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June 2, 2009JAMA 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
JAMA NEWS RELEASES — Theme Issue On Child And Adolescent Health
(Embargoed for Early Release: 10 a.m. ET Tuesday, June 2, 2009)
JAMA REPORT (VIDEO SCRIPT)
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED. JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ON-LINE. Go to www.jamamedia.org for more information and to apply for access. SAVE THE DATE: JAMA will present new research from a theme issue on Child Health at a media briefing on Tuesday, June 2, from 10 a.m. – 12:15 p.m., at the Hilton New York, 1335 Avenue of the Americas. To register, go to www.jamamedia.org and click on the Events tab, or call 312-464-JAMA. Program information will be included in a future email. TV Note: This week's JAMA Report video is on an intervention for the prevention of depression in at-risk teens. The report will be fed Tuesday, June 2, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Galaxy 28 (C-Band), Transponder 19, downlink frequency: 4080 vertical, audio 6.2/6.8. For more information, call 312/464-JAMA. Please Note: The FOR THE MEDIA website now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org EMBARGOED FOR RELEASE UNTIL 10 A.M. (ET), Tuesday, June 2, 2009
Cognitive Behavioral Intervention Helps Prevent Depression Among At-Risk Teens
NEW YORK—Adolescents at an increased risk of depression who participated in a group cognitive behavioral intervention significantly reduced their symptoms and episodes of depression compared to teens who received usual care, although this effect was not seen for adolescents with a parent with current depression, according to a study in the June 3 issue of JAMA, a theme issue on child and adolescent health. Judy Garber, Ph.D., of Vanderbilt University, Nashville, Tenn., presented the findings of the study at a JAMA media briefing in New York. Adolescent-onset depression is strongly associated with chronic and recurrent depression in adulthood, and despite substantial progress in treatments, only about 25 percent of depressed youth receive treatment and at least 20 percent develop recurrent, persistent, and chronic depression that is very difficult to treat, according to background information in the article. "The serious developmental consequences of adolescent depression and the associated treatment challenges once it has developed underscore the need for programs aimed at prevention," the authors write. They add that one of the most potent risk factors for the development of depression in youth is a parent who experiences depression, which increases the risk for adolescent depression by 2- to 3-fold. Although some smaller trials have found that depression risk can be reduced in this population, these results have yet to be replicated in larger studies. Dr. Garber and colleagues examined the effectiveness of a cognitive behavioral (CB) program for preventing depression in at-risk adolescents. This multicenter trial included 316 adolescent (age, 13-17 years) offspring of parents with current or prior depressive disorders. Adolescents had a past history of depression, current elevated but subdiagnostic depressive symptoms, or both. Assessments were conducted at the beginning of the study, after the 8-week intervention and after a 6-month continuation phase, with symptoms and disorders being measured with questionnaires and clinical interviews, respectively. Adolescents were randomly assigned to the CB prevention program (n = 159) or to usual care (n = 157). The intervention consisted of eight weekly 90-minute group sessions (followed by six monthly continuation sessions), led by a therapist, in which adolescents were taught problem-solving skills and cognitive restructuring techniques to identify and challenge unrealistic and overly negative thoughts. The researchers found that the rate for new depressive episodes was lower for those in the CB prevention program than for those in usual care through the postcontinuation follow-up (21.4 percent vs. 32.7 percent). Self-reported change in the symptoms of depression declined at a significantly greater rate for youth in the CB prevention program than for those in usual care. Having a parent with depression at the beginning of the study significantly moderated the effect of the CB prevention program, with analyses indicating that the CB program was significantly better than usual care in preventing depressive episodes if a parent did not have a current depressive episode (11.7 percent vs. 40.5 percent). When parents were actively depressed at the start of the study, rates of youth depression did not differ significantly between the CB program and usual care (31.2 percent vs. 24.3 percent). Comparisons within the CB prevention program condition indicated that offspring of currently depressed parents had a significantly higher rate of incident depression than adolescents of currently nondepressed parents. Within the usual care group, rates of depression did not differ significantly between offspring of currently depressed vs. nondepressed parents.
"...these positive findings support the clinical utility of this CB prevention program as a preventive intervention to reduce or delay the incidence of depression in offspring of depressed parents. Most youth in the current study had a history of depression and thus the CB prevention program prevented recurrence. Therefore, this program may be useful as a continuation or maintenance intervention," the authors write.
