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 GENERAL PSYCHIATRY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, February 2, 2009)
Teen Media Exposure Associated With Depression Symptoms in Young Adulthood
Hormone Level During Pregnancy May Identify Women at Risk for Postpartum Depression
Study Examines Association Between Mental Illness and Violent Behavior
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, February 2, 2009)
An Estimated One-Third of U.S. Children and Teens Take Vitamin or Mineral Supplements
African American Parents More Likely to Report Distrust of Medical Research
Teens Who Frequently Go Out With Friends More Likely to Use Marijuana
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, February 2, 2009
Media Advisory: To contact Brian A. Primack, M.D., Ed.M., M.S., call Amy Dugas Rose at 412-586-9776 or e-mail dugasak{at}upmc.edu.
Teen Media Exposure Associated With Depression Symptoms in Young Adulthood
CHICAGO—Exposure to more television and other electronic media during the teenage years appears to be associated with developing depression symptoms in young adulthood, especially among men, according to a report in the February issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Depression, the leading cause of non-fatal disability worldwide, commonly begins in adolescence or young adulthood, according to background information in the article. "The development of depression in adolescence may be understood as a biopsychosocial, multifactorial process influenced by risk and protective factors including temperament, genetic heritability, parenting style, cognitive vulnerability, stressors (e.g., trauma exposure or poverty) and interpersonal relationships," the authors write. Media exposure is another plausible influence, since teens are exposed to an average of eight and one-half hours of electronic media per day.
Brian A. Primack, M.D., Ed.M., M.S., of the University of Pittsburgh School of Medicine, and colleagues used data from the National Longitudinal Survey of Adolescent Health (Add Health) to determine exposure to electronic media among 4,142 adolescents who were not depressed at the beginning of the study in 1995. The teens were asked how many hours they had spent during the last week watching television or videocassettes, playing computer games or listening to the radio (the survey was conducted before DVDs or the Internet became widely used). They reported an average of 5.68 hours of media exposure per day, including 2.3 hours of television, 0.62 hours of videocassettes, 0.41 hours of computer games and 2.34 hours of radio.
Seven years later (at an average age of 21.8), participants were screened and 308 (7.4 percent) had developed symptoms consistent with depression. "In the fully adjusted models, participants had significantly greater odds of developing depression by follow-up for each hour of daily television viewed," the authors write. "In addition, those reporting higher total media exposure had significantly greater odds of developing depression for each additional hour of daily use." Given the same amount of media exposure, young women were less likely to develop symptoms of depression than young men.
Media exposure could influence the development of depression symptoms through many different mechanisms, the authors note. The time spent engaging with electronic media may replace time that would otherwise be spent on social, intellectual or athletic activities that may protect against depression. Media exposure at night may disrupt sleep, which is important for normal cognitive and emotional development. In addition, messages transmitted through the media may reinforce aggression and other risky behaviors, interfere with identity development or inspire fear and anxiety.
"Psychiatrists, pediatricians, family physicians, internists and other health care providers who work with adolescents may find it useful to ask their patients about television and other media exposure," the authors write. "When high amounts of television or total exposure are present, a broader assessment of the adolescent's psychosocial functioning may be appropriate, including screening for current depressive symptoms and for the presence of additional risk factors. If no other immediate intervention is indicated, encouraging patients to participate in activities that promote a sense of mastery and social connection may promote the development of protective factors against depression."
(Arch Gen Psychiatry. 2009;66[2]:181-188. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by a Career Development Award from the National Cancer Institute, a Physician Faculty Scholar Award from the Robert Wood Johnson Foundation and a grant from the Maurice Falk Foundation. 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, February 2, 2009
Media Advisory: To contact Ilona S. Yim, Ph.D., call Laura Rico at 949-824-9055 or e-mail lrico{at}uci.edu.
