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May 2001

Study Shows Long-Term Impact of Heroin Use
A study that tracked heroin users from the early 1960s shows the destructive impact heroin has on users, Reuters reported May 14. Researchers at the University of California at Los Angeles (UCLA) followed 581 male heroin users who were involved in the California Civil Addict Program in the early 1960s.
According to the research, 48.9 percent of the heroin users had died, while 20.7 percent of the survivors still tested positive for heroin when surveyed in 1996-97.
"This answers the question of where have all the heroin addicts gone?" said Dr. Alan Leshner, director of the National Institute on Drug Abuse, part of the National Institutes of Health. "Many people believe that millions of heroin addicts have just quit. It's not true. They've died."
The research showed that 40.5 percent of the study group said they used heroin in the past year, 35.5 percent used marijuana, 19.4 percent took cocaine, 10.3 percent used crack cocaine, and 11.6 percent took amphetamines. In addition, 66.9 percent said they currently use tobacco products, while 22.1 percent reported that they drank alcohol daily.
"It is not a surprising result," said Yih-Ing Hser, adjunct professor at UCLA and the study's principal investigator. "We know they are getting old and maybe having risky behavior beyond heroin use. It is just very sad to see."
From their study, researchers concluded that treatment stressing total abstinence was ineffective.
The study is published in the May 2001 issue of the Archives of General Psychiatry.

Risk of Behavioral Problems Increased in Extremely Low-Birthweight Children 
By ages 8 to 10 years, children born weighing less than 1001 grams are at higher risk than normal-birthweight children for difficulties in thought, social interactions and attention, according to data from a prospective, multinational study.
Using a child behavior checklist completed by subjects' parents, Dr. Judith F. Feldman, of Columbia University and New York State Psychiatric Institute in New York, and colleagues assessed 78 to 150 children in each of four cohorts: from the US, Canada, Germany and the Netherlands. Their findings appear in The Lancet for May 26.
Compared with almost 3000 country-specific, same-age, normal-birthweight controls, the extremely low-birthweight children scored significantly higher, by 0.48 to 1.20 standard deviations, on scales measuring social, thought, and attention difficulties. These difficulties included acting young, not being liked, hearing or seeing things, and being unable to concentrate.
"We were primarily interested in the pattern of problems and to determine whether that pattern was the same in different cultures," Dr. Feldman told Reuters Health. "The fact that different cultures, having somewhat different childrearing practices and schooling, exhibit the same elevation of problems in children born at extremely low birthweight, that's what's new about our research."
"That this pattern was repeated across cultures may point in the direction of there being something organically different in the brains of these individuals," she added.
Dr. Feldman noted that scores did not indicate clinically significant problems in these children. In addition, she said, "The cultures that were examined were all western. We don't know yet if the pattern would be repeated in nonwestern cultures."
Lancet 2001;357:1641-1643.

Researchers find early indicator for autism 
 Elevated levels of proteins in the blood at birth appear to foreshadow the development of autism and mental retardation later in childhood, researchers said in a finding that could lead to earlier diagnosis and better treatment. Researchers studied archived neonatal blood samples from children born in four northern California counties from 1983 to 1985 who later developed autism, mental retardation, cerebral palsy or developed normally.
They found that concentrations of proteins in the blood called neural growth factors were significantly elevated in children who later developed autism or mental retardation, but not in the other children. The findings appear in the journal Annals of Neurology.
Dr. Karin Nelson, who led the study, said the discovery of this early warning indicator for the development of autism and mental retardation before the onset of symptoms could help doctors make earlier and more definitive diagnoses.
Nelson, who works at the National Institute of Neurological Disorders and Stroke, part of the US government’s National Institutes of Health, said the research could point the way for developing drugs that could be used in children showing these early warning signs to better treat and perhaps prevent the development of autism.
Nelson said despite the similarities in these early biological markers for autism and childhood mental retardation, there is so no reason to think they are the same disorder.
Source: Annals of Neurology.

