center in San Diego, California. Between 1995 and 1996 or in 1997, the participants completed confidential questionnaires regarding adverse childhood events (ACEs) that took place during their first 18 years of life.
Shanta R. Dube, of the Centers for Disease Control and Prevention in Atlanta, Georgia, and associates found that 64% of respondents reported at least one of the ACEs included in the survey: frequent emotional abuse, frequent physical abuse, any sexual abuse, other domestic violence, a household member who abused drugs or alcohol, a household member with mental illness or depression, parental separation or divorce, or incarceration of a household member.
The adjusted ACE score averaged 1.5 out of 8. The lifetime prevalence of having at least one suicide attempt among the entire cohort was 3.8%.
Among persons with an ACE score of 0, the prevalence was 1.1%. Risk was increased two- to five-fold by any adverse childhood experience. An ACE score of 7 or 8 increased the likelihood of suicide attempt before adulthood 51-fold, while for adult suicide attempts it increased the risk 30-fold.
"For every increase in the ACE score, the risk of suicide attempts increases by about 60%," the investigators report.
For this population, the lifetime attributable risk fraction (ARF), which the authors define as "an estimate of the proportion of the health problem (eg, attempted suicide) that would not have occurred if no persons had been exposed to the risk factor being assessed," was 67%.
"Our estimates of the ARFs are of an order of magnitude that is rarely observed in epidemiology and public health data," the investigators write.
Dube told Reuters Health, "The study didn't delve into any particular type of adverse event. We wanted to look at a broad range of different types because they are so common and interrelated."
"What this gives the healthcare professional is an indication of what types of experiences increase the risk of suicide attempts," she continued. "Assessing these types of adverse childhood experiences by questionnaire may help to alert primary care physicians to numerous potential health outcomes and health risk behaviors, as well as suicide attempts," Dube added.
In an associated commentary, Dr. Charles R. Keith, of Duke University Medical Center in Durham, North Carolina, rhetorically questions why many people with adverse life events do not become suicidal.
He postulates that other nurturing relationships, fortunate life events, or neurobiological developmental strengths confer protection against the self-destructive, depressive thought patterns that often accompany ACEs.
JAMA 2001;286:3089-3096,3126-3127.

Eating Problems in Childhood Predictive of Disorders in Adulthood
Eating conflicts, struggles with food, and unpleasant meals in early childhood are linked to the development of eating disorders in adulthood, according to a report published in the December issue of the Journal of the American Academy of Child and Adolescent Psychiatry.
Dr. Lisa A. Kotler and colleagues, from the New York State Psychiatric Institute, assessed the eating patterns and outcomes of approximately 800 children over a 17-year period.
Subjects with bulimia nervosa in early adolescence were 20 times more likely to be diagnosed with the disorder in adulthood than subjects without the disorder in adolescence. A 35-fold increased risk was identified for subjects with bulimia nervosa in late adolescence.
The presence of bulimia nervosa and anorexia nervosa symptoms in adolescence correlated with the presence of these symptoms in adulthood. For both disorders, patient gender and eating symptoms in adolescence were predictive of eating disorder symptoms in young adulthood.
Early childhood eating problems were also significantly tied to the development of adulthood eating disorders (p < 0.05).
While early eating problems were associated with an increased risk of later disorders, the absolute prevalence of eating disorders in young adulthood was low. Therefore, most adolescents with eating disorder symptoms will not have an eating disorder in young adulthood, the authors state.
The ideal treatment for adolescents with eating disorder symptoms remains unclear. Since most will not develop full-blown disorders, a careful monitoring approach may be the most appropriate treatment option, the researchers conclude.
J Am Acad Child Adolesc Psychiatry 2001;40:1434-1440.

