JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. the Archives of Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENTS
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, November 5, 2007)
STUDY EXAMINES SUBSTANCE ABUSE PREVALENCE AMONG TEENS RECEIVING ROUTINE MEDICAL CARE
SURVEY IDENTIFIES CHARACTERISTICS OF TEENS WHO SMOKE MARIJUANA BUT NOT TOBACCO
MEDICATION PLUS COUNSELING MAY HELP TEENS KICK THE SMOKING HABIT
BEHAVIOR THERAPY PLUS MEDICATION MAY HELP TEENS WITH DEPRESSION AND SUBSTANCE USE DISORDERS
ARCHIVES OF GENERAL PSYCHIATRY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, November 5, 2007)
NON-MATERNAL CARE ASSOCIATED WITH REDUCED LEVELS OF PHYSICAL AGGRESSION IN CHILDREN OF MOTHERS WITH LOW EDUCATION LEVEL
MATERNAL ALCOHOL DRINKING DURING PREGNANCY ASSOCIATED WITH RISK FOR CHILDHOOD CONDUCT PROBLEMS
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, November 5, 2007
Media Advisory: To contact John R. Knight, M.D., call Jamie Newton at 617-355-2520.
STUDY EXAMINES SUBSTANCE ABUSE PREVALENCE AMONG TEENS RECEIVING ROUTINE MEDICAL CARE
CHICAGO—Approximately 15 percent of teens receiving routine outpatient medical care in a New England primary care network had positive results on a substance abuse screening test, according to a report in the November issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
"According to the National Institute on Drug Abuse, addiction is a chronic disease with genetic, environmental and behavioral factors contributing to its cause, manifestations and natural history," the authors write. Addiction often begins during adolescence and can predict future addictive disorders. About 80 percent of teens have begun to drink and half have used an illegal drug by senior year in high school. "Substance use is associated with the leading causes of death among U.S. teenagers: unintentional injuries, homicides and suicides." Depression, conduct disorder and unplanned sexual activity are also associated with substance use.
John R. Knight, M.D., of Harvard Medical School and Children’s Hospital Boston, and colleagues administered a substance abuse screening test consisting of six questions focused on the use of alcohol or other drugs and risky behavior to 2,133 adolescents age 12 to 18 who received outpatient medical care from March 2003 to August 2005.
The sample consisted of 56.3 percent female participants and 48.6 percent non-Hispanic whites. Most came from middle-class and upper−middle-class families. In total, 43.5 percent reported any use of alcohol or other drugs and 24.1 percent reported impaired driving risk during their lifetimes.
Overall, 14.8 percent of teens screened positive for substance abuse on the questionnaire. Of these, 29.5 percent were tested at school-based health centers, 24.2 percent at rural family practice facilities, 16.6 percent at adolescent clinics, 14.1 percent at health maintenance organizations and 8 percent at pediatric clinics. Teens who visited their physicians because they were sick were more likely to screen positive for substance abuse than those who went in for well-child care visits (23.2 percent vs. 7.1 percent).
"Given the pressures of time on primary care providers, more research is needed on efficient and effective office-based systems for substance abuse screening and therapeutic interventions," the authors conclude. "Early identification and intervention of adolescent substance use presents the greatest opportunity for reducing the burden of addictive disorders later in life."
"Substance abuse screening should occur whenever the opportunity arises, not at well-child care visits only."
(Arch Pediatr Adolesc Med. 2007;161(11):1035-1041. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by grants from the Robert Wood Johnson Foundation, the National Institute on Alcohol Abuse and Alcoholism and from the Maternal and Child Health Bureau. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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, November 5, 2007
Media Advisory: To contact J. C. Suris, M.D., Ph.D., e-mail: joan-carles.suris{at}chuv.ch.
