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To contact David J. Pettitt, M.D., call Michelle Rose 805/682-7638

TELEVISION WATCHING AND SOFT DRINKS MAY CONTRIBUTE TO ADOLESCENT OBESITY

CHICAGO—Researchers report a correlation between television viewing and soft drink consumption and obesity in adolescent students in the September issue of The Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

According to the article, the prevalence of obesity has been growing at an alarming rate in both children and adults for decades. In children, the prevalence of obesity doubled from the late 1970s to 1994 and is it estimated that 25 percent of children today have a body mass index (BMI) above the 85th percentile and 11 percent have a BMI above the 95th percentile. The decrease in physical activity and the popularity of high-fat, high calorie foods have been implicated in the rising rates of obesity. Obesity is a known risk factor for many health problems including hypertension and diabetes mellitus.

David J. Pettitt, M.D., of Sansum Medical Research Institute, Santa Barbara, Calif., and colleagues investigated the prevalence of obesity among sixth- and seventh-graders and identified lifestyle factors associated with obesity.

The researchers studied 186 boys and 199 girls in the sixth and seventh grades from three Santa Barbara schools who completed a screening study. Three hundred nineteen students also completed a short questionnaire about lifestyle, weight, eating and exercise habits. Height and weight were measured for each student, and BMI was calculated.

Overall, 35.5 percent of the students had a BMI at or above the 85th percentile and half of these students (17.4 percent) had a BMI at or above the 95th percentile. The rates were higher among Latino students and lower among Asian students compared to non-Hispanic white students.

The researchers found significant associations between BMI and hours of television watched and daily soft drink consumption (both diet and regular soft drinks). For students who watched less than 2 hours of television per night, 26.2 percent had BMIs at or above the 85th percentile, and 47.1 percent of students who watched 3 or more hours of television per night had BMIs at or above the 85th percentile. For students who drank less than 3 soft drinks per day, 33.2 percent had BMIs at or above the 85th percentile, and 58.1 percent of students who drank 3 or more soft drinks per day had BMIs at or above the 85th percentile.

The surveys also revealed that Latino students watch more television (2.4 hours per night) than non-Hispanic white or Asian students (1.3 hours per night) and consumed more soft drinks (1.6 per day) than non-Hispanic white students (1.1 per day) or Asian students (0.7 per day).

"Our analysis indicates that increased levels of television viewing and soda intake are associated with a higher prevalence of overweight and obesity among sixth- and seventh-grade school children, and overweight can lead to increased risk of developing chronic health conditions, such as type 2 diabetes," the authors write.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, SEPTEBER 8, 2003
To contact Tim McManus, M.S., call the Centers for Disease Control and Prevention Press Office at 404/639-3286.

PHYSICAL ACTIVITY AND PARTICIPATION IN TEAM SPORTS MAY REDUCE HEALTH RISKS FOR ADOLESCENTS

CHICAGO—High school students who are both physically active outside school and also participate in team sports, may be at a lower risk for using cigarettes or drugs and engaging in risky sexual behavior, according to an article in the September issue of The Archives of Pediatric & Adolescent Medicine, one of the JAMA/Archives journals.

According to the article there are many long-term health benefits of physical activity, including the prevention of cardiovascular disease, diabetes mellitus, obesity, colon cancer and hypertension later in life. Being physically active is also associated with a lower prevalence of engaging in risky behaviors such as smoking cigarettes, using marijuana and other drugs and sexual promiscuity. Previous studies have shown a negative relationship between being physically active and using cigarettes and marijuana, and other studies show that students who participated in sports were less likely to use alcohol and engage in risky sexual behaviors.

Tim McManus, M.S., of the Centers for Disease Control and Prevention, Atlanta, and colleagues investigated whether being both physically active as well as participating in team sports, or being active without being a member of a team sport were associated with substance abuse and risky sexual behaviors.