Ethicists Question New Guidelines on Pre-Adoption Genetic Testing
A recently advanced consensus on pre-adoption genetic testing may not go far enough to provide states with the information they need to place children in appropriate adoptive homes, according to an article in the December 1st issue of the American Journal of Medical Genetics.
The consensus view should be revised to include more pre-adoption genetic testing, state Lynn A. Jansen, of St. Vincent's Hospital in New York City and Lainie Friedman Ross, of the University of Chicago.
"Our chief concern is to draw attention to the interests that pre-adoptive children have in being placed in suitable homes, as well as in the duty that state agencies that have authority over these children have to further this interest," Jansen told Reuters Health.
Jensen and Ross believe that interest is not considered in the current recommendations of the American College of Medical Genetics (ACMG) and the American Society of Human Genetics (ASHG). Rather, Jansen explained, the new consensus view "presuppose[s] that all children," adoptive or not, "have the same interests regarding genetic testing."
The authors suggest that the recommendations be revised to "allow for greater pre-adoption genetic testing." Without such testing, they argue, adoptive parents cannot be fully prepared for the responsibility they are assuming. Adoptive children, they conclude, deserve to be placed in families that are prepared for any special responsibilities their care may entail.
The authors suggest that testing be allowed for presymptomatic genetic disorders that are likely to manifest in the adoptive home, including Duchene muscular dystrophy, Tay Sachs disease and Fragile X syndrome. The ethicists also recommend genetic testing for conditions that can be modified through the environment during childhood.
Jansen asks physicians and other providers caring for adoptive families to keep these special interests in mind, "even if the current recommendations fail to account for them." She further advises healthcare professionals to take the necessary steps to obtain all other relevant genetic information that is available.
Am J Med Gen 2001;104:214-220.

Study links youth drinking to alcohol-related car injury as adults
The younger people are when they start drinking, the more likely they are to drive after drinking and get into alcohol-related car crashes over the course of their adult lives, a study says.
The Boston University study found that adults who began drinking before age 14 were seven times more likely to report ever being in an alcohol-related crash than those who started to use alcohol after age 21.
``We found that when they drink, they are more likely to drive and get into crashes,'' said Ralph Hingson, associate dean of BU's School of Public Health and a national board member of Mothers Against Drunk Driving (MADD).
``With each age group, the earlier they started to drink, the greater the likelihood of being in a crash,'' he said.
Hingson said it has been known for years that raising the drinking age helped reduce the number of alcohol-related crashes among those under age 21.
``But this study suggests there's a carry-over benefit later on in life,'' he said.
The study, published in the Journal of Accidental Analysis and Prevention, was based on interviews with 42,000 adults.
The findings were consistent even after the researchers controlled the frequency of drinking among the respondents and how often they got drunk. The findings suggest that efforts must be strengthened to prevent underage drinking, he said.
At Boston Medical Center, he said, kids between the ages of 14 and 20 who come in to the emergency room will be asked about alcohol use and offered blood tests and counseling.
Also to that end, MADD will hold a ``youth summit'' May 5-7 at the Westin Hotel in Waltham to propose policy recommendations to curb underage drinking.
``Underage drinking is often dismissed as a rite of passage, and it isn't one that all people survive,'' said Barbara Harrington, executive director for MADD in Massachusetts. ``We don't just have to worry if they get to the legal drinking age without consequences, because we know that early drinking is a predictor of adult alcohol problems. We're worried about those adults becoming drinking drivers at some point.''
SOURCE: Journal of Accidental Analysis and Prevention

Study links child abuse, drugs
Repeated sexual abuse makes physical changes in the brain, changes that can explain why abused children often use illegal drugs later in life, researchers said this week.
They found that children who were sexually abused had changes in the blood flow and function of a brain region called the cerebellar vermis, which is also known to change when people abuse drugs.
"This part of the brain has been recently implicated in the coordination of emotional behavior, is strongly affected by alcohol, cocaine, and other drugs of abuse, and may help regulate dopamine, a neurotransmitter critically involved in addiction," McLean Hospital in Belmont, Massachusetts, where the study was done, said in a statement.
Writing in the January issue of the journal Psychoneuroendocrinology, Carl Anderson and colleagues said they used functional magnetic resonance imaging (fMRI) to look at the brains of 32 adults, aged 18 to 22. Half had been abused as children.
They homed in on the cerebellar vermis because it develops slowly and can be affected easily by stress hormones.
"Damage to this area of the brain may cause an individual to be particularly irritable, and to seek external means, such as drugs or alcohol, to quell this irritability," Anderson said in a statement.
A second study published this week showed related results.
A team at the University of Buffalo in New York found that post-traumatic stress disorder (PTSD) can increase the craving for drugs in abusers.
Psychiatry professor Scott Coffey and colleagues at the Medical University of South Carolina tested 30 cocaine-dependent and 45 alcohol-dependent volunteers, all of whom also suffered from PTSD resulting from a physical or sexual attack.
They made the volunteers describe their worst trauma on tape, and then played this back to them while presenting them with a drug or alcohol "cue" such as a crack pipe or a serving of alcohol.
They then asked each volunteer how badly he or she wanted a drink or a dose of drugs.
Writing in the journal Drug and Alcohol Dependence, they said craving increased significantly when participants heard the tape and were then shown cues related to their substance of choice.
"From our research with trauma victims, we know that intrusive trauma memories are very upsetting to patients, and now we have shown that these trauma memory-induced negative emotions increase craving in substance abusers with PTSD," Coffey said in a statement.
"These findings add support to our contention that we need to treat the two disorders at the same time."
SOURCE: January issue of Psychoneuroendocrinology and the journal Drug and Alcohol Dependence

