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July 2001

Dissociation May Mediate Psychiatric Impact of Sexual Abuse
Although it is considered a protective response to traumatic stress, dissociation may actually increase the risk of psychiatric disturbances in sexually abused children and adolescents.
The finding, reported in the July issue of the American Journal of Psychiatry, raises new questions about "how dissociation is adaptive in the short term and when and how it becomes maladaptive" in this population, according to Dr. Cassandra L. Kisiel and Dr. John S. Lyons.
The investigators, of Wellesley College in Massachusetts, and Northwestern University Medical School in Chicago, respectively, examined levels of dissociation and psychiatric disturbance in 114 children who were wards of the Illinois Department of Children and Families. They found significantly higher levels of dissociation in children who had been sexually abused than in those classified as physically abused.
Moreover, both dissociation and sexual abuse were independently associated with a range of psychiatric disturbances, including suicidality, self-mutilation and sexual aggression. "Dissociation was associated with more symptoms, more frequent risk-taking behaviors and less competent functioning," Dr. Kisiel and Dr. Lyons explain in the journal.
The finding could have implications for physicians and other healthcare and mental health professionals caring for sexually abused children, the authors propose. In particular, "assessing dissociation may be an important aspect of clinical care among traumatized children," they say. Further study of the link may also provide important clues about ways to reduce the impact of dissociation in this population.
Source: Am J Psychiatry 2001;158:1034-1039.

Study of Teens in Four Cities Finds Drug Treatment Effective
The first large-scale study designed specifically to evaluate drug abuse treatment outcomes among adolescents found that community-based treatment programs can reduce drug and alcohol use, improve school performance, and lower involvement with the criminal justice system. The study, which is published in the July, 2001, issue of the Archives of General Psychiatry, evaluated the treatment outcomes for nearly 1,200 adolescents, ranging in age from 11 to 18, who were enrolled in one of 23 community-based treatment programs in four cities — Pittsburgh, Minneapolis, Chicago, and Portland — between 1993 and 1995.
"It is clear from this evaluation that treating drug abuse in teens reduces their use of drugs and improves many aspects of their lives, " says NIDA Director Dr. Alan I. Leshner. "The years of research spent developing effective treatment approaches are beginning to pay off for these young people."
This study, conducted by Dr. Yih-Ing Hser and her colleagues at the University of California, Los Angeles, is part of NIDA's ongoing Drug Abuse Treatment Outcome Studies for Adolescents (DATOS-A).
The research team evaluated outcomes for 799 boys and 368 girls enrolled in a variety of drug treatment programs, including residential programs, outpatient drug-free programs, and short-term inpatient programs.
Dr. Hser says the teens made significant progress, even though their length of time in treatment was generally short. The study found that longer stays in treatment resulted in lower drug use and lower rates of arrest following treatment.
"Community-based drug treatment programs do work for adolescents," says Dr. Hser. "But in order to maximize their therapeutic benefits, we need to devise strategies specific to adolescents to improve retention and completion of the programs."

Details about the study
More than 400 teens participated in residential treatment, in which they were provided with education, individual and group counseling, and interventions to develop social responsibility. Almost 300 participated in outpatient drug-free programs, which included counseling sessions, education, and skills training. Nearly 460 were admitted to short-term inpatient programs, which provided counseling, 12-step sessions within a medically controlled environment, and referral for continued outpatient treatment.
About a quarter the study's participants had used three or more drugs prior to treatment. Nearly two-thirds were dependent upon marijuana, over one-third dependent on alcohol, and 10 percent were addicted to cocaine. In addition to substance abuse problems, more than half were criminally active and 63 percent met diagnostic criteria for a mental disorder. About one-third had dropped out of school.

Improvements Cited After Treatment
Comparing the year before treatment to the year following treatment, improvements were seen in the following areas:

• Drug Use — weekly or more frequent marijuana use dropped from 80.4 percent to 43.8 percent; abstinence from use of other illicit drugs increased from 52 percent to 57.8 percent.
• Heavy Drinking — dropped from 33.8 percent to 20.3 percent
• Criminal Activities — dropped from 75.6 percent to 52.8 percent.
• Following treatment, the teens showed better psychological adjustment as indicated by having fewer thoughts of suicide, lower hostility, and higher self-esteem.
• More of the teens attended school and reported average or better-than-average grades following treatment.