Editor's Note: 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. EMBARGOED FOR RELEASE UNTIL 10 A.M. (ET), Tuesday, June 2, 2009
Likelihood of Survival May Be Improving For Extremely Preterm Infants
NEW YORK—Infants born extremely preterm are surviving at a high rate, with about 70 percent of infants born alive between 22 and 26 weeks of gestation in Sweden surviving at least one year, with high rates of interventions being used to improve survival, according to a study in the June 3 issue of JAMA, a theme issue on child and adolescent health. Karel Maršál, M.D., Ph.D., of Lund University Hospital, Lund, Sweden, presented the findings of the study at a JAMA media briefing in New York. The rate of preterm births is increasing worldwide and advances in perinatal (relating to the period shortly before and after birth) medicine have increased survival so that neonatal (the newborn period, usually the first four weeks after birth) intensive care can today be life saving even for the most preterm infants. But the evidence for improved outcomes among extremely preterm infants, which is important for decision making before, during, and after birth, has been questioned, with there being a need for up-to-date information on infant survival. "...misconceptions regarding outcomes may result in suboptimal perinatal care because chances for survival are underestimated," the authors write. Dr. Maršál and colleagues conducted a study to evaluate the short- and long-term outcomes of infants born before 27 gestational weeks in Sweden during 2004-2007. During the study period, 305,318 infants were born in Sweden; of these, 1,011 were extremely preterm infants (incidence, 3.3/1000 infants) born before 27 gestational weeks in 904 deliveries to 887 mothers, with 102 multiple births. Of the infants in the study, 707 were live-born and 304 stillborn. Overall survival at 1 year of age for infants born alive was 70 percent: for those born at 22 weeks it was 9.8 percent; at 23 weeks 53 percent; at 24 weeks 67 percent; at 25 weeks 82 percent; and at 26 weeks 85 percent. Of the 104 deaths occurring at least 24 hours after admission to a neonatal intensive care unit, 42 (40 percent) involved a decision to withdraw intensive care due to anticipated poor long-term prognosis. Among 1-year survivors, 45 percent had no major neonatal illness. "The most important finding in this study is the high survival of extremely preterm infants born alive. Survival rates at hospital discharge in recent population-based studies have been reported as 0 percent at 22 weeks, 6 percent to 26 percent at 23 weeks, and 29 percent to 55 percent at 24 weeks," the authors write. The overall perinatal death rate was 45 percent, ranging from 93 percent at 22 gestational weeks to 24 percent at 26 weeks. Of live-born infants, 152 (22 percent) died during the early neonatal period (0-6 days) including 58 (8.2 percent) who died in the delivery room; and 35 (5 percent) who died during the late neonatal period (7-27 days). Altogether, 210 live-born infants (30 percent) died before the age of 1 year. The proportion of stillbirths, delivery room deaths, neonatal deaths, and infant deaths decreased with gestational age. For infants who survived 28 days, no significant association between gestational age at birth and 1-year survival could be detected. Antenatal (occurring before birth) treatment with tocolytics (a drug that delays or halts labor), corticosteroids, or both; surfactant (a fluid that is produced shortly before birth and prevents the lung from filling with water) treatment within 2 hours after birth; and birth at a level III hospital were significantly associated with lower risk of infant death.
"In summary, overall 1-year survival was 70 percent in extremely preterm infants born alive at 22 to 26 weeks of gestation in Sweden during 2004-2007. Proactive perinatal management is likely to have contributed to this outcome. Therefore, non-initiation or withdrawal of intensive care for extremely preterm infants cannot be based solely on a notion of unlikely survival. This is not to suggest that all extremely preterm live-born infants should be kept alive at any cost. The prognosis, based on an individual assessment, including early and subsequent morbidities, and parental desires are still the most important factors in decision making," the authors conclude.
Editor's Note: 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. EMBARGOED FOR RELEASE UNTIL 10 A.M. (ET), Tuesday, June 2, 2009
Childhood Health Disparities Can Have Life-Long Health Effects
Starting Health Promotion, Disease Prevention Early In Life Important
NEW YORK—Research indicates that physical and mental stress in childhood may have life-long adverse health effects and policy initiatives are needed to emphasize the importance of starting health promotion and disease prevention early in life, according to an article in the June 3 issue of JAMA, a theme issue on child and adolescent health. Jack P. Shonkoff, M.D., of Harvard University, Cambridge, Mass., presented the article at a JAMA media briefing in New York. "A scientific consensus is emerging that the origins of adult disease are often found among developmental and biological disruptions occurring during the early years of life," writes Dr. Shonkoff and colleagues. "In this article, we explore the scientific validity of the proposition that reducing significant disadvantage early in life may be a powerful strategy for reducing the population-level burden of chronic morbidity and premature death." The authors assert that the promotion of health and prevention of disease in adults should begin in the early years of life. "Investigators have postulated that early experience can affect adult health in at least 2 ways—by accumulating damage over time or by the biological embedding of adversities during sensitive developmental periods. In both cases, there can be a lag of many years, even decades, before early adverse experiences are expressed in the form of illness." If health damage occurs through a cumulative process, chronic diseases can be seen as the products of repeated encounters with both psychologically and physically stressful experiences. "Strong associations have been shown between retrospective adult reports of increasing numbers of traumatic childhood events with greater prevalence of a wide array of health impairments including coronary artery disease, chronic pulmonary disease, cancer, alcoholism, depression, and drug abuse, as well as overlapping mental health problems, teen pregnancies, and cardiovascular risk factors such as obesity, physical inactivity, and smoking." In some cases, the cumulative burden of multiple risk factors early in life may limit the effectiveness of interventions later in life, thereby making it impossible to completely reverse the neurobiological and health consequences of certain risk factors, such as growing up in poverty, they write. A considerable body of research also suggests that adult disease and risk factors for poor health can be embedded biologically during sensitive periods in which the developing brain is more receptive to a variety of environmental signals, whether positive or negative. "Early experiences of child maltreatment and poverty have been associated with heightened immune responses in adulthood that are known risk factors for the development of cardiovascular disease, diabetes, asthma, and chronic lung disease." Despite increasing evidence of the long-term effects of early adversity on lifelong health, little attention has been paid to the development of health promotion and disease prevention strategies based on the reduction of significant stressors affecting everyday life for vulnerable young children and their parents. The authors say areas worth consideration for health promotion and policy include the design and implementation of new approaches for both the prevention and treatment of toxic stress (such as from extreme poverty, recurrent physical and/or emotional abuse) and its consequences, beginning in the early childhood years; using high-quality early childhood programs to address the stress-related roots of social class disparities in health; and having child welfare services implement health promotion practices.
