EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, JUNE 9, 2003
To contact S. Goya Wannamethee, Ph.D., e-mail goya{at}pcps.ucl.ac.uk.

LIGHT TO MODERATE ALCOHOL CONSUMPTION MAY BE ASSOCIATED WITH LOWER RISK OF TYPE 2 DIABETES IN YOUNG WOMEN

CHICAGO—Women who are light to moderate drinkers have a lower risk of developing type 2 diabetes mellitus than women who abstain from drinking alcohol, according to an article in the June 9 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

Previous studies of the relationship between drinking alcohol and type 2 diabetes have had conflicting results, according to information in the article. Some studies, mostly conducted among men, report that heavy drinking is a risk factor for type 2 diabetes, while other studies have reported that light to moderate drinking may be protective against the disease. Few studies have investigated the effects of drinking alcohol and type 2 diabetes among women.

S. Goya Wannamethee, Ph.D., and colleagues studied the effects of various levels of alcohol consumption among 109,690 women aged 25 to 42 years old in the Nurses' Health Study II, who had no history of coronary heart disease, stroke, cancer or diabetes mellitus. Participants completed detailed lifestyle and medical history questionnaires in 1989. During 10 years of follow up, the researchers documented 935 new cases of type 2 diabetes mellitus among the participants.

The researchers found that compared with lifelong abstainers, women who consumed 0.1 to 4.9 grams of alcohol per day (less than one beer) had a 20 percent reduction in risk for developing type 2 diabetes; women who drank 5.0 to 14.9 grams of alcohol per day (about one beer) had a 33 percent risk reduction; women who drank 15.0 to 29.9 grams of alcohol per day (about one to two beers) had a 58 percent risk reduction, and those who drank 30 or more grams of alcohol per day (about two to three beers) had a 22 percent risk reduction.

The researchers found that the inverse association with light to moderate drinking and reduction in risk of developing type 2 diabetes was most apparent in women who reported drinking beer or wine. However, women who reported drinking 30 grams or more of liquor per day had a significantly increased risk (about two and one half times higher) of diabetes compared to those who did not drink.

"In this cohort of mainly premenopausal women, a nonlinear relationship was seen between alcohol consumption and risk of type 2 diabetes mellitus," write the authors. "We found a linear inverse association up to levels of 29.9 grams per day, beyond which risk increased compared with light and moderate drinkers."

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, JUNE 9, 2003
To contact Karin Yeatts, Ph.D., call Lisa Katz at 919/966-7467.

HEALTH CONSEQUENCES MAY BE SUBSTANTIAL FOR ADOLESCENTS WITH ASTHMA SYMPTOMS

CHICAGO—The health consequences for children who report asthma-like symptoms but are not diagnosed with asthma can be substantial, according to an article in the June issue of The Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

Asthma is the most common chronic childhood disease in the United States, according to information in the article. Recent research suggests that asthma is under-diagnosed and under-treated, though to what extent is unknown.

Karin Yeatts, Ph.D., of the University of North Carolina at Chapel Hill, and colleagues surveyed 122,829 children aged 12 to 14 years in North Carolina public middle schools. The adolescents were shown a video depicting scenes of people having asthma attacks and asthma-related symptoms. Afterwards, they were given questionnaires asking if they had ever experienced similar symptoms. The questionnaire also asked about school absences, sleep disturbances, activity limitation, physician visits, emergency department visits and hospitalizations.

The researchers found that 17 percent (n=21,184) of the adolescents reported current asthma-like symptoms without a diagnosis of asthma (within the last 12 months). Eleven percent (n=13,619) reported physician-diagnosed asthma and current asthma symptoms.

Of the children with asthma-like symptoms and no diagnosis of asthma, 20 percent missed a half day of school or more per month because of wheezing, 25 percent had limited activities because of wheezing once or more per month, and 32 percent had sleep disturbances due to wheezing in the last 4 weeks.