Some Exceptions Noted
However, there were some exceptions to the general pattern of improvement. Cocaine use increased three percentage points, from 16.5 percent prior to treatment to 19.2 percent after treatment. This was attributable primarily to increases in cocaine use among teens in the short-term inpatient and the outpatient drug-free programs. Among those in the outpatient treatment group, the use of hallucinogens and stimulants did not improve.
The researchers evaluated whether a minimum length of stay for 90 days in residential and outpatient programs and 21 days in short-term inpatient care were related to better outcomes. Almost 60 percent of the residential treatment group, 27 percent of the outpatient group, and 63.7 percent of the inpatient group met or exceeded these goals. The patients who met or exceeded these length of stay criteria had significantly better outcomes than those who did not. They were about one and a half times more likely to be abstinent from marijuana, alcohol, and other drug use in the year after treatment. They were 1.45 times less likely to be arrested and about one and a third times more likely to have average or better grades in school than adolescents who did not reach these treatment stays.
Source: Archives of General Psychiatry, July 2001
The full paper can be found on-line at the journal's Web site at www.archpsyc.ama-assn.org

Clinical Trials for Anti-Cocaine Drug
A British biotechnology firm received U.S. approval to begin clinical trials on TA-CD, dubbed the world's first anti-cocaine addiction vaccine, Reuters reported July 9.
Last August, the U.S. Food and Drug Administration (FDA) placed a "clinical hold" on TA-CD because another anti-cocaine product caused eye irritation in rabbits. U.S. regulators lifted the hold when TA-CD proved not to have similar side-effects.
TA-CD works by generating antibodies in the bloodstream that prevent cocaine from crossing into the brain. As a result, users do not get high from the drug.
George Bigelow, a researcher at The Johns Hopkins University in Baltimore, Md., who works on developing medications to treat cocaine and heroin addiction, said the new drug could help addicts in the initial stages of withdrawal.
"People begin getting the medication and in part are protected from the risk and temptation of getting high," he said.
A clinical study is set to begin shortly at Columbia University. The number of participants for the trial has not been determined.

UK Helpline Documents Extent of Childhood Suicidal Ideation
Thousands of children in the UK consider committing suicide every year, according to figures from ChildLine, a national telephone helpline.
The helpline has received calls from children as young as the age of 6 who wish to take their own lives and has even had calls from others while they are trying to commit suicide. According to the service, bullying, sexual and physical abuse, bereavement and exam stress are among their reasons.
ChildLine says that it receives calls from 500 children, mostly teenagers, every year who want to or have actually attempted to kill themselves — most commonly by taking an overdose or slashing their wrists. A further 1000 children tell helpline counsellors they have suicidal thoughts.
The figures are revealed in a new book, Saving Young Lives, published Wednesday. It analyses more than 700 telephone calls to ChildLine between April 1998 and March 1999.
It found that girls were more likely to call the helpline, raising concerns that boys were more at risk of committing suicide because they were unwilling to seek assistance. Girls accounted for four out of five calls over the 12-month period.
The histories documented in the book indicate that thoughts of suicide build up over a prolonged period and can be attributed to a number of factors, in particular a combination of abuse, neglect and low self-esteem.
ChildLine Chairman Esther Rantzen said in a statement: "Talking about problems can bring hope, or at least dissipate the intensity of desperation...Some of these children had such painful lives filled with abuse that we can only wonder they found the courage to survive at all."
Dr. Sue Bailey, chairwoman of the Royal College of Psychiatrists' child and adolescent faculty, told Reuters Health that educating children was a key factor in preventing young people from taking their own lives.
The College is piloting a number of studies aimed at helping children to cope with problems associated with exams, bullying and depression. It has also organised programmes aimed at changing the attitudes of young people towards those with mental health problems or those who are simply different and at risk of bullying.
"I think the question is how do we educate children," she told Reuters Health.
"We know opinions towards mental health problems are pretty fixed by 8 years of age and we have launched a number of pilot studies and programmes aimed at tackling this. We decided to take the bull by the horns and educate these children at a very young age. Educating children early will help them to help others."
Source: ChildLine UK