Everyday traffic noise harms health,  well-being of children
Even the low-level but chronic noise of everyday local traffic can cause stress in children and raise blood pressure, heart rates and levels of stress hormones, reports a new study by a Cornell University environmental psychologist and his European co-authors. "We also found that girls exposed to the traffic noise become less motivated, presumably from the sense of helplessness that can develop from noise they couldn't control," says Gary Evans, an international expert on environmental stress, such as noise, crowding and air pollution.
The study, the first to look at the nonauditory health effects of typical ambient community noise, is published in the Journal of the Acoustical Society of America.
The researchers analyzed data on 115 fourth-graders in Austria with similar family characteristics, such as parent education, parental marital status, housing and family size. Half the children lived in quiet areas -- below 50 decibels (dB), the sound level, for example, of a clothes dryer or a quiet office -- and half lived in a noisier residential area -- above 60 dB, about the intensity of an average dishwasher or raised voices.
"We found that even low-level noise can be a stressor because it elevates psychophysiological factors, triggers more symptoms of anxiety and nervousness when the children are stressed (by taking a test) and can diminish motivation," says Evans.
Specifically, the researchers found that children in noisier neighborhoods experienced marginally higher resting systolic blood pressure, greater heart rate reactivity to a test (which served as a stressor) and higher overnight cortisol levels, which are signs of modestly elevated physiological stress.
"Anything that increases blood pressure, for example, has negative implications for long-term health effects," says Peter Lercher, M.D., and an epidemiologist at the Institute of Hygiene and Social Medicine at the University of Innsbruck, Austria, and a co-author on the study. Elevated blood pressure in childhood is thought to predict higher blood pressure later in life. Boosts in stress hormones also are of concern because they are linked to adult illnesses, some of which are life-threatening, including high blood pressure, elevated lipids and cholesterol, heart disease and a reduction in the body's supply of disease-fighting immune cells.
The study adds evidence to Evans' previous research showing that noise can have serious health, learning and task-motivation effects in children and adults exposed to chronic noise.
"The findings suggest that children living in noisier areas are subject to stress, which may have serious health implications," the researchers conclude. They intend to monitor the Austrian children and the noise levels to which they are exposed and assess any long-term health effects.
Since the children studied live in small villages and towns in an alpine area with higher traffic noise exposure during the night (night exposure was 2 dB higher than during the day), a direct transfer of the results to other residential neighborhoods is difficult, the researchers point out. A typical urban residential neighborhood in the United States has decibel levels between 55 and 70. Continued exposure to noise above 85 dB causes hearing loss.
Other co-authors of the study are Markus Meis at the Institute for Research into Man-Environment-Relations, University of Oldenburg, Germany; Hartmut Ising at the Federal Environmental Agency, Germany; and Walter W. Kofler at the Institute of Hygiene and Social Medicine, University of Innsbruck.
The study was supported mainly by the Austrian Ministry of Science and Transportation and also, in part, by the Austrian-U.S. Fulbright Commission, the National Institute of Child Health and Human Development, and the College of Human Ecology at Cornell.
Journal of the Acoustical Society of America  The original news release can be found at http://www.news.cornell.edu/releases/May01/roads.noise.kids.ssl.html

Students hooked on the internet 
Students spend so long surfing the internet and emailing friends that their college work suffers, a study has shown. Up to 15 per cent of college students admit that their studies are affected by the amount of time they spend online and that their computer use is "out of control".
First-year students who use email and chatrooms to keep in touch with school friends and family are most vulnerable to internet addiction. The findings are from a survey of 570 American college students carried out at Rutgers University in New Jersey.
Students who reported internet-related problems spent five times as much time online as other students, the study found. Dr Robert Kubey, who reports the findings in the Journal of Communication, said the heaviest users were more likely to admit that the internet caused them to stay up late, miss out on sleep and skip lectures and tutorials.
He said: "Although the majority of 570 undergraduate students sampled do not report internet-related problems, a small but significant group of about 10 to 15 per cent do report feeling that they are not in control of their internet use and that it has hurt their school work.
Source: Journal of Communication