The researchers also found that 7 percent of children with current asthma-like symptoms but no diagnosis reported 1 or more emergency department visits for asthma-like symptoms and 5 percent reported wheezing-related hospitalizations in the past year. Forty-seven percent of children with physician-diagnosed asthma reported missing a half day or more of school in the last month, and 30 percent reported one or more emergency department visits in the past year for asthma-like symptoms.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, JUNE 9, 2003
To contact Carol A. Ford, M.D., call David Williamson, 919/962-8596.

MANY YOUNG ADULTS RECOVERED FROM EMOTIONAL TRAUMA OF SEPTEMBER 11, 2001 WITHIN WEEKS

CHICAGO—Young adults who did not directly witness the events of September 11, 2001, experienced transient reactions in the weeks following the terrorist attacks, according to The Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

According to information in the article, the United States experienced unprecedented attacks on September 11, 2001. These attacks, which killed thousands of American citizens, were witnessed by immediate bystanders as well as by millions of viewers worldwide as the events unfolded in real time on television. Previous surveys measuring the reactions of adults to September 11 have shown that many respondents experienced varying degrees of acute stress or posttraumatic stress symptoms.

Carol A. Ford, M.D., and colleagues surveyed 7,095 young adults aged 18 to 26 years old - 2,913 before and 4,182 within 9 weeks after September 11 to determine their feelings, perceptions and behaviors following the attacks and to test the influence of time and distance from terrorist sites. The respondents had been previously interviewed as part of The National Longitudinal Study of Adolescent Health (Add Health), which included questionnaires regarding emotional states including depression and anxiety and asked about relationships with parents and peers.

The researchers found that males were 33 percent more likely and females were 44 percent more likely to report sadness and increased trust in the government following the September 11 than those interviewed before the attacks. The number of respondents reporting sadness returned to levels previous to the attacks within four to six weeks, and increased trust in the government persisted for the 9 week study period. Males interviewed during the second week after the attacks were more than twice as likely to report religious faith, and 75 percent more likely to respond that a spiritual life is important than those interviewed before the attacks. Female respondents interviewed after the attacks were 40 percent more likely to report higher levels of psychological distress and were 36 percent more likely to report closeness to their fathers.

The researchers also found that the rate of substance abuse among respondents was similar before and after the attacks, and respondents closest to terrorist sites were most affected.

"Differences among respondents interviewed before and after September 11 suggest that young adults were affected by the events that occurred on this date," write the authors. "The predominant reactions of young adults who did not directly witness events at the World Trade Center of the Pentagon were feelings of sadness and psychological distress, increased importance of religion and spirituality, and greater trust in all levels of government. Most of these reactions were transient. The striking exception to this pattern was persistent trust in government."

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, JUNE 9, 2003
To contact Lisa M. Klesges, Ph.D., call Nancy Bailey 901/448-5115.

NICOTINE REPLACEMENT THERAPY USED BY ADOLESCENT SMOKERS AND NONSMOKERS

CHICAGO—Nicotine replacement therapies, including the patch and gum, are readily available to adolescents, and are used by adolescent smokers and nonsmokers, according to an article in the June issue of The Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

Rates of smoking in adolescents and youths remains high, according to information in the article. In 2000, 15.1 percent of middle school students and 34.5 percent of high school students reporting that they smoke. More than half of these smokers stated that they have tried to quit in the previous 12 months. Because of the difficulty of quitting smoking, especially in adolescents, nicotine replacement therapy (NRT) has been considered for this group. However, information on the availability of NRT to youth and their use of these products has not been available.

Lisa M. Klesges, Ph.D., of University of Tennessee Health Science Center, Memphis, Tenn., and colleagues investigated the prevalence, accessibility and reasons for NRT use among adolescent smokers and nonsmokers.

The researchers surveyed 4,078 high school students in city schools in Memphis, Tenn., during the 1998 school term. The researchers found that 216 (approximately 5 percent) adolescents reported trying or using nicotine gum or patches. Females were less likely than males, and African Americans were less likely than others to use NRT. African American smokers used NRT the most if they reported low smoking levels, while other smokers used NRT when smoking more.

