(Embargoed Until: 3 P.M. (CT), Monday, May 3, 2004)
(Embargoed Until: 3 P.M. (CT), May 3, 2004)
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, May 3, 2004
To contact Margaret R. Savoca, Ph.D., call Toni Baker at 706/721-4421. To contact editorialist Stephen R. Daniels, M.D., call Jim Feuer at 513/636-4656.
CAFFEINE CONSUMPTION ASSOCIATED WITH INCREASES IN BLOOD PRESSURE IN ADOLESCENTS
CHICAGO—Caffeine intake is associated with increased blood pressure in some adolescents, according to an article in the May issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
According to the article, the prevalence of hypertension among youth is rising, and African American adolescents have higher systolic blood pressures (the top blood pressure number) than white adolescents. "Caffeine is considered a preventable risk factor for hypertension and cardiovascular disease," the authors write. "It is estimated that 68 percent of boys and 62 percent of girls aged 12 to 17 years drink one or more soft drinks daily and 21 percent of boys and 22 percent of girls consume coffee or tea on a daily basis."
Margaret R. Savoca, Ph.D., of the Medical College of Georgia, Augusta, and colleagues investigated the association between the consumption of caffeinated beverages and blood pressure in 81 African American (32 boys, 49 girls) and 78 white (56 boys, 22 girls) adolescents (average age, 16.4 years). Participants were placed on a sodium-controlled diet for three days, and then asked to select food and drinks from a menu that they would consume for a three-day period. The menu included a variety of breakfast, lunch, dinner, snack, and beverage choices. Of the 15 beverage choices, six contained caffeine. There were also ten chocolate items with small amounts of caffeine. Based on their caffeine intake, participants were categorized into three groups: 0-50 milligrams per day of caffeine, 50-100 milligrams of caffeine per day, and more than 100 milligrams of caffeine per day.
The researchers found that the association between systolic blood pressure and caffeine category varied by race. African Americans consuming more than 100 milligrams per day of caffeine (n=11) had higher systolic blood pressure readings than the other two groups. The effect on diastolic blood pressure (the bottom number) of the participants consuming more than 100 milligrams per day was 3.7 millimeters of mercury higher than the group consuming more than 50 to 100 milligrams per day, and was not significantly different from the group consuming 0 to 50 milligrams per day.
"In this observational study, we identified a group of adolescents who chose and subsequently consumed large amounts of caffeinated beverages during a three-day sodium-controlled diet," the authors write. "The African Americans in the highest caffeine-intake category had higher systolic blood pressure readings than all other adolescents in the study, including white participants in the highest caffeine-intake category."
"For adolescents, especially African American adolescents, caffeine intake may increase blood pressure and thereby increase the risk of hypertension," write the researchers. "Alternatively, caffeinated drink consumption may be a marker for dietary and lifestyle practices that together influence blood pressure. Additional research is needed owing to rising rates of adolescent hypertension and soft drink consumption."
(Arch Pediatr Adolesc Med. 2004;158:473-477. Available post-embargo at archpediatrics.com)
Editor's Note: This study was supported by grants from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.
EDITORIAL: Diet and Blood Pressure Elevation in Children and Adolescents
In an accompanying editorial, Sarah C. Couch, Ph.D., R.D. of Cincinnati and Stephen R. Daniels, M.D., Ph.D., of Cincinnati Children's Hospital Medical Center, Ohio, comment on the study by Savoca et al. "Of interest, there was no dose-response relationship between blood pressure and caffeine among white teens or in African American adolescents consuming caffeine intakes less than 100 milligrams per day, suggesting individual variations in caffeine metabolism and/or adaptation to habitual use, both of which could influence the effects of caffeine on blood pressure. Alternatively, greater genetic susceptibility to hypertension and/or coexisting 'unhealthful' dietary and lifestyle habits (low fruit, vegetable, and dairy consumption and lack of exercise) among the African American high caffeine users could potentially explain the higher systolic blood pressure in this group of adolescents," the editorialists write.
They conclude, "… the study provides evidence that high caffeine intakes, particularly from soda, should be included among the dietary components to evaluate in adolescents with hypertension or with a family history of high blood pressure. This finding is important, given recent statistics that soft drink consumption has more than tripled among adolescents in the past three decades."
