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

September 2001

California Prop 36 on drug treatment: Implementation going well
California's Proposition 36 drug-diversion program, which took effect July 1, is proceeding on course, Alcoholism & Drug Abuse Weekly reported Sept. 10.
Proposition 36 calls for drug-treatment services as an alternative to incarceration for all first- and second-time nonviolent drug offenders. The initiative does not apply to those caught distributing or selling drugs.
While implementation of Proposition 36 is proceeding as planned, the state is seeing varying enrollment rates. Some counties, such as Sacramento and Santa Clara, have several hundred defendants enrolled in Proposition 36 programs, while others, like San Francisco, have enrolled only a handful.
Officials say the wide variation is linked to the readiness of the county's treatment and justice-system infrastructure and the existence of pre-plea diversion programs prior to Proposition 36.
"Everyone is working within the intent of the law," said Whitney Taylor, Proposition 36 implementation director for The Lindesmith Center/Drug Policy Foundation. "We're heartened to see the cooperation between all the different players."
In addition, the state legislature is addressing concerns about program evaluation and accountability provisions. One bill would allocate $18 million for drug testing, which is currently not included in Proposition 36.
Source: Alcoholism & Drug Abuse Weekly

Teen Drinkers Show Signs of Liver Damage
A new study by researchers at the University of Pittsburgh School of Medicine found that some teen drinkers are suffering from the silent, toxic effects of alcohol on the liver, according to a Sept. 17 press release from the university.
In a study of health problems among 259 adolescents between the ages of 14 and 18, researchers found that teens with alcohol-use disorders (AUDs) had elevated liver enzyme levels and more abnormalities in physical exams, especially oral exams.
"The rise in liver enzymes is statistically significant, but in most cases was not clinically abnormal," said Duncan B. Clark, M.D., Ph.D., associate professor of psychiatry at the University of Pittsburgh School of Medicine. "Although the enzyme levels in these teens is not an immediate health concern, it does show that their bodies are not invulnerable to the effects of alcohol. With continued excessive drinking, they may develop permanent liver damage."
Researchers also found that most of the physical complaints among the study group were psychosomatic and not related to organ damage caused by drinking.
"Prior research had shown a definite link between AUDs and self-reported health problems, but none had gone on to determine the origins of those complaints," said Dr. Clark. "Our results place much of the blame for these health complaints on negative emotionality, although some complaints such as shortness of breath can be traced to cigarette smoking, which is common in this group."
Researchers will continue to follow the study group of adolescents to determine adult outcomes in health and other areas.
The study's findings are published in the Sept. 17 issue of Alcoholism: Clinical & Experimental Research.

Brain study shows how surprises help us learn
Because they are hard to forget, surprises can help us learn. Now scientists have identified a part of the brain that may be involved in learning from surprises.
A team led by Dr. Paul C. Fletcher at the University of Cambridge in the UK monitored the brain activity in a group of volunteers who were participating in a simulation exercise. The participants pretended to work at drug companies and were asked to predict whether a particular fictitious drug would trigger a particular fictitious syndrome.
In an article published Monday in the online edition of Nature Neuroscience, Fletcher's team reports that the activity of a brain region called the dorsolateral prefrontal cortex varied depending on whether the participants were surprised during the experiment.
In the early phase of the study, when the participants were not familiar with the effects of the various drugs, imaging tests detected high levels of activity in this part of the brain. As the volunteers became familiar with the effects of the drugs, so that they were no longer surprised by the results, activity in the dorsolateral prefrontal cortex declined, according to the report.
But later in the study, this region became more active when the participants were surprised by unexpected responses.
This study, according to the researchers, supports the theory that unpredictability forms the basis for learning.
SOURCE: Nature Neuroscience advance online 2001;10.1038.

