Maternal and Child Health Library
This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html.
June 13, 2008
1. American Academy of Pediatrics Releases Statement on
Strategies To Improve Adolescent Health Care
2. Report Presents Findings from the 2007 National Youth
Risk Behavior Survey
3. Study Clarifies Changing Role of Genes and Environment
in Psychoactive Substance Use from Early Adolescence Through Middle
Adulthood
4. Trial Assesses Intervention to Prevent Recurrent
Sexually Transmitted Infections in Minority Adolescents
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Special Notice: Pregnancy and Lactation Labeling provides information
about the Food and Drug Administration's proposed revisions to
prescription drug labeling to offer more complete information about the
effects of medicines during pregnancy and breastfeeding. The proposed
rule summary, consumer article, questions and answers, media briefing
transcript, and industry guidance are available at http://www.fda.gov/cder/regulatory/pregnancy_labeling/default.htm.
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1. AMERICAN ACADEMY OF PEDIATRICS RELEASES STATEMENT ON STRATEGIES
TO IMPROVE ADOLESCENT HEALTH CARE
Achieving Quality Health Services for Adolescents provides
recommendations and criteria for assessing the quality of adolescent
health care and discusses the need for comprehensive efforts to improve
the quality of primary care delivered to adolescents in the United
States. The policy statement, developed by the American Academy of
Pediatrics' Committee on Adolescents, focuses on quality issues that
relate to staying healthy -- preventive care themes. Topics include
adolescent health status and risky behaviors, primary care access and
utilization, access to quality care for adolescents, emerging quality
measures for adolescent care, and opportunities and challenges for
primary care. Conclusions and recommendations are included. The policy
statement is available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;121/6/1263.
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2. REPORT PRESENTS FINDINGS FROM THE 2007 NATIONAL YOUTH RISK BEHAVIOR
SURVEY
"Since 1991, the prevalence of many health-risk behaviors among
students nationwide has decreased. However, many students continue to
engage in behaviors that place them at risk for the leading causes of
mortality and morbidity," state the authors of a report published on
June 6, 2008, in MMWR Surveillance Summaries. The national Youth Risk
Behavior Survey (YRBS) is the primary source of data to measure 15
Healthy People 2010 objectives and three leading health indicators.
This report provides the 2010 target and data from the 2007 national
YRBS for all 15 objectives.
The Youth Risk Behavior Surveillance System (YRBSS) includes a national
school-based survey conducted by the Centers for Disease Control and
Prevention and state and local school-based surveys conducted by state
and local education and health agencies. This report summarizes results
from the national survey, 39 state surveys, and 22 local surveys
conducted among students in grades 9-12 during 2007.
The authors found that
- Among students in grades 9-12 nationwide during 2007, 11% had
never or rarely worn a seatbelt when riding in a car driven by someone
else.
- During the 30 days before the survey, 29% of students had ridden
in a car or other vehicle driven by someone who had been drinking
alcohol, 18% had carried a weapon, and more than 5% had not gone to
school because they felt they would be unsafe at school or on their way
to or from school.
- During the 12 months before the survey, almost 7% of students had
attempted suicide. In addition, 75% had ever drunk alcohol, and more
than 4% had ever used methamphetamines.
- About 48% of students had ever had sexual intercourse, 35% were
currently sexually active, and more than 38% of currently sexually
active students had not used a condom during last sexual intercourse.
- Twenty percent of students had smoked cigarettes during the 30
days before the survey, 35% had watched television 3 or more hours per
day on an average school day, and 13% were obese.
- During the 7 days before the survey, almost 79% of students had
not eaten fruits and vegetables five or more times per day, about 34%
had drunk soda or pop at least one time per day, and more than 65% had
not met recommended levels of physical activity.
The authors conclude that "more effective school health programs and
other policy and programmatic interventions are needed to reduce risk
and improve health outcomes among youth."