(Arch Pediatr Adolesc Med. 2004;158:418-419. Available post-embargo at archpediatrics.com)
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, May 3, 2004
To contact Wendy P. Pulver, M.S., call the Office of Public Affairs for the New York State Health Department at 518/474-7354. To contact editorialist Lynne M. Mofenson, M.D., call Bob Bock at 301/496-5133.
PREVALENCE OF HIV AMONG CHILDBEARING WOMEN HAS DECLINED IN NEW YORK
CHICAGO—The prevalence of human immunodeficiency virus (HIV) infection among childbearing women has declined in New York from 1988 through 2000, according to an article in the May issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
According to information in the article, infection with HIV has increasingly occurred among women of childbearing age, with New York State (NYS) having the largest proportion of HIV-infected women and children in the United States. In November 1987, the NYS Department of Health began monitoring the HIV epidemic among childbearing women with the implementation of the Survey of Childbearing Women, in which blood specimens from all infants born in NYS were tested for HIV antibodies by the state Newborn Screening Program.
Wendy P. Pulver, M.S., of the New York State Department of Health, Albany, and colleagues assessed HIV prevalence trends among childbearing women in NYS from 1988 through 2000. A total of 3.43 million infants were tested for HIV antibodies during the 13-year period studied
The researchers found that trends indicated a steady decline in HIV prevalence in NYS over the study period. New York City had a 49 percent decrease in prevalence from 1.22 percent between 1988 through 1989 to 0.62 percent in 1999 through 2000. The rest of NYS showed a 24 percent decline (from 0.17 percent to 0.13 percent). Analysis showed that some areas of the state experienced little or no decline.
"White and Hispanic women experienced the greatest declines in NYC (68 percent and 61 percent, respectively)," the researchers write. "African American women in NYC also experienced a decline in prevalence (31 percent) but not as great a decline as that seen in white and Hispanic women. Outside NYC, Hispanic and African American women (73 percent and 37 percent, respectively) also experienced declines, with white women showing the smallest decline (17 percent)."
The researchers discuss several factors that may contribute to the decline: the widespread use of highly active antiretroviral therapy; older women with HIV were likely dying prematurely or having difficulty conceiving or carrying an infant to term; and efforts aimed at minority populations were successful in affecting women in NYS.
"Throughout this period, significant declines in HIV prevalence have been observed in New York among childbearing women," the researchers write. "In addition, there have been dramatic decreases in the number of deaths due to AIDS in NYS. The availability of highly active antiretroviral therapy may lead some HIV-infected women to decide to become pregnant because of a more positive outlook for their own health and because, coupled with the use of zidovudine [an anti-HIV drug], the therapy reduces vertical transmission, resulting in a potential reversal of the observed downward trends in maternal HIV prevalence among childbearing women. Thus, the continued decrease in prevalence is even more remarkable because of this possibility that more women who know their HIV status may be electing to have children."
The researchers conclude: "These data will continue to be used to evaluate and target HIV prevention efforts and serve as an early warning of changes in populations at risk as the epidemic continues to evolve."
(Arch Pediatr Adolesc Med. 2004;158:443-448. Available post-embargo at archpediatrics.com)
Editor's Note: Data collection for this study was initially partially supported with funding through cooperative agreements with the Centers for Disease Control and Prevention, Atlanta, Ga.
EDITORIAL: Successes and Challenges in the Perinatal HIV-1 Epidemic in the United States as Illustrated by the HIV-1 Serosurvey of Childbearing Women
In an accompanying editorial by Lynne M. Mofenson, M.D., of the National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Md., writes that although HIV mother-to-child transmission (MTCT) rates have decreased in the United States over the past ten years, MTCT still occurs. Dr. Mofenson writes that "Whereas adolescent pregnancy rates have declined, adolescent pregnancy rates remain higher in the United States than in many other resource-rich countries, and they are particularly high among adolescents of minority race or ethnicity, the very group most at risk for HIV-1 infection. Thus, prevention of unwanted adolescent pregnancies is also an important component of preventing MTCT."