Australian Alcohol Campaign Reaches Target
Australia's National Alcohol Campaign, launched in February 2000 with the aim of reducing excessive teenage drinking and its associated harm, has been hailed as a success.
Presenting results of the evaluation stage, psychologist Tom Carroll, senior adviser in research and marketing in the federal health department, said that the campaign had in its initial year reached and effectively communicated with both teenagers and parents.
Speaking at a conference of the Alcohol and Drug Foundation last week, he said that 61% of parents said that they planned to do something to reinforce the campaign message, and that around 80% of the teenagers are now thinking about the positives associated with not drinking too much or not drinking at all.
About 90% of targeted teenagers said that the advertisements made them think about the negatives of drinking too much.
The evaluation revealed that of those who drank in the last 3 months, about 40% of teenage boys had consumed seven or more drinks on the last occasion, and about the same number of girls had consumed five or more drinks, Dr. Carroll said.
"These are harmful levels," he commented. "We don't have indicators to say whether behavior changes had occurred in terms of consumption, but the campaign advertising was clearly seen to be communicating effectively with this audience."
"The messages received were not just the negative aspects of drinking but also the positive advantages of either not drinking or of not drinking to excess," he continued.
The images in the advertising, which were suggested by a focus group of young people, highlighted the negative consequences of making the wrong choices that could results from too much alcohol.
"Over three quarters of them are now talking about the choices you make when you have a drink, so clearly the advertisements have a high degree of credibility amongst those teenagers."
Dr. Carroll said that parents were an extremely important target audience of the campaign, and over half had discussed with their teenagers what could go wrong if they drank too much and how to make the right sorts of decisions.
"We placed the advertisements in programs which would be viewed by both parents and teenagers at the same time in order to stimulate discussion."
After the launch phase, the campaign entered a booster phase between December 2000 and January 2001.
This reinforced the messages of the launch phase and also took the campaign into all Australian schools through posters carrying images from the campaign.
Alcohol and Drug Foundation Conference

Many College Students Frown on Condom Use: Survey
A "sizable minority" of college students attempt to talk their sex partners out of using a condom, new survey findings suggest. The most popular anti-condom ploys include claims that sex feels better without a condom and going without one will not raise the odds of pregnancy or sexually transmitted diseases (STDs).
What's more, students who admitted to trying to convince a partner to forgo the condom were much more likely to have had 10 or more sex partners in their lives, according to findings published in the August issue of Archives of Sexual Behavior.
Dr. Bruce M. King of the University of New Orleans in Louisiana and colleague Renee M. Oncale surveyed more than 900 undergraduates on their sexual history and condom use. While 93% said they had used condoms, only 20% used them consistently and just half said they always used them with a new partner.
In addition, 30% of men and 41% of women said that a partner had tried to dissuade them from condom use. However, only about 17% of men and 14% of women admitted to trying to get condoms out of the picture. This discrepancy, the researchers note, may be due to respondents' desire to "make themselves look good."
Those who did admit to anti-condom maneuvers were more likely than others to have had 10 or more sex partners--a particularly troubling finding, according to King and Oncale.
"The combination of multiple sexual partners and active dissuasion of partners from the couple using condoms poses a serious challenge to educators in HIV/AIDS prevention programs," they write.
Among the challenges to educators, the report indicates, are the ways students tried to dissuade their partners from condom use. For both men and women, the most popular tactic was saying that sex "feels better" without a condom. Other common maneuvers were attempts at dismissing the risk of pregnancy and STDs.
"Obviously," the researchers write, "sex educators are going to have to address the physical gratification aspect of condoms, and not just their role in STD and pregnancy prevention."
On the bright side, students who said others had tried to dissuade them from condom use also reported these attempts were unsuccessful more often than not--although this conflicted with the high success rates reported by self-proclaimed dissuaders.
The survey also revealed that women were more successful than men at both dissuading condom use and resisting dissuaders' attempts. This, King and Oncale point out, is consistent with other research showing that women, not men, seem to dominate condom "negotiation."
SOURCE: Archives of Sexual Behavior 2001;30:379-391.

