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Stuttering best treated in pre-school years — study
Children who stutter should be treated
before they start school to improve the speech disorder that affects
about 5 percent of youngsters, Australian scientists said on Friday.
Stuttering, or stammering, usually begins when a child is three or four
years old. Boys are three times more likely to suffer from the problem.
There is no cure for the condition but
researchers at the Australian Stuttering Research Center at the
University of Sydney who developed and evaluated an early treatment
called the Lidcombe programme to treat stuttering said it improved the
problem.
"After nine months, the reduction of stuttering in the Lidcombe
programme group was significantly and clinically greater than natural
recovery," Mark Onslow, the director of the center, said in a report in
the British Medical Journal.
The programme, which is named after a
Sydney suburb, is a behavioural treatment for young children that is
administered by a parent with guidance from a speech pathologist.
The parent conducts the treatments and learns to measure the child's
stuttering on a 10-point scale. During weekly visits the speech
pathologist examines the progress.
Once the stuttering has disappeared or vastly diminished, the second
stage of the programme which aims to maintain the improvement for a
year, begins.
Onslow and his team evaluated the
programme in a study involving 54 children. Twenty-nine received the
treatment and 25 children acted as a control group.
Only 15 percent of the youngsters in the control group attained a
minimal amount of stuttering, compared to 77 percent of those who had
the treatment.
Some children recover naturally from stuttering but the researchers said
identifying them is difficult and starting treatment in the pre-school
years seems to be most effective.
"If the disorder persists into the school age years a child is exposed to unacceptable risk of experiencing the disabling effects of chronic and intractable stuttering throughout life," Onslow added.
Stuttering may result from a variety of causes, including genetics, signaling problems between the brain and nerves and muscles and a developmental difficulties.
Teen Sex and Drug Use May Be Cause of Depression, Not the Effect
A new study is challenging the belief that young people begin sex and drug behaviors to “self-medicate” depression. “Findings from the study show depression came after substance and sexual activity, not the other way around,” says health policy researcher Denise Dion Hallfors.
The study, published in the October edition of the American Journal of Preventive Medicine, uncovered gender-specific pathways to depression.
“For females, even modest involvement in substance use and sexual experimentation elevates depression risk,” the study found. “In contrast, boys show little added risk with experimental behavior, but binge drinking and frequent use of marijuana contribute substantial risk.”
Hallfors’ advice to health professionals is to routinely screen for drug use and sexual behavior in teens.
Psychiatrist Chris Lucas, a clinical coordinator with
the New York University Child Study Center, also advocates more vigilant
screening. He says pediatricians who give yearly before-school checkups
are in a unique position to ask a few simple questions that could
uncover clues about depression.
Only about one in five adolescents who have depression will be
recognized and diagnosed, Lucas says.
Hallfors’ study culled data from a national survey of adolescents to create a population-based sample of 13,491 girls and boys in grades 7 to 11. Each child was placed in one of 16 groups based on his or her reported experience with a range of risk behaviors. One of the groups was “abstainers” — those who had never tried alcohol, tobacco or other drugs and who had never had sex.
Depression rates for each of the other 15 groups were
compared to the abstainer group one year later. The study found that
girls who had experimented with drugs and sex were two to three times
more likely to be depressed than abstaining girls.
Male binge drinkers were four and a half times more likely to be
depressed compared to abstainers. Boys who used marijuana were more than
three times more likely to be depressed compared abstainers.
Lucas says Hallfors’ study reiterates the fact that experimentation with substance use and sex — along with reduced academic functioning and social isolation — can be markers for depression.
Because the research is based on data collected over a
two-year period, the study was able to show that the drug and alcohol
use and sexual experimentation preceded depressive symptoms, which
challenges the popular notions about self-medicating.
Lucas says low mood can come after risky behavior in adolescence, but
adds, “I think it’s partially true for a portion of kids. It’s not the
whole story.”
“It can be quite hard to detect depression,” he says. “The general
thinking is that depression precedes risky behaviors like substance
abuse.”
Understanding the timing is crucial when pediatricians
and child psychologists begin to craft prevention and treatment
strategies, Hallfors says. Health professionals often try
antidepressants or talk therapy first, she says, when they believe that
depression precedes adolescent experimentation with adult behaviors.
“If you have a boy or girl coming in with depression and a substance use
problem, would treating the substance abuse be enough to also curb the
depression?” Hallfors asks.
“I would think that that is optimistic,” Lucas says. “Depression usually
precedes those behaviors and will likely persist after substance abuse.”
Taunya English
Health Behavior News Service
20 September 2005
http://www.hbns.org/getDocument.cfm?documentID=1133
Guidelines ensure correct drug and dose for children
A "DRUGS Bible" was launched yesterday to
help doctors decide on the best medicines to use when treating children.
Most medicines are tested on adults because drug companies have little
financial incentive to develop treatments specifically for children.
Doctors are forced to use adult medicines, risking adverse reactions.
New guidance has been developed to help
judge the best dosage and drugs for children.
The British National Formulary for Children, which will be made
available to more than 30,000 health professionals in Scotland, will
give advice on drugs and dosages.
Dr George Rylance, of the Royal College of Paediatrics and Child Health,
said there were research gaps in many areas of prescribing for children.
"For complicated or more serious
conditions, doctors often need to use drugs tested in adults which have
not been specifically licensed for children. It's a great step forward
for children's medicine The new guide will bring all this information
together in one reliable source."
A spokesman for the Executive said: "These new guidelines are an
excellent development, which will ensure that GPs and other healthcare
professionals will have vital guidance on the prescribing of medicines
to children."
Louise Gray
21 September 2005
http://news.scotsman.com/health.cfm?id=1970192005
Alarm as prescriptions of Ritalin to children reach a record high
The number of children being prescribed drugs for so-called behavioural disorders has soared to a record high, causing alarm that children are being unnecessarily "drugged into submission".
Prescriptions of Methylphenidate - most commonly sold as Ritalin - rose to 359,100 last year, a rise of 344,400 since 1995. Figures from the Prescriptions Pricing Authority reveal that there has been a 180-fold increase in prescriptions since 1991 when only 2,000 were issued in England.
Dawn James says her son Sam became withdrawn on Ritalin The growing use of Ritalin - an amphetamine-based stimulant which improves concentration and is nicknamed the "chemical cosh" because of its calming effects - has alarmed critics. It is almost entirely prescribed to children under 16 in this country. Controversially, it has been estimated that one in 20 children suffers behavioural disorders such as attention-deficit hyperactivity disorder or ADHD, for which Ritalin is prescribed.
