ENGLISH-SPEAKING HISPANIC YOUTH MORE LIKELY TO HAVE SEX EARLY

CHICAGO—Hispanic teenagers with lower acculturation (integration into American society) who use Spanish as their primary language are significantly less likely than their English-speaking more highly acculturated Hispanic peers to have had an initial experience of sexual intercourse, according to an article in the March issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

Although researchers have begun to estimate the contribution of other social factors such as income or family structure to reported differences among ethnic/racial groups in sexual behavior, sexually transmitted diseases, and pregnancy, a focus on between-group differences within racial/ethnic groups is also necessary to understand these differences in behaviors, according to background information in the article. The current study focuses on the variability within Hispanic adolescents in the onset of sexual intercourse.

Mary B. Adam, M.D., M.A., of the University of Arizona, Tucson, Ariz., and colleagues used preprogram survey data from 7,270 Hispanic or white teens in seventh to 12th grade involved in the Arizona Abstinence-Only Education Program to predict the probability of onset of sexual intercourse based on age, gender, family structure, program location, religiosity, free school lunch, grades, rural residence, acculturation, and ethnicity. Specific attention was given to the influence of their integration into U.S. culture among Hispanic teens. The primary language spoken by the respondents (English, Spanish, or both) was used as a proxy (substitute) measure for their integration into U.S. culture.

"Although Spanish-speaking Hispanic youth differ from English-speaking Hispanic youth on most of the variables in our model...the multivariate analysis allows us to consider the effect of the ethnicity and language beyond the impact of those other predictors," the authors state. "We find that acculturation has a unique contribution to the onset of intercourse beyond those other predictors."

Overall, Hispanic youth were at greater risk for having experienced sexual intercourse than white youth, when controlling for all other predictors, the researchers found. However, when acculturation was considered, less acculturated Hispanic youth were 40 percent less likely to have experienced first intercourse than white youth, 65 percent less likely than English-speaking Hispanic youth and 55 percent less likely than bilingual Hispanic youth. Highly acculturated Hispanic English-speaking teens were 170 percent more likely to have had intercourse than white youth.

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COGNITIVE BEHAVIORAL THERAPY AND MEDICATION IS EFFECTIVE IN THE TREATMENT OF PANIC DISORDER

CHICAGO—Therapy for panic disorder that combines an evidence-based cognitive behavioral therapy (CBT) with medication may be more effective than the usual care offered to these patients in a primary care setting, according to an article in the March issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.

Panic disorder is one of the most disabling and costly anxiety disorders and is commonly treated in primary care settings, according to background information in the article. This randomized, controlled trial assesses the extent to which the benefits of evidence-based, specialist-delivered, panic disorder interventions can be generalized to primary care settings with non-specialist therapists and more diverse patient populations.

Peter P. Roy-Bryne, M.D., of the University of Washington School of Medicine at Harborview Medical Center, Seattle, and colleagues randomly assigned 232 primary-care patients meeting the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV) criteria for panic disorder to receive treatment as usual (medication and counseling from the physician on recognition and treatment of panic disorder) or to receive an intervention consisting of up to six sessions in the course of three months of CBT, with up to six follow-up telephone contacts during the next nine months, and medications provided by the primary care physician with guidance from a psychiatrist. The patients were selected from six primary care clinics associated with three university medical schools, serving a diverse patient population.

"The combined cognitive-behavioral and pharmacotherapeutic [medications] intervention resulted in sustained and gradually increasing improvement relative to treatment as usual," the authors state. The proportion of patients who remitted, defined as patients who had had no panic attacks in the past month, minimal anticipatory anxiety about panic and a low score on a measure of agoraphobia [fear of going out], was significantly higher than those receiving usual care at all points-at three months, 20 percent versus 12 percent and at 12 months, 29 percent versus 16 percent. The proportion of patients who responded, defined by a low score on a test for anxiety level, was also significantly higher than those receiving usual care at all points-at three months, 46 percent versus 27 percent, and at 12 months, 63 percent versus 38 percent.

The patients receiving the CBT and medication intervention also made significantly greater improvements on two standard measures of mental health functioning. "These effects were obtained in spite of similar rates of delivery of guideline-concordant [appropriate, taken as directed] pharmacotherapy to the two groups," the authors write.

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COLLEGE STUDENTS AT NO GREATER RISK OF ALCOHOL-RELATED PROBLEMS THAN PEERS

CHICAGO—Although college students had higher rates of yearly, monthly, and weekly alcohol use than their peers not attending college, they did not appear to be at a greater risk for alcohol dependence problems, according to an article in the March issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.

According to background information in the article, binge drinking among college students has been identified as a major public health problem by the U.S. Surgeon General and the U.S. Department of Health and Human Services. A recent report estimated that alcohol is involved in about 1,400 student deaths, 500,000 injuries, 600,000 assaults, and 70,000 sexual assaults each year on college campuses. Other studies have generally found that, compared to their same-age peers, college students are more likely to take part in heavy and/or binge drinking.

Wendy S. Slutske, Ph.D., from the University of Missouri at Columbia, compared alcohol use disorders in young adults attending college and their peers not attending college. The researchers used data from the 2001 National Household Survey on Drug Abuse (NHSDA), focusing on people aged 19 to 21 years. Of the 6,352 participants, 51 percent were female, 66 percent were white, 14 percent were African American, and 14 percent were Hispanic. Participants were asked about the quantity and frequency of their yearly, monthly, weekly, and daily alcohol consumption, including any binge drinking.

The researchers found that in the past year, 18 percent of U.S. college students (24 percent of men, 13 percent of women) had alcohol-related problems, compared with 15 percent of their non-college-attending peers (22 percent of men, 9 percent of women). The college students also exceeded their peers in all yearly, monthly, and weekly alcohol use, as well as weekly binge drinking, although daily drinking was more common among those not in college. Although college students were drinking more, they weren't more likely to be diagnosed with alcohol dependence.

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CURRENT DAILY SMOKING MAY BE ASSOCIATED WITH INCREASED RISK FOR SUICIDAL THOUGHTS AND ATTEMPTS

CHICAGO—Suicidal thoughts or attempts are associated with daily smoking in current smokers, but not former smokers, according to an article in the Archives of General Psychiatry, one of the JAMA/Archives journals.

"A link between cigarette smoking and suicide has been reported in epidemiological investigations since the 1970s," according to background information in the article. However, these interpretations have been subject to controversy. It is believed that depression may result in part from smoking and should not be controlled in analysis of this relationship. However, it's also been reported that symptoms of depression in adolescents predicts their starting smoking and that major depression leads to an increased risk for regular smoking and dependence; therefore, a history of depression must be considered when examining suicide in smokers.

Naomi Breslau, Ph.D., from Michigan State University, East Lansing, and colleagues examined the association between cigarette smoking and suicidal thoughts and attempts. Participants aged 21 to 30 years were interviewed in 1989 and completed follow-up interviews in 1992, 1994, and 1999 - 2001. At each assessment, they were asked about lifetime smoking history, whether they were current daily smokers or had been in the past, and psychiatric disorders. Nearly nine hundred people completed all three investigations.

During the ten-year follow-up, nineteen participants attempted suicide, while 130 reported having suicidal thoughts. The researchers found that current daily smoking, but not past smoking, as reported at the beginning of each of the assessments, predicted the subsequent occurrence of suicidal thoughts or attempt. These findings remained when adjusted statistically for prior depression, substance use disorders, prior psychiatric disorders and prior suicidal disposition. Rates of suicidal behavior were also higher in those experiencing depression at the start of each follow-up period.