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March 2001

For Children, Seeing and Overhearing Is Often Believing
For some young children, seeing--as well as hearing misinformation--is believing. Young children's reports of an incident can be altered by false facts given to them by their parents, according to a new study. This means that gauging the truth of children's answers, such as eyewitness accounts or descriptions of pain or physical abuse given to a doctor or in the courtroom, can be tricky.
Researchers measured the impact of false information by interviewing children immediately after meeting a man called "Mr. Science," who demonstrated four science experiments. The children, all between the ages of three and eight, were asked to tell an interviewer about everything they saw or heard in the science room.
Three months later, parents were instructed to read a book to their child called "A Visit to Mr. Science" that described two of the experiments the children actually witnessed, and two they did not. The book also included instances of "fictitious touch," such as one case where Mr. Science "hurt the child's tummy … when he pushed a little too hard to apply a reward sticker." Neither stickers nor physical contact of this kind were part of the actual visit to Mr. Science.
Shortly after having the book read to them, the children were interviewed again about what happened when they visited Mr. Science in person. However, this time many of the children described events that took place only in the book.
"Even the older children, the seven- and eight-year-olds, would initially report events during an interview that hadn't happened to them. If they had merely heard these events described in their home by a parent, they would report those events, even though they knew that they hadn't happened," says Debra Ann Poole, PhD, professor of psychology at Central Michigan University. The study, by Poole and co-author D. Stephen Lindsay, PhD, professor of psychology at the University of Victoria in British Columbia, Canada, appears in the March issue of the Journal of Experimental Psychology: Applied.
But while the memories of children can be fuzzy, often adults don't do much better, especially when emotions are involved, says child psychiatrist Elizabeth Berger, MD, author of the book Raising Children With Character. "Human memory is a slippery eel," she says.
Berger points to the new study, where the authors note that a "crude summary" of what is known on the topic indicates that while even very young children can remember some events with great accuracy and detail, older children and adults can also provide poor or inaccurate recollections in some cases.
"You have to put this in the broad context that human beings are really miserable at memory," Berger says. Emotional cues, such as the importance that children likely place in what a trusted parent tells them, can play a major role, she says. Research has proven that factors like emotion can addle the memory of adults, and it's no surprise that children react the same way, she says.
Berger notes that in the legal community, there is a division between those who believe that children are bad witnesses and those who believe children are especially truthful--and she warns against taking either view to the extreme. This study shows some of the mechanisms by which children's memories are "bamboozled," she says--but in the context that human memory, even in adults, is easily fooled.
It would be useful to study older children's responses in the same way that the new study looked at young children, says study author Poole, since although some data indicates that there is little difference between how a 10-year-old and an adult report an event, not a whole lot is known about older children. "I think our research suggests that we might want to be more attentive to that age group, especially using procedures in which we mimic more what probably happens in the real world--people learning about things in their natural environment," she says.
"For most of life, it's pretty irrelevant where that knowledge is learned. And that's one of the reasons why it's so difficult when suddenly that information becomes critical, like in the legal system. You're really going against the strategies that are efficient in the real world," Poole says.
Source: the Journal of Experimental Psychology: Applied.

Dads More Involved But Moms Still Main Caregivers
Today's dad clocks more hours on all aspects of childcare than his counterpart a generation ago. But he still lags behind the modern-day mom, even when her wages are equal, a new study reveals.
Researchers found that the number of hours a mother spent at work had no effect on the amount of time a father devoted to childcare during the week. Similarly, a mother's income had very little impact on fathers' involvement in childcare.
On weekends, however, fathers spent more time with their children.
"Despite women's increasing role in the labor market, most mothers remain the primary caregivers of young children on weekdays," according to Dr. W. Jean Yeung and colleagues from the University of Michigan, Ann Arbor.
Household chores, infant care, studying, and reading "remain domains in which fathers have a very low relative contribution," the authors note.
The study in the February issue of the Journal of Marriage and Family looked at children up to age 12 whose parents lived together. The data were drawn from time diaries kept over certain days in 1997 by nearly 2,000 children or their mothers. This information was then compared to findings from research conducted in the 1960s through the 1980s.
Yeung and colleagues found that fathers spent an average of 2.5 hours on a weekday and about 6 hours on a weekend day with their children. This included time spent playing together or doing schoolwork, personal care such as bathing and feeding, and simply being available.
On weekdays, children spent one-third less time with their fathers than with their mothers, but on weekends the time gap closed and kids spent only 13% more time with their mothers than with their fathers.
Children of women who made more money spent more time with their fathers on weekends, however. Children of a mother who contributed at least half of the family income were found to spend 48 minutes more with their father on weekends.
"The good news is that as women become equal contributing partners, the relative participation of fathers does increase," Yeung told Reuters Health. "The bad news is ... that men still do less on 'traditional women's jobs'-- (taking care of) babies, dishes and laundry."
In other findings, fathers with some college education spent 17 more minutes per weekday with their children than dads without any college education. Fathers who made more money spent less time with children on weekdays, but the amount of time was fairly small. For every $10,000 more that a father made, for instance, that father spent 3.5 minutes less per day with his children.
"Our findings suggest that although mothers still shoulder the lion's share of the parenting, fathers' involvement relative to that of mothers appears to be on the increase," the researchers conclude. "A 'new father' role is emerging on weekends in intact families."
SOURCE: Journal of Marriage and Family 2001;63:136-154.