Computer simulation may help identify child abuse
Caretakers suspected of child abuse often report that their charge's bruises and injuries were caused by a fall down stairs. Yet because little is known about the injuries sustained from such falls, it is often impossible to determine whether or not the caregiver is telling the truth, researchers say.
Now investigators led by Dr. Gina E. Bertocci of the University of Pittsburgh, Pennsylvania, report that computer simulation of stair falls may help to solve this problem.  "Working hand-in-hand with physicians," Bertocci told Reuters Health, "engineers and engineering tools that have been traditionally used to solve engineering problems are able to aid in determining whether injuries are consistent with the stated cause of injury."
Bertocci and her colleagues used computer simulation to determine the influence of different stair characteristics, such as the number of stairs and the friction of a stair surface, on a 3-year-old's risk of injury. They focused on femur, or thigh bone, fractures, which can result from stair falls but are also the most common fracture type associated with child abuse.
The investigators found that as the number of stairs increased, the speed and the force with which the upper leg hit the steps also increased. Consequently, the risk of injury to the upper leg grew, Bertocci and her colleagues report in the September issue of Archives of Pediatrics and Adolescent Medicine.
"This study further highlights the need for a multi-disciplinary team, which includes both pediatric emergency medicine physicians and engineers, when attempting to distinguish between abusive and non-abusive trauma," according to Bertocci.
Yet computer simulation need not be limited to detecting cases of child abuse, according to editorialist Dr. David Grossman of the University of Washington. It can also be used to predict risk and injury in motor vehicle crashes, he suggests.
"Although computer simulation of real-world injury scenarios will never fully replace the need for continued epidemiological studies, (Bertocci and colleagues' analysis) will add valuable information to our understanding of the causes and consequences of injury," Grossman concludes.
SOURCE: Archives of Pediatrics and Adolescent Medicine 2001;155:992-993, 1008-1014.

Childhood Hearing Impairment in UK More Common Than Previously Thought
Based on universal neonatal screening estimates, about one in 1000 neonates in the UK has some degree of permanent hearing impairment. However, a report published in the September 8th issue of the British Medical Journal indicates that 50% to 90% more cases are detected by 9 years of age.
Dr. Heather M. Fortnum, from the MRC Institute of Hearing Research in Nottingham, UK, and colleagues performed a questionnaire-based ascertainment study to determine the prevalence of hearing impairment among children who were born between 1980 and 1995, and were UK residents in 1998. The study group consisted of 17,160 children.
For 3-year-olds, the prevalence of permanent hearing impairment was 0.91 cases/1000 live births. This figure rose to 1.65 cases/1000 live births for children who were 9 to 16 years of age, the authors state. After adjustment for possible under-ascertainment, the prevalence among these younger and older age groups was 1.07 and 2.05 cases/1000 live births, respectively.
"It has been predicted that only an additional 16% of children will remain to be detected in the postnatal years, given current yields from universal neonatal hearing screening," the investigators write. However, the present findings indicate that "an additional 50% to 90% of children will remain to be detected in the postnatal years," they add.
"These additional children would comprise some with congenital impairments who either miss neonatal hearing screening or pass the screening despite having a hearing impairment, some who acquire an impairment postnatally, and others who manifest late onset or progressive impairments," the authors note.
In a related editorial, Dr. Shirley Russ, from Cedars-Sinai Medical Center in Los Angeles, comments that it is particularly important "that new, universal screening programmes are evaluated adequately" and that "both parents and professionals have realistic expectations of universal screening and what it can achieve."
British Medical Journal 2001;323:525-526,536-540.