Eaton DK, Kann L, Kinchen S, et al. 2008. Youth risk behavior
surveillance -- United States, 2007. MMWR Surveillance Summaries
57(SS04):1-131. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5704a1.htm.
Readers: More information is available from the following MCH Library
resources:
- Healthy People 2010 (bibliography) at
http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_hp2010.html&-MaxRecords=all&-DoScript=auto_search_hp2010&-search
- School Health: Selected Resources at
http://www.mchlibrary.info/guides/schoolhealth.html
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3. STUDY CLARIFIES CHANGING ROLE OF GENES AND ENVIRONMENT IN
PSYCHOACTIVE SUBSTANCE USE FROM EARLY ADOLESCENCE THROUGH MIDDLE
ADULTHOOD
"In adolescence, the correlations in different forms of substance use
are driven largely by shared environmental factors. However, as
individuals age, the genetic contribution to the correlations in drug
use becomes progressively stronger, whereas the effect of familial
environmental factors becomes gradually weaker," state the authors of
an article published in the June 2008 issue of Archives of General
Psychiatry. Prior research suggests that the initiation of drug use is
strongly influenced by social environmental factors, whereas the
progression from first use to heavy use and from heavy use to abuse or
dependence is more closely associated with neurobiological factors.
However, genetically informative longitudinal studies of drug use have
been restricted to a small number of measurements (typically three),
preventing detailed analyses of developmental changes. In recent
interviews with male-male twin pairs from the Virginia Adult Twin Study
of Psychiatric and Substance Use Disorders (VATSPSUD), researchers used
a life history calendar to assess participants’ average use of alcohol,
caffeine, nicotine, and cannabis for each year of their lives up to
their age at interview. This article compares the similarity of
psychoactive substance use (PSU) in the twin pairs at each year of age.
The study used data collected in the third wave of interviews of white,
adult, male twins born between 1940 and 1974 from the VATSPSUD.
Interviews were conducted between 1998 and 2004 to determine the
proportion of subjects who reported any use of caffeine, nicotine,
alcohol, and cannabis each year between the ages of 9 and 40 (N=1,796
male twins, including both members of each twin pair). The analyses
sought to clarify the developmental pattern of genetic and
environmental influences on PSU and whether these patterns differ
across various substances. The researchers also explored how genetic
and environmental factors contribute to the correlations in different
forms of substance use.
For nicotine, alcohol, and cannabis, the authors found that
- Familial environmental factors were quite strong. As individuals
aged, however, these effects generally declined in importance; they had
disappeared by age 35 for nicotine and cannabis and by age 40 for
alcohol.
- The magnitude and duration of the familial environmental
influences differed across substances, being least prominent for
alcohol, intermediate for nicotine, and most marked for cannabis.
- Genes were without influence on PSU in early adolescence but
gradually increased in importance as individuals aged.
- For alcohol-cannabis, nicotine-cannabis, and nicotine-alcohol,
correlations start at relatively high levels and slowly decline with
age.
By contrast, for caffeine,
- There was a short interval in late childhood (ages 9-12) with
strong familial environmental influences. These largely disappeared by
age 13, and from then on, no systematic changes in genetic and
environmental influences on caffeine use were seen.
- Consumption is generally not correlated with the use of other
substances. The exception is for nicotine-caffeine, which begins at low
levels in early adolescence and gradually increases with age.
Future research may address issues such as variation in individual drug
use trajectories or the degree of cross-time continuity in genetic and
environmental risk factors for PSU.
Kendler KS, Schmitt E, Aggen SH, et al. 2008. Genetic and environmental
influences on alcohol, caffeine, cannabis, and nicotine use from early
adolescence to middle adulthood. Archives of General Psychiatry
65(6):674-682. Abstract available at http://archpsyc.ama-assn.org/cgi/content/short/65/6/674.