Why Do Some Young People Start Smoking?
Even though the message that smoking can be bad for your health gets through to most teens, thousands of young people start smoking each year. Why?
One new study indicates that schools may hold some of the answers, while another study suggests that what teens don't know about the addictive qualities and health risks of smoking could play a role.
Schools--the places where teens, their teachers and administrators spend hours each day, and more weeks than not each year--are unique micro-communities, explains study author Cheryl Alexander, PhD, a professor in the department of population and family health at the John Hopkins Bloomberg School of Public Health.
Understanding how smoking is viewed by a school community can go a long way toward learning how teens in that school choose to smoke--or not to smoke, Alexander says. Her group looked at information from over 2,500 young people in grades 7 through 12 that took part in a nationwide teen health study.
And it's not just about whether one group of popular people makes smoking seem "cool" for the whole student body, she says, although that can be a key influence. Policies and--if smoking is banned--punishments regarding smoking in the building can also play a role, as well as whether or not teachers are allowed to smoke, Alexander says.
"Adolescents don’t live in isolation," says Alexander--their schools, parents, peer groups and local governments, who enforce laws that prevent minors from buying tobacco--all may play some role, she says.
Results of another survey suggest that some teens may also start smoking because they think it will be easier to quit than it really is.
The way teens decide whether or not to start smoking seems to involve a very different thought process than, say, whether or not they choose to have a burger for lunch, explains the study's lead author Daniel Romer, PhD, research director with the Annenberg Public Policy Center at the University of Pennsylvania.
"They're probably not understanding what the risks and benefits are," Romer says.
Romer's group looked at the results of a telephone survey of 600 teens from across the US who were asked about their smoking habits, and about how much they know about the health risks of smoking.
The teens' comments were in some ways contradictory, Romer points out. For instance, while 80% of the young people said that smoking was addictive, about 60% said it wasn't too hard to quit. Presumably this belief plays some role in the decision to start making tobacco use a habit, he says.
"They're trying smoking, saying, 'I'll figure that out later,'" he says. "It's a very tough habit to give up, and a lot of young people start it thinking they're not going to do it for long."
The teens also had a good idea of how dangerous smoking is--most knew that smoking could lead to lung cancer, and the majority actually overestimated the risk--but a surprising number didn't think that many smokers died of smoking-related illness like lung cancer.
The American Lung Association estimates that 156,900 people died of lung cancer, which is the leading cause of cancer deaths for men and women, in 2000.
By Erin R. King, Medical Writer, (CBS HealthWatch). The studies from Alexander's and Romer's groups both appear in the July issue of the Journal of Adolescent Health.

Early Childhood Problems Delay Social Development
Infants and toddlers who develop social, emotional, and behavioral problems may not only disrupt the family dinner but could also experience delays in their social and emotional development, researchers suggest.
The findings underscore the need for early identification and intervention of these problems, Dr. Margaret Briggs-Gowan from Yale University in New Haven, Connecticut, told Reuters Health.
"Our ongoing research further shows that social-emotional and behavioral problems are likely to persist for 1 year in more than 50% of children," she said in an interview. "However, we have also found that very few families with concerns about their children seek or receive evaluation or treatment when their children are younger than 3 years of age."
In an effort to understand how these problems affect children and their parents, Briggs-Gowan and associates studied 1,280 children aged 1 to 3 years and their families. The findings are published in the July issue of the Journal of the American Academy of Child and Adolescent Psychiatry.
About 12% to 16% of 2-year-old children showed some sign of social-emotional problems and about 6% of 1-year-olds were reported to have high levels of difficult behavior according to parental reports.
Boys were particularly susceptible to delays in social-emotional competencies and parents tended to worry more about boys than about girls, the report indicates.
Children from single-parent homes with poorly educated parents and low-income levels were about twice as likely to have social-emotional problems, the investigators found.
"Social-emotional problems include aggression, overactivity, noncompliance, sleep and eating problems, social withdrawal, anxiety, difficulty regulating emotions, intense negative reactions and difficulty begin soothed," Briggs-Gowan explained.
She said that children without these problems tend to share and take turns, are aware of others' feelings, can comply with adults' requests and are curious, interested and persistent when faced with challenging tasks.
"It is critical to increase awareness about early-emerging psychopathology among professionals who are working with parents of very young children and thereby promote early identification," the study authors conclude.
By Will Boggs, MD. (Reuters Health)  SOURCE: Journal of the American Academy of Child and Adolescent Psychiatry 2001;40:811-819.