SURVEY IDENTIFIES CHARACTERISTICS OF TEENS WHO SMOKE MARIJUANA BUT NOT TOBACCO
CHICAGO—A Swiss study suggests that teens who use only cannabis appear to function better than those who also use tobacco, and are more socially driven and have no more psychosocial problems than those who abstain from both substances, according to a report in the November issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
Cannabis or marijuana is the illegal drug most commonly used by youth, according to background information in the article. Cannibis use is associated with the use of other substances, including tobacco and illegal drugs. "The gateway theory hypothesizes that the use of legal drugs (tobacco and alcohol) is the previous step to cannabis consumption," the authors write. "However, recent research also indicates that cannibis use may precede or be simultaneous to tobacco use and that, in fact, its use may reinforce cigarette smoking or lead to nicotine addiction independently of smoking status."
J. C. Suris, M.D., Ph.D., and colleagues at the University of Lausanne, Switzerland, analyzed data from a 2002 national survey of Swiss students aged 16 to 20 years. A total of 5,263 students were included in the analysis, including 455 who smoked marijuana only, 1,703 who smoked marijuana and tobacco and 3,105 who abstained from both substances.
"Our findings in this nationally representative sample of adolescents show that 6 percent of them use cannabis without having used tobacco and that one-fifth of current cannabis users (21.1 percent) declare never having used tobacco," the authors write.
The survey also found that, compared with students who used both substances, students who smoked marijuana only were more likely to be male (71.6 percent vs. 59.7 percent), play sports (85.5 percent vs. 66.7 percent), live with both parents (78.2 vs. 68.3) and have good grades (77.5 vs. 66.6). However, they were less likely to have been drunk in the past 30 days (40.5 percent vs. 55 percent), have started using cannabis before the age of 15 years (25.9 percent vs. 37.5 percent), to have smoked marijuana more than once or twice during the previous 30 days (44 percent vs. 66 percent) or to use other illegal drugs (8.4 percent vs. 17.9 percent).
Compared with students who abstained from both substances, marijuana users were more likely to be male (71.6 percent vs. 47.7 percent), to have a good relationship with their friends (87.0 percent vs. 83.2 percent), to be sensation-seeking (37.8 percent vs. 21.8 percent) and to play sports (85.5 percent vs. 76.6 percent), and less likely to have a good relationship with their parents (74.1 percent vs. 82.4 percent).
Although teens who smoke both marijuana and tobacco seem to have more psychosocial problems and thus may be worthy targets for preventive intervention, those who smoke marijuana only also should be monitored closely and counseled. "In any case, and even though they do not seem to have great personal, family, or academic problems, the situation of those adolescents who use cannabis but who declare not using tobacco should not be trivialized," the authors conclude.
(Arch Pediatr Adolesc Med. 2007;161(11):1042-1047. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by a contract from the Swiss Federal Office of Public Health and the participating cantons. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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, November 5, 2007
Media Advisory: To contact Myra L. Muramoto, M.D., M.P.H., call Darci Slaten at 520-626-7217.
MEDICATION PLUS COUNSELING MAY HELP TEENS KICK THE SMOKING HABIT
CHICAGO—The medication bupropion plus counseling appears to help adolescents quit cigarette smoking in the short term, according to a report in the November issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
Almost one-fourth of U.S. high school students currently smoke cigarettes, according to background information in the article. Many teen smokers want to quit, but studies estimate that only about 4 percent of those who try are successful each year. The antidepressant bupropion has been shown to help adults quit smoking and also is used to treat attention deficit disorders in children.
Myra L. Muramoto, M.D., M.P.H., Scott J. Leischow, Ph.D., and colleagues at the University of Arizona, Tucson, conducted a clinical trial of 312 adolescents age 14 to 17 who smoked six or more cigarettes per day and had tried to quit at least twice before. They were randomly assigned to receive 150 milligrams (105 teens) or 300 milligrams (104 teens) of bupropion per day, or placebo (103 teens). Participants visited the clinic weekly for seven weeks—six weeks of treatment plus one week post-treatment—and received 10- to 20-minute individual cessation counseling sessions. They were interviewed by phone after 12 weeks and in person after 26 weeks.
During treatment, quit rates were higher for the 300-milligram group than for placebo every week except the fourth week. After six weeks, 5.6 percent of those in the placebo group, 10.7 percent of those in the 150-milligram bupropion group and 14.5 percent of those in the 300-milligram group had quit smoking. At the 26-week follow-up, 10.3 percent of those who took placebo, 3.1 percent of those who took 150 milligrams of bupropion and 13.9 percent of those who took 300 milligrams were still abstaining from cigarettes. The teens’ reported quit rates were verified by checking the level of cotinine, a byproduct of nicotine processing, in the urine.