But critics of the drug say that doctors give it to children who are merely displaying normal emotional changes experienced during childhood. Campaigners believe that the increasing use of Ritalin follows the trend in America where it has been prescribed to children as young as 15 months.
Last night, the Citizens Commission on Human Rights, an organisation that campaigns against psychiatric violations of human rights, condemned the increasing prescription of drugs for children. "Too many psychiatrists are being irresponsible in prescribing mood-altering drugs which are pharmacologically similar to cocaine, and then claiming they have 'cured' children of their 'condition'," said a spokesman.
"Some children may be a little boisterous but psychiatry's fixation on labelling such difficulties and prescribing medication is nothing more than pseudo science. Children are being drugged into submission."
There are currently no medical tests for ADHD and children are diagnosed on the basis of their behaviour and questionnaires that ask if a child displays symptoms including restlessness, inattentiveness and fidgeting. Sami Timimi, a consultant child expert and adolescent psychiatrist based in Lincolnshire, described the soaring use of Ritalin as "a scandal" and insisted that the drug should be used only as a last resort.
"It is ludicrous that the normal spectrum of behaviour that all kids will demonstrate at some time in their childhood is now interpreted as a disorder which requires medication," he said.
"Various methods of behaviour management therapy and a change in diet are often all a child needs but adults are increasingly turning over the role of parenting to professionals who feel more "doctory" if they can make a diagnosis and prescribe medication."
Dr Timimi said that not enough parents were aware of the potential health risks and side-effects associated with Ritalin, which include loss of appetite, insomnia and unresponsiveness.
A recent survey that compared international prescription rates for children of antidepressants and mood-altering drugs including Ritalin showed that Britain has the highest rate in the world.
Research in the United States found that Ritalin may cause lasting changes to the brain. In a study carried out by the Harvard Medical School, healthy rats given the drug in their infancy were found to have a reduced sense of pleasure and were more prone to signs of despair during adulthood.
Prof Sir Alan Craft, the president of the Royal College of Paediatrics and Child Health, said that the growing use of Ritalin was "concerning".
Prof Peter Hill, an ADHD specialist and honorary consultant in child psychiatry at the Great Ormond Street Hospital in London, believes that the concept of ADHD has become popular, "partly because it offers an alternative explanation for antisocial behaviour, other than imperfect parenting".
"While Methylphenidate undoubtedly works for some children, clinicians are under increasing pressure from vast waiting lists to see people as quickly as possible, resulting in some medicating where it is perhaps not necessary," he said.
"I have children coming to me who have been prescribed all sorts of medication without much preparatory work-up."
Janice Hill, the founder of the Overload Network, a charity that campaigns against the prescription of drugs to children, said that parents were not being given enough information on alternative treatment. "Doctors are far too quick to medicate drugs as a quick-fix answer, instead of recommending therapy or properly analysing the root causes of a child's anxiety," she said.
Sam James, an eight-year-old schoolboy from Reading, was diagnosed with ADHD and prescribed Ritalin when he was just two years old, after showing symptoms including fidgeting and constant screaming.
However, his mother was so shocked by the effects of the drug that she took him off the medication after four weeks.
"The results were unbelievably horrific," said Mrs James, 34. "Within a matter of weeks Sam went from being a lively boy to a zombie who sat on a chair in the corner rocking.
"He became completely withdrawn and uncommunicative and I could hardly recognise him as my son."
After taking him off Ritalin, which costs around £6 for one month's supply, Sam's psychiatrist, who has since been struck off the medical register, prescribed yet another sedative over the telephone, which Mrs James did not give to her son.
"We found that using cognitive behaviour therapy and just talking to our son has been much more helpful than medication," she said.
"Having seen the effects of Ritalin on Sam, I would advise parents to try any other avenue before resorting to drugs."
Roya Nikkhah
18 September 2005
Mental problems soar among children using cannabis
The number of children treated for mental disorders caused by smoking cannabis has quadrupled since the government downgraded the legal status of the drug, according to a leading drug charity. Since April last year, three months after police stopped arresting anyone found in possession of small amounts of the drug, the overall number of users treated for such conditions rose 42%, according to data from Addaction.
But it is the figure for children that will cause the greatest alarm. Addaction treated 1,575 cannabis users for psychotic problems between April 2004 and April 2005, of whom 181 were aged 15 or below — a rise of 136 on the previous year.
Many experts blame the relaxation of the law and the wider use of skunk, a high-strength variant of cannabis.
“A minority of people who take it repeatedly and over a long period, particularly people who take it as adolescents, will suffer psychotic episodes. They may ultimately suffer schizophrenia,” said Robin Murray, professor of psychiatry at King’s College London.
Addaction’s findings are backed up by recent government figures that reveal a 22% leap in hospital admissions attributed directly to cannabis. They show that 710 people were sent to hospital with mental illness caused by cannabis in the 12 months to April 2004, up from 580 in the two previous years.
The Advisory Council on the Misuse of Drugs is meeting next weekend to decide whether there should be a full review of the working of the cannabis law. It was set up by Charles Clarke, the home secretary, after research released earlier this year suggested cannabis may cause mental illness.
A New Zealand research project involving 1,000 people born in 1977 found that cannabis could double the risk of mental illnesses such as schizophrenia. A Dutch study by Professor Jim van Os also discovered that frequent cannabis use during adolescence increased the risk of psychotic symptoms later in life, especially among those genetically vulnerable to mental illness.
A member of the committee said this weekend, however, that the panel was unlikely to recommend any revision of the law because there was still insufficient evidence to show any increased risk. One option it is considering is upgrading skunk but leaving “ordinary” cannabis as a class C drug.
Jonathan McDonnell, project manager for the Buckinghamshire branch of Young Addaction, said that last year 250 cannabis users under 19 were referred to his unit for treatment; 85% of those were skunk users.
He said that the higher street price of
skunk — £20 for an eighth of an ounce rather than £12 for normal
cannabis — meant that many users were now involved in “junkie crimes”
such as burglary and robbery, traditionally the preserve of hard-drug
users.
Will Iredale and Holly Watt
18 September 2005
http://www.timesonline.co.uk/article/0,,2087-1785508,00.html
Youth drug use shock for Ulster: Half of all 15-year-olds have used narcotics
HUNDREDS of Ulster schoolchildren are on drugs by the time they reach 15, a shock new study revealed yesterday.