Marijuana Use Increasing Among Arrested Youth
A newly released report from the U.S. Department of Justice called the rising rate of marijuana use among youth in the criminal-justice system an "epidemic."
The study, prepared by the National Institute of Justice and the Substance Abuse Policy Research Program, tracked youths aged 18 to 20 who were arrested in 23 U.S. cities. It found that marijuana use among youthful arrestees increased from 25 percent in 1991 to 62 percent in 1999. The highest rates of marijuana use were in Midwestern cities; West Coast cities had rates below the national average, and only slight increases.
"The pattern seems to be indigenous to today's youth," said Andrew Golub, a senior researcher at the New York-based National Development Research Institute and one of the report's authors. "In other words, the habit was not passed down to them. They chose it."
Golub attributed the trend to the prevalence of the drug in hip-hop culture.
"We're seeing kids in eighth or ninth grade who are way beyond prevention treatments," said Dan Lloyd, interim director of the Children, Family and Community Services Division of the Department of Alcohol and Drug Services of Santa Clara County, Calif. "Young people are looking at harder drugs and seeing the dangers, then gravitating to drugs that they perceive cause less harm, like marijuana. And they are using their peers as a standard."
The study also found that the use of heroin and cocaine declined over the same time period, casting doubt over whether marijuana is a "gateway drug" to harder substances.
U.S. Department of Justice

Foster Kids May Fare Worse After Returning Home
Laws that encourage children placed in foster care to be reunited with their families as quickly as possible may undermine attempts to help resolve the problems that drove them into foster care in the first place, study findings suggest.
According to interviews with 149 children who were placed in foster care in San Diego, California in 1990 and 1991 for at least 5 months, substance abuse, dropping out of school and arrests were more common among those who were reunited with their biological families.
Over 6 years, 49% of these children received tickets or were arrested, compared with about 30% of children who were not reunited with their families. Similarly, more than 20% dropped out of school, compared with less than 10% of children who remained in foster care, the investigators found.
There were no significant differences in rates of pregnancy, suspensions or delinquency among the two groups of children, who were between the ages of 7 and 12 when they entered foster care.
It is not clear why children who returned to their biological families fared worse in some areas. But according to Dr. Heather N. Taussig, the study's lead author, factors that led to the youths' initial removal--such as inadequate parenting--may have still have been present when the child returned home. Alternatively, the stress of living again as a family or differences between biological parents and foster parents, such as socioeconomic status, could account for the findings, she said.
The results of the study should spur further research, as well as encourage monitoring of children who have returned home from foster care, write Taussig, from the University of Colorado in Denver, and colleagues.
``The study's findings strongly caution us against presuming that children who return to live with their birth parents have achieved positive outcomes,'' the researchers report in the July online issue of Pediatrics.
Taussig said that the success of child welfare has traditionally been based, in part, on the number of children who return home from foster care.
``This paper highlights the importance of examining child functioning as a key outcome,'' she said. ``We want to know how children and families are doing as a result of the placement decisions that are made.''
Children in the current study were placed with foster families as a result of abuse or neglect.
SOURCE: Pediatrics July 2001;108:e10.

'Mild' Behavioral Risk Factors Linked to Suicidal Thoughts and Attempts in Youth
Certain common risky behaviors of children and adolescents are independently associated with an increased risk of suicide attempts and suicidal ideation, according to data from the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study.
Included in the MECA Study, which was sponsored by the National (US) Institute for Mental Health, were 1176 nonsuicidal subjects, 67 who reported suicidal ideation within the past 6 months, and 42 who had previously attempted suicide. Ages ranged from 9 to 17 years.
Dr. Mary Schwab-Stone, of the Yale Child Study Center, New Haven, Connecticut, and colleagues found that involvement in serious physical fights, onset of sexual activity, and even very low levels of tobacco, marijuana, or alcohol use significantly increased the risk for suicidal ideation or attempt.
The risk remained significant after adjustment for gender, ethnicity, socioeconomic status, and any psychiatric diagnosis, the investigators report in the Journal of the American Academy of Child and Adolescent Psychiatry for July.
"We haven't known much about how behavioral risk factors relate to attempts and ideation," Dr. Schwab-Stone told Reuters Health. "With this work we tried to see whether inward self-destructiveness travels together with outward behavior, and it turns out they do."
"While these behavioral risk factors are less predictively specific than depression, it may be that screening for them will reveal opportunities for clinical intervention," Dr. Schwab-Stone conjectured.
Low parental monitoring was also associated with an increased risk of suicide ideation and attempts. Dr. Schwab-Stone suggested that this factor may be "a proxy for the parent-child relationship."
"Monitoring, itself, may facilitate communication and child disclosure," she said. "A parent who is not monitoring is not giving strong enough messages about limits and self-control. Also, however, if the child is feeling desperate and destructive, the parent simply may not know."
J Am Acad Child Adolesc Psychiatry 2001;40:837-846.