Study: Treatment More Effective When Children Involved
A new report found that women addicted to alcohol and other drugs have better outcomes if their children are involved in their treatment programs, the Associated Press reported Sept. 6.
A survey of 5,000 addiction-treatment patients conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) found that women were less likely to continue their addiction or commit crimes when their children were involved in their treatment programs.
In addition, women who entered treatment during pregnancy had fewer premature or low-birth-weight babies and lower infant mortality rates compared to those not receiving treatment.
"Keeping children with their parents while their mothers learned parenting skills, as well as how to live drug- and alcohol-free, is itself a laudable goal," said SAMHSA's Westley Clark.
The survey was conducted from 1993 to 2000. Substance Abuse and Mental Health Services Administration

Study Supports Child Welfare Teams
Child welfare workers can better satisfy the families they serve, as well as gain more job satisfaction, if they work in teams and spend more time on possible abuse and neglect cases, starting from the first referral.
That's the finding of a Brigham Young University study to be published in the September issue of Research on Social Work Practice.
But while the Division of Child and Family Services enthusiastically supports the theory, the understaffed division, which struggles with a first-year caseworker turnover rate as high as 50 percent, lacks the staff and funding to follow the study's recommendations to the letter.
Instead, the division is focusing on many of the same issues with its practice model training, now being implemented, officials said.
The study, conducted with 208 families from 1996 to 1998 in Utah County, teamed a family preservation worker with a child protective worker to respond to referrals.
Under the study, the child protective worker would examine issues dealing with potential child abuse or neglect, while the family preservation worker would evaluate families' strengths and what they need to remain together, said Elaine Walton, associate professor of social work at BYU and the study's lead author. In some situations, caseworkers more than doubled the usual time spent with families. "Most families can stay together if they have some support," be that financial or emotional, Walton said.
Families receiving the more intensive approach sought more services, such as counseling or substance abuse treatment, and reported being more satisfied with them, the study showed.
For instance, 36 percent of families who received a traditional approach sought parental training. In Walton's study, the number was nearly 47 percent.
Still, "if you look at the numbers of child protection cases we have, sending out two workers [on every call] would be difficult for us," said Abel Ortiz, the division's child welfare projects director.
"I thought it was a fabulous idea," said Dan Chatterton, a family preservation caseworker in Utah County. But "we have to come back to reality a little bit."
Chatterton's office adopted a more flexible version of the study in 1998. Today, two caseworkers are sent only in complicated or potentially problematic situations. "It's a lot more effective, a lot more family-friendly," Chatterton said. "This really has set the mind frame. It's a lot more of a team approach."
Theories behind the study in many ways resemble the division's practice model. "We've kind of taken that concept," Ortiz said. "What we're trying to do with the practice model is to teach all of our workers how to handle [families] in a friendlier way, in a way that makes the family feel more comfortable and less threatened." In the study, caseworkers assembled a team of people, such as clergy members or teachers, to support the family. That's also part of the practice model, although the team is not assembled at the time of referral, Ortiz said.
Using the study's concepts, "it's not just one caseworker making an executive decision," Chatterton said. "That part has been really favorable."
Source: Research on Social Work Practice.

Earlier Sex, Pregnancy Linked to Foster Care
Young women and girls from foster homes have sex at a younger age, have more sexual partners and get pregnant earlier compared with girls in the general population, a new study has found. The findings suggest that a child who has been placed in the foster care system may need closer attention with regard to high-risk sexual behaviors, the authors say.
Writing in the September online issue of the journal Pediatrics, Dr. Sara C. Carpenter of the University of Colorado Health Sciences Center in Denver and colleagues note that more than 500,000 US children enter the foster care system each year. Many of these children have suffered physical abuse, neglect, sexual abuse and abandonment. They live either in foster care or with a relative, which is known as kinship care.
Carpenter and her team surveyed 9,620 women ages 15 to 44. Eighty-nine of the women had lived or were living in foster care, and 513 in kinship care. The rest had never been in either care setting and were used as a comparison group.
On average, the researchers found that women who spent time in foster or kinship care had voluntary sexual intercourse between 7 months and 1 year earlier than women in the comparison group. Women in the foster care system got pregnant for the first time at age 19, on average, compared with age 21 in the comparison group.
And women living in foster care or kinship care were also more likely than the comparison group to have had more than three sexual partners, which is considered average. About three-quarters of the women in foster care had more than three sex partners, while 62.5% of those in the comparison group did.
The authors note that despite their findings the ``data cannot implicate placement into foster care and kinship care as the direct cause of these high-risk behaviors. Rather, out-of-home placement serves as a marker, reflecting the high-risk homes from which these women were removed.''
``Pediatric and adult health care providers should recognize that female patients who are currently in foster or kinship care or have a history of such a living situation are at greater risk for the earlier initiation of sexual activity and for the long-term ramifications of those behaviors,'' the authors conclude.
One limitation of the study, the authors note, is the fact that it only includes women placed in foster care or kinship care between 1951 and 1990. ``More recent developments in foster care systems are not reflected here,'' they write.
SOURCE: Pediatrics online 2001;108.