Teens Turn to Internet for Health Answers
Embarrassment, the need for confidentiality and a desire to find easily accessible answers drive many teens to the Internet in search of health information, a new study reveals.
More than three-quarters of 10th-grade students surveyed used the Internet to answer questions about health. Nearly half (49%) accessed information for personal use and more than two-thirds (67%) accessed information for school projects, the survey found. Results of the survey, which included more than 400 students, are being presented this week at the annual meeting of the Society for Adolescent Medicine in San Diego, California.
"This suggests they are going to the Internet for school use but that may serve as an entrée for personal use," Dr. Dina L.G. Borzekowski from Mount Sinai School of Medicine in New York City, said in an interview. "Kids realize what a resource the Internet can be. They are very savvy and understand what they can get from the Internet, more so than adults."
Topics most frequently researched include sexually transmitted diseases (STDs), diet, exercise, sexual behaviors, violence and alcohol use, among others. Boys were just as likely to turn on their computers in search of health-related answers as girls. Ethnicity, the mother's education, and the teen's own health status did not affect how often adolescents searched the Internet for answers.
Young people of different ethnic backgrounds did appear to research different topics, however. Whites and Asians more frequently searched for information on diets while Latinos and blacks were more likely to search for information on violence among peers and gangs, findings show.
While the Internet can allow teenagers to research their questions privately, it can also be used to self-diagnose medical problems, Borzekowski said.
"There is anecdotal evidence that kids use the Internet for health information and then go to their (health) provider with reams of information, which may or may not be relevant to their own health."
But adults, she concedes, may be just as likely to do the same.
Source: Society for Adolescent Medicine

Inner-City Kids Witness High Levels of Violence
According to a survey of inner-city youngsters in the US, by 6 years of age 60% had witnessed someone being shot, stabbed, beat up or threatened with a knife.
The survey was originally designed to find out if children of drug-using mothers were more likely to witness violence than other children were. However, the researchers at the University of Maryland in Baltimore found that most children--regardless of their mother's drug use--were exposed to violent scenes.
"Surprisingly, we found no difference between the children living with drug-using moms and non-drug-using moms," developmental psychologist Dr. Maureen E. Schuler, told Reuters Health. "What was amazing was the amount of violence all the children were exposed to. It's part of growing up in the inner city."
Schuler found that children witnessing violence showed significantly higher amounts of aggression, anxiety, depression, delinquent behavior, attention problems, social problems and stress.
"Witnessing violence is leading to a lot of behavioral problems," Schuler said. "We wonder if this will lead them to be involved in more violent acts themselves. What are we going to see in a couple of years? We'd like to keep following these children."
The study, which was funded by the National Institute on Drug Abuse and the Thomas Wilson Sanitarium for Children in Maryland, is published in the March issue of the Archives of Pediatrics and Adolescent Medicine.
Schuler interviewed 40 inner-city women with a history of drug abuse who had been tracked since the birth of their child. The women were predominately African American, single and unemployed.
Each woman was asked whether her child had witnessed violence, whether there was a history of violence in her household, and whether it had affected her child's behavior. These results were compared to responses from a group of similar women who reported they did not abuse drugs.
Although there were no differences found between the two groups of children with and without drug-abusing mothers, 47 of the 75 children in the study reported witnessing violent acts either inside or outside of their homes.
About 40% of the 6-year-olds had observed someone being beaten up, 9% saw someone being threatened with a knife, and 7% had witnessed someone being stabbed or shot.
The youngsters also witnessed other types of violence, including organized dogfights. In another example, one child watched a neighbor "jumping naked out the second-story window with her infant in her arms when drug dealers burst into her house."
However, much of the violence witnessed occurred within the home: 25% of the mothers reported they had used major violence against their partners during the last year and 23% of their partners had used major violence against the child's mother in the past year.
"The first step is to try to work on reducing violence in the home," Schuler said. "We need to get parents into parenting classes and counseling. Then, it becomes a community-wide issue, in terms of getting the drug dealers out of the neighborhood."
SOURCE: Archives of Pediatrics and Adolescent Medicine 2001;155:342-346.

