Booster Shots

Oddities, musings and news from the health world

Category: adolescents

Should all children be screened for high cholesterol?

July 11, 2010 |  9:01 pm

High cholesterol is common enough in children these days that all of them should be screened for the condition, say the authors of a new study examining the rates of high cholesterol in children.

KidsStatins Currently, the American Academy of Pediatrics recommends screening children and teens who have a family history of premature heart disease or high cholesterol or those children who already have risk factors for heart disease, such as obesity, high blood pressure or who smoke or have diabetes. For these children, screening should start after age 2 and before age 10.

However, a sizable number of people don't have accurate information on family medical history. In the new study, released online Sunday in the journal Pediatrics, researchers reviewed data from more than 20,000 fifth-grade children in West Virginia, including examining their family history and conducting blood cholesterol tests. They found that more than 71% of the children met guidelines for cholesterol screening based on family history. Among children whose family history wasn't known, 9.5% had high cholesterol -- with 1.7% of those children requiring medication to treat the condition.

Screening all children for cholesterol, rather than just those with a family history, will uncover many more cases of the condition that can be treated early to prevent heart disease later in life, the authors said. Statin therapy has been shown to be safe and effective in lowering LDL cholesterol (the bad kind of cholesterol) levels in children.

Moreover, the authors wrote: "...the added and undeniable benefit of identifying and screening parents and other first-degree relatives as a result to finding elevated LDL levels in their children could lead to the prevention of premature cardiac events in adults that may have otherwise gone undiagnosed."

-- Shari Roan

Photo: More than 13 million Americans are taking statins to lower their cholesterol and stave off heart disease. Credit: Bob Chamberlin / Los Angeles Times


High school students show a slower rate of decline in smoking in recent years

July 8, 2010 |  4:11 pm

One in five high school students in the U.S. is still smoking, and the rate of decline in smoking has slowed, according to a new report released Thursday from the Centers for Disease Control and Prevention.

L39z6zncSmoking rates among high school students slowed dramatically from the late 1990s through the early 2000s. But those rates of decline decreased more gradually from the early to late 2000s. The CDC analyzed data from the National Youth Risk Behavior Survey of high school students in public and private schools in all states and the District of Columbia.

The percentage of students who said they currently smoke cigarettes (defined as smoking a cigarette at least one day of the 30 before the survey) went from 27.5% in 1991 to 36.4% in 1997, then went down to 21.9% in 2003. In 2009 that number was 19.5%, representing a slower decline.

The percentage of students who ever smoked or tried cigarettes (even taking one or two puffs constituted trying a cigarette) stayed steady from 1991 to 1999. That category then saw a big dip -- rates went from 70.4% in 1999 to 58.4% in 2003. Another gradual decline was seen after that, to 46.3% in 2009.

High schools students who said they were currently frequent cigarette smokers (smoking at least 20 days out of the 30 prior to the survey) went from 12.7% in 1991 to 16.8% in 1999. It went down to 9.7% in 2003, then saw yet another slight decline to 7.3% in 2009.

Current cigarette smoking rates declined for all racial, ethnic and gender subgroups -- except for black females. That group saw no leveling off or slowing in rates of decline after 1999.

"Although four of five don't smoke, it's discouraging to see that current smoking did not continue to decline more rapidly among youth," said CDC director Dr. Thomas Frieden in a news release. "Smoking is the leading preventable cause of death in this country and nine out of 10 adults started smoking in their teens or earlier. The slow progress since 2003 tells us that much more needs to be done to reduce youth smoking."

-- Jeannine Stein

Photo: The rate of decline in smoking among high school students has slowed in recent years. Credit: Greg Wood / AFP/Getty Images


Emergency room visits linked to underage drinking are thought to jump over the July 4th holiday

July 3, 2010 |  9:00 am

Most July 4th-centric health warnings involve fireworks and the nightmarish consequences of setting off pyrotechnics -- death, loss of limbs, severe burns, etc.

L3159anc But the Substance Abuse and Mental Health Services Administration wants to warn people that that's not the only potential danger of the weekend. Hospital visits that involve underage drinking jump over the three-day Fourth of July weekend by a lot.

On a typical day in July 2008, 502 emergency room visits in the U.S. were linked with underage drinking, according to the Drug Abuse Warning Network, which monitors drug-related hospital emergency department visits in the U.S.