Experts have branded drug use in Northern Ireland "a major social problem".
And more than one in ten of those surveyed were regular users by the age of 15.
These are two of the shock findings from a major five-year study into teenage drug use by the Institute of Child Care Research at Queen's University, Belfast.
More than 150 delegates from schools and youth agencies across the province gathered yesterday for a conference to reveal the results.
The Youth Development Study research team at the Institute of Child Care Research has been tracking more than 3,500 young people in Northern Ireland from their first year of secondary school (aged 11) through to fifth form (aged 16).
The researchers collected information on key aspects of adolescent life, including smoking, alcohol and drug use, their friendship networks, relationships with their parents and friends, personality, leisure activities, behaviour problems, attitudes to education and behaviour in school, and their neighbourhoods.
Among the findings were that while drug use was very limited among young people in their first year of secondary school (aged 11/12), by the time they are aged 15 almost half have used an illicit drug.
And one in ten have made the transition to more regular drug use.
Risk factors identified for regular drug use at age 15 included: having a risk-taking personality profile, getting into trouble at school, and being involved in delinquent behaviours.
At age 11, a clear gender divide existed in smoking, alcohol and drug use, with more boys than girls using.
However, as young people grow older this gap narrows.
By the age of 15 more girls smoke than boys (50% versus 42%), and girls are as likely as boys to get drunk or use illicit substances.
"It is possible to identify sub groups of young people who are at high risk of developing drug related problems. One such group is young people who are excluded from school," the survey reveals.
"There is also evidence of a potentially 'hidden' group of young people within schools who report regular and frequent drug use."
Delegates heard a number of international experts speak on the development of problem behaviour in young people and on the services provided to meet the needs of these young people.
Professor Dorota Iwaniec, director of the Institute of Child Care Research at Queen's University, said: "Drug use is a major social problem for Northern Ireland."
Nigel Gould
15 September 2005
http://www.belfasttelegraph.co.uk/news/story.jsp?story=661600
Warm parenting makes for sociable kids
A new study has reaffirmed the popular notion that early parenting style makes a big difference in child’s social behaviour, by stating that warm, nurturing parents make socilable adolescents.
Published in the recent issue of the journal Child Development, the study by Arizona State University researchers evaluated 186 adolescents three times over a six-year period, once every two years from the time the children were about 9 to about age 13.
They used parent and teacher reports to evaluate how well adjusted the children were in terms of aggression, antisocial and delinquent behavior, and how well the children were able to self-regulate.
The researchers assessed the children’s self-regulation by measuring their persistence in completing a frustrating task, along with reports from parents and teachers. Additionally, they observed the parents’ warmth and positive emotions as they interacted with their child during each of the three assessments.
They found that parenting, youths’ self-regulation, and youths’ adjustment were generally related to each other within and across time.
Parents who interacted warmly and positively with their children at the youngest age had children who were relatively self-regulated two years later, and, in turn, exhibited fewer problem behaviors at the final assessment.
“Our results are consistent with the view that parenting affects children’s self-regulation and their overall adjustment. Thus, the quality of parent-child interactions in childhood seems to foreshadow whether young adolescents experience behavioral problems in adolescence, and this relation appears to be at least partly due to the fact that warm, positive parents have children who are well regulated,” said researcher Nancy Eisenberg,
“Because warm parenting seems to foster children’s self-regulation, it is likely to contribute to youths’ positive functioning in a variety of areas,” she added.
Source: Child Development
15 September 2005
http://www.newkerala.com/newsdaily.php?action=fullnews&id=22848
World risks duplication in AIDS vaccine push – expert
Attempts to develop an AIDS vaccine need greater coordination to avoid duplication and increase the chances of success, a senior official of the International AIDS Vaccine Initiative (IAVI) said on Tuesday.
"There is that danger we see right now in AIDS vaccines, a lot of so-called me-too or similar vaccines being tested," Robert Hetch, senior vice-president for public policy of IAVI, USA, told a meeting of the Global Forum for Health Research in Mumbai. The not-for-profit IAVI, backed by the World Bank, European Union and the Bill & Melinda Gates Foundation, wants a stronger scientific consensus on priorities and a tighter funding system to "avoid this kind of duplication and wasted use of resources."
There are 40 million people infected with HIV around the world and every year 5 million more people are infected and 3 million deaths occur from HIV-related illnesses, Hetch said. More than 30 vaccine candidates are now in clinical trials around the world, but scientists are not confident that any of them will be really effective in defeating HIV because the virus mutates frequently.
"We estimate that through a series of coordinated and targeted efforts, the timeline could be speeded up by as much as 50 percent," he told the forum in Mumbai, formerly Bombay.
Hetch said the $680 million spent worldwide on AIDS vaccine research and development fell short by several hundreds of millions of dollars.
Anti-retroviral (ARV) drug treatment programs were a long-term cost burden and investing in finding a vaccine was urgent because it could prevent millions of infections and save resources that would otherwise be spent on ARVs, he said. In 2005 alone, nearly $4 billion was expected to be spent on ARVs in the developing world and it was estimated that this would increase dramatically in coming years, he added.
13 September 2005
Experts: Headphones may lead to widespread hearing loss
Researchers fear the growing popularity of portable music players and other items that attach directly to the ears — including cell phones — is contributing to hearing loss in younger people.
"It's a different level of use than we've seen in the past," says Robert Novak, director of clinical education in audiology at Purdue University in Indiana. "It's becoming more of a full-day listening experience, as opposed to just when you're jogging."
Increasingly, Novak says he's seeing too many young people with "older ears on younger bodies" — a trend that's been building since the portable Walkman made its debut a few decades back.
Everywhere she turns, Angella Day sees people carrying portable music players, often with the ear buds stuffed firmly in place.
"They're very widespread," says Day, a senior at Chicago's DePaul University who regularly listens to music on her own iPod while studying or working out. "So addicting."
To document the trend, Novak and colleagues have been randomly examining students and found a disturbing and growing incidence of what is known as noise-induced hearing loss. Usually, it means they've lost the ability to hear higher frequencies, evidenced at times by mild ear-ringing or trouble following conversations in noisy situations.
Hearing specialists say they're also seeing more people in their 30s and 40s — many of them among the first Walkman users — who suffer from more pronounced tinnitus, an internal ringing or even the sound of whooshing or buzzing in the ears.