WHO Highlights Global Impact of Unsafe Water
More than a billion people all over the world consume unsafe drinking water, and every year 3.4 million people — mostly children — die due to water-related illnesses, said the World Health Organization on the occasion of World Water Day, Thursday, March 22.
"Much of the suffering is needless," says Dr. Gro Harlem Brundtland, director-general of the WHO, in the preface to a new report 'Water for Health: Taking Charge,' released on this occasion by the agency. "Most of these illnesses and deaths can be prevented through simple, inexpensive measures," she adds.
"Every year 2.2 million people die from diarrhea. 90% of these deaths are among children, mostly in developing countries," the report points out. "Diarrhea can be reduced by 26% when basic water, hygiene and sanitation are supplied," it says. "Yet...40% of the world's 6 billion people have no acceptable means of sanitation, and more than 1 billion people draw their water from unsafe sources."
"According to estimates globally, [a] 23-billion-dollar investment is needed annually to meet the international targets of water and sanitation services by 2015," Terrance Thompson, Regional Advisor for Water, Sanitation and Health of WHO in New Delhi, told Reuters Health. "But our studies show that, in the last decade, the actual investment has been only 16 billion dollars per year."
Thompson contrasted this investment with other expenditures in the developed world. "It has been calculated that in Europe alone, expenditure on ice cream is 11 billion dollars per year, and Europe and [the] US combined spend some 17 billion dollars annually on pet food," he said.
"Waiting for new projects to come is no longer an acceptable option, because the health impact of inadequate water and sanitation services, together with poor water resource management, has already reached unacceptable proportions," Poonam Khetrapal Singh, deputy regional advisor of WHO, South East Asia Region, told Reuters Health.
"Without new approaches, the situation will worsen," Singh cautioned.
WHO is now advocating low cost technological solutions such as chlorination of water, solar water disinfection and behavior change.
Solar water disinfection, promoted by the Swiss Institute for Environmental Science and Technology (SIEST), involves keeping transparent water-filled bottles horizontally on a flat surface, preferably black, for about 5 hours in sunlight. Ultraviolet rays kill harmful microorganisms in the water.
"Solar water disinfection is a nearly cost-free system, because sunlight costs nothing, and the only other elements are throwaway plastic soft-drink bottles and a black surface," says SIEST researcher Martin Wegelin.
Behavior change can be very effective in bringing down the incidence of water-related diseases, says the WHO. Studies on diarrhea done by the London School of Hygiene and Tropical Medicine show that simple handwashing with soap and water can reduce the incidence of diarrhea by 35%.

Fear of Injury, Arrest Keeps Boys from Guns: Study 
Thumbing their nose at federal laws, a full 25% of American teenage boys say they have at one time or another carried or used a handgun. But researchers say a few key factors-- fear of arrest, fear of hurting themselves or others, and respect for opinions of others--can keep teens away from firearms. 
"The decision to acquire or carry a gun is a complex one...(and) things that dampened the adolescents' desires to acquire or carry a gun were much more important obstacles to gun involvement than were supply-side factors," according to Dr. Lorraine H. Freed, of Johns Hopkins University in Baltimore, Maryland. 
Freed and her colleagues conducted interviews with 45 males aged 14 to 18 who were incarcerated in a short- or long-term residential juvenile justice facility in Maryland. The investigators report their findings in the March issue of the Archives of Pediatrics and Adolescent Medicine. 
 About 67% of the study participants were black and 22% were white, and over 70% were experienced with handling a gun. Most had been convicted for drug possession, robbery or assault. 
Freed's team reports that 90% of the juveniles indicated that on at least one crime-related occasion they chose not to carry a gun. The investigators found that certain considerations played a role in restraining these boys from acquiring or carrying a gun, whether or not the juveniles had any prior gun experience. 
 Although some juveniles said that a lack of a good gun source and high prices impeded their ability to get a firearm, other factors appeared to play a greater role in their decision. The reasons included a fear of being arrested and imprisoned if caught with a gun; respect for friends and relatives--primarily females--who did not approve of firearms; fear of hurting themselves or others--particularly younger siblings; and a perceived lack of need--either because they felt they were at low risk of violence or a friend was carrying one. 
Freed and her team further noted that almost one third of the adolescents reported feeling conflicted about gun-carrying, feeling simultaneously "safe and in danger" while they had the gun. The study authors suggest that by focusing on the psychological sources of such conflict, social workers and police might be able to develop better ways to prevent gun-carrying by teens. 
 SOURCE: Archives of Pediatrics and Adolescent Medicine 2001;155:335-341. 

Teens With HIV Not Taking Meds as Needed
Less than half of adolescents with HIV are taking their medications as required, increasing the risk both to themselves and the community, researchers report.
A study of 161 teens infected with HIV found that only 41% were taking all their medications as required. The report is published in the February 2001 issue of AIDS Care.
"Strict adherence to drug therapy is critical for keeping the virus suppressed," according to one of the study's co-authors, Dr. Craig Wilson, an associate professor of pediatrics at the University of Alabama at Birmingham.
"Partial compliance not only allows the virus to multiply, but it encourages the growth of strains that may be resistant to currently available drugs," he told Reuters Health. "If others become infected with these new strains, it could create a public health problem."
One of main reasons for such noncompliance appears to be depression. Of those teens in the study that were depressed, only 29% took their medications as required.
Authors of the study suggest that healthcare workers may need to screen for and treat adolescent depression before they can expect better compliance. Yet depression is not the only suggestive factor since even among non-depressed teens, only 55% showed full compliance. The other factor that contributes to poor adherence is the quantity of pills that those with HIV need to take each day.
"It's not unusual for a patient to have to take three or four different drugs, three times a day," he told Reuters Health. "If such a regimen is hard for adults to follow, you can imagine the challenge it poses for less disciplined teenagers."
This second hurdle to compliance will become lower in the near future, the researchers suggest, as pharmaceutical companies develop medications that last longer and combine two drugs in one pill.
SOURCE: AIDS Care 2001;13:27-40.