Hormone Level During Pregnancy May Identify Women at Risk for Postpartum Depression
CHICAGO—Women who have higher levels of a hormone produced by the placenta midway through their pregnancy appear more likely to develop postpartum depression, according to a report in the February issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Postpartum depression (PPD) is more serious than "baby blues" and begins within four to six weeks of giving birth, according to background information in the article. Risk factors include a history of depression, stressful life events, a lack of social support, low self-esteem and depression, anxiety or stress during pregnancy. However, these risk factors explain only a portion of the differences between women who develop PPD and those who do not.
"Endocrine risk factors for PPD have been identified as well, including changes in reproductive hormones during pregnancy, a history of premenstrual syndrome and a history of oral contraceptive–induced mood changes," the authors write. A possible link between a hormone produced by the placenta, known as placental corticotropin-releasing hormone (pCRH), and PPD has also been hypothesized. Ilona S. Yim, Ph.D., of the University of California, Irvine, and colleagues studied this hormone in 100 pregnant women who visited two southern California medical centers during the study period. Blood samples were taken at 15, 19, 25, 31 and 37 weeks' gestational age, and symptoms of depression were assessed at the last four pregnancy visits and again an average of 8.7 weeks after delivery.
A total of 16 women developed PPD symptoms at the follow-up visit. Levels of pCRH when the women were 25 weeks pregnant strongly predicted the development of PPD. A cutoff of 56.86 picograms of pCRH per milliliter of blood has a sensitivity of 0.75 and a specificity of 0.74 for PPD, meaning that about three-fourths of women with future PPD would be identified using this marker and only 24 percent of women would be misclassified. The predictive capability of the hormone levels increased when midpregnancy depressive symptoms were also assessed.
The narrow window of time in which pCRH levels predicted PPD symptoms—at 23 to 26 weeks' gestational age—roughly coincides with a surge in levels of the hormone. "We do not know which factors may precipitate the surge in pCRH, but some evidence suggests an early association between elevated cortisol [stress hormone] early in pregnancy and increased pCRH late in pregnancy," the authors write.
"Our study has important clinical and theoretical implications," they continue. "If our results are replicable, it may be considered useful to implement a pCRH PPD screen into standard prenatal care. Because blood draws to screen for gestational diabetes are typically performed at 24 to 28 weeks' gestational age, a potential PPD screen could be completed at the same time. In addition, a better understanding of the role of pCRH in the pathophysiologic mechanism leading to PPD may contribute to the development of preventions targeted at this rather common disorder."
(Arch Gen Psychiatry. 2009;66[2]:162-169. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by U.S. Public Health Service research awards from the National Institute of Child Health and Human Development. 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, February 2, 2009
Media Advisory: To contact Eric B. Elbogen, Ph.D., call Tom Hughes at 919-966-6047 or e-mail tahughes{at}unch.unc.edu.
Study Examines Association Between Mental Illness and Violent Behavior
CHICAGO—Violence appears to be more common among those with mental illness only when they also report substance abuse or dependence, according to a report in the February issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Researchers have been studying the connection between mental illness and violent behavior for the past 20 years, but there is controversy regarding how to interpret the links, according to background information in the article. "The relationship between mental illness and violence has a significant effect on mental health practice and policy, guides allocation of the limited resources in the mental health and criminal justice systems and serves as the basis for imposing mandatory treatment to protect public safety at the expense of patients' self-determination and liberty," the authors write. "Reliable data are needed to properly inform public perception about the relationship between mental illness and dangerousness to avoid potentially unwarranted stigmatization of people with mental illness."
Eric B. Elbogen, Ph.D., and Sally C. Johnson, M.D., of the University of North Carolina at Chapel Hill School of Medicine assessed data collected as part of the National Epidemiological Survey on Alcohol and Related Conditions, a survey conducted by the National Institute on Alcohol Abuse and Alcoholism. A total of 34,653 individuals were interviewed about their mental health, demographics, history of violence and other risk factors between 2001 and 2003. The participants then answered questions about any violent behavior—including fighting, sexual assault and starting fires—perpetrated between then and a second interview (conducted between 2004 and 2005).