More Young People Using Antidepressants
A new study shows a sharp increase in the use of antidepressants among children ages 2 to 19, the Associated Press reported May 9. According to a study by Julie Zito, associate professor of pharmacy and medicine at the University of Maryland, the use of antidepressants among youth increased three to fivefold between 1988 and 1994.
The study's findings were based on nationwide data of 900,000 youths from two different state Medicaid systems and a health-maintenance organization (HMO). Zito declined to identify the sources.
The research shows that in 1994, about 1.8 percent of children in the Medicaid programs and nearly 1.3 percent in the HMO were taking antidepressants. Furthermore, the analysis showed that usage increased with age, ranging from about 0.2 percent in children ages 2 to 4, to 3 to 4 percent for youth ages 15 to 19.
The study will be presented this week at the American Psychiatric Association meeting in New Orleans, La.

Bad Parenting Puts Child at Risk for Anxiety
In what may be the first study to investigate the role of parental behavior in relation to child psychiatric disorders, researchers report that individuals with poor parenting skills may put their child at risk for anxiety or depression.
"Such findings are of particular interest because it may be possible to prevent the onset of psychiatric disorders among many children and adolescents by helping parents to modify their child-rearing behavior," according to Dr. Jeffrey G. Johnson of Columbia University in New York and colleagues.
The investigators interviewed almost 600 parents and their children about psychiatric disorders and poor parenting behaviors--i.e., verbal abuse, arguments between the mother and father in front of the child, poor child supervision and inconsistent rule enforcement.
The researchers found that more than 60% of the children who experienced high levels of such parental behaviors developed an anxiety, depressive, disruptive, personality or substance abuse disorder during late adolescence and early adulthood, according to the report in the May issue of Archives of General Psychiatry. This finding held true even after the parents' psychiatric disorders were taken into consideration, the authors note.
"Parents with psychiatric disorders may not convey increased risk for psychiatric disorders to their offspring if they do not raise their children in a maladaptive way," Johnson told Reuters Health in an interview.
On the other hand, the more poor behaviors exhibited by the parents, the more likely it may be for a child to develop a psychiatric disorder, the report indicates.
"Parents can help to minimize the likelihood that their children will develop psychiatric disorders by avoiding common mistakes in child rearing, such as spending too little time with their children, failing to show enough affection to their children, failing to monitor their children's behavior, and relying too heavily on harsh punishment, guilt, and verbal abuse as methods for controlling their children's behavior," according to Johnson.
SOURCE: Archives of General Psychiatry 2001;58:453-460.

Trouble with Math: All in the Mind?
Wonder why you're always having trouble balancing the checkbook? Or figuring out a grocery bill? A new study suggests that your struggle with numbers may have to do more with anxiety than with not having a "math head."
People with high math anxiety tend to make more mistakes, says study author Mark Ashcraft, PhD, professor and chair of the department of psychology at Cleveland State University. He says in order to avoid arithmetic-type problems, the anxious tend to be rash, "Rather than forcing themselves to spend the time and actually get the problem right despite their anxiety, they just go ahead and blurt out an answer that's likelier to be wrong."
Ashcraft and colleague Elizabeth Kirk studied more than 150 college students and determined their level of math anxiety. After giving the students tests involving arithmetic functions, researchers found the participants with a higher fear of numbers tended to have smaller spans of working memory--the short-term memory that is important when doing math computations.
The math-anxious "are literally using up their working memory resources that they should be spending on the math problem," says Ashcraft.
At least one expert says the findings of the study make sense.
"Any anxiety inhibits performance," says Irene Deitch, PhD, professor of psychology at the College of Staten Island in New York City. "Anxiety can lead to an avoidance reaction. If every time I look at a math problem and I get terrified of it, I am going to try to avoid things that have to do with math."
The fear can lead to not only dodging math classes, but reportedly to steering clear of careers that would require crunching numbers such as engineering, science or economics.
Women have particularly suffered from math anxiety, Deitch points out, because of past social and cultural factors that expected men to be the wage earners and women to be the happy homemakers. Men, she says, were encouraged to take the hardest math courses, while it was okay for women to take the lower-level arithmetic classes. The result was that women whose husbands died often ended up feeling lost because their men usually managed the finances.
Deitch says the stereotypes about math and gender have gradually changed, and now she sees males with similar levels of math anxiety.
People who think they have math anxiety are encouraged to seek help. "Math anxiety is learned," says Ashcraft, "so it can be unlearned and overcome."
A complete report on the study appears in the June 2001 issue of the Journal of Experimental Psychology, published by the American Psychological Association.