The researchers used data from the 1999 national Youth Risk Behavior Survey, which asked questions about substance use and sexual behavior as well as questions about sports participation and physical activity. The researchers included 15,349 surveys completed by U.S. high school students.

The researchers found that 41.9 percent of the students were both physically active and participated in team sports, 22.1 percent were physically active but not a member of a sports team, 12.6 percent were physically non-active sports team members, and 22.3 percent were physically inactive and did not play a team sport. More female students (29.3 percent) than male students (15.3 percent) were non-active, and more male students were both physically active and participated in team sports (48.9 percent) than were female students (34.8 percent).

The researchers also found that African American students were more likely to be physically non-active and not members of a sports team. Compared to female students who were not active or members of a sports team, those who were active and participated in team sports were less likely to be substance users or engage in risky sexual behaviors than were active non-team and non-active team female students.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, SEPTEMBER 8, 2003
To contact Donald M. Lloyd-Jones, M.D., Sc.M., call Esta Shindler at 508/935-3434.

RISK OF DEVELOPING CORONARY HEART DISEASE LINKED TO ELEVATED CHOLESTEROL LEVELS

CHICAGO—The lifetime risk for developing coronary heart disease (CHD) is higher for people who have elevated cholesterol levels at any age, according to an article in the September 8 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

According to the article, knowing the long-term risk for coronary heart disease (CHD) is important for younger patients with risk factors for CHD. However, many of these patients do not receive proper preventive treatment for CHD because many physicians focus on their low, short-term risk for CHD. Lifetime risk estimates calculate the probability of developing a particular disease before dying of something else. These estimates can be useful in the decision making process for beginning therapy.

Donald M. Lloyd-Jones, M.D., Sc.M., of the Framingham Heart Study, Framingham, Mass., and colleagues determined how cholesterol levels at different ages influence the lifetime risk of CHD.

The researchers studied participants in the Framingham Heart Study who were examined from 1971 through 1996 and who did not have CHD and were not receiving lipid-lowering therapy at the beginning of the study. Cholesterol levels were measured at ages 40, 50, 60, 70 and 80 years old. Each participant was followed up through 1996 or until the occurrence of a first CHD event (heart attack, stroke, etc.), death or reaching 95 years old.

The researchers found that among 3,269 men and 4,019 women, 1,120 developed CHD and 1,365 died free of CHD during the follow up period. At each of the ages at which cholesterol was measured, the lifetime risk of CHD increased with higher cholesterol levels. The lifetime risk for CHD at ages 40 through 80 was as follows: At age 40 years, the lifetime risks of CHD through age 80 years for men with

• less than 200 milligrams cholesterol per deciliter of blood (mg/dL, the standard measure for cholesterol levels, (with more than 200 mg/dL considered high), CHD risk was 30 percent for men and 15 percent for women
• 200 to 239 mg cholesterol/dL, CHD risk was 43 percent for men and 26 percent for women
• 240 mg cholesterol/dL or greater the CHD risk was 57 percent for men and 33 percent for women

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, SEPTEMBER 8, 2003
To contact Maxia Dong, M.D., Ph.D., call the Centers for Disease Control and Prevention Press Office at 404/639-3286.

ADULT LIVER DISEASE IS ASSOCIATED WITH A HISTORY OF ABUSE AND NEGLECT IN CHILDHOOD, DRUG USE AND RISKY SEXUAL BEHAVIOR

CHICAGO—People who experienced childhood abuse and neglect may be at an increased risk for developing liver disease as adults, according to an article in the September 8 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

Chronic liver disease and cirrhosis is one of the 10 leading cause of death in the United States, according to the article. Two important causes of chronic liver disease are alcohol abuse and viral hepatitis (Hepatitis B virus [HBV] and hepatitis C virus [HCV]). It is estimated that 70 percent of these chronically infected with HCV will develop chronic liver disease and 40 percent of all patients with chronic liver disease also have HCV infection. People using illegal drugs or engaging in high-risk sexual behaviors account for most people with HBV and HCV infections. According to the Centers for Disease Control and Prevention, about 1.25 million Americans are chronically infected with HBV and 2.7 million with HCV.