"It may be that we're seeing the tip of the iceberg now," says Dr. John Oghalai, director of The Hearing Center at Texas Children's Hospital in Houston, who's treating more of this age group. "I would not be surprised if we start to see even more of this."
Noise-induced hearing loss happens any number of ways, from attending noisy concerts and clubs to using firearms or loud power tools and even recreational vehicles (snowmobiles and some motorcycles are among the offenders).
Today, doctors say many people also are wearing headphones, not just to enjoy music, but also to block out ambient noise on buses, trains or just the street. And all of it can contribute to hearing loss.
"The tricky part is that you don't know early on. It takes multiple exposures and sometimes years to find out," says Dr. Colin Driscoll, an otologist at Minnesota's Mayo Clinic.
One telltale sign that you've done damage to your ears is when you leave a loud venue with ringing ears. If you rest your ears, they might recover, at least partially, doctors say. But with repeated exposure comes more damage to the hair cells in the inner ear, which are key to good hearing.
With long-lasting rechargeable batteries, people who use portable music players also are listening longer — and not giving their ears a rest, says Deanna Meinke, an audiologist at the University of Northern Colorado who heads the National Hearing Conservation Association's task force on children and hearing.
Often, she says, people also turn up the volume to ear-damaging levels.
A survey published this summer by Australia's National Acoustic Laboratories found, for instance, that about 25 percent of people using portable stereos had daily noise exposures high enough to cause hearing damage. And further research by Britain's Royal National Institute for Deaf People determined that young people, ages 18 to 24, were more likely than other adults to exceed safe listening limits.
How much is too much?
Meinke says a good rule of thumb comes from a study published in
December: Researchers at Boston Children's Hospital determined that
listening to a portable music player with headphones at 60 percent of
its potential volume for one hour a day is relatively safe.
Experts also recommend protecting hearing in other ways — standing away from loud speakers, for instance, and using hearing protection when using machinery at work, home or for recreation.
Day, the DePaul student, concedes that she's never thought to carry ear plugs with her, as Driscoll at Mayo Clinic and others suggest.
"So what if you gave them out at the door at the concert? Would people wear them more?" Driscoll asks. "I think some would."
To that end, professional musicians have formed Hearing Education and Awareness for Rockers (HEAR) to promote hearing protection. And Meinke's committee is developing a teacher kit with a meter to show dangerous levels of sound — something educators in Oregon also have demonstrated with a Web-based program called Dangerous Decibels.
"In the future," Meinke says, "I hope people will wear ear plugs the same as they wear their bike helmets or wear a seat belt."
Fox News and Associated Press
13 September 2005
http://khon.com/khon/display.cfm?storyID=7160§ionID=1163
Cereal for breakfast may help girls stay slim
Eating a bowl of high-fiber cereal in the morning before school "as part of an overall healthful lifestyle" may help teenage girls maintain a healthy body weight as well as adequate nutrient intake, research shows.
In a study supported by the National Heart, Lung and Blood Institute and cereal maker General Mills Inc., researchers analyzed data collected over a 10-year period on more than 2,300 girls participating in a long-term study of growth and health.
The investigators had the girls, who were 9 or 10 years old at the start of the study, complete 3-day food records at different times over the study years and they recorded the girls' weight by body mass index (BMI), a measure of weight in relation to height.
As the girls moved through the turbulent teenage years, those who ate cereal three times per week or more had lower BMI than girls who did not eat cereal, investigators report in the Journal of the American Dietetic Association. This appeared to be true regardless of the girls' level of physical activity.
"As girls matured through adolescence, body mass index increased as would be expected, but cereal eaters were leaner than girls who did not eat cereal, regardless of age," Dr. Bruce A. Barton of the Maryland Medical Research Institute in Baltimore and colleagues report.
According to the researchers, calcium-packed milk is often consumed with cereal and calcium has been tied to lower body mass index in children, possibly because calcium may help regulate body fat.
Beyond the relationship between cereal and a healthy BMI, eating cereal had positive effects on nutrient intake in girls, resulting in diets significantly lower in fat and cholesterol and significantly higher in calcium and fiber.
It's possible, Barton and colleagues offer, that cereal "displaces less-healthful food choices at breakfast." Unfortunately, they also found that breakfast and cereal consumption fell during the adolescent years.
Journal of the American Dietetic
Association
September 2005.
How 'dirt' could educate the immune system and help treat asthma
Scientists believe that knowing exactly which type of dirt provides the best 'education' for the immune system, could be key to providing new treatments for diseases such as asthma.
Speaking at the launch of the BA Festival of Science today, Professor Peter Openshaw, explains that a lack of exposure to dirt and common viral infections among children could be behind the rise in the levels of asthma.
Professor Openshaw, from Imperial College London, and based at St Mary's Hospital, says: "Although we have seen a dramatic decline in many previously common childhood infections over the past 100 years, we have also seen a considerable rise in the prevalence of diseases such as asthma. The increase in asthma cannot be blamed purely on changes in genetic risk, so must be down to environmental factors."
Scientists have called this the 'hygiene' hypothesis, with a lack of exposure to viruses and other environmental factors meaning children are not able to build up resistance, and can become more susceptible to disease later in life. They also believe having many older siblings, attending day care at an early age, or growing up on a farm can help in promoting resistance to disease.
Studies have shown that most common colds can help protect against wheezing in later childhood, and other childhood infections such as chickenpox also provide a level of protection.
Professor Openshaw adds: "The challenge now is to find ways of reproducing the protective effects of early childhood infections, while reducing the burden of actually getting these infectious diseases. Knowing exactly which 'dirt' provides the best education for the immune system, and how to mimic its affects in a cleaner environment, could be the key to reducing the rise in the prevalence of asthma and related diseases."
Professor Openshaw is a respiratory medicine researcher, looking at immunological responses to diseases such as asthma, the common cold and other lung diseases.
I-Newswire
11 September 2005
http://i-newswire.com/pr46002.html
Regular ecstasy users risk depression and disease
Regular users of ecstasy risk contracting infectious diseases and developing long-term psychological problems associated with anxiety and depression.
Ecstasy lowers the immune defences of the body and destroys the nerve cells in the brain that help to counteract the effects of depression, according to Thomas Connor of Trinity College Dublin. "Ecstasy has important immuno-suppressive properties so it can dampen down the normal functioning of the immune system which has the potential to increase an individual's susceptibility to disease," Dr Connor told the British Association Festival of Science in Dublin.