At the first interview, 10.87 percent of participants were diagnosed with schizophrenia, bipolar disorder or major depression alone, 21.41 percent with substance abuse or dependence alone and 9.4 percent with a severe mental disorder plus substance abuse or dependence.
Having a mental illness alone at the first interview did not predict whether an individual would have violent behavior before the second interview. However, individuals with both mental illness and substance abuse or dependence were at higher risk for future violence. "The highest risk was shown for dual-disordered subjects with a history of violence, who showed nearly 10 times higher risk of violence compared with subjects with severe mental illness only," the authors write.
Other factors that predicted future violence included a history of juvenile detention, physical abuse or having witnessed parental fighting; a recent divorce, unemployment or victimization; or being younger, male or lower-income. Most of these risk factors were present more often in individuals with mental illness.
"Because severe mental illness did not independently predict future violent behavior, these findings challenge perceptions that mental illness is a leading cause of violence in the general population," the authors conclude. "Still, people with mental illness did report violence more often, largely because they showed other factors associated with violence. Consequently, understanding the link between violent acts and mental disorder requires consideration of its association with other variables such as substance abuse, environmental stressors and history of violence."
(Arch Gen Psychiatry. 2009;66[2]:152-161. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Please see the article for additional information, including 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, February 2, 2009
Media Advisory: To contact Ulfat Shaikh, M.D., M.P.H., call Phyllis Brown at 916-734-9023 or e-mail phyllis.brown{at}ucdmc.ucdavis.edu.
An Estimated One-Third of U.S. Children and Teens Take Vitamin or Mineral Supplements
CHICAGO—A large number of U.S. children and teens age 2 to 17 appear to use vitamin and mineral supplements, although most may not need them, according to a report in the February issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
Many Americans use vitamin and mineral supplements despite the fact that these products are largely deemed unnecessary for children and adults who eat varied diets, according to background information in the article. "Multivitamin preparations for older children and adolescents are not regulated by the Food and Drug Administration and may result in adverse effects ranging from nausea, vomiting and abdominal pain to increased cerebrospinal pressure, liver abnormalities and neuropathy [nerve damage]," the authors write. Supplemental vitamins are recommended only for certain groups of children, including those with chronic diseases, eating disorders, problems absorbing nutrients or liver disease, or obese children in weight-loss programs.
Ulfat Shaikh, M.D., M.P.H., of the University of California Davis School of Medicine, Sacramento, and colleagues analyzed data from 10,828 children age 2 to 17 who participated in the 1999 to 2004 National Health and Nutrition Examination Survey. As part of the study, parents filled out questionnaires and participated in household interviews, and children and teens underwent medical examinations.
Approximately 34 percent of the children and adolescents had used vitamin and mineral supplements in the past month, with underweight children having greater intakes. "Our results supported our hypothesis that underweight children would have the highest use of vitamin and mineral supplements," the authors write. "However, in contrast to what we expected to find, children and adolescents with healthier nutrition, more active lifestyles, greater food security and greater health care access were more likely to use vitamin and mineral supplements."
This indicates that children at the highest risk for deficiencies—including those with less healthy patterns of diet and exercise, greater obesity, lower income and food security, poorer health and less access to health care—may be least likely to use vitamin and mineral supplements, they authors.
"Such supplements contribute significantly to total dietary intakes of vitamins and minerals, and studies of nutrition should include their assessment," the authors conclude. "Since vitamin and mineral supplement users report greater health care access, health care providers may be in a position to provide screening and counseling regarding dietary adequacy and indications for supplement use."
(Arch Pediatr Adoles Med. 2009;163[2]:150-157. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This publication was made possible by a grant from the University of California Davis Medical Center Children's Miracle Network and a grant from the National Center for Research Resources, a component of the 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, February 2, 2009
Media Advisory: To contact Kumaravel Rajakumar, M.D., call Marc Lukasiak at 412-692-5016 or e-mail marc.lukasiak{at}chp.edu. To contact editorial author Somnath Saha, M.D., M.P.H., call Mike McAleer at 503-808-1920 or e-mail michael.mcaleer2{at}va.gov.