"...a fundamental transformation in the circumstances of children who experience significant adversity early in life could not only affect their own individual well-being but also improve societal health and longevity," the authors conclude.
Editor's Note: 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. EMBARGOED FOR RELEASE UNTIL 10 A.M. (ET), Tuesday, June 2, 2009
Easier Access to Media By Children Increases Risk For Influence on Numerous Health Issues
NEW YORK—With children having easier access to media and a wider variety of content, the possible negative influence on health issues such as sex, drugs, obesity and eating disorders is increased, and warrants monitoring usage and limiting access if necessary, according to a commentary in the June 3 issue of JAMA, a theme issue on child and adolescent health. Victor C. Strasburger, M.D., of the University of New Mexico School of Medicine, Albuquerque, presented the commentary at a JAMA media briefing in New York. On average, children and adolescents spend more than 6 hours a day with media—more time than in formal classroom instruction, writes Dr. Strasburger. In addition, U.S. youth have unprecedented access to media (two-thirds have a television set in their bedrooms, half have a VCR or DVD player, half have a video game console, and almost one-third have Internet access or a computer), making parental monitoring of media use difficult. All of this media access does have an influence on a variety of health issues, according to Dr. Strasburger. "The media are not the leading cause of any pediatric health problem in the United States, but they do make a substantial contribution to many health problems, including the following." Violence - Research on media violence and its relationship to real-life aggression is substantial and convincing. Young persons learn their attitudes about violence at a very young age and, once learned, those attitudes are difficult to modify. Conservative estimates are that media violence may be associated with 10 percent of real-life violence. Sex - Several longitudinal studies have linked exposure to sex in the media to earlier onset of sexual intercourse. The media represent an important access point for birth control information for youth; however, the major networks continue to balk at airing contraception advertisements at the same time they are airing unprecedented amounts of sexual situations and innuendoes in their primetime programs. Drugs - Witnessing smoking scenes in movies may be the leading factor associated with smoking initiation among youth. In addition, young persons can be heavily influenced by alcohol and cigarette advertising. More than $20 billion a year is spent in the United States on advertising cigarettes ($13 billion), alcohol ($5 billion), and prescription drugs ($4 billion). Obesity - Media use is implicated in the current epidemic of obesity worldwide, but it is unclear how. Children and adolescents view an estimated 7,500 food advertisements per year, most of which are for junk food or fast food. Contributing factors to obesity may include that watching television changes eating habits and media use displaces more active physical pursuits. Eating Disorders - The media are a major contributor to the formation of an adolescent's body self-image. In Fiji, a naturalistic study of teenage girls found that the prevalence of eating disorders increased dramatically after the introduction of American TV programs. Dr. Strasburger adds that network contraceptive advertising should be encouraged and legislation should be passed banning all cigarette advertising in all media and limiting alcohol advertising to advertisements that only show the product. Education of parents, teachers, and clinicians about these issues is necessary, and education of students about the media should be mandatory in schools. "Parents have to change the way their children access the media—not permitting TV sets or Internet connections in the child's bedroom, limiting entertainment screen time to less than 2 hours per day, and co-viewing with their children and adolescents. Research has shown that media effects are magnified significantly when there is a TV set in the child's or adolescent's bedroom." At the same time, media can be an extraordinary positive power, writes Dr. Strasburger. "Antiviolence attitudes, empathy, cooperation, tolerance toward individuals of other races and ethnicities, respect for older people—the media can be powerfully prosocial." Media can also be used constructively in the classroom in ways that are better than traditional textbooks, such as for viewing plays on DVDs or documentaries of historical events.
"The media are a powerful teacher of children and adolescents—the only question is what are they learning and how can it be modified? When children and adolescents spend more time with media than they do in school or in any leisure-time activity except for sleeping, much closer attention should be paid to the influence media has on them," Dr. Strasburger concludes.
Editor's Note: Please see the article for additional information, including 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.
JAMA REPORTS
VIDEO: Windows Media | Quicktime
ADOLESCENTS AT-RISK FOR DEPRESSION MAY BENEFIT FROM A PREVENTION PROGRAM — EXCEPT WHEN THEY’VE GOT A CURRENTLY DEPRESSED PARENT
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