"The drug has traditionally been associated with the rave dance club scene, a crowded environment where teenagers congregate - optimal for transmitting airborne infection between individuals," he said. "Exposure to higher doses of ecstasy and longer duration of exposure causes more damage to the immune system.''
Ecstasy also damages the nerve cells in the brain that produce the mood-enhancing neurotransmitter serotonin, an effect that can last for years and can lead to anxiety and depression. "It does recover slowly but not in the way it should. There's still damage in the long term," Dr Connor said. "This could be a predisposing factor to anxiety, depression, impulsive behaviour, which are associated with low serotonin."
Ecstasy also destroys the brain cells that are the targets of anti-depressants such as Prozac. "This raises the question as to whether those people who abuse ecstasy long-term, and do become depressed, will then become resistant to existing drugs," he said. "Anxiety and depression is already evident in ecstasy abusers."
Regular users of ecstasy risk contracting infectious diseases and developing long-term psychological problems associated with anxiety and depression.
Ecstasy lowers the immune defences of the body and destroys the nerve cells in the brain that help to counteract the effects of depression, according to Thomas Connor of Trinity College Dublin. "Ecstasy has important immuno-suppressive properties so it can dampen down the normal functioning of the immune system which has the potential to increase an individual's susceptibility to disease," Dr Connor told the British Association Festival of Science in Dublin.
"The drug has traditionally been associated with the rave dance club scene, a crowded environment where teenagers congregate - optimal for transmitting airborne infection between individuals," he said. "Exposure to higher doses of ecstasy and longer duration of exposure causes more damage to the immune system.'' Ecstasy also damages the nerve cells in the brain that produce the mood-enhancing neurotransmitter serotonin, an effect that can last for years and can lead to anxiety and depression. "It does recover slowly but not in the way it should. There's still damage in the long term," Dr Connor said. "This could be a predisposing factor to anxiety, depression, impulsive behaviour, which are associated with low serotonin."
Ecstasy also destroys the brain cells that are the targets of anti-depressants such as Prozac. "This raises the question as to whether those people who abuse ecstasy long-term, and do become depressed, will then become resistant to existing drugs," he said. "Anxiety and depression is already evident in ecstasy abusers."
By Steve Connor
8 September 2005
http://news.independent.co.uk/uk/this_britain/article311062.ece
Many Male Teens Fatalistic About Unplanned Pregnancy
Most sexually active male American teens say they have no intention of getting a girl pregnant, but more than half also believe it is likely that they will do so within the next six months, a new study finds.
This fatalistic attitude "highlights the need to have a larger conversation about pregnancy, condom use, and what the barriers to condom use might be among male adolescents," said lead researcher Cynthia Rosengard, an assistant professor of medicine at Brown University School of Medicine in Providence, R.I. "We need to help them, so that their actions fall more in line with their plans."
According to the Alan Guttmacher Institute, a nonprofit group focusing on reproductive health issues, by the time American teens reach age 17 most have already experienced intercourse. Institute data suggest that most young people start engaging in sexual relations at some point in their mid-to-late teens.
The institute also notes that although teen pregnancy rates dropped significantly in the 1990s, they remain much higher than those in other developed countries -- twice as high as in either Canada or England, and nine times higher than either the Netherlands or Japan. Nearly 80 percent of all teen pregnancies are unplanned -- accounting for an estimated 25 percent of all accidental pregnancies in the United States, according to the institute.
Reporting in the September issue of the journal Pediatrics, the study authors reviewed data from interviews with 101 sexually active teen males attending a sexually transmitted disease clinic in northern California between 1996 and 1998. The boys, aged 14 to 19, were questioned regarding their sexual attitudes and behaviors.
Forty-three percent of those interviewed were black, with white teens and Hispanics comprising another 15 percent each. About 11 percent of the teens were Asian.
While more than 75 percent of the male teens said they had no plans to get anyone pregnant over the next six months, more than 56 percent said there was nonetheless some likelihood they would do so whether or not this was their intention, the researchers report.
Almost 25 percent said they were both planning and likely to get someone pregnant, while 33 percent said the likelihood existed despite their lack of intention. Almost 43 percent said they neither planned nor thought it likely they would get someone pregnant.
Teens who thought they might get a partner pregnant in the near future also admitted to being less able to use condoms in "challenging situations." They also expressed less intention to use condoms in the future, compared with boys who believed they would not impregnate a girl.
Teens who actively planned on impregnating -- or thought they might do so accidentally -- tended to be less negative about pregnancy in general, and came from families with relatively less-educated mothers, the researchers added. Teen boys actively planning pregnancy also tended to subscribe to the notion that condom use undermined trust in a relationship.
The findings highlight the need to take young male viewpoints into account when tackling the issue of unplanned pregnancy, Rosengard said.
"Males inform how often intercourse takes place and whether or not condoms are used," said Rosengard. "Males can influence how the female feels about pregnancy, whether or not she'll have an abortion, and how the baby will be raised once it's born. And yet our work is one of the first of its kind because we focus on males, while most adolescent pregnancy work has focused only on females and their attitudes on pregnancy."
"The problem is that most male adolescents don't have discussions about reproductive health-care issues when they go to access health services," said Rosengard, who is also a researcher in internal medicine at Rhode Island Hospital. "So medical health-care professionals should be aware that that's something they should be talking about with their male patients -- not just their female patients."
David Landry, a senior research associate at the Alan Guttmacher Institute, agreed. He believes health-care professionals need to devote more time to frank discussions of reproductive issues with young males, instead of just handling crises as they arise.
"It's important that teens -- both male and female -- are empowered to feel that they have the right to discuss these issues with their doctor," he said. "And also -- in the U.S. as compared with many countries in Western Europe -- we struggle as a society with how to deal with issues of sexuality. So there's the issue of adults largely putting up barriers to discussions about sex."
But Landry said male teens face additional gender-specific obstacles.
"It's very apparent that health providers do not discuss the use of contraception with male adolescents too often," he noted. "In part I think this is due to the advances in contraception decades back, which gave females so much control over their own reproduction that the medical field and public health officials overstated the role of females and understated the role of males in pregnancy and STD prevention."
Nadine Kaslow, a professor and chief psychologist at the Emory University School of Medicine in Atlanta, said, "I think that it's really important that health-care providers discuss reproductive issues equally with male and female patients. It takes two to tango, and doctors definitely have a responsibility to bring up the issue -- to discuss condom use."