Bullied Students at Risk for Depression, Anxiety
A new study found that children who are bullied or teased at school are at risk for depression, anxiety, and loneliness, Reuters reported Aug. 31.
The study by Dr. Lyndal Bond and colleagues at the Royal Children's Hospital in Victoria, Australia, included 2,500 secondary-school students who were bullied at age 13. Bullying was defined as being teased, having rumors spread about them, being deliberately excluded, or being targets of physical threats or violence.
The researchers found that a year after such an incident occurred, the students reported symptoms of depression, anxiety, and loneliness. The risk was particularly prominent among girls. In addition, the researchers found that the risk existed even among students who talked to others and shared feelings about being bullied.
"These findings have implications for how seriously the occurrence of victimization is treated and for the focus of interventions aimed at addressing mental-health issues in adolescents," Bond and colleagues wrote.
Researchers said the findings show the need for parents and teachers to tackle bullying and establish programs that address the mental health of adolescents.
"This study suggests that a reduction in victimization in schools is potentially a useful preventive intervention, especially for girls," the authors wrote. "The indications from this study are that such a reduction could have a substantial impact on the emotional well-being of young people."
The study's findings are published in the Sept. 1 issue of the British Medical Journal.

Kids may need more exercise than guidelines say
Despite perceptions that children are increasingly becoming couch potatoes, children worldwide are meeting and even exceeding guidelines for getting moderate amounts of daily exercise, according to a review of the medical literature. But researchers say this could mean that general US guidelines are not tough enough for kids.
"Children are way above the guidelines," study co-author Dr. James N. Roemmich, of the State University of New York at Buffalo, told Reuters Health. "The guidelines may be too low for children. We don't want to discourage them to get less activity."
Current guidelines from the Centers for Disease Control and Prevention and the American College of Sports Medicine suggest that all Americans strive for 30 minutes of moderate exercise daily. In the new study, researchers wanted to see whether children were meeting these standards and whether the standards are set at appropriate levels for children.
"It's important children get adequate amounts of physical activity," Roemmich said. "We want to get children in the habit of being physically active because being physically active as a child may be predictive of being active as an adult."
The researchers reviewed 26 studies conducted during the 1980s and 1990s that tracked nearly 1,900 children ages 3 to 17. In all the studies, the children wore monitors for at least 8 hours each day that measured their heart rates.
The researchers looked at studies conducted in the US and other nations, including the UK, Saudi Arabia, Japan and France.
Overall, children engaged in an average of 30 minutes of high-intensity exercise and nearly an hour of moderate-intensity exercise daily, according to findings published in the September online issue of Pediatrics.
These findings were somewhat surprising, in light of the rising levels of obesity among children and the widespread perception that youth are becoming more sedentary, Roemmich noted.
The researchers conclude that new guidelines advising that children exercise more intensely or for longer periods of time may need to be developed.
"We would suggest children should get an hour of physical activity a day, perhaps up to two hours," Roemmich said. "And we need to find ways of targeting those children who are not getting these levels."
SOURCE: Pediatrics online September 2001;108.

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