School playgrounds, recess can get kids moving
School playgrounds and longer recess periods can help boost activity levels among children, a recent report reveals.
The investigators found that more than half of boys and more than 40% of girls aged 5 to 12 years were at least moderately active in playgrounds during recess, and a smaller number of students were very active during these periods.
The findings are important as obesity rates in developing countries surge. According to the researchers led by A. Zask from Southern Cross Institute of Health Research in New South Wales, Australia, physically active children are not only healthier during their childhood but may reap the benefits as they age. Exercise, they explain, improves the strength of bones, lowers the risk of developing heart disease, type 2 diabetes and high blood pressure, and boosts the immune system.
But studies have shown that substantial numbers of children are sedentary, with at least one survey showing that more than two thirds of US kids watch more than 2 hours of TV each day and about one-fourth watch more than 4 hours of television a day.
And the results of a US study released last month confirmed that young people are getting fatter. Between 1986 and 1998, the rate of overweight grew by more than 120% among African American and Hispanic children, and by 50% among white children aged 4 to 12. Overweight children were heavier in 1998 than they were 12 years earlier.
"With growing concern about children's physical activity, school playgrounds offer an opportunity to increase children's moderate to vigorous physical activity engagement, especially among girls," Zask and colleagues conclude. "Consideration may be given to the lengthening of recess periods in order to increase physical activity levels."
The findings, published in a recent issue of Preventive Medicine, are based on observational data of nearly 4,000 children from 18 primary schools in rural Australia.
SOURCE: Preventive Medicine 2001;33:402-408.

Some Factors Help Predict Future of Troubled Youth
Certain factors can help predict if a troubled teen will return to the ``straight and narrow'' with treatment or continue to be an aggressive and emotionally disturbed individual, according to New Hampshire researchers.
In a study of more than 300 troubled youngsters, those teens whose parents were consistently employed, who had a positive relationship with a parent and had more support from their family were more likely to benefit from treatment. Other factors seemed to help as well, including contact with peers who were positive role models, a higher reading level and good problem-solving abilities, according to Dr. J. Eric Vance of Seacoast Mental Health Center in Portsmouth and colleagues.
The study is published in the January issue of the Journal of the American Academy of Child and Adolescent Psychiatry.
The study included children at least 13 years old who were certified by the state of North Carolina as severely or chronically aggressive, and were diagnosed with neurological or psychiatric disorders. Such children had been placed in public custody or did not have access to needed treatment or educational services, according to the report.
During the year-long study, the youths received a combination of treatments, including behavioral therapy, psychiatric care and medication.
While teens with a lower IQ were less likely to improve their behavior, Vance and colleagues point out, the child's relationship with his or her parents and family played a large role in terms of outcome. Those with a negative parent-child relationship were less likely to get better with treatment.
The study also revealed that children with ``superior interpersonal skills'' like empathy, a sense of humor and good problem-solving abilities had better outcomes after a year of treatment.
The authors conclude by noting that ``successful interventions with adolescents with aggressive disorders may require building social support bridges to estranged families or (friends).''
SOURCE: Journal of the American Academy of Child and Adolescent Psychiatry 2002;41:36-43
 

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