Of the study by Pulver and colleagues, Dr. Mofenson writes, "First, the study illustrates the focality of the HIV-1 epidemic; even within the high-risk area of New York City, there was a focus of higher HIV-1 prevalence in the Bronx. This is consistent with the concept of core subpopulations that create an interrelated high-risk transmission network for infection that has been reported for other sexually transmitted diseases."
"Second, the study demonstrates the disproportional impact of HIV-1 infection on women of minority race or ethnicity. Despite a general decline in HIV-1 [prevalence] among childbearing women in New York State in general, this decline was lowest in women of minority race or ethnicity, particularly in younger African American women in New York City for whom the rate of [prevalence] was stable or increased over time."
Dr. Mofenson concludes, "In summary, the New York State longitudinal [survey] of childbearing women is invaluable for understanding the HIV-1 epidemic in women and children in New York and for the development of targeted programs and new policies to intervene and prevent MTCT. It provides a model for the conduct of surveillance programs in other areas of the United States."
(Arch Pediatr Adolesc Med. 2004;158:422-425. Available post-embargo at archpediatrics.com)
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, May 3, 2004
To contact Jill S. Halterman, M.D., M.P.H., call Travis Anderson at 585/273-1757.
ASTHMA SYMPTOMS REDUCED AMONG CHILDREN WHOSE SCHOOLS PROVIDED ASTHMA MEDICATION
CHICAGO—Urban children with asthma who attended schools that provided inhaled corticosteroids (an asthma medication) had improved symptoms and fewer days absent from school than children in a usual care group (inhaled corticosteroids not given through school), according to an article in the May issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
According to the article, national guidelines recommend that children with mild to severe persistent asthma take daily maintenance medications (including inhaled corticosteroids), but undertreatment with these medications and poor adherence is common, especially for young urban children.
Jill S. Halterman, M.D., M.P.H., of the University of Rochester School of Medicine and Dentistry, N.Y., and colleagues evaluated the impact of school-based provision of inhaled corticosteroids on asthma severity among urban children.
The researchers identified children aged three to seven years with mild to severe persistent asthma at the start of the 2000-2001 and 2001-2002 school years in Rochester, N.Y. Of the 242 eligible children, 184 enrolled in the study, and data for 180 children was available.
For the school-based care group (n=89), one dose of inhaled corticosteroid from an inhaler was given by the school nurse each day the child was in school. For days the child was home, the parents were provided with a second, identical inhaler for daily doses. Primary care practitioners and parents of children in the usual care group (n=91) were informed of the child's asthma severity and parents were advised to contact their clinician for asthma care.
Children in the school-based care group missed fewer days of school compared to children in the usual care group (average number of days missed, 6.8 vs. 8.8), and had more symptom-free days during the early winter months (average number of days in a two week period, 9.2 vs. 7.3).
In later analysis, the researchers found that their findings were caused by differences among children who were not exposed to secondhand smoke. Among children not exposed to secondhand smoke, those in the school-based care group (47 children) had more symptom-free days compared to children in the usual-care group (54 children) (11.5 vs. 10.5 days), had fewer days needing rescue medications (1.6 vs. 2.3 days) and were less likely to have had three or more emergency visits for asthma.
"This study demonstrates two new and potentially important findings about the management of urban children with asthma: the utility of a system change involving school-based provision of inhaled corticosteroids and the ineffectiveness of this program among those children with secondhand smoke in their homes," the authors write.
The authors conclude: "Most children included in this study were poor and from minority populations, and represent the group with the greatest need for assistance with this common chronic illness. If these findings are replicated in other settings, this school-based system of preventive care could become standard for the management of childhood asthma in underserved communities."
(Arch Pediatr Adolesc Med. 2004;158:460-467. Available post-embargo at archpediatrics.com)
Editor's Note: This study was supported by a grant from the Halcyon Hill Foundation, Webster, N.Y.; and by the Robert Wood Johnson Foundation's Generalist Physician Faculty Scholars Program.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, May 3, 2004
To contact R. Jay Turner, Ph.D., call Jill Elish at 850/644-8345.
STRESS LINKED TO INCREASED RISK OF DEPRESSIVE AND ANXIETY DISORDERS
CHICAGO—High levels of stress during childhood and young adulthood are associated with depressive and anxiety disorders among young adults, according to an article in the May issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.