Drugs, Violence Among Top Concerns of Pre-Teens
A new study found that drugs and violence are top concerns of pre-teens, ABC News reported March 12. According to the study of 2,072 children, nearly 50 percent of 8- to 11-year-olds said alcohol, illicit drugs and violence are big problems in their lives. The percent increases to 68 percent among 12- to 15-year-olds.
The study, which also included interviews with the children's parents, found that 96 percent of parents with children ages 12 to 15 talked about alcohol and drugs. But only 46 percent of the children whose parents said they talked about these issues remember the conversation.
By way of contrast, 43 percent of the children ages 12 to 15 said they got "a lot" of information about alcohol, illicit drugs, sex and AIDS from their friends, while 37 percent said they obtained knowledge from movies and television.
The study showed that more than 40 percent of pre-teens want more information about alcohol and drugs, sex and relationships and teasing and bullying.
The study was sponsored by Nickelodeon, the Kaiser Family Foundation and Children Now.

Program Reduces Risky Sex Behaviors in HIV-Infected Teens
The prevention program, "Act Safe," can reduce risky sexual behavior among teens infected with HIV by as much as 82%, according to researchers in California. The program is one of the first to demonstrate a positive effect on sexual risk behaviors in HIV-infected youth.
Dr. Mary Jane Rotheram-Borus and colleagues at UCLA and elsewhere assigned 310 HIV-infected youths to participate in a two-part intervention — "Stay Healthy" and "Act Safe" — or to a control category. HIV-related risk and health behaviors were monitored up to 6 months after the conclusion of the second module.
The first part of the intervention, "Stay Healthy," had some positive effects on healthy lifestyle changes among young women in the study, but not men. However, in both genders, the module increased social support coping significantly compared with controls.
More dramatic benefits were observed following the "Act Safe" portion of the intervention, the investigators say in the March issue of the American Journal of Public Health. "The 'Act Safe' module resulted in a 50% reduction in the number of HIV-negative partners, an 82% decrease in the number of unprotected sex acts and a 31% reduction in a weighted index of drug use," they report.
Dr. Rotheram-Borus told Reuters Health that she found these effects somewhat surprising in light of "stereotypes people have about youth." However, she also noted that many of the youths began to show positive changes even before the program, after learning of their HIV-positive status.
The study director and her colleagues are now in the midst of several followup studies. Some are examining alternative delivery methods of the program, such as individual sessions and telephone sessions, while others have been initiated to examine the effects of the program in adults with HIV. The data from these studies should be available in 6 to 18 months, she said.
Source: Am J Public Health 2001;91:400-405.

Youth Drug Use Strongly Influenced by Friends 
Teens whose friends smoke marijuana are far more likely to try the drug themselves, and "mild" drug warnings from parents are not enough to overcome this peer pressure, a government study shows. 
A nationwide survey of 7,844 adolescents aged 12 to 17 reveals that teens who have a few close friends who smoke marijuana are 39 times more likely than other teens to have used the drug in the past year. And respondents were far more likely to try pot if they thought their friends would not be bothered by it. 
Among adolescents who said their friends would be "very upset" if they tried marijuana, just 2% had used the drug in the past year. That compares with 44% of those who said their friends would not mind their marijuana use at all. 
As for parental influence, the study shows that "mild antidrug attitudes" make no impression on teens. Survey respondents who thought their parents would be somewhat upset if they used marijuana were just as likely to use the drugs as those who felt their parents would not care. 
"Parents need to be very, very clear that they will not accept any drug use," Dr. Ruth Sanchez-Way told Reuters Health. And, she said, the antidrug message cannot come across in a one-time-only discussion. "It needs to be done throughout life." Sanchez-Way heads the Center for Substance Abuse Prevention at the Substance Abuse and Mental Health Services Administration, the federal agency that conducted the survey. 
That friends play such a large role in whether teens use marijuana comes as no surprise. But, Sanchez-Way said, "this study proves scientifically that our mothers were right when they worried about who we hung around with." 
She stressed that parents need to know who their children's friends are, and stay aware of their kids' feelings and attitudes by listening to the things they say. 
And it is never too early to begin talking to children about drugs, she said, pointing out that the agency offers free pamphlets on talking to children as young as 4. 
According to the US Centers for Disease Control and Prevention, marijuana use increased among American high school students over the 1990s. In 1991, 31% of high school students reported using pot at some point. By 1999, that number had increased to 47%. 

