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

November 2001

Mom's Depression Linked to Child's Future Problems
Women who are depressed while pregnant are known to be more likely to have infants who show increased irritability, erratic sleep patterns and diminished responsiveness. Now new study findings suggest that a mother's prenatal depression may also put her child at risk for problem behavior during the early elementary school years.
"A mother's psychological well-being is important for her child's well-being, even before birth and through childhood," lead study author Dr. Ilona Luoma, of the University of Tampere in Finland, told Reuters Health. "In our study, mothers' depressive symptoms during pregnancy were related to children's behavioral problems 8 to 9 years later."
Luoma and her colleagues investigated the effect of maternal self-reports of depression on child well-being in a long-term study of 147 first-time mothers and their children. The mothers participated in depression screenings while pregnant, after delivery and when their children were 8 to 9 years old.
Mothers who reported prenatal depression had a threefold increased risk of having children with a high level of delinquency or aggressiveness. They were also 8.5 times more likely to have children with a high level of total problems, including delinquency, aggressiveness and symptoms of depression or anxiety, Luoma's team reports in the December issue of the Journal of the American Academy of Child and Adolescent Psychiatry.
Mothers who reported current depression were also more likely to have low-functioning or problematic children than their nondepressed peers--a finding consistent with previous research.
Factors such as depression during the postnatal period, single parenthood, maternal age of 35 years or older, and having a male child were linked to a mother's low rating of her child's social competence, which included activity participation, peer and family relationship functioning and school achievement.
And a mother's report of current depression seemed to predict whether her child's behavior, working, learning and happiness were rated low by the child's teacher.
"In the light of these results it is important to note maternal depressive symptoms at each stage of motherhood, beginning at the prenatal stage," the researchers conclude.
"Transient mood swings are rather common during the pregnancy and after delivery, and they are usually not deleterious for the child," Luoma said. "However, the possibility of depressive disorder should not be forgotten.
"If a mother's depressive feelings are severe, recurrent or long-lasting, they can be harmful both for the mother and her child, even in the long term," she added.
SOURCE: Journal of the American Academy of Child and Adolescent Psychiatry 2001;40:1367-1374.

Girls Exposed to Violence More Likely to Take Drugs
A new study shows that teenage girls who witness or experience violence have a higher risk of engaging in risky health behaviors, such as using alcohol and other drugs, Reuters reported Nov. 15.
Researchers at the University of Texas Medical Branch in Galveston interviewed 517 girls younger than age 18 who came to a clinic for birth-control counseling. The teenagers completed a survey that asked questions about their exposure to violence, including robbery, assault and rape, and on health factors, such as smoking, drug use, and sexual habits.
Among the group, 48 percent said they had witnessed or experienced violence, with 13 percent having both seen and experienced a violent act.
From the survey, researchers determined that the teenage girls who had witnessed violence were two to three times more likely to use tobacco or marijuana, drink alcohol, or use illicit drugs before sex. These girls also were more likely to have had intercourse with a partner who had multiple partners than girls who had not witnessed or experienced violence.
Furthermore, girls who experienced violence first-hand were more likely to take the same health risks, and were two to four times more likely than those with no exposure to violence to have sex at an early age, have intercourse with strangers, have multiple sex partners, or test positive for a sexually transmitted disease.
According to the researchers, girls who said that they had both witnessed and experienced violence "demonstrated the greatest risk of adverse health behaviors."
"Exposure to violence is clearly associated with an increased likelihood of engaging in multiple health-risk behaviors, with adolescent girls who both experience and witness violence at greatest risk," said Dr. Abbey B. Berenson, lead author of the study.
The researchers recommended that, "clinicians should consider screening adolescent girls in their care for prior exposure to violence."
The report is published in the November 2001 issue of the Archives of Pediatric and Adolescent Medicine.