Where Are Children Most Likely to Drown? — Depends on Age
Toddlers and adolescent males are more likely to drown in swimming pools than children in other age groups, according to a new study that provides the first national data on the places where children of different age groups are most likely to drown.
About 1,500 children drown each year in the United States. In this study, researchers examined where children were most likely to drown according to age, sex and ethnic status. Researchers say this information is important because prevention efforts depend greatly on the body of water in which children drown.
"We found that infants were most likely to drown in bathtubs, and toddlers in swimming pools," says the study's lead author Ruth Brenner, MD, MPH, of the Division of Epidemiology, Statistics, and Prevention Research at the National Institute of Child Health and Human Development in Bethesda, Maryland.  While freshwater poses the greatest risk for teens, Brenner says that a surprising finding was that 26% of the drowning deaths among toddlers were also at freshwater sites such as lakes and rivers.
Researchers analyzed the death certificates of 1,420 children under 20 years old who died from unintentional drowning in 1995. They grouped specific drowning sites into four categories:

• Artificial pools (swimming pools and hot tubs)
• Freshwater bodies (lakes, ponds, rivers, canals and other specified sites)
• Domestic sites (primarily bathtubs and buckets)
• Salt water (seas and oceans)

They found that drowning varied by age and location as follows:

• Under the age of 1 year--65 cases (78% in bathtubs)
• Between the ages of 1 and 4 years--521 cases (56% in artificial pools, 26% in freshwater sites)
• Between the ages 5 and 9 years--208 cases (54% in freshwater sites)
• Under the age of 14 years--219 cases (61% in freshwater sites)
• Between the ages of 15 and 19 years--407 cases (69% in freshwater sites)

Researchers say that 37% of children who drowned were between the age of one and four years, 29% were between 15 and 19 years, and 74% of children who drowned were male. "We see the peaks of drowning among toddlers and adolescents," says Brenner. "Drowning is still a big problem in the United States. Most of the drowning cases are preventable. We need to have a multi-faceted approach within each age group."
Young children need to be supervised in all bodies of water, says Gary Smith, MD, DrPH, a spokesperson for the American Academy of Pediatrics. Unfortunately, when children get in trouble in water, he says, the results are often fatal.
"The findings reaffirm that drowning is a major cause of death among children," says Smith, who is also director of the Center for Injury Research and Policy at Children's Hospital in Columbus, Ohio. "The study helps us understand where the high-risk areas are for which age groups, so we can start taking steps using strategies that we know work to prevent injuries in the first place."
Smith points out that some parents may have some misconceptions after their children take swimming lessons, "They may think that their kids are 'drown proof,'" says Smith. "Unfortunately, that is a dangerous misconception. Supervision within an arm's reach is needed for young children."
Researchers also found that after the age of five, African-American males had significantly higher rates of drowning than white males. Much of this disparity was due to an increased risk of drowning in swimming pools.
Among females, drowning rates were low after the age of five years, but African-American females were also at increased risk of drowning in a swimming pool compared to white females of the same age.
Researchers say that they have known that African-American males are at a greater risk for drowning, but that they didn’t expect this to be due to an increased risk of drowning in swimming pools.
Brenner says that there is a need to seek possible explanations for this racial disparity. One possibility is that African-Americans may be exposed to more dangerous situations in pools, such as overcrowd pools or those without a lifeguard. Differences in swimming ability and availability of swimming lessons may also play a role.

• To prevent death by drowning, the American Academy of Pediatrics recommends:
• Teaching all children five years of age and older to swim
• Constant supervision of infants and young children around all bodies of water
• Installation of fencing separating residential pools from the house
• Use of personal floatation devices when riding on a boat or playing near a river, lake or ocean
• Teaching children never to swim alone or without adult supervision
• Teaching children on the dangers of alcohol and drug consumption during aquatic activities
• Stressing the need for parents and teens to learn cardiopulmonary resuscitation (CPR)

The study was published in the July issue of Pediatrics.

Girls With Eating Disorders Fans of Fitness Mags
Teenage girls who use dieting tactics such as appetite suppressant pills, laxatives, vomiting after eating or severely restricting their calories are more likely to be heavy readers of women's health and fitness magazines, a team of researchers reports.