African American Parents More Likely to Report Distrust of Medical Research
CHICAGO—Distrust of medical research appears more common among African American parents than white parents and may present a barrier to enrollment of minority children in research studies, according to a report in the February issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
The inclusion of ethnic minorities and children in research helps ensure that results can be applied to the general population, according to background information in the article. The National Institutes of Health have mandated that researchers include representatives of these groups. However, African Americans frequently remain underrepresented. "African Americans' distrust of medical research has been suggested to be an important reason for their lack of participation," the authors write. "This distrust may be attributed both to a cultural memory of victimization and exploitation during clinical experiments, such as in the Tuskegee Syphilis Study, and to personal experiences with discrimination."
Kumaravel Rajakumar, M.D., of the University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh, and colleagues surveyed 190 parents (140 African American and 50 white) who accompanied their children to a primary care clinic between August 2004 and April 2005. In addition to demographic characteristics, participants were asked about their attitudes toward their child's medical care, beliefs about medical research and whether incentives (such as money or free medical care) would affect their decision about allowing their child to participate in research.
As compared with white parents, African American parents:
- More often reported distrust of medical research, when questions assessing trust were combined and analyzed (67 percent vs. 50 percent)
- More often believed that physicians prescribe medications as a way of experimenting on unknowing patients (40 percent vs. 28 percent)
- Were more likely to believe that medical research involves too much risk to the participant (46.8 percent vs. 26 percent), that physicians will not make full disclosures regarding their child's participation (24.6 percent vs. 10 percent) and that research participants would be favored and receive better medical care (48.6 percent vs. 28 percent)
Education level was also associated with distrust, with high distrust scores among 74 percent of those with less than a high school education vs. 44 percent of college graduates. However, race remained associated with higher levels of distrust even after the researchers controlled for education, with African American parents having two times the odds of being distrusting compared with white parents.
"Although the overall attitude toward medicine and research was positive in both African American and white parents, the degree of distrust was significantly greater among African American parents," the authors write. "Our data suggest that African American parents with higher levels of distrust are less likely to enroll their children in clinical research. Additionally, traditional incentives (financial compensation and free medicine, transportation and medical care) did not overcome the barrier of high distrust."
"Strategies for overcoming the distrust in medicine and research among African American parents are warranted to ensure adequate representation of African American children in clinical research," they conclude. These strategies might include culturally appropriate recruitment materials, use of research assistants with similar racial and cultural backgrounds and the establishment of community research advisory boards.
(Arch Pediatr Adoles Med. 2009;163[2]:108-114. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported in part by a grant from the National Center on Minority Health Disparities and a grant from the National Institute of Child Health and Human Development, National Institutes of Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: Minority Representation Needed in Research Institutions
Community involvement in research governance and decision-making are critical but are only part of the solution, writes Somnath Saha, M.D., M.P.H., of the Portland VA Medical Center, Ore., in an accompanying editorial.
"From the perspective of minority communities, research institutions will continue to have a biased slant until more people from their communities are part of those institutions," Dr. Saha writes. "Many minority groups are grossly underrepresented in the health care professions and in the research enterprise.
"If we want our study samples to be broadly representative, then we should make every effort to make our institutions equally representative by increasing the presence of minority clinicians, scientists and members of research teams and institutional review boards. If we want minority communities to participate in our work, we must first fix the racial and ethnic imbalance that continues to tilt our ivory towers."
(Arch Pediatr Adoles Med. 2009;163[2]:181-182. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Please see the article for additional information, including 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, February 2, 2009
Media Advisory: To contact Emmanuel Kuntsche, Ph.D., e-mail ekuntsche{at}sfa-ispa.ch. To contact editorial author John E. Schulenberg, Ph.D., call Diane Swanbrow at 734-647-4416 or e-mail swanbrow{at}umich.edu.