Study Says Teens Buying Cigarettes, Despite Tough Laws
A new study found that underage youth in California are able to buy cigarettes even though the state has increasingly toughened its laws to discourage retailers from selling to minors, HealthScout reported May 10. "The study shows that the problem of youth access to tobacco might be more serious than many people think," said Eric Lindblom, a policy analyst at the Campaign for Tobacco-Free Kids, an anti-smoking group. "It also suggests that cigarette companies that say retailers can police themselves are even more wrong than we already knew they were."
For the study, San Diego State University psychologists Hope Landrine, Elizabeth Klonoff and colleagues recruited 12 California teens between the ages of 15 and 17. The teens were sent out to 227 stores in California to see if the clerk would sell them a pack of Marlboros.
The research was conducted in three phases -- two in which the teens asked to buy cigarettes, and one in which they offered ID, in the form of a driver's license or state card, but flashed it only briefly to fool clerks.
The study found that store clerks asked for IDs in nearly 56 percent of the attempted purchases, but asked the teenager's age in just 12 percent of the attempts. Clerks often failed to verify the date on an ID, researchers found.
"If they're going to sell, they just ignore what they see in front of them," said Klonoff. "We have anecdotal reports of clerks saying to kids, 'Just hand me anything so the security camera can see that I asked for something.'" She also noted that many times clerks "can't do the math" to determine if the age on the ID meets legal requirements.
The study's findings are published in the May 9 issue of the Journal of the American Medical Association.

Doctors Play Key Role in Underage-Drinking Prevention 
Brief interventions in doctors' offices and emergency rooms, coupled with environmental strategies that address alcohol consumption and marketing on a community-wide basis, can delay the onset of alcohol use and prevent binge drinking, according to experts who spoke at the annual medical/scientific conference of the American Society of Addiction Medicine (ASAM). Ralph Hingson, Sc.D., chair of the Social and Behavioral Sciences Department at the Boston University School of Public Health, said that research has shown that the younger a person is when they first start drinking, the more likely they are to become dependent upon alcohol at some point in their lifetime.
Early onset of drinking also can lead to problems other than dependence. Hingson's own research has demonstrated a link between early-onset drinking and an elevated risk of unintentional injuries, drunk driving, and involvement in alcohol-related motor-vehicle crashes. And in a forthcoming study to be published in the journal Pediatrics, Hingson and colleagues conclude that children who start drinking prior to age 14 are seven times more likely to engage in an alcohol-related fight over their lifetime than individuals who start drinking at age 21.
Physicians can play a critical role in counseling their young patients about the consequences of starting to drink, said Hingson. Research shows that such brief interventions can be highly effective. For instance, when trauma patients injured while under the influence of alcohol were told of the risks of drinking and advised of treatment resources, they reported consuming an average of 21 fewer drinks per week a year later, according to a study led by Larry Gentilello, M.D., of the Univeristy of Washington and published in the Annals of Surgery in 1999.
Gentilello's study group also experienced a 47-percent reduction in new injuries, 48 percent fewer hospitalizations, and 23 percent fewer DUIs. "Catching these people at a teachable moment had a recognizable impact on behavior," Hingson noted, adding that between 10 and 30 percent of patients who receive counseling in a general or primary-care setting will change their drinking behavior.
Norman Wetterau, M.D., an assistant professor of family medicine at the University of Rochester School of Medicine and a practicing physician with Tricounty Family Medicine in Dansville, N.Y., said primary-care physicians need to:

• ask patients about their alcohol and other drug use 
• ask patients what they think about their use 
• provide both written and oral information 
• connect patients with treatment resources, as needed 
• connect patients with community groups for teens (which he says is especially good prevention for socially isolated nonusers and experimenters whose friends are using) 

Environmental prevention also can prevent drinking problems associated with early onset of use, Hingson said. For example, long-term studies have shown that people who grew up in states with age-21 drinking laws drank less between ages 21 and 25 than those who grew up in states where the drinking age was lower than 21. Richard Yoast, director of the Robert Wood Johnson Foundation National Alcohol Program at the American Medical Association, said the power of the environmental-change model lies in its ability to create a new standard of behavioral expectations around drinking and other drug use. "It makes it easier to do the right thing," said Yoast.
By changing laws and community standards, community groups -- which can and should include participation from doctors and medical organizations -- can create policies that are long-lasting and require minimal maintenance.
Unfortunately, said Yoast, the alcoholic-beverage industry actively works against some of the key facets of environmental prevention, including price controls, enforcement of liquor laws, and curbs on availability. "The alcohol industry has wiped out alcohol prevention in the federal government, alcohol taxes have not kept pace with inflation, and the number of outlets is up while enforcement has not kept pace," he said. "By and large, the information people get about alcohol is through alcohol advertising."
The challenge of delay first use of alcohol and preventing underage drinking is especially acute at America's colleges, where Yoast says an increasing number of freshmen are showing up with established alcohol problems. In one study, 74 percent of college students who reported binge drinking also said they had binged in high school. "That's a marked change over the last 20 years," said Yoast.
The focus of most prevention efforts -- including those promulgated by the alcohol industry -- focuses strictly on changing individual behavior. "But that's backwards," said Yoast. "Youth don't control prices, taxes, or distribution laws."
Yoast charges that the alcohol industry, which sells $5.5 billion worth of its products to college students annually, has little real interest in comprehensive strategies that shift the focus from individual to collective responsibility for drinking problems. "Frequent bingers consume 64 percent of alcohol on campus," he said. "When the beverage industry says it is targeting moderate drinkers, that's nonsense. Bingers is where the sales are."
Local action on college alcohol problems often is stymied because state laws trump local action, and the alcohol industry influences the creation and enforcement of state laws, said Yoast. Despite such obstacles, a number of partnerships between colleges and communities have sprung up nationally to deal with the issue of underage drinking.
Through the A Matter of Degree initiative, for example, 10 communities and schools have worked together to address issues such as bar density, alcohol advertising, pricing, attitudes toward drinking, law enforcement, recruitment issues (such as promoting the institution as a "party school"), campus policies, media messages and norms, non-alcohol alternative activities, and industry sponsorship and promotion.
Such efforts have helped to break down hostility between schools and their communities, and resulted in some changes, such as the University of Florida banning bars from handing out promotional leaflets on campus. Other schools have put parental-notification policies in place or banned alcohol at certain sports and social events, while college towns have moved to boost enforcement and ban drink specials, Yoast said.

Contraception: Pill or patch?
The world's first contraceptive patch, Johnson & Johnson's Ortho Evra -- now awaiting government approval -- is as safe and effective as the pill and easier to remember to use, research suggests. The adhesive hormone patch is about the size of a matchbook. It can be worn on the abdomen or buttocks.
Three patches, each worn for a week, are used during a menstrual cycle. The user has her period in the fourth week.
SOURCE: The study, conducted at 45 clinics in the U.S. and Canada, appeared last week in the Journal of the American Medical Association.