The idea that stress or adversity (major and potentially traumatic events experienced during one's lifetime) affect health and well-being is widely accepted by the public and by many researchers and physicians, the article states. Evidence has accumulated linking exposure to recent stressful events with psychological distress, most typically with depressive symptoms.
R. Jay Turner, Ph.D., and Donald A. Lloyd, Ph.D., of Florida State University, Tallahassee, investigated whether lifetime exposure to adversity was a risk factor for the later onset of depressive and anxiety disorders.
The researchers conducted a 1,803 interviews (between 1998 and 2000) among a sample of individuals aged 18 to 23 years living in a southern Florida community, most of whom participated in another study five to seven years earlier. Participants were interviewed (either in their homes or over the telephone) and were assessed for major depression, dysthymia (a mild, chronic form of depression), generalized anxiety disorder, social phobia, panic disorder, alcohol abuse and dependence, drug abuse and dependence, posttraumatic stress disorder, and antisocial personality disorder. Interviewers also asked about specific kinds of stressful events or traumatic incidents over the course of the participants' lifetimes.
The researchers found that the level of lifetime exposure to adversity was associated with an increased risk of developing depressive or anxiety disorders.
The researchers write: "As previously reported, these results indicate that exposure to major and potentially traumatic events is commonplace among young people, at least in South Florida. The typical African American in the sample had experienced more than nine such events, and the remaining three groups [Cuban, Hispanic, and non-Hispanic white] averaged more than six. A total of 26 of the 33 events examined were associated with significantly increased risk for a depressive or anxiety disorder. In some cases the experience itself may be implicated in the observed elevation in risk, whereas in others the event may represent simply a marker for the occurrence of other stressors and/or the presence of other significant risk factors."
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, May 3, 2004
To contact corresponding author John C. S. Breitner, M.D., call Ellen Flores at 206/764-2435.
PRESENCE OF GENETIC VARIATION APPEARS TO ACCELERATE ONSET OF ALZHEIMER DISEASE
CHICAGO—The APOE ε4 allele (variation in a certain gene that has been linked with Alzheimer disease) appears to be a powerful risk factor for developing Alzheimer disease (AD), and may accelerate the onset of AD in some persons, but not all, according to an article in the May issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.
According to background information in the article, the incidence of AD increases with age, but little is known about the cumulative incidence of AD over a very long lifetime (100 years) or its relationship to the APOE ε4 allele, a genetic variation that has been identified as a strong genetic risk factor for AD. The prevalence of AD may reach 45 percent or higher after 85 years of age, the article states.
The Cache County, Utah population has been extensively studied for the occurrence of AD. The population is one of the longest-lived in the United States, and includes 719 individuals older than 85 and 249 individuals 90 years and older. Additionally, 97 percent of the population has donated DNA for analysis of the APOE allele.
Ara S. Khachaturian, Ph.D., of Khachaturian and Associates, Inc., Potomac, Md., and colleagues estimated the occurrence of AD as it relates to age, and the number of APOE ε4 alleles in 3,308 elderly participants in the Cache County Study.
The researchers entered their data into a model that estimated the 100-year lifetime incidence of AD was 72 percent, implying that 28 percent of individuals would not develop AD over any reasonable life expectancy. The researchers confirmed that the onset of AD was accelerated in individuals with one and especially with two, APOE ε4 alleles.
"These analyses support our previous observation that APOE genotype primarily influences when, and not whether, individuals will develop AD," the researchers write.
"Our findings do not dispute the importance of APOE as a risk factor for AD. They do, however, suggest a different role for APOE than is sometimes discussed. Through its effects on the timing of disease expression, the gene appears to influence the age-specific risk of AD onset," write the authors. They write that the presence of one, and especially two APOE ε4 alleles "translates to a strongly increased age-specific risk of AD, especially in early old age."
(Arch Gen Psychiatry. 2004;61:518-524. Available post-embargo at archgenpsychiatry.com)
Editor's Note: This study was supported by a grant from the National Institutes of Health, Bethesda, Md. (Dr. Breitner) and a grant from the National Institute of Mental Health (Dr. Zandi).
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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