Teens Who Frequently Go Out With Friends More Likely to Use Marijuana
CHICAGO—Marijuana use appears to have decreased among most European and North American adolescents between 2002 and 2006, and those who went out with friends on fewer evenings of the week were less likely to report using the drug, according to a report in the February issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
"Cannabis [marijuana] use among young people is a serious public health concern," the authors write as background information in the article. Recent evidence links marijuana use to motor vehicle accidents, injuries, inflammatory and cancerous changes in the airways and mental health problems, including depression. Long-term detrimental effects include poor academic performance and failure to complete schooling, impeding development and hampering future career opportunities.
"One factor that may help explain why adolescents engage in cannabis use is association with cannabis-using peers, which can increase the availability of cannabis and socially influence use," the authors write. To investigate this link and also trends in marijuana use over time, Emmanuel Kuntsche, Ph.D., of the Swiss Institute for the Prevention of Alcohol and Drugs Problems, Lausanne, and colleagues analyzed data from 93,297 15-year-old students who participated in the Health Behavior in School-Aged Children study. Participants in 31 countries (mostly in Europe and North America) were surveyed in 2002 and again in 2006 about marijuana use and the number of evenings per week they usually spend out with their friends, among other topics.
During the four-year study period, marijuana use decreased in most of the countries, with the most significant declines in England, Portugal, Switzerland, Slovenia and Canada. Increases were observed in Estonia, Lithuania, and Malta and among Russian girls. The number of evenings out with friends also declined in most countries during the same time period, although there was a wide range in averages, from about one evening per week for Portuguese girls to more than three evenings per week among boys and girls in the Ukraine, Russia, Scotland, Estonia and Spain.
"The more frequently adolescents reported going out with their friends in the evenings, the more likely they were to report using cannabis," the authors write. "This link was consistent for boys and girls and across survey years. Across countries, changes in the mean [average] frequency of evenings spent out were strongly linked to changes in cannabis use."
Besides a decline in evenings out with friends, potential reasons for the decline in marijuana use include prevention efforts, availability or changes in teen preferences. It is more difficult to pinpoint factors behind the decline in evenings out, the authors note. New forms of communication, such as e-mail and text messaging, may have replaced some face-to-face interactions, or that the high rate of marijuana use in 2002 may have increased parental concerns about substance use and made access to the drug and evenings out more difficult.
"This overview of trends in 31 countries and regions provides policy makers with important information on the prevalence and amount of change in cannabis use among boys and girls in their countries," the authors write. "There is a great need to learn more about the nature of evenings out with friends and related factors that might explain changes in adolescent cannabis use over time. Because there are many benefits to adolescent social interaction, it is important to determine how best to foster it without unduly increasing exposure opportunities for cannabis use."
(Arch Pediatr Adoles Med. 2009;163[2]:119-125. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by the Swiss Institute for the Prevention of Alcohol and Drug Problems and a grant from the Swiss Federal Office of Public Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: Reducing Social Time for Teens Not an Ideal Prevention Method
"What we have gained from this well-designed international study is further convincing evidence that unsupervised social time is a critical ingredient for cannabis use for many young people," write John E. Schulenberg, Ph.D., and Patrick M. O'Malley, Ph.D., of the University of Michigan, Ann Arbor, in an accompanying editorial.
"This might lead some to suggest a simple intervention of reducing unsupervised time with friends by, for example, increasing structured time with friends, increasing school and work time or increasing alone time," the authors write. "However, this strategy may have unintended consequences for many adolescents. An important part of adolescence is exploring and forming friendships, having bonding experiences and finding a safe haven with friends away from adult supervision."
"Thus, rather than trying to reduce socializing with friends, a more complicated but possibly more successful approach to intervention would help young people find activities together that do not promote marijuana use," they conclude.
(Arch Pediatr Adoles Med. 2009;163[2]:183-184. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Preparation of this article was supported in part by a grant from the National Institute of Drug Abuse. Please see the article for additional information, including 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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