HOMELESS CHILDREN HAVE HIGH RATES OF ASTHMA

CHICAGO—Prevalence of asthma among homeless children in New York City is approximately 40 percent, which is six times the national rate for children, according to an article in the March issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

"In the United States, children of color, children who live in urban medically underserved communities, and children whose families have limited economic resources have excessively high rates of asthma," according to background information in the article. Identifying high-risk groups of children is important in the development of successful interventions, the article states.

Diane E. McLean, M.D., Ph.D., M.P.H., from Columbia University and the New York State Psychiatric Institute, NY, and colleagues at the Childern's Health Fund and Columbia's Mailman School of Public Health investigated the prevalence of asthma among 740 children whose families entered three New York City family shelters between June 30, 1998 and September 18, 1999.

"Of the children, 26.9 percent had a prior physician diagnosis of asthma. In addition, 12.9 percent of the children without a prior physician diagnosis of asthma reported symptoms consistent with moderate or severe persistent asthma," the authors write. They also found that few of the children with persistent asthma received anti-inflammatory treatment.

The authors state that "High levels of exposure to adverse psychological factors may play a critical role in determining the high levels of severity and undertreatment found among homeless children."

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, March 1, 2004
To contact Karen C. Johnson, M.D., M.P.H., call Elizabeth Maynard-Garrett at 901/448-4957. To contact editorialist William P. Adelman, M.D., call Chito Peppler at 301/295-5727.

MINORS ABLE TO BUY NICOTINE REPLACEMENT THERAPY PRODUCTS

CHICAGO—Although over-the-counter nicotine replacement therapy products like gum and patches have labeling indicating that they are not for sale to minors, these products were successfully purchased by a minor in more than 80 percent of purchase attempts, according to an article in the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

According to the article, an estimated 28.5 percent of high school students smoke cigarettes and more than half try to quit each year. Public health guidelines recommend that health care providers counsel adolescents to stop smoking, and to try nicotine replacement therapy (NRT, including gum, patches, etc.) to help in smoking cessation. Many NRT products are sold over-the-counter, but the labeling on these items indicates that they should not be sold to anyone under 18 years.

Karen C. Johnson, M.D., M.P.H., from The University of Tennessee Health Science Center, Memphis, and colleagues investigated the ability of a minor to purchase over the counter NRT products.

The researchers identified 165 stores (retail, drug stores and grocery stores) in Memphis that sold over the counter NRT products. A 15-year-old girl visited the stores and attempted to buy NRT. She was instructed not to lie about her age, and carried no identification indicating her age. The minor was accompanied by an adult supervisor who entered the stores separately to observe the purchase attempts. The supervisor had no direct contact with the minor or the sales clerks.

In 81 percent of purchase attempts, the minor was able to purchase NRT. She was not questioned about her age in 79 percent of purchase attempts. The researchers also found that if the clerk asked the girl's age, she was much less likely to be allowed to buy NRT.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, March 1, 2004
To contact Kathleen M. Carroll, Ph.D., call Jacqueline Weaver at 203/432-8555.

DISULFIRAM AND COGNITIVE BEHAVIORAL THERAPY APPEAR EFFECTIVE FOR TREATING COCAINE DEPENDENCE

CHICAGO—Disulfiram (a drug used to help selected patients with alcohol disorders remain sober) and cognitive behavioral therapy appear effective in reducing cocaine use, especially among cocaine users who are not dependent on alcohol, according to an article in the March issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

Patients taking disulfiram who ingest even small amounts of alcohol develop a reaction that produces nausea, flushing, vomiting, and throbbing headache. At times, this reaction can be severe and can lead to critical illness, such as severe respiratory problems, circulatory problems, or even death. According to the article, alcohol is a powerful "cue" for using cocaine, and can impair judgment and lower resistance to cravings for cocaine. Researchers hypothesize that by reducing alcohol use with disulfiram, users might be less likely to abuse cocaine. However, use of disulfiram has not been evaluated in general populations of cocaine users.

Kathleen M. Carroll, Ph.D., from Yale University School of Medicine, New Haven, Conn, and colleagues randomly assigned 121 cocaine-dependent adults (average age, 34.6 years) to receive either disulfiram or placebo over a 12-week period. Participants were also randomized to participate in either cognitive behavioral therapy (CBT) or interpersonal psychotherapy (IPT, a less structured form of behavioral therapy).

"Participants assigned to disulfiram reduced their cocaine use significantly more than those assigned to placebo, and those assigned to CBT reduced their cocaine use significantly more than those assigned to IPT," the authors found. The benefits of disulfiram and CBT were most pronounced in participants who were not alcohol-dependent and who did not drink during the study.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, March 1, 2004
To contact George R. Uhl, M.D., Ph.D., call Blair Gately at 301/443-6245.

HIGH SOCIETAL COST OF BRAIN AND NERVOUS SYSTEM DISORDERS ATTRIBUTED TO GENETIC INFLUENCES

CHICAGO—More than 40 percent of the societal burden of brain disorders is estimated to be due to complex genetic influences, according to a special report in the March issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.

George R. Uhl, M.D., Ph.D., of the National Institutes of Health, Baltimore, Md., and Robert W. Grow, M.S., of the National Institutes of Health and The Johns Hopkins University School of Medicine, Baltimore, Md., provided estimates of the impact of complex genetics on brain and nervous system disorders (including depressive illness, stroke, Parkinson disease, Huntington disease, schizophrenia and anxiety disorders) in the United States based on approximations of disease costs to society and disease heritability. Costs were calculated based on literature sources and the Lewin-National Foundation for Brain Research estimates updated for population growth and consumer price index inflation. Heritability estimates were taken from studies based on twins.

"Brain and nervous system disorders may cost the United States as much as $1.2 trillion annually, and affect many millions of American each year," write the authors. "Twin data suggest that more than 40 percent of the societal burden of brain disorders is likely to be genetically mediated." The authors also suggest that most of the disease burden can be traced to complex, multi-gene interactions, as well as environmental factors. Less than 2 percent of the costs can be attributed to single-gene influences.