Maxia Dong, M.D., Ph.D., of the Centers for Disease Control and Prevention, Atlanta, and colleagues investigated the relationship of adverse childhood experiences (ACEs) including abuse, neglect and household dysfunction, and the mediating role of substance abuse and risky sexual behavior on liver disease.

The researchers collected data on 10 different kinds of ACEs, including emotional, physical and sexual abuse, household dysfunction, domestic violence, substance abuse, crime, mental illness and health-related behaviors from 17,337 adult health plan members. Respondents were asked to fill out the survey based on experiences from the first 18 years of their lives. Incidence of liver disease was collected through surveys and was self-reported.

The researchers found that each of the 10 ACEs increased the risk of liver disease 1.2 to 1.6 times. Compared to people with no ACEs, the chances of ever having liver disease for people with 6 or more ACEs was 2.6 times higher. The researchers also found that the strength of the relationship of ACEs to liver disease was reduced by 38 percent to 50 percent when they adjusted for alcohol abuse and risky sexual behavior, suggesting that these behaviors are strong mediators of the ACE-liver disease relationship.

"To our knowledge, this study is the first to demonstrate the association between a broad range of ACEs and liver disease," write the authors. "The results showed compelling evidence that behaviors that are strongly associated with ACEs and known to increase the risk of liver disease are mediators of this relationship."

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, SEPTEMBER 8, 2003
To contact Wayne J. Katon, M.D., call Walter Neary at 206/543-3620.

DEPRESSED ELDERLY PATIENTS HAVE HIGHER HEALTH CARE COSTS

CHICAGO—Elderly patients with depressive symptoms or confirmed depression have higher overall health care costs, according to an article in the September issue of The Archives of General Psychiatry, one of the JAMA/Archives journals.

According to the article, major depression (MD), dysthymia and minor depression are common in elderly primary care patients, with prevalences estimated at 6.5 percent to 9 percent for MD, 3 percent to 5 percent for dysthymia and 10 percent to 20 percent for minor depression. Major and minor depression in older adults are associated with increased unexplained physical symptoms such as headache, dizziness, functional impairment and decreased quality of life. Several studies have also indicated increased medical costs for elderly patients with depressive symptoms.

Wayne J. Katon, M.D., of the University of Washington School of Medicine, Seattle, and colleagues examined whether older adults with depressive symptoms below the diagnostic threshold and those with major depression and/or dysthmia have higher medical costs than those without depression.

The researchers mailed a questionnaire to patients in 2 large primary care clinics of a health maintenance organization (HMO) in Seattle, Wash. to determine depression and depressive symptoms. Of all 11,697 patients 60 years old or older with primary care providers at the participating clinics, 8,894 (76.2 percent) were enrolled. An additional 107 patients were referred to the study by their primary care physicians.

The researchers state that the non-respondents (those who didn't return the survey) were slightly younger and had higher inpatient medical costs over the previous 6 months than responders. The total cost of medical services for participants was obtained from the cost accounting system of the HMO.

The researchers found that total outpatient costs were 43 percent to 52 percent higher and total outpatient and inpatient costs were 47 percent to 51 percent higher in depressed compared to non-depressed patients even after the researchers took into account chronic medical illnesses. The increase was seen in all areas of health costs, with costs for mental health treatments accounting for only a small percentage of the overall increase.

Depressed elderly patients had an average increase of $763 to $979 in outpatient costs and $1,045 to $1,700 in outpatient and inpatient costs combined. The researchers did not note any differences in health care costs between patients with sub-threshold depression and those with confirmed depressive disorders.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, SEPTEMBER 8, 2003
To contact Hector Vila, Jr., M.D., call Andrea Brunais 813/632-1478.

