Maternal and Child Health Library
This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html.
February 22, 2008
1. New Edition of Nutrition Knowledge Path Available
2. MCH Library Helps Families Identify Resources on
Assisted Reproductive Technologies
3. Report Estimates Incidence of Unintentional
Strangulation Deaths from the "Choking Game"
4. Study Explores the Role of Parental Consent in
Adolescent Substance Use Research
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1. NEW EDITION OF NUTRITION KNOWLEDGE PATH AVAILABLE
Knowledge Path: Child and Adolescent Nutrition is an electronic guide
to recent resources that analyze data, describe public-awareness
campaigns and other health-promotion programs, and report on research
aimed at identifying promising strategies for improving nutrition and
eating behaviors within families, schools, and communities. The
knowledge path, produced by the MCH Library, contains information on
Web sites, publications, databases, and newsletters and online
discussion lists. Separate sections identify resources for
professionals, resources for families, and resources on specific
aspects of child and adolescent nutrition. Topics include child care
and early childhood education, food marketing to children, food safety,
food-security and nutrition-assistance programs, and school-based
nutrition education and food services. The knowledge path is available
at http://www.mchlibrary.info/KnowledgePaths/kp_childnutr.html.
MCH Library knowledge paths on other maternal and child health topics
are available at http://www.mchlibrary.info/KnowledgePaths/index.html.
The MCH Library welcomes feedback on the usefulness and value of these
knowledge paths. A feedback form is available at http://www.mchlibrary.info/KnowledgePaths/feedback.html.
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2. MCH LIBRARY HELPS FAMILIES IDENTIFY RESOURCES ON ASSISTED
REPRODUCTIVE TECHNOLOGIES
Assisted Reproductive Technologies (ARTs) and Families: Selected
Resources is a guide to Web sites and other electronic resources that
focus on the psychological and social impacts of ART on children
conceived via ART and on their families. ARTs are used to help women
become pregnant when they are unable to conceive through normal
intercourse or to carry an infant to term. Techniques may include in
vitro fertilization, sperm or egg donation, surrogacy, or other
methods. The ART resource guide, produced by the MCH Library, lists
resources that are available at no charge, including resources related
to ethical and legal issues associated with ART. The guide is available
at http://mchlibrary.info/guides/ART.html.
MCH Library Resource Guides on other maternal and child health topics
are available at http://www.mchlibrary.info/guides.html. The MCH
Library welcomes feedback on the usefulness and value of these
knowledge paths. A feedback form is available at http://www.mchlibrary.info/guestbook/addnew.html.
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3. REPORT ESTIMATES INCIDENCE OF UNINTENTIONAL STRANGULATION DEATHS
FROM THE "CHOKING GAME"
"In recent years, news media reports have described numerous deaths
among youths attributed to the choking game," state the authors of a
report published in the February 15, 2008, issue of Morbidity and
Mortality Weekly Report. The "choking game" is defined as
self-strangulation or strangulation by another person with the hands or
a noose to achieve a brief euphoric state caused by cerebral hypoxia.
Serious neurologic injury or death can result if strangulation is
prolonged. No traditional public health dataset collects mortality data
on this practice. The Centers for Disease Control and Prevention (CDC)
used news media reports to estimate the incidence of deaths from the
choking game. This report describes the results of that analysis.
The CDC identified probable choking-game deaths from (1) a LexisNexis
search in November 2007 of newspaper reports since the 1970s and (2)
reports on two choking-game-awareness Web sites, which were created in
2005 and 2006. A case was defined as a death, described in a news
report, resulting from self-strangulation or strangulation by another
person as part of an activity with elements of the choking game. The
LexisNexis search and follow-up Internet searches for confirmatory news
reports on deaths from the two choking-game Web sites produced 106
deaths that referred to the choking game. A total of 24 of the deaths
were excluded, 20 because news reports either provided no evidence of
the choking game or because the medical examiner ruled the death was of
undetermined intent, three because the death circumstances had
autoerotic elements, and one because no age of the decedent was
reported.
The authors found that
- There were 82 probable choking-game deaths among children and
adolescents ages 6-19 during 1995-2007.
- Seventy-one (86.6%) of the 82 decedents were male, with a mean
age of 13.3 years.
- Among the 70 deaths for which sufficient detail was reported, 67
(95.7%) occurred while the decedent was alone.
- Choking-game deaths occurred in 31 states; no geographic
clustering was evident.
- No information regarding decedent drug use, race and ethnicity,
or socioeconomic status was available.