Readers: More information is available from the following MCH Library
resources:
- Emotional, Behavioral, and Mental Health Challenges in Children and
Adolescents: Knowledge Path at
http://www.mchlibrary.info/KnowledgePaths/kp_Mental_Conditions.html
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4. TRIAL ASSESSES INTERVENTION TO PREVENT RECURRENT SEXUALLY
TRANSMITTED INFECTIONS IN MINORITY ADOLESCENTS
"Teens randomized to the SAFE [Sexual Awareness For Everyone]
intervention had significant decreases in recurrent [gonorrhea and
Chlamydia]," state the authors of an article published in the June 2008
issue of Obstetrics and Gynecology. In a previous randomized controlled
trial, researchers found that the SAFE behavioral intervention
significantly reduced the rate of recurrent gonorrhea and Chlamydia
infections among reproductive-age Mexican-American and African-American
women. Subsequently, they found that risk reduction was largely
explained by five modifiable behaviors: unprotected sex with untreated
partners, lack of mutual monogamy, unsafe sex (defined as never using
condoms with one or more casual sexual partners or more than five
unprotected sex acts in the past 3 months and incorrect or problematic
condom use), rapid (less than 3 months) partner turnover, and douching
after intercourse. This article presents findings from a secondary
analysis to answer two questions: (1) was the SAFE intervention equally
effective in preventing recurrent sexually transmitted infections
(STIs) in adolescents and adults and (2) what modifiable behaviors
accounted for differences in re-infection in the two cohorts.
Mexican-American and African-American females ages 14-45 diagnosed with
a nonviral STI were contacted by the research clinic and randomized to
the SAFE intervention or the control group, stratified by ethnicity. In
the control group, individual STI risk-reduction counseling was
provided by nurse clinicians according to guidelines issued by the
Centers for Disease Control and Prevention. Those in the study group
received the SAFE intervention, which entailed three weekly 3-hour
small-group multi-component behavioral cognitive interventions. All
participants were interviewed, examined, screened, and treated for STIs
at baseline and at 6 and 12 months follow-up. Subjects were encouraged
to return to the clinic as needed for any symptoms of or concerns about
re-infection. The primary study outcome was subsequent re-infection
with Chlamydia or gonorrhea. Secondary outcomes included the presence
or absence of risky sexual behaviors. The researchers analyzed
behavioral changes from baseline at 0-6 months, 6-12 months, and
cumulative intervals for group differences for baseline behaviors. In
the final analysis, they determined the relative effect of each
behavior on re-infection compared with "no infection."
The authors found that
- The final study sample included 148 adolescents and 313 adults
(N=461). Among the adolescent and adult study groups, 79.5% and 78.9%
attended all three sessions, respectively.
- Cumulatively, 33.1% of adolescents (N=49 of 148) and 14.4% (N=45
of 313) of adults had a recurrent STI.
- Adolescents in the study group had significantly lower
re-infection rates than those in the control group at 0-6 months and,
cumulatively, at 0-12 months, with a strong trend toward lower
re-infection rates at 6-12 months. None of the participants tested
positive for HIV during the study.
- Cumulatively (0-12 months), re-infection in adolescents was
significantly predicted by unprotected sex with untreated partners,
rapid (less than 3 months) partner turnover, and nonmonogamy.
- Cumulative re-infection in adults was significantly associated
with unsafe sex, rapid partner turnover, and douching after sex.
"Interventions designed to prevent recurrent STIs in adolescents need
to emphasize skills to help adolescents ensure their partners are
treated or to otherwise refuse intercourse," the authors conclude.
Thurman AR, Holden AEC, Shain RN, et al. 2008. Preventing recurrent
sexually transmitted diseases in minority adolescents: A randomized
controlled trial. Obstetrics and Gynecology 111(6):1417-1425. Abstract
available at http://www.greenjournal.org/cgi/content/abstract/111/6/1417.
Readers: More information is available from the following MCH Library
resources:
- Adolescent Pregnancy Prevention: Knowledge Path at
http://www.mchlibrary.info/KnowledgePaths/kp_adolpreg.html
- Sexuality Education: Selected Resources at
http://www.mchlibrary.info/guides/sexuality.html
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and
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