Though the results suggest that 300 milligrams of bupropion plus brief counseling sessions may help teens quit smoking over the short term, abstinence rates at the end of the treatment period were lower than those seen in adults taking the same medication, the authors note. In addition, the high rate of relapse after stopping medication suggests that a longer treatment period—such as the 12 weeks recommended for adult smokers—may be needed.
“Nonetheless, this study provides hope for helping a generation of smokers quit before they become adults,” the authors conclude. “These results are critically important because few effective treatment options are available for adolescent smokers who want to quit.”
(Arch Pediatr Adolesc Med. 2007;161(11):1068-1074. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by a National Cancer Institute grant, The Robert Wood Johnson Foundation (financial support for all aspects of the study) and GlaxoSmithKline (provided study medication and placebo, financial support for cotinine analyses, subject screening, data cleaning and review of the draft manuscript; all data were maintained by the University of Arizona). Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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, November 5, 2007
Media Advisory: To contact Paula D. Riggs, M.D., call Tonya Ewers-Maikish at 303-724-1524.
BEHAVIOR THERAPY PLUS MEDICATION MAY HELP TEENS WITH DEPRESSION AND SUBSTANCE USE DISORDERS
CHICAGO—The antidepressant fluoxetine combined with cognitive behavioral therapy appears as effective for treating depression among teens who also have substance use disorders as among those without substance abuse problems, according to a report in the November issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
"Adolescents with substance use disorders (SUDs) have higher rates of depression (15 percent to 24 percent) than adolescents in the general population," the authors write as background information in the article. "Comorbid [co-occuring] depression is also associated with more severe substance abuse, poorer drug treatment outcomes and higher relapse rates."
Paula D. Riggs, M.D., and colleagues at the University of Colorado Denver conducted a randomized controlled trial of the antidepressant fluoxetine in 126 teens (average age 17) who met diagnostic criteria for major depressive disorder, lifetime conduct disorder and at least one substance abuse disorder other than tobacco. The adolescents were randomly assigned to receive either 20 milligrams of fluoxetine daily or placebo, along with cognitive behavioral therapy, a type of psychotherapy addressing the way individuals currently think and act rather than past events. The cognitive behavior therapy was focused on substance abuse rather than depression.
At the end of the 16-week treatment period, fluoxetine combined with cognitive behavioral therapy improved the teens’ scores on one of the two depression scales used. There were no significant differences on the other depression scale or in substance use or conduct disorder symptoms between the fluoxetine and placebo groups.
The results, the authors write, "indicate that, in the context of cognitive behavior therapy (substance abuse treatment), co-occurring depression may improve or remit without antidepressant pharmacotherapy. However, if depression does not appear to be improving early in the course of substance treatment, fluoxetine treatment should be considered, even if adolescents are not yet abstinent, with weekly monitoring of treatment adherence, substance use, adverse effects and target symptom response."
(Arch Pediatr Adolesc Med. 2007;161(11):1026-1034. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by a grant from the National Institute on Drug Abuse, National Institutes of Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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, November 5, 2007
Media Advisory: To contact Sylvana M. Côté, Ph.D., call Christine Marcoux at 514-343-6963.
NON-MATERNAL CARE ASSOCIATED WITH REDUCED LEVELS OF PHYSICAL AGGRESSION IN CHILDREN OF MOTHERS WITH LOW EDUCATION LEVEL
CHICAGO—Among children of mothers with low education levels, those who receive regular care from other adults during preschool years may be less likely to have problems with physical aggression, according to a report in the November issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Hitting, kicking, biting and other forms of physical aggression are central features of a severe conduct disorder, according to background information in the article. These behaviors may be associated with social, physical and mental health problems. "The origin of physical aggression problems can be traced back to early childhood, and studies have specifically shown that maternal characteristics, especially low levels of education, are among the best predictors of high physical aggression from early childhood to adolescence," the authors write.