Study finds teens missing needed medical advice
Pediatricians are being trained to talk about risky behaviors help young patients be healthier.
In today's fast-paced, cost-conscious world of health care, the patients who most need a doctor's advice may not be getting enough of it.
Teenagers, for whom risky behaviors can have lifelong consequences, often breeze through their annual checkups without frank talk about the facts of life.
Researchers at the University of California, San Francisco have learned that a carefully designed program to teach pediatricians how to talk to teenagers about things such as cigarette smoking, sexually transmitted diseases and riding in a car without a seat belt can increase the number of teens who are screened for risky behaviors by an average of 16 percent.
The study, published in today's issue of Pediatrics, involved 63 pediatricians and nurse practitioners, including 45 providers from Kaiser Permanente's Roseville and south Sacramento sites. The final phase of the project will determine whether doctor-teen chats affect behavior.
"A lot of behaviors begin at early adolescence," said Julie Lustig, lead author of the report. "A routine pediatric checkup provides a wonderful opportunity to ask important questions and counsel teens."
Tamu Mitchell, a research director at People Reaching Out, which works to reduce substance abuse and violence among young people, said doctors should join parents, peers and schools in helping prevent dangerous behaviors.
"One of the things we know about prevention is it has to be comprehensive," she said. "Silver bullets don't exist."
Studies show many doctors feel ill-equipped to talk to teens about risky behaviors.
Dr. Ravinder Khaira, a private practice pediatrician in Roseville and south Sacramento, thinks pediatricians have a duty to deal directly with the health issues facing their teen patients.
"Pediatricians should be trained to embrace the responsibility of adolescent medicine," he said. "Otherwise, they shouldn't be pediatricians."
Most young teens say they are not doing risky things, said Elizabeth Ozer, the study's other principle investigator.
But they can benefit from prevention advice from doctors. "If you don't ask if they smoke cigarettes, that sends a message that it must not be very important to their health," she said.
Nicole Lotto, 17, is dubious. The Elk Grove High School senior said teens tend to look to peers for information, not adults.
"You take a health class your freshman year," said Lotto, who as president of Students Reaching Out spends extracurricular time talking to elementary school kids about making healthy choices. "They talk to you about drugs. We get tired of hearing about it."
The UCSF program taught the doctors about risky behaviors and how to discuss the issues with young patients confidentially and respectfully.
Doctors were taught to encourage patients who said they abstained from drugs or sexual relations, for example. And they gave additional information, follow-up appointments or referrals to those who indicated they had engaged in risky behaviors.
Dr. Karen Camfield, a pediatrician at Kaiser's Roseville facility, said the risk screening is more time-consuming, but doable.
"What's exciting is that the training did change our behavior," she said. "All pediatricians should do this."
Source: May 8th issue of Pediatrics

Strict BAC Limits Discourage Teen Drinking and Driving 
A new survey found that states with stricter blood-alcohol limits (BAC) for young people have fewer teen drinking and driving incidents, the Associated Press reported April 30.
The survey, conducted by researchers at the University of Minnesota, compared drinking and driving habits of 5,000 high-school seniors in 30 states before and after specific BAC laws for young people were implemented.
The survey found that after BAC laws were passed, 19 percent fewer teen drivers got behind the wheel of a car, truck, or motorcycle after drinking alcohol. When asked if they had driven after five or more drinks, 23 percent fewer teens admitted doing so.
The survey also found that 7.1 percent fewer teens rode with drivers who had been drinking, while 13.5 percent fewer said they were a passenger in a car with a driver who had consumed five or more drinks.
"The BAC law for young people reinforces the law that moved the legal drinking age up to 21," said Alexander C. Wagenaar, lead author of the study. "Policies, such as raising the drinking age to 21 or tighter regulation on alcohol sales, help to engender a norm that alcohol is not the same as soda pop, that it can be a risky substance and that it is not without hazards."
All 50 U.S. states now have BAC limits of .02 percent for drivers under age 21. But states have different thresholds for adults. Currently, 19 states and the District of Columbia have a .08 percent level. Under a federal law passed last year, states that fail to enforce .08 percent as the legal BAC limit could lose federal highway funds.
The report is published in the May 1 issue of the American Journal of Public Health.

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