"We found there was a moderate to strong positive association between reading frequency and these dieting behaviors," lead author Dr. Steven R. Thomsen, associate professor of communications at Brigham Young University, told Reuters Health.
To investigate whether there is a correlation between eating problems among teenage girls and the growth in circulation of health-related magazines targeted at young women, the researchers surveyed 498 girls at two Salt Lake City-area high schools, asking them about their weight loss methods and their magazine reading.
The findings were published in the May/June issue of the American Journal of Health Education. The research was funded by a grant from the Wendell Ashton Fund, Thomsen said.
The study found that eating disorders were common: 15% of the girls said they had taken diet pills, 11% had used laxatives, 9% had made themselves vomit, and slightly more than half had restricted their calories to less than 1,200 a day as part of a diet.
Overall, 92% of the girls said they read health and fitness magazines, with 45% of the girls reporting they read the magazines frequently, or at least once a month.
However, the researchers found that girls who used laxatives, diet pills, vomited or ate restricted diets were more likely than girls who did not use such dieting behaviors to be heavy readers of the magazines.
For example, 73% of girls who used diet pills were frequent readers of the magazines, while only 42% of girls who did not use diet pills were frequent readers. Similarly, 79% of the girls who vomited to control weight gain were frequent readers of the magazines, compared to only 43% of girls who did not vomit to control weight gain.
However, the study does not prove that the magazines caused such a reaction in the girls. It is also possible, Thomsen noted, that girls with a propensity to abusive dieting sought out such magazines for dieting tips and ideas.
"We can't state that one causes the other," Thomsen said. "Based on all the previous research we've done and what these young women have told us, I believe that young women who already have begun to develop eating disorders may turn to these magazines for reinforcement and information. I think the best argument is that they serve as a perpetuating function rather than an initiating function."
Thomsen said that editors and writers for the magazines need to keep in mind that these women may distort the health-oriented messages they send. "They need to be aware that there is a group that takes a message different than what it is intended to be," he said. "Even when these magazines attempt to advise or suggest moderation, sometimes, the young women focus on the images and pictures, ignoring the advice but remember seeing thin bodies."
Finally, parents should "not panic" if their daughters read the magazines, but should investigate the girls' motives for doing so, he said. "I would question, 'why are you reading them, how do you feel about your body,'" he said. "That would give me a cue to the mental state of my daughter."
SOURCE: American Journal of Health Education 2001; 32: 130-135.

Behavior Drug Ritalin Abused by Children
A powerful prescription drug has gotten into the wrong hands--children's hands. CBS News correspondent Thalia Assuras reports in an Eye on America investigation.
At a Rhode Island middle school, half a dozen sixth graders have been charged with drug possession or distribution. Five teenagers at a Florida high school face similar charges.
"They're taking this to get up in the daytime and get their schoolwork done, or just to fit in in the crowd, to be cool," says parent Hilda Cuarrion.
What some kids consider cool is the illicit use of pills that millions of others are given legally--at home by their parents or at school by a nurse. They are medications prescribed for attention deficit disorder. Among the most popular is Ritalin.
"It's a significant problem," says Terry Woodworth of the US Drug Enforcement Administration (DEA). One of the DEA's most tightly controlled drugs, Ritalin, has the agency worried since it's easy to get and kids believe it's safe.
"They use it as a party drug," says Woodworth. "They crush it up and snort it. Some of them refer to it as 'kiddie cocaine.'"
With 11 million Ritalin prescriptions given out every year, there's plenty circulating in what has become a schoolyard black market. Students who are prescribed the drug are selling it to their peers for a few dollars a pill.
A recent study in Massachusetts found that of 3,500 high school students almost 13% admitted to using someone else's Ritalin.
Woodworth warns that Ritalin, snorted or injected, is not only addictive, but can also be deadly. "You have tremors, palpitations, hypertension. You can even go into convulsions," she says.
The DEA is set to distribute a pamphlet to schools warning about potential Ritalin abuse and recommending tight storage and supervision to stem the problem. One company is developing another safeguard--a skin patch for slow release of the drug.
"You can't take a patch and crush it up and snort it and you can't give it away to somebody after you've had it on your own body. It doesn't work if you try to put it on somebody else's," says William Pelham of the State University of New York in Buffalo.
A patch, however, is at least 2 years away, leaving Ritalin readily available at home and at school.
SOURCE: Eye on America

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