Attention Problems Increase Smoking Risk
Individuals with attention problems that are not severe enough to warrant a diagnosis of attention deficit/hyperactivity disorder (ADHD) are more likely to be smokers than those without attention problems, researchers report in the November issue of Nicotine and Tobacco Research.
These findings may help in the design of more effective anti-smoking programs, according to Dr. Caryn Lerman of the University of Pennsylvania Cancer Center in Philadelphia and colleagues.
Dr. Lerman's group suggests that future studies investigate whether nicotine patches and antidepressants, which may treat both ADHD and smoking addiction, can be useful anti-smoking tools for these individuals.
"Such studies may be valuable to identify subgroups of smokers who should be targeted for additional intervention and to tailor such interventions to their individual needs," Dr. Lerman and colleagues write.
Nicotine has long been known to improve attention and ability to focus in individuals with ADHD, who are more likely to begin smoking at a younger age and are less likely to quit smoking in general. It is not known, however, whether nicotine affects individuals with less severe symptoms in the same way.
To investigate, the researchers interviewed more than 200 people at least 18 years old who were enrolled in a smoking cessation program. On average, the group smoked 20 cigarettes a day. Only four of the study volunteers had attention and hyperactivity problems severe enough to warrant a diagnosis of ADHD.
Smokers with the most severe symptoms were more likely to smoke, the researchers report. Individuals who had trouble paying attention were more likely to report using tobacco to help them focus and remain alert. They were also more likely to say that smoking helped them to deal with symptoms of depression.
Hyperactivity without attention problems was not found to significantly affect whether a person smoked. However, hyperactive individuals who also had trouble paying attention were more likely to report smoking to prevent nicotine withdrawal symptoms, a finding that suggests that nicotine may be more beneficial for improving concentration than controlling behavior.
"These results suggest that smokers with frequent symptoms of inattention may use nicotine as a stimulant drug to help manage these symptoms," the study concludes. "Future studies of the role of inattention symptoms in response to smoking treatment are warranted."
Nicotine Tobac Res November 2001.

Involving Youth Offenders in Social Causes Reduces Recidivism
Youths offenders who become involved in developing and implementing their own community-service projects have reduced discipline problems and lower recidivism rates, the Youth Crime Alert reported in its November issue.
"Learning to care for others gives them a sense of purpose and helps them to keep out of trouble themselves," said Jack Calhoun, president and chief executive officer of the National Crime Prevention Council (NCPC).
The Youth as Resources (YAR) program, started in 1991 by the NCPC at a youth correctional facility in Indiana, has since resulted in fewer discipline problems among youths in all Indiana detention centers and lower recidivism rates. Nationwide, the recidivism rate is 40 percent for girls and 60 percent for boys. At Indiana correctional facilities, it's 13 percent.
Under the program, youth offenders are required to identify and meet a community need. "They do the planning and the work themselves," said George Rice, executive director of the Center for Youth as Resources.
Erin Jacoba-Croy, who was incarcerated in 1992 at the Indiana Girls' School, said YAR turned her life around. "I would not be the person I am today if not for this program," she said.
Jacoba-Croy worked with young patients with cerebral palsy. "I couldn't believe how much trust they gave us," she said. "Imagine being told that you'll never amount to anything, and then having a total stranger love you for just who you are."
Jacoba-Croy, who is now married and the mother of a six-year-old, is preparing to enter law school in the fall.
Calhoun pointed out that YAR gives youth offenders "connectedness." He explained, "YAR is not a panacea. We still need to provide these kids with all the usual juvenile services."
http://www.jointogether.org/sa/news/summaries/reader/0,1854,546477,00.html

Crack cocaine can tear open major blood vessel
Cocaine use--especially crack--can lead to an often-fatal rip in the major blood vessel leaving the heart, California researchers reported here Tuesday at the American Heart Association's annual scientific sessions.
The rip or tear, known as aortic dissection, is normally very rare. The condition is fatal unless the patient receives emergency surgery in time. About half of patients die within 48 hours if left untreated.
There are fewer than 1,000 cases of aortic dissection a year, Dr. Priscilla Y. Hsue of the University of California, San Francisco, told Reuters Health, but she and her colleagues at San Francisco General Hospital noticed what seemed to be an unusually high incidence of the condition among cocaine users.
This led them to analyze all cases of aortic dissection at that inner-city institution in the past 20 years. They identified 38 cases, with 14 directly related to cocaine use. All but one patient had used the drug in the form of crack cocaine.
"This is 37% of the whole group," Hsue commented, a significantly high percentage.
Hsue said all 14 of the cocaine-related cases were smokers. Their average age was 41, compared with 59 for the cases that were not related to cocaine use. The cocaine users had often been on drug binges just before arriving at the hospital.
High blood pressure is a risk factor for aortic dissection, Hsue noted, as is blood vessel wall stiffness, which smoking can cause. A stiff aorta under high pressure that is increased even further by cocaine use is a recipe for disaster, according to Hsue.
Doctors and nurses should suspect aortic dissection in cocaine users with chest pain, Hsue told Reuters Health.