But Kaslow stressed that communication with male teens about reproductive health needs to be broadly based, including parents and teachers as well.
"Teachers and other community leaders can help with all this," she said. "And it's also important that parents do this. It's a family responsibility. Of course, a lot of families don't believe in pre-marital sex, and so even though they may know or fear their son is having sex, they think if they don't talk to him about it, it will go away. So parents need to think about their own value systems and what the reality is."
Alan Mozes
6 September 2005
http://www.healthcentral.com/newsdetail/408/527808.html
Anorexia patients still restrict food after therapy
Even though anorexic women show substantial weight gain and major reductions in psychological symptoms after three months of hospitalization, they continue to eat much smaller meals than women who have never had the disease, a new study shows.
While treating anorexia in the hospital often is successful, 30 percent to 70 percent of patients relapse when they go out into the real world, Robin Sysko of Rutgers University in Newark, New Jersey and colleagues report in the American Journal of Clinical Nutrition. Little is known, Sysko and her team add, about the actual eating behavior in anorexic patients and how treatment affects this behavior.
While patients can clearly eat normally during treatment, Sysko told Reuters Health, "when control is transferred back to them over their eating behavior, that's when we seem to see the difficulty arising."
Sysko and her team tested eating behavior among 12 anorexic patients and 12 normal individuals by having them consume a strawberry yogurt shake. The shake was placed in an opaque, popcorn bucket-sized container and participants drank it with a straw so it was not possible for them to see the food. Study participants were told the drink would be their lunch for the day, and that they could consume as much as they liked. They were not told what the meal consisted of or its calorie content.
The anorexic patients were tested upon entering the hospital, and 11 of them were re-tested after they had reached 90 percent of their ideal body weight. All had experienced significant improvement in levels of depression and disordered behavior.
When the anorexic patients were first tested, they consumed about 104 grams of the shake on average. After three months of treatment, they consumed an average 178 grams, compared to 490 grams for the healthy control patients. The shake was about one calorie per gram.
The anorexic patients found the study situation very difficult, Sysko noted, largely because the food was unknown and they had no idea how many calories it contained.
"It tends to be very anxiety-provoking at least by self report -- patients found it quite uncomfortable to be in that situation," she told Reuters Health in an interview. "They just experienced a lot of anxiety around not being able to see the food and not being able to see what was in the food."
Sysko and her colleagues are hoping to develop interventions that will help to normalize patients' eating behavior outside the hospital, for example by helping reduce the anxiety and fear they feel about eating unknown quantities of food.
"This might be just one area that would be important to address post-hospitalization," she added. "Clearly we need additional strategies to help people once they're leaving an intensive program, because that's the period that's fraught with all kinds of potential difficulties for patients."
SOURCE: American Journal of Clinical Nutrition, August 2005.
Anne Harding
5 September 2005
Search for a Perfect Tan May Prove Addictive
For people who have trouble heeding their doctors' warnings to stay out of the sun, a Tanners Anonymous may someday be there to help.
Like many dermatologists, Dr. Richard Wagner of the University of Texas Medical Branch at Galveston was frustrated by patients who, while they knew exposure to ultraviolet light was dangerous, continued to lie in the sun - even some who had developed skin cancer. "They told me they just couldn't stop," Dr. Wagner said.
To investigate whether tanning truly can be addictive, he and his colleagues interviewed 145 people on a Galveston beach using modified versions of two surveys that screen for alcoholics and other drug addicts.
The questions included: "Do you try to cut down on the time you spend in the sun, but find yourself still sun tanning?" and "Do you think you need to spend more and more time in the sun to maintain your perfect tan?"
Depending on the questionnaire used, 26 or 53 percent of the interviewees met the criteria for "ultraviolet light tanning dependent."
The scientists, who published their results online last month in Archives of Dermatology, suggest that tanning dependence could stem from endorphin production by skin that is exposed to ultraviolet light. Previous research, although inconclusive, has supported this hypothesis.
Not all dermatologists are ready to accept the addiction theory.
The study was "an interesting, innovative way to look at whether there may be any biological basis to tanning," said Dr. Vikas Patel, a dermatologist in Washington. "But the biggest motivations for tanning are societal and cultural."
If people start to view sunbathing as an addiction, he said, it may make them believe they cannot stop.
But if Dr. Wagner's results hold up, they could help explain the limited success of public health campaigns to keep people out of the sun, which assume that incentives for tanning are only aesthetic. "The simplest explanation for tanning is that people like the way it looks," he said. "But for some segments of the population, the reasons seem to be more complex."
Eventually, Dr. Wagner said, treatment programs may be available for tanning addiction, modeled after Alcoholics Anonymous and similar therapies that break patterns of abuse.
In some cases, Dr. Wagner said, friends, families and co-workers may try to coerce a chronic tanner into therapy - what is known as intervention in alcohol and drug treatment circles. That approach may be warranted "for someone who is getting a lot of skin cancers," he said.
Laura Tangley
September 6, 2005
http://www.nytimes.com/2005/09/06/health/psychology/06tan.html
Eight percent of US kids have ADHD,
survey finds
Just under 8 percent of U.S.
children aged 4 to 17 had ever been diagnosed with attention-deficit
hyperactivity disorder in 2003, and more than half of them are being
treated with drugs, the U.S. Centers for Disease Control and Prevention
reported on Thursday. Boys are more than twice as likely to be diagnosed
with ADHD than girls, especially boys from poorer families, the CDC
said.
The 2003 survey is the first comprehensive analysis of precisely how
many U.S. children have the disorder and how many are on medication for
it, the CDC said in its weekly report in death and disease. "In 2003,
approximately 7.8 percent (4.4 million) of U.S. children aged 4 to 17
years had ever had ADHD diagnosed," the report reads.
Estimates had ranged from anywhere between 2 percent and 18 percent, the
CDC said. It said 2.5 million, or 56 percent, had ever taken medication
for the disorder.
"ADHD diagnosis was reported approximately 2.5 times more frequently
among males than females. Prevalence of reported ADHD increased with age
and was significantly lower among children aged 4 to 8 years compared
with children aged more than 9 years."
For the report, the CDC experts analyzed data from the 2003 National
Survey of Children's Health. It said more 6-year-old boys were on
medication for ADHD -- 4.3 percent -- than any girl of any age. "The
highest rates of medication treatment for ADHD by sex and age were
reported among males aged 12 years (9.3 percent) and among females aged
11 years (3.7 percent)," the CDC said.