Teen Pregnancy 'Virtually Eliminated' in The Netherlands 
Providing sex education and free contraceptives and fostering liberal attitudes toward sex are among the best ways to reduce soaring teenage pregnancy rates, a Dutch researcher said Friday.
"Teenage pregnancy seems virtually eliminated as a health and social problem in the Netherlands," Dr. Simone Buitendijk, of the Dutch Institute for Applied Scientific Research in Leiden, told Reuters.
The tiny country has fewer pregnant teenagers than most Western countries. Less than 1% of 15- to 17-year-olds in the Netherlands get pregnant each year, compared with nearly 5% percent in Britain, which has the highest rate in Western Europe, and 9.9% in the United States.
The Dutch have seen a steady drop in the number of young mothers for decades, even as the teen pregnancy rate has been increasing in other countries. "It's due to a whole mix of things. It is very hard to pinpoint what the major factor is. The liberal attitude is probably one very important determinant," Dr. Buitendijk said in a telephone interview.
While other countries have been teaching celibacy, the Dutch have accepted that teens are sexually active and have introduced measures to deal with it.
"In Holland teens know about sexuality and about procreation, how it works and what you should do not to become pregnant. Their peers know and it is a very socially acceptable thing to prevent pregnancy," Dr. Buitendijk said.
Oral contraceptives are available at pharmacies and free through the National Sick Fund, a state-funded system that ensures that low-income people have medical care. Statistics show that Dutch teenagers are using them. In 1995, 70% of sexually active 18-year-olds were using birth control pills, along with 40% of students 3 or 4 years younger. Eighty-five percent of teens used a condom, the pill or both during their first sexual experience.
Dr. Buitendijk, who will present the Dutch data at a meeting on child health in London, attributed use of contraceptives by Dutch teenagers to "their sufficient knowledge of reproduction and contraception, the large amount of information available to them both in school and informally, and the general permissive attitude the Dutch hold toward teen sexuality."
Dutch Institute for Applied Scientific Research

Spring Training Doesn’t Have To Be Painful for Kids
More than 1.4 million young athletes under 15 seek medical attention each year for injuries related to team sports like basketball, football, baseball or soccer. But experts say many of those injuries can be prevented by following simple steps to ensure your children’s safety before they head out on the playing field.
"There’s a huge misconception about sports injuries--their magnitude and the effect they’re having on our populace, from the youth level to the senior level," says David Janda, MD, director of the Institute for Preventative Sports Medicine in Ann Arbor, Mich. "Most people believe injury is inherent is sport no matter what you do."
However, the vast majority of sports-related injuries may actually be preventable. For example, Janda says a recent study found that 71% of all injuries sustained in baseball and softball were related to the act of sliding. But by switching to breakaway bases that weren’t firmly bolted to the ground, researchers found the number of sliding-related injuries dropped by 96%.
Wearing the appropriate safety gear for the sport can also significantly reduce the number of injuries. For soccer, that may be as simple as wearing an air-cushioned shin guard, but most experts say the single most important piece of equipment for many sports is a helmet.
"Head injuries are the number one thing we’d like to prevent by wearing helmets," says Doug Hill, MD, spokesperson for the American College of Emergency Physicians and a practicing emergency room physician in Denver. He says the best way to teach safety is by example. If mom and dad wear a helmet when riding a bike, the child is more likely to follow suit when biking or engaging in other sports.
Warming up and stretching can also prevent a lot of unnecessary muscle pulls and strains, which Hill says are some of the most common injuries he sees in the ER.
Other tips for preventing sports injuries from the American Academy of Orthopedic Surgeons and other sports and health organizations include the following:

• Make sure children get a sports physical from their physician before going out and trying a new sport and perhaps talking to that provider about what sports might be appropriate for their body type. Many schools require this, but some recreational leagues do not.
• Teach your child not to play through pain. If you child feels pain, stop the activity and have the injury checked out by a physician.
• Make sure the coach is familiar with first aid procedures, or parents themselves can enroll in first aid classes offered by the American Red Cross.
• Make sure your child is training at a level appropriate for his or her age. Most experts say children are not ready to participate in team sports until they are 6 years old. Janda says the growing number of sports injuries is a public health epidemic in the US. "The vast majority of these injuries actually have very long-term consequences associated with them, not just short-term from both a pain and suffering standpoint as well as disability and economic standpoints," says Janda.