SURGERIES PERFORMED IN DOCTOR'S OFFICES MAY BE MORE LIKELY TO RESULT IN INJURY OR DEATH

CHICAGO—Death and injury is approximately 10 times more likely to occur during a surgical procedure performed in an office setting compared to procedures performed in outpatient clinics, according to a study in the September issue of The Archives of Surgery, one of the JAMA/Archives journals.

According to the article, during the 1980s, many surgical procedures previously performed in hospitals began to be performed in ambulatory surgery centers (ASC, or outpatient clinics where the patient can go home on the same day as the surgery). By the 1990s, more than 50 percent of all surgeries were being performed in ASCs. In the 1990s, more surgeries began to be performed in physician offices that were previously done in ASCs. The safety of surgeries performed in licensed ASCs has been widely accepted. It has been estimated that up to 1.2 million surgical procedures nationwide per year are currently being performed in physician offices. Procedures taking place in offices are not government-regulated as are ASC procedures.

Hector Vila, Jr., M.D., of the H. Lee Moffitt Cancer Center and Research Institute, Tampa, Fla., and colleagues compared surgical outcomes for patients who underwent surgeries in ASCs vs. doctors' offices in Florida.

The researchers reviewed all adverse incidents reported to the Florida Board of Medicine for procedures performed between April 1, 2000 and April 1, 2002. The researchers estimated the total number of office procedures by extrapolating from the number of procedures performed in a 4 month period. Data on ASC deaths, adverse incidents and number of procedures for 2000 were obtained from the Florida Agency for Health Care Administration. A total of 182 office surgery incident reports for the 2 year study period were reviewed, and 17 of those reports indicated the death of the patient.

The researchers concluded that 66 adverse events occurred per 100,000 procedures performed in offices and 5.3 adverse events occurred per 100,000 procedures performed in ASCs. The death rate per 100,000 procedures was 9.2 in offices and 0.78 in ASCs.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, SEPTEMBER 8, 2003
To contact Frank A. Sloan, Ph.D., call Tracey Koepke at 919/660-1301.

NUMBER OF ELDERLY WITH EYE DISEASES INCREASING

CHICAGO—The number of elderly people with common eye diseases associated with aging has risen substantially over the past decade, according to an article in the September issue of The Archives of Ophthalmology, one of the JAMA/Archives journals.

Many elderly people develop eye diseases, many of which have causes that are preventable or treatable, according to the article. Of the 44 million annual visits to ophthalmologists in 1991, more than half were by elderly patients. The U.S. population 65 years and older will grow from 43.4 million in 2000 to 70.3 million by 2030, suggesting further increases in the prevalence of eye diseases.

Frank A. Sloan, Ph.D., of Duke University, Durham, N.C., and colleagues determined the prevalence of 3 chronic eye diseases among elderly people.

The researchers analyzed a random national sample of Medicare beneficiaries 65 years and older. Incidence of diabetic retinitis, glaucoma and age-related macular degeneration were recorded. Participants were followed from 1991 to 1999 or until death, or enrollment in a health maintenance organization for 6 or more months in one year.

The researchers found that of 20,325 Medicare beneficiaries in 1991, 10,476 were available for analysis in 1999. The prevalence of diabetes mellitus increased from 14.5 percent in 1991 to 25.6 percent in 1999, with diabetic retinopathy (disorders of the retina due to diabetes) among people with diabetes mellitus increased from 6.9 percent to 17.4 percent. Glaucoma increased from 4.6 percent to 13.8 percent. The prevalence of age-related macular degeneration increased from 5.0 percent to 27.1 percent. Overall, the proportion of patients with at least 1 of the 3 diseases studied increased from 13.4 percent to 45.4 percent.

"The clinical diagnosis of major chronic eye diseases associated with aging increased dramatically in [this] sample," write the authors. "At the end of 9 years, nearly half of the surviving Medicare beneficiaries had at least 1 of [the three diseases studied]."