New ADHD Drug Reduces Symptoms, Improves Social and Family Functioning
Atomoxetine hydrochloride significantly reduces core attention deficit hyperactivity disorder (ADHD) symptoms in children and adolescents. It also has been shown to improve specific measures of social and family functioning, according to a study published in the November issue of Pediatrics.
"Social and family relationships are very important in a child's daily life and development, and children with ADHD often have trouble in these areas," said David Michelson, MD, medical director at Elly Lilly, the drug's manufacturer, and lead author of the study. "This study supports previous clinical findings that show atomoxetine is effective in reducing core ADHD symptoms. But we also wanted to understand how reducing those symptoms affects quality of life for a child and his or her family. These data suggest there was a significant improvement on specific measures of family and social functioning with atomoxetine."
The 8-week, multicenter, placebo-controlled study is the first to measure the effect of any ADHD treatment on social and family functioning, such as a child's self-esteem, general behavior and the impact of ADHD on the entire family. Previous studies have focused only on the reduction of core ADHD symptoms, such as inattention, hyperactivity, and impulsivity.
Children and adolescents 8 to 18 years old were eligible to participate in the study if they met the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria for ADHD by clinical assessment, confirmed by structured physician interview.
After an initial 12- to 18-day evaluation and medication washout period, 297 patients were randomized to placebo or atomoxetine dosed on a weight-adjusted basis at either 0.5 mg/kg/day, 1.2 mg/kg/day, or 1.8 mg/kg/day for an 8-week period. Core ADHD symptoms and social and family functioning were assessed using parent and investigator rating scales.
The primary outcome measure for core ADHD symptoms was the ADHD RS, an 18-item scale based on an interview with the patient's primary caretaker. Each item corresponds to 1 of the 18 DSM-IV diagnostic criteria.
Atomoxetine was superior to placebo on the ADHD RS scale in both the 1.2 mg/kg/day and 1.8 mg/kg/day treatment groups. Outcomes were similar for the inattentive and hyperactive/impulsive subscales. Core ADHD symptoms were reduced similarly in younger children compared with older children and adolescents based on the median age split (10.8 years). The 1.2 mg/kg/day dose of atomoxetine appeared to be as effective as 1.8 mg/kg/day and is likely to be the appropriate initial target dose for most patients.
Social and family functioning was measured using the Child Health Questionnaire (CHQ), a set of questions answered by a child's parents or immediate caregiver. The CHQ measures physical and psychosocial well-being in the following areas:

• Self-esteem (in school, athletic ability, looks/appearance, and the ability to get along with others)
• General behavior (aggression, delinquency, social withdrawal, and hyperactivity/impulsivity)
• Impact of a child's ADHD symptoms on family activities
• Impact on parents' emotions
• Impact on parents' time.

CHQ summary scores for overall psychosocial functioning indicate that patients receiving atomoxetine achieved statistically significant improvements over those receiving placebo (P<.05). In addition, atomoxetine was associated with statistically significantly superior outcomes at the 2 higher dose levels on most subscales, such as self-esteem and parents' emotional distress, compared with placebo.
Lilly submitted a new drug application (NDA) for atomoxetine to the US Food and Drug Administration in October. If approved for use, atomoxetine would be the first nonstimulant and the first new type of medication for the treatment of ADHD in more than 30 years.
ADHD is a common disorder that affects 3% to 7% of school-age children. It is associated with impairment of academic and social functioning, and a growing body of data suggests that it is also associated with considerable morbidity and poorer outcomes later in life.
Pediatrics 2001;108(5):e83