Hill agrees and says some common sports injuries, such as bone fractures can have more long-term consequences for a child or teen. "When a child is growing, their growth plates aren’t completely fused and a serious injury [like a bone fracture] can cause an abnormality in their growth. They may have one arm grow shorter than another, requiring further reconstructive surgery," says Hill.
Institute for Preventative Sports Medicine

Study: Gateway Theory Less Applicable to Today's Youth
The gateway theory, which holds that youth who use drugs like marijuana will tend to move on to hard drugs, may be greatly exaggerated, at least where kids born in the 1970s is concerned. A new study found that young people using marijuana are less likely to move on to hard drugs than once believed. "The recent increase in youthful marijuana use has been offset by lower rates of progression to hard drug use among youths born in the 1970s," according to the report in the February edition of the American Journal of Public Health. "Dire predictions of future hard drug abuse by youths who came of age in the 1990s may be greatly overstated."
Substance Abuse Funding News reported that the study by the National Development & Research Institute and the National Center on Addiction & Substance Abuse at Columbia University found that, unlike teens from past generations, there is little evidence that youth who started smoking marijuana in the 1990s would progress to hard drugs like heroin, cocaine and crack later in life.
Andrew Golub, chief investigator of the study, said that overall, children born between 1956 and 1971 who used marijuana before the age of 11 had an 80 percent chance of moving on to heroin, cocaine or crack. Those who started using marijuana in their teens has a 50 percent chance of progressing to hard drugs. The rate dropped to 20 percent for those who started using marijuana in their early 20s.
Substance Abuse Funding News

Children Who Sleep Well, Do Well
Sleep problems affect about 70 million Americans of every age, but they can be especially troublesome for a child trying to grow and succeed in school. Now, a new national initiative hopes to educate children and the public about the importance of healthy sleep habits.
"It's one thing for parents to say, 'You need to go to sleep now because I say so.' It's certainly going to be more compelling if children and parents understand the downside of not getting sleep," says Carl Hunt, MD, director of the National Center on Sleep Disorders Research at the National Heart, Lung and Blood Institute of the National Institutes of Health.
"We know that good, healthy sleep habits allow young children to do better," says Hunt, who announced the new five-year, national "Sleep Well, Do Well Star Sleeper Campaign," which features the cartoon character Garfield as "spokescat." The educational initiative is designed to reach children ages 7 to 11, their parents, teachers, and health care providers with the message that at least nine hours of sleep each night is vital to good health.
"It's important not only for school performance and general emotional health, but it's also important to their safety," says Hunt. "We know that children who are sleep deprived are more likely to have accidents."
A recent survey by the National Sleep Foundation found that 60% of children under the age of 18 complained of being tired during the day in the past year, and 15% of children reported falling asleep at school during the past year.
Pediatric sleep researcher, Judith Owens, MD says spotting a sleeping problem in children can be tricky for parents and teachers.
"Kids this age don't necessarily act sleepy in the ways that adults do when they're not getting adequate sleep," says Owens, who is associate professor of pediatrics at Brown University. Instead, Owens says children may develop behavioral problems such as acting out aggressive or defiant behavior, and some children may become more anxious, depressed and withdrawn. They may also have developmental and learning problems that may be related to cognitive, memory and attention issues.
"Their attention span, their reaction time and their vigilance is impaired in this sort of situation," says Owens. "A lot of these kids can really look like they have attention deficit disorder."
Owens says many pediatricians don't screen for sleep problems in children and parents don't bring it up, but there are clues that parents can look for that may indicate that their child is having a sleeping problem.
"A lot of parents aren't aware that snoring is a red flag in kids," says Owens. Loud, nightly snoring could be a symptom of a more serious problem known as sleep apnea. Other warning signs that a child is not getting enough sleep include the following:

• Chronic difficulty in getting up in the morning
• Falling asleep during the day (on a car ride, in front of the TV or while reading)
• Sleeping in on non-school days
• Mood changes, especially crankiness in the morning 

"For the modern American family, sleep has become less and less of a priority," says Owens. "We spend so much teaching kids about other aspects of health--nutrition, sexual abstinence, using sunscreen and dental hygiene--but sleep is very seldom taught within the context of health curriculums in elementary schools. We spend a third of our lives doing it, we need to pay more attention to it."
For more information on the campaign, visit the NHLBI Web site. For general information about sleep disorders and treatment options see the National Sleep Foundation Web site. http://www.sleepfoundation.org/