To be diagnosed with ADHD a child must have six or more symptoms for six
months including frequent failure to pay attention in schoolwork or
play, frequent mistakes due to inattention to schoolwork, frequent
failure to listen when spoken to directly, failure to follow up on
chores and forgetfulness.
"ADHD poses substantial costs both to families and society," the CDC
said. "Health care costs associated with ADHD are conservatively
estimated at $3.3 billion annually," it added. "Moreover, persistent and
negative side effects of stimulants have been documented, including
sleep disturbances, reduced appetite, and suppressed growth, which might
have important health implications for the millions of children who are
currently taking medication for ADHD."
Therefore, it said, experts should keep an eye on how many children have
ADHD and are being medicated for it.
1 September 2005
http://today.reuters.com/news/newsArticle.aspx?type=healthNews&storyID=2005-09-02T003129Z_01_MCC201913_RTRIDST_0_HEALTH-ATTENTION-DC.XML
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You're still smoking?
The recent death of Peter Jennings from lung cancer and the announcement
that Dana Reeves, a lifelong non-smoker, is currently battling the
deadly disease have brought lung cancer back to the forefront of news,
and it is very grim. Lung cancer is the deadliest of all cancers; the
National Cancer Institute estimates that in 2005 over 164,000 people
will lose the battle with lung cancer, triple the amount of people who
will die from the next deadliest cancer, colorectal. The hope of
recovery for those diagnosed with lung cancer is very distressing as
well. Nearly 60% of those diagnosed succumb to the disease within a year
of diagnosis and only 15% of all people diagnosed with lung cancer are
still living five years after the initial diagnosis. It is a silent
cancer, spreading throughout the body without presenting many symptoms,
just one reason for its incredibly small survival rate.
Even in light of all these new discoveries, this fact remains about lung
cancer: 87% of all cases of lung cancer result directly from smoking.
Even though this is very well publicized and it is common knowledge that
smoking kills, 22.5% of American adults and 22.9% of American teenagers
currently smoke at least once a week. While teenage cigarette use has
declined over 10% in the past 5 years, the age group with the largest
percentage of smokers is the 18-24 group (almost 30%). The threats are
well publicized and well known; yet one in four Americans are still
smoking. The questions remain: why are people still smoking, and what
will it take to get them to stop?
Killing the body, one puff at a time
It is common knowledge that smoking wreaks havoc on the human body, and
scientists and researchers are continually finding more ways in which
tobacco negatively affects humans. A study done recently on the cadavers
of smokers (both heavy and light) found traces of tobacco in every human
organ, and even in the breast milk of women. This finding reaffirms past
studies of the dangers of tobacco: it is the single most avoidable cause
of death and disease. Researchers have even found that tobacco mutates
DNA and accounts for one in five deaths in the US.
The most common result of smoking is cancer. While lung cancer is the
most often diagnosed smoking induced cancer, the 2004 Surgeon General's
report found that smoking causes many more types of cancers. Tobacco
also causes oral cavity, pharynx, larynx, esophagus, stomach, cervix,
kidney and pancreas cancer, as well as acute myeloid leukemia. This is
due to the fact that carcinogens in tobacco damage genes that control
the growth of cells. This results in two things: abnormal cell growth
and an unhealthy rate of cell reproduction, which not only increases
one's chance of cancer, but also causes it to spread more quickly than
in a nonsmoker.
While cancer is the most well-known result of smoking, there are
actually more tobacco induced deaths due to cardiovascular disease per
year (5.5 million) than cancer (4.1 million). Tobacco dramatically
increases the risk of coronary heart disease and stroke, which are the
first and third leading causes of death in the United States
respectively. It kills one person every 33 seconds. Toxins in the blood
from smoking cause atherosclerosis, a continual hardening of the
arteries, which obstructs blood flow to the heart. This leads a smoker's
resting heart rate to be two to three beats faster than a nonsmoker's.
Another obvious result of smoking on the human body is respiratory
problems. Smoking dramatically increases the chances of chronic
obstructive pulmonary disease (COPD), the fourth leading cause of death
in the United States More than 90% of cases of COPD are due to smoking.
This disease includes chronic bronchitis and emphysema. Smoking also
reduces the rate of lung growth in adolescents who smoke and children
who were exposed to tobacco while in the womb. Also, the carbon monoxide
in cigarettes binds to hemoglobin in red blood cells, preventing cells
from carrying a full load of oxygen, which leads to wheezing and trouble
breathing.
An unlikely result of smoking is the effect on the immune system.
Smokers suffer from a decreased functioning of the immune system. A
smoker is not only more likely to get sick, but will have a virus
longer. Tobacco also wreaks havoc on the mouth and teeth. Smoking leads
to periodontitis, a serious gum disease that can result in loss of
teeth. It also yellows the teeth and increases the chance of cold sores.
Smoking not only affects the health of the smoker, but also those around
him while smoking. Secondhand smoke, also known as environmental tobacco
smoke, is defined as a mixture of the smoke given off by the burning end
of tobacco-products (side stream smoke) and the smoke exhaled by smokers
(mainstream smoke). While it may seem that secondhand smoke would not be
as deadly as actually inhaling a cigarette, studies have found that
secondhand smoke contains a mixture of over 4,000 chemicals, more than
50 of which are known carcinogens. It is classified as a Group A
carcinogen, which puts it in the same group as asbestos and radon gas.
Secondhand smoke particularly affects children, whose lungs have not
fully developed. In the United States, 60% of nonsmokers have biological
evidence of secondhand smoke. It is because of this fact that
governmental and non-governmental agencies are attempting to make
changes to policies about public smoking.
Forcing You to Quit
One way in which the government is attacking the smoking epidemic and
trying to persuade smokers to quit is by passing stricter smoking laws
as well as dramatically increasing cigarette taxes. As of today, there
are 12 states with a 100% smoke free law in effect for at least one of
the three following categories: workplaces, restaurants or bars. These
states are: California, Idaho, Utah, South Dakota, New York, Maine,
Massachusetts, North Dakota, Connecticut, Florida, Rhode Island and
Delaware. Four of these states are completely smoke free and Montana and
Vermont have enacted smoke free laws that are not yet in effect. The
only problem has been that very little legislation has made any headway
in the states with the highest percentage of smokers, like Kentucky
(32.6%) and Mississippi (33.2%). These laws were not only put into
effect to protect non-smokers' health, but also in the hopes of
convincing people to quit smoking all together. Results have been very
positive. New York City passed a smoke free air law, as well as
significantly raised its cigarette tax in 2002, and they found that
close to 200,000 people had quit smoking in the two years after the law
went into effect.