But on the weekend of the 4th, those numbers jumped to 938 visits per day, an increase of 87%.

"Underage drinking is not a harmless right of passage," said SAMHSA administrator Pamela Hyde in a news release. "It has far-reaching consequences. In addition to emergency department visits, injuries, arrests and embarrassment, 5,000 deaths in people under age 21 are linked to alcohol each year."

The agency, part of the U.S. Department of Health and Human Services, provides information on how to help prevent underage drinking.

-- Jeannine Stein

Photo: Underage drinking can end in an emergency room visit. Credit: Oliver Lang / AFP/Getty Images


Black and Latino males twice as likely to have poor health

June 30, 2010 |  8:17 am

Black Latino Men health Given the inequality in healthcare in the United States, it's no surprise that some groups of people suffer far worse health outcomes than people with better resources. But if there is one group that has been especially overlooked in this equation, it's black and Latino boys. The major factor in their poor health, according to a new report by the California Endowment, is where they live. Growing up in poor and stressful neighborhoods with limited healthcare resources leads to poor health.

According to the findings in the report:

  • The odds of poor health outcomes for boys and men of color are more than two times higher than for white boys and men in California.
  • Latino boys are 4.1 times more likely than white boys to suffer from post-traumatic stress disorder.
  • African-American boys are 2.5 times more likely.
  • Latinos are 3.1 times more likely to have limited access to health care and 4.8 times more likely to lack health insurance.
  • Asthma disproportionately affects children who live in poorer neighborhoods.
    Black young men have a homicide rate 16 times greater than that of young white men.
  • African-American and Latino children are 3.5 times more likely to grow up in poverty compared to whites.

Poorer neighborhoods mean less access to stores selling health foods, fewer parks and safe places to run and play in and fewer social networks to promote health and safety.

The California Endowment has launched a 10-year initiative, called Building Healthy Communities, to improve the health of men and boys of color by making strategic improvements in the communities and neighborhoods in which they live. In the report, the group identifies a handful of successful programs to improve the lives of men of color already in place in the state that could be applied on a larger scale -- and why implementing these programs statewide cannot wait.
 
-- Shari Roan

Photo credit: Carlos Chavez  /  Los Angeles Times


Parenting style influences teen drinking patterns, researchers say

June 24, 2010 |  6:00 am

Teenagers alcohol parenting Some parents assume that teenagers will drink alcohol and there is little they can do to prevent it. Research does indicate that parenting has little effect on whether kids decide to try alcohol. But parenting attitudes and actions can make a big difference in how much and how often a teenager drinks.

Researchers at Brigham Young University surveyed 5,000 adolescents about their drinking habits and their relationship with their parents. They found the kids least prone to heavy drinking had parents who scored high on accountability (knowing where their kids were and with whom) and warmth. Having so-called "indulgent" parents, who were low on accountability and high on warmth, nearly tripled the risk of the teen participating in heavy drinking. The study also found that "strict" parents -- high on accountability and low on warmth -- more than doubled their teen's risk of heavy drinking. These results were apparent even when researchers controlled for other influences, such as peer pressure, religious and economic background.

"Authoritative parents tend to be highly demanding and highly responsive," the authors wrote. "They monitor their children closely and provide high levels of support and warmth. Our data suggest that peer encouragement to drink might have less impact when parents are both highly supportive and highly attentive."

The study is published in the July issue of the Journal of Studies on Alcohol and Drugs.

-- Shari Roan

Photo credit: Lee Romney  /  Los Angeles Times


Teenage girls may need two annual preventive health checkups

June 23, 2010 |  6:00 am

Teengirl Most kids have a well-child medical check-up once a year. That's what the experts recommend for school-age children and teenagers. But one medical group suggests that teenage girls should have two annual preventive health visits: one a general checkup with a primary care doctor and a second "dedicated" reproductive health visit.

The idea is proposed in the July issue of the journal Obstetrics & Gynecology by an American College of Obstetricians and Gynecologists committee. The group recommends a girl have her first visit with an ob-gyn between the ages of 13 and 15. The visit should be primarily educational and a chance to establish a relationship with the doctor, according to the paper. Topics of discussion could include puberty, menstruation, healthy eating habits, sexually transmitted disease and pregnancy prevention, sexual orientation and gender identity. A pelvic exam would be performed only if warranted. The visit should include a discussion involving the teenager, a parent and the doctor about patient confidentiality