Angry and Sad Teens Are More Likely to Smoke
Moody teenagers may be the norm, but a new study shows that adolescents who are often sad or angry are more likely to smoke than do their less aggressive or less depressed peers.
The findings reportedly suggest that negative emotions may make young people more vulnerable to risky behavior.
"The fact that teens with externalizing and depressive dispositions reported elevated rates of both smoking and negative affectivity suggests that it may be the blend of negative mood and proneness toward unconventionality that encourages a cluster of health-risking acts, including cigarette smoking," write the researchers in an article published in the March 2001 issue of Health Psychology. Carol K. Whalen, PhD, at the University of California at Irvine led the research team.
The study analyzed questionnaires and daily diary entries from about 150 ninth grade students. After analyzing the participants' dispositions and smoking status, investigators found kids with high rates of negative emotions tended to smoke more than kids who weren't as angry or sad.
The results of the study are consistent with research on kids who have high sensation-seeking personalities. Such personas require constant stimulation from new and risky things. They also tend to be more aggressive and be involved in risk-related behavior, says Philip Palmgreen, professor of communications at the University of Kentucky, and a member of a scientific panel at the Office of National Drug Control and Policy.
Palmgreen recently conducted a study on the effectiveness of focusing anti-drug media campaigns on sensation-seeking teens. His study found television spots targeting sensation-seeking teens are very successful in cutting down marijuana use.
Whalen and colleagues emphasized the importance of focused interventions as well. "Our findings suggest the merit of targeting adolescents with depressive and aggressive dispositions," said Whalen in a press release.
Parents who suspect their teenage children may have emotional or behavioral problems, and may be at risk for dangerous behavior are encouraged to talk to their son or daughter, and if necessary, seek the help of a mental health professional.
"If you have an ongoing relationship with [your child], then hopefully you'd know whether this is basically a solid kid who's going through the ups and downs, or whether this is something sustained," says Lawrence Josephs, PhD, professor of psychology at Adelphi University in New York. "Some parents assume that kids will grow out of things."
Josephs advises parents to assess whether their child can handle responsibility and independence, or whether he is the type to externalize blame and turn to substance abuse for relief.
March 2001 issue of Health Psychology

Shame Attached to Depression Keeps People From Treatment
Regular visits to a therapist may not be as uncommon as they were a decade ago, but a new study shows the stigma attached to depression treatment still continues to plague older adults.
"Going to treatment--even though somebody may be under significant distress--really is difficult, especially for older adults," says lead author Jo Anne Sirey, PhD, associate professor of psychology in clinical psychiatry at the Weill Medical College of Cornell University. "It does lead to people considering whether they'll take medication or they'll stay in treatment or not."
Sirey and colleagues studied 92 outpatients with depression (29 of them were 65 years old or older). The participants were asked what they perceived was the mainstream view of their mental illness, and whether they believed other people would discriminate against them or devalue them if their condition was known. Investigators then followed the patients for 3 months.
The study found younger patients perceived higher levels of stigma than older adults did, but the seniors were more likely to drop out of treatment.
"That's a particular concern because our older population is getting larger and larger, and they, as a group are not particularly open to seeking treatment," says Sirey. "This is a group of individuals who really did not grow up at a time where mental health treatment was available, where we understood mental illness. We're still feeling the historical effects."
The younger group may have perceived more stigma, adds Sirey, but they may have been better able to reconcile the feelings of shame in order to get proper treatment. She says older people, in order to get needed help, must acknowledge the stigma and consciously decide that treatment is a priority.
One expert says it's important to keep in mind that the stigma attached to depression stems from lack of understanding about the illness, which leads to fear, and then leads to prejudice.
"Prejudice, in general, comes from when people don't understand other people, and they see other people as different," says Michael Blumenfield, MD, chairperson of the joint commission of public affairs at the American Psychiatric Association. "In the case of mental illness, it's the desire to keep people separate because they're also afraid of what they perceive as their own irrationalities."
Bill Callahan, MD, president of the Orange County Psychiatric Society, recommends treating stigma like any other form of prejudice. "All of us owe it to ourselves and society that anytime we identify a hatred or prejudice, to try to stamp it out of ourselves and tell ourselves to be rational."
Both Callahan and Blumenfield say depression is a valid medical condition that is treatable, and no one should be deprived of that treatment, just as people shouldn't be turned away when they
have other diseases in their bodies.
For people who need help with depression, experts advise checking with your doctor, or visiting the Web site of the American Psychiatric Association for information.
"It takes more courage to face these difficulties than it does to run from them and cover them up, and it takes more courage to feel and experience a feeling than it does to push it down and stay tense and anxious," says Callahan.

Girls (and Boys) Affected by Negative Body Images
Thoughts of "Does my butt look too big?" and dieting are not only common among adults and teenagers, but a growing number of children are now feeling the pressure to be thin.
A new survey of 234 Girl Scouts found that nearly 30% of the 10- and 11-year-old girls reported trying to lose weight, and more than 25% agreed pictures of thin girls and women "make me wish I were thin." Researchers say the results suggest that efforts to prevent eating disorders should not overlook pre-adolescents.
"It's concerning that at such a young age some young girls are on the path to developing problems," says study author Nancy Sherwood, PhD, research associate at the School of Public Health at the University of Minnesota. "Even if they don't go on to develop a clinical, diagnosable eating disorder, the fact that they're spending a lot of their time and energy on dieting and weight concern could potentially be compromising their health and is a problem."
Girls who were dieting also tended to be more dissatisfied with their bodies and even specific body parts like their stomach and thighs. "Typical body parts that women complain about, at 10 and 11, some of these girls were thinking those body parts were too big," says Sherwood.
Although the majority of girls that reported trying to lose weight used healthy methods like increasing their levels of exercise and decreasing the consumption of high-fat foods, about 5% of the girls said they took diet pills, purged or took laxatives to lose weight.
Even though the girls surveyed were members of a group that promotes self-esteem, more than 75% of the girls agreed that advertisements influence people's thoughts and behaviors. Sherwood says the more the girls internalized the cultural idea of thinness promoted by the media, the more likely they were to be dieting.
Researchers say the study's findings, published in the March 2001 issue of the American Journal of Health Promotion, suggest that pre-adolescence is an ideal time to intervene and prevent unhealthy weight control practices in both boys and girls.
"They are thinking about these issues, but they aren't yet entrenched in any harmful behavior patterns," says Sherwood.
Registered dietician Leslie Bonci agrees and says pre-adolescence is a good time to step in, because parents want to nip these problems in the bud so that children don’t have to deal with any long or short-term physical consequences of restrictive eating.
"This is really a key time for the body in terms of lean muscle mass and optimum bone health," says Bonci, who is also a spokesperson for the American Dietetic Association.
Bonci and Sherwood recommend the following tips for parents to help promote healthy eating habits and positive body images among children and teens:

• Parents shouldn't criticize their own bodies in front of their children.
• Be a good model for a healthy body image, eating habits and activity patterns.
• Parents should provide their children with positive feedback about themselves, not just their appearance. Comment on their successes in school, sports, the arts and other areas of their lives.
• Monitor media use and exposure to help girls and boys critically evaluate the messages that promote unhealthy media images. Ask questions like, "How do these boys and girls compare to those in your classes?"
• Sit down and eat together as a family. "It's important for kids to see that it's ok to eat because caregivers are eating, siblings are eating and everybody's fine. Food takes on more of a positive slant," says Bonci. "I don't think the word diet should be in anybody's house in any way, shape or form--uttered from a child or from a parent." Bonci says fathers also need to take an active role in praising their sons and daughters as well as other men and women in front of their kids for attributes other than their appearance.

If parents notice signs of unhealthy weight control practices like taking pills, laxatives or self-induced vomiting, experts say they should talk to their child about it and seek professional help from a mental health professional.
March 2001 issue of the American Journal of Health Promotion

Report: Heroin Use on Rise in U.S.
Heroin use is on the rise, especially along the East Coast of the United States, with the drug spreading from inner cities into suburbs and farm towns, Reuters reported March 6. "From 1998, we started seeing heroin starting to spread beyond the cities into the surrounding area with some dealers setting up shop in apartments in the suburbs and smaller towns," said Erin Artigiani, coordinator of the Drug Early Warning System at the University of Maryland's Center for Substance Abuse Research.
Officials are particularly concerned about Vermont, Atlanta, and Miami. "Vermont has a substantial heroin problem. We're a small market but we're on the corridor between Montreal and Boston and New York and there's a natural creep to the trade," said David Peebles, a top official in the state's corrections department.
According to the December 2000 report from the Community Epidemiology Work Group at the U.S. Department of Health and Human Services, heroin use has been on the rise in Atlanta, Baltimore, Boston, Miami, Newark, Philadelphia, Chicago, Detroit, Minneapolis, St. Louis, New Orleans and other communities.
"My sense is that the use of heroin is going up. I think this is very real. It's most prevalent on the East Coast but moving into the Midwest," said Alan Leshner, director of the National Institute on Drug Abuse.
Two trends in the heroin trade that have officials especially concerned are the significant increase in the purity of the drug and the substantial decline in the street price. "With the increase in purity and the decrease in cost, new populations have been recruited," Leshner said. He added that the number of hard-core heroin addicts in the U.S. rose by 25 percent in the past five years.
On the West Coast, officials noted a growth in the use of "designer drugs" and methamphetamine.

Family Support Prevents Teen Suicide
A new report found that family support plays an important role in preventing teen suicide, Reuters reported March 6. According to the study conducted by Dr. Michael D. Resnick and colleagues at the University of Minnesota in Minneapolis, American adolescents and teenagers are more likely to attempt suicide if they had previous suicide attempts, used illicit drugs or alcohol, had academic problems, or had a history of being a perpetrator or victim of violence.
On the other hand, the report determined that teens are 70 to 85 percent less likely to attempt suicide if they have a sense of "connectedness" to parents, family, or other care-giving adults. The results hold true for teens in all ethnic groups.
"What this study affirms is the remarkably important role of parents and families, adults outside of the family, and school as sources of connection and anchoring points in the lives of young people," said Resnick.
The report's findings were based on interviews conducted between 1994 and 1996 with more than 13,000 students in grades 7 through 12 from 134 schools throughout the United States.
"There is no reason to give up on a kid and say nothing can be done," said Resnick. "What this analysis shows is that protective factors can offset the effects of risk factors. The good news in this is that when one of those environments is not nurturing -- when for example a family is not a source of love and support -- other adults and schools can provide that kind of connectedness to kids that we see as very beneficial in preventing suicide in the short and long term."
The report is published in the March issue of the journal Pediatrics.

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