Study reveals self-esteem inflation among US kids
American kids have a bloated sense of themselves, a new study suggests.
According to the report, in a recent issue of Personality and Social Psychology Review, self-esteem among America's youth in general and college students in particular has been on the rise for the past 30 years. Meantime, societal indicators that these feelings are warranted, such as higher SAT scores and lower rates of teen pregnancy, have not kept pace with attitudes.
To be sure, there is nothing wrong with feeling good about oneself. People with a healthy dose of self-esteem are more satisfied with life and are less likely to suffer from anxiety or depression, the authors note.
But self-esteem based on nothing can set people up for disappointment, Dr. Jean Twenge of San Diego State University in California said in an interview with Reuters Health.
"They may also feel that the world owes them something," she added.
Twenge blames the trend on the self-esteem movement in schools, which teaches children slogans and affirmations such as "I am lovable and capable."
However, "it is more important that a child actually accomplishes something than that he or she have high self-esteem," she said. "Once a child accomplishes something, self-esteem will follow naturally. Children should be praised, but only when the praise has a basis in fact."
Among younger children, declining divorce, unemployment and crime rates were found to correlate with higher self-esteem. Under these circumstances, Twenge and her colleagues suggest, children grow up feeling more connected and may feel better about themselves because their parents are able to spend more time with them and can provide a better environment.
"The culture we create has an impact on our children's feelings about themselves," Twenge said. "Based on these results, it is more important to change the larger society by lowering crime rates and divorce rates than to spend energy and dollars on programs designed to increase children's self-esteem," she and her colleagues write.
The results are based on an analysis of hundreds of different studies on self-esteem conducted between 1965 and 1994. The studies included more than 105,000 children and young adults.
The findings also challenge the notion that girls' self-esteem suffers more than boys' self-esteem during adolescence. In junior high school, self-esteem was found to deteriorate at similar rates. A rebound was noted among both groups in high school, although boys' self-esteem was found to recover more quickly that of girls. The gap appears to narrow in college, however.
SOURCE: Personality and Social Psychology Review 2001 November.

Distress Increases Risk of Pregnancy in Adolescents
Teenage girls who are psychologically distressed are twice as likely to become pregnant than their non-distressed peers, a new study has found. The researchers suggest this may be because distressed girls lose the confidence to negotiate safe sex practices with their partners.
"Girls who had threshold scores that indicated psychological distress were more likely to engage in risky behaviors and twice as likely to get pregnant," lead author Dr. Ralph J. DiClemente, a professor of public health, pediatrics and psychiatry at Emory University in Atlanta, Georgia, told Reuters Health.
The researchers surveyed 522 African-American girls between the ages of 14 to 18 years old living in the southeastern US. The subjects' level of distress was assessed at the beginning of the study and 6 months later. At this point, the girls were also tested for sexually transmitted diseases and pregnancy.
According to the report in the November online edition of Pediatrics, the investigators found that nearly half the girls met the threshold for experiencing mental distress, a form of nonclinical depression. The distressed girls had twice the risk of becoming pregnant during that 6-month time period — 11% of the distressed girls became pregnant compared with 6% of those who were not distressed.
The "good news," Dr. DiClemente observed, was that the distressed girls were not more likely to have contracted an STD, primarily because they were not having sex in a high-risk network of partners.
Girls who were depressed were more likely to develop patterns of behavior that led to pregnancy, such as perceiving barriers to condom use, being fearful of negotiating condom use, and perceiving themselves as having less control in the relationship.
"First, we need to recognize the prevalence of psychological distress among teenage girls," Dr. DiClemente said. "Second, it's important for providers, as well as parents, to recognize associations with distress and this other causal chain which may result in adverse consequences, such as pregnancy."
He suggested doctors may want to give teenage girls a quick screening for mental distress and refer those at risk to a mental health provider.
"Rarely do STD and HIV prevention programs address issues like distress. These findings suggest we may want to have tailored programs for young teens to address this issue as well," he said.
"No matter how much we motivate them to protect themselves, if they're not feeling good about themselves, they're not likely to adopt those behaviors," Dr. DiClemente added. "We assume people are not listening to us, when it may not be that at all. Maybe they just can't focus on our message because they're dealing with other things, like depression."
Pediatrics 2001;108:e85. [Abstract] 

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