"Parents, educators, and health-care providers should become familiar
with warning signs that youths are playing the choking game," conclude
the authors.
Centers for Disease Control and Prevention. 2008. Unintentional
strangulation deaths from "the choking game" among youths aged 6-19
years -- United States, 1995-2007. Morbidity and Mortality Weekly
Report 57(6):141-144. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5706a1.htm.
Readers: More information, including the warning signs that a child or
adolescent is playing the choking game, is available from the CDC at http://www.cdc.gov/ncipc/duip/research/choking_game.htm.
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4. STUDY EXPLORES THE ROLE OF PARENTAL CONSENT IN ADOLESCENT SUBSTANCE
USE RESEARCH
"This study suggests that parental consent may negatively affect study
participation in adolescent health risk behavior research, and that it
may result in substantial self-selection bias towards lower substance
risk reporting," state the authors of an article published in the
February 2008 issue of the Journal of Adolescent Health. Federal
regulations protecting minors in research currently allow waiving,
altering, or substituting active consent with passive consent
procedures if certain conditions are met. A small number of
school-based studies have directly or indirectly assessed the effect of
parental consent on adolescent substance use research. Few studies,
however, have explored the effect of parental consent in clinical
populations of adolescents studied for substance use risks. The article
presents findings from a study to assess the effects of requiring
parental consent vs. obtaining a waiver of the requirement for parental
consent on study participation and sample characteristics among
adolescents ages 14-18 who attended an adolescent clinic for routine
medical care and who were invited to participate in substance use
research.
This study was a secondary analysis of combined data from two studies
of adolescent substance use that recruited participants from the
Adolescent and Young Adult Medical Practice (AYAMP) at Children's
Hospital Boston. Study 1 waived parental consent and Study 2 required
parental consent. The purpose of Study 1 was to validate the Car,
Relax, Alone, Forget, Friends, Trouble (CRAFFT) test among adolescents
ages 14-18 coming for routine medical care. (CRAFFT is a six-item
screening test for substance-related problems and disorders in
adolescents.) The purpose of Study 2 was to assess the association
between adolescents' substance use and spirituality in a sample of
adolescents ages 12-18 arriving for routine care at the AYAMP, as well
as two other clinic sites. For the comparison study, a combined
database was created by including all AYAMP participants ages 14-18
from Study 1 (N=536) and Study 2 (N=168). Summary statistics were used
to assess differences between the two study samples. In addition, the
analysis evaluated the association between study status, an indicator
variable for the parental consent requirement, and CRAFFT score, while
controlling for age, gender, and race and ethnicity.
The authors found that
- The refusal rate in Study 1, where consent was waived, was 19.7%;
in Study 2, where consent was required, the refusal rate was 59.1%.
- The Study 1 sample (which waived parental consent) had more than
a threefold higher proportion of white non-Hispanic participants
compared with the Study 2 sample; the Study 2 sample (which required
parental consent) had nearly twice the proportion of black non-Hispanic
participants compared with Study 1.
- After controlling for age, gender, and race and ethnicity, the
adjusted proportional odds ratio for a one-point increase in CRAFFT
score was 1.47 for Study 1 compared with Study 2.
"Varying interpretations of federal regulations concerning the possible
waiver of parental consent in research on minor children can lead to
differences in determinations between review bodies," state the
authors. They conclude that "it may be time to for a new look at this
important issue on a federal level, and time to develop guidelines
under which parental consent can be waived."
Rojas NL, Sherrit L, Harris S, et al. 2008. The role of parental
consent in adolescent substance use research. Journal of Adolescent
Health 42(2):192-197. Abstract available at http://www.jahonline.org/article/S1054-139X(07)00322-9/abstract.
Readers: More information about substance use is available from the MCH
Library's organizations resource list at http://www.mchlibrary.info/action.lasso?-database=Organizations&-layout=Web&-response=/databases/OrgLists/orgs_subuse.html&-MaxRecords=all&-DoScript=auto_search_subuse&-search.
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MCH Alert © 1998-2008 by National Center for Education in Maternal
and
Child Health and Georgetown University. MCH Alert is produced by
Maternal and Child Health Library at the National Center for Education
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(U02MC00001) with the Maternal and Child Health Bureau, Health
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Please contact us at the address below.
MANAGING EDITOR: Jolene Bertness
CO-EDITOR: Tracy Lopez
COPYEDITOR/WRITER: Ruth Barzel
LIST ADMINISTRATOR: Beth DeFrancis Sun
MCH Alert
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