Sylvana M. Côté, Ph.D., of the University of Montreal, and colleagues studied 1,759 infants representative of all children born in Quebec in 1997 or 1998. Mothers were interviewed yearly from the time the children were age 5 months to 60 months, answering questions about family, parent and child characteristics and behaviors. This included details about non-maternal care services, provided to care for a child, usually while the mother is working. This may have involved center-based day care, family arrangements or other non-maternal care provided regularly during preschool years. Physical aggression levels were evaluated at 17, 30, 42, 54, and 60 months.
Of the 1,691 children who were followed for the whole study, 111 (6.6 percent) received no non-maternal care before preschool, 234 (13.8 percent) received some type of non-maternal care beginning before age 9 months and 1,346 (79.6 percent) received non-maternal care beginning at age 9 months or after. Children whose mothers had a low education level (i.e., did not have a high school diploma) were less likely to receive day care. However, children who did receive non-maternal care had lower levels of physical aggression, and the association was statistically significant among children who started day care before age 9 months.
Children of mothers who graduated from high school were at lower risk of developing physical aggression problems, and non-maternal care had no additional effect on their behavior.
"In summary, we provide robust evidence that the provision of non-maternal care services to children of mothers with low levels of education could substantially reduce their risk of chronic physical aggression, and that the protective impact is more important if children begin to receive these services before age 9 months," the authors conclude. "Because the children most likely to benefit from non-maternal care services are those less likely to receive them, universal programs involving the provision of non-maternal care should include special measures encouraging the use of non-maternal care services among high-risk families."
(Arch Gen Psychiatry. 2007;64(11):1305-1312. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This research was supported by the Quebec Government Ministry of Health and Fond, Quebecois de la Recherche sur la Societe et la Culture, Canada’s Social Science and Humanities Research Council, Canadian Institutes for Health Research, St-Justine Hospital’s Research Center and the University of Montreal. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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, November 5, 2007
Media Advisory: To contact Brian M. D'Onofrio, Ph.D., call Tracy James at 812-855-0084.
MATERNAL ALCOHOL DRINKING DURING PREGNANCY ASSOCIATED WITH RISK FOR CHILDHOOD CONDUCT PROBLEMS
CHICAGO—Maternal alcohol drinking during pregnancy appears to be associated with conduct problems in children, independently of other risk factors, according to a report in the November issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Previous research has linked maternal drinking during pregnancy to several problems in offspring, including conduct problems, criminal behavior, attention and impulsivity problems and alcohol disorders, according to background information in the article. However, new questions have been raised about the strength of the evidence, as some researchers have suggested that certain family processes or genetic risk factors could be associated with both maternal drinking and childhood problems.
Brian M. D’Onofrio, Ph.D., of Indiana University, Bloomington, and colleagues analyzed data from 4,912 mothers who enrolled in a large national survey in 1979. Yearly through 1994 and then every other year through 2004, the women answered questions about their substance use during each of their pregnancies. Beginning in 1986, 8,621 of their offspring were also assessed every other year between ages 4 and 11 for behavioral problems.
For each additional day per week that mothers drank alcohol during pregnancy, their children had an increase in conduct problems. This association remained even after factoring in other variables such as the mothers’ drug use during pregnancy, education level or intellectual ability.
Children whose mothers drank alcohol during pregnancy also had more attention and impulsivity problems than unrelated children whose mothers did not drink. However, siblings whose mother drank more frequently during one pregnancy had the same level of difficulty with attention and impulsivity.
"These results are consistent with prenatal alcohol exposure exerting an environmentally mediated causal effect on childhood conduct problems, but the relation between prenatal alcohol exposure and attention and impulsivity problems is more likely to be caused by other factors correlated with maternal drinking during pregnancy," they continue. These other factors may include the use of tobacco, illegal drugs and other substances in addition to alcohol.
"The findings thus support a strong inference that prenatal alcohol exposure causes an increased risk of offspring conduct problems through environmental processes," the authors conclude. "Therefore, prevention efforts should continue to target alcohol consumption during pregnancy."
(Arch Gen Psychiatry. 2007;64(11):1296-1304. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This research was supported by a grant from the National Institute of Mental Health (co-author Dr. Lahey). Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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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