The passing of these laws was very controversial because many
restaurants and bars worried about the economic effects that a smoking
ban would have on their establishments. While results have been mixed,
it seems that more states have seen positive economic changes rather
than negative ones. Florida saw sales for restaurants up 7% and requests
for restaurant licenses up 3% after the ban of smoking in restaurants
was put into effect. The only studies that have found any negative
economic effects have been those sponsored by the tobacco industry.
Currently, DC is close to making all workplaces 100% smoke free. Mayor
Anthony Williams has recently voiced his support for the bill and is
encouraging council members to pass it. Yet, the bill has hit a snag
because Carol Schwartz, Chair of the Committee on Public Works and the
Environment, has said she would not call a vote on the bill, but she
would consider a compromise. Fellow council member David Catania is
attempting to circumvent Schwartz by including smoke free laws in a bill
he is proposing in the fall. Also, council member Kwame Brown has hinted
that he would propose emergency legislation that would take the bill out
of Schwartz's hand. Therefore, it seems inevitable that DC will be smoke
free in the near future.
You're Still Smoking?
Even though everyone knows that smoking is bad for one's health, it
continues to attract new users everyday. In order to combat the growing
number of smokers, governmental agencies, non-profit organizations and
researchers are working together to convince people, with a particular
focus on children and teenagers, not even to try smoking. The main
governmental agency working against tobacco is the Center for Disease
Control (CDC). The CDC has created a website, Tobacco Information and
Prevention Source (TIPS), with educational information of the dangers of
smoking, as well as information to help those smokers who want to quit.
The CDC works closely with the Surgeon General to research and publicize
the effects of tobacco on the body.
One of the major differences between research about smoking now and
research in the past is that the focus has greatly expanded. In the
past, research focused squarely on the ill effects of smoking on the
body. The tactic was to scare people into not smoking rather than
educate them about the dangers of becoming addicted. Now instead of
simply publishing reports about effects, publications are focusing on
how to quit, the benefits of quitting and dispelling rumors about any
kind of benefits of smoking.
In reality, many smokers want to quit. In a survey by the CDC, they
found that 70% of smokers said they want to quit. Going "cold turkey"
was always the way that people thought was the only way to quit smoking.
In reality, only 5% of people who attempt to quit smoking by going cold
turkey will actually not be smoking a year later. In the past ten years,
quitting smoking has gotten easier with the invention of the nicotine
patches, nicotine gum, nicotine lozenges and nasal sprays. The patches
and gum make quitting much easier on smoking because it slowly weans
them off of nicotine instead of just completely eliminating it from
their daily intake. By slowly decreasing the amount of nicotine the body
is receiving, one is not as likely to go through as severe withdrawal
symptoms as someone going cold turkey. While these aids have proven to
be helpful, the chance of them working for someone who is a heavy smoker
is still very slim. A smoker will overindulge by chewing too much gum or
wearing too many patches, therefore getting them same fix they would if
they actually smoked. Now, aids have become even more powerful with the
creation of prescription drugs like Zyban and Wellbutrin. This pill is
Bupropion SR, which reduces the urge to smoke by affecting the same
chemical messengers in the brain that are affected by nicotine. These
are thought to be an even healthier way to quit smoking since the body
is no longer being fed nicotine. Yet, researchers now believe that one
needs more than just replacements for the cigarettes to quit.
Groups now advocate a three-prong approach to quitting. In order to be
successful, one should use some sort of aid to attempt to lessen
withdrawal symptoms. The first few weeks are the most important to get
through because that is when withdrawal symptoms will be the strongest.
The second prong is counseling. This can be done in a variety of ways.
One on one sessions with a counselor is the most helpful form of
counseling for quitting. A more popular and cheaper way to get
counseling is to attend a smoking cessation or nicotine addict group.
This allows smokers to meet others who are going through the same
struggles and possibly find strength in numbers. An increasingly popular
form of counseling is telephone counseling in which a struggling smoker
can call 24 hours a day to speak with someone who will be able to help
him with his problem. What is most important is that those who want to
quit continue to attend some form of counseling because the
effectiveness of the counseling increases as the number and length of
the sessions increase. The final part to successful quitting is social
support. If a smoker has the support of friends and family, it makes
their attempt 50% more likely to be successful. Sometimes this part can
be the most difficult for smokers if their family and/or friends smoke,
therefore increasing their chances of relapsing.
Another way in which advocacy groups are trying to discourage smoking is
by dispelling rumors that made smoking popular. One reason many people,
particularly women, smoke is because they feel it helps them lose or
maintain their weight and many people do not quit because they think
they will gain weight if they do quit. The fact is that smoking does
burn calories, up to 200 a day for a heavy smoker. Smoking also
increases one's metabolism, which leads to the burning of more calories.
Yet, the impact of these two facts is usually minimal for most people.
The real reason people will lose weight when they begin smoking is that
smoking most often replaces food. Instead of eating a snack during a
break, a smoker will have a smoke. This also contributes to the fact
people gain weight when they quit. They often replace a cigarette with
food or attempt to quell cravings by eating. Also, one will gain weight
because the metabolism will slow, yet it will digest food more
efficiently, meaning that the body will absorb more calories, but will
also absorb more vitamins and nutrients.
Another myth about smoking is that it alleviates stress, yet a recent
study by psychologist Andy Parrott, Ph.D, of the University of East
London has found that smoking actually increases stress. Parrott found
that people simply think they are relieving stress when they are simply
fulfilling their desire for nicotine. "Regular smokers, therefore,
experience periods of heightened stress between cigarettes and smoking
briefly restores their stress levels to normal," observed Parrott.
Therefore, one's addiction to nicotine is the reason that the smoker is
feeling stressed and the only reason for their stress at that moment.
Parrott was quoted as saying "this message needs to be far more widely
known because it may help many adults to stop smoking."
While it is probably impossible to completely eliminate smoking from
society, current trends are pointing in a positive direction for the
health of Americans. With decreased numbers of smokers and more smoking
obstacles, the future is getting clearer and clearer.
Amanda Kuzma
August 31, 2005
http://www.thegeorgetownindependent.com/media/paper136/news/2005/08/31/News/Youre.Still.Smoking-972497.shtml
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