Almost 40 percent of former smokers reported using NRT to help them quit smoking, but 75 percent of current smokers endorsed using NRT for reasons other than trying to quit smoking, including using NRT when they were unable to smoke, and 18 percent of NRT users reported that they never were smokers. The researchers also found that more than 50 percent of the students reported that it would be easy for them to get NRT.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, JUNE 9, 2003
To contact Johanna M. Seddon, M.D., Sc.M., call Mary Leach 617/573-4170

OBESITY AND LACK OF EXERCISE INCREASE THE RISK THAT MACULAR DEGENERATION WILL GET WORSE

CHICAGO—Obesity may increase the risk for progression to advanced age-related macular degeneration (AMD) and increased physical activity may help reduce the risk, report researchers in the June issue of The Archives of Ophthalmology, one of the JAMA/Archives journals.

The exact causes of AMD remain elusive, yet several factors have been identified that play a role in the disease including increased age, cholesterol levels, genetic predisposition, cigarette smoking and some nutritional factors, according to information in the article. Most patients diagnosed with AMD have a mild form of the disease, and approximately 30 percent of individuals 75 years and older have mild AMD.

Johanna M. Seddon, M.D., Sc.M., of Massachusetts Eye and Ear Infirmary, Boston, and colleagues evaluated physical, behavioral and medical factors associated with the progression of mild AMD to advanced stages of AMD.

The researchers studied 261 patients 60 years or older in a hospital-based retinal practice who had some signs of mild AMD. The average follow up was 4.6 years.

The researchers found that higher body mass index (BMI, a measurement comparing weight to height) increased the risk for progression to more advanced stages of AMD. Patients with BMIs of 25 to 29 (overweight) or BMIs greater than 30 (obese) were more than twice as likely to experience worsening AMD compared to patients with BMIs of less than 25. Higher waist circumference also was associated with a two-fold increased risk for progression.

More physical activity tended to be associated with a reduced rate for progression of AMD, with a 25 percent reduction for patients who engaged in vigorous activity 3 times per week compared with those who did not engage in physical activity, report the researchers.

The researchers write: "Approximately 1.7 million people have decreased visual acuity due to AMD, and advanced AMD with visual loss develops in 200,000 people every year. These numbers are expanding as the percentage of elderly people in the population continues to grow. Furthermore, obesity is becoming an epidemic among adolescents and adults in the United States and in developing countries."

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, JUNE 9, 2003
To contact Benoit H. Mulsant, M.D., call Craig Dunhoff at 412/624-2607.

SUICIDAL OLDER PATIENTS WITH DEPRESSION TAKE LONGER TO RESPOND TO TREATMENT

CHICAGO—Suicidal elderly patients with depression require special attention during therapy because they have a lower response rate and take longer to respond to treatment, according to an article in The Archives of General Psychiatry, one of the JAMA/Archives journals.

According to information in the article, people 65 years old and older have the highest rate of suicide, but little is known about the occurrence and course of thoughts about suicide (suicidal ideation) during the treatment of depression in elderly patients.

Benoit H. Mulsant, M.D., of Western Psychiatric Institute and Clinic, Pittsburgh, and colleagues investigated how suicidal ideation changes during short-term depression treatment and whether the response to treatment differed among three groups of patients depending on their level of suicidality at the beginning of the study. Patients were divided into three groups as follows: those with a recent suicide attempt or current suicidal ideation (high-risk group, n=46); those with recurrent thoughts of death (moderate-risk group, n=143); and those with no suicide attempt, suicidal ideation or thoughts of death (low-risk group, n=206).

All participants were part of a previous study of patients with a major depressive episode treated with antidepressants paroxetine hydrochloride or nortryptyline hydrochloride, with or without psychotherapy.

The researchers found that suicidal ideation decreased rapidly early in treatment (weekly, 45-minute psychotherapy sessions), with more gradual changes afterwards. At the beginning of treatment, 77.5 percent of the patients reported suicidal ideation, thoughts of death or feelings that their life is empty. After 12 weeks of treatment, suicidal ideation had resolved in all treated patients, and 4.6 percent still reported thoughts of death. Six-week and 12-week rates of response were significantly lower in high-risk patients than in low- and moderate-risk patients. High- and moderate-risk patients needed a significantly longer time to respond to treatment than low-risk patients (average time to respond, 6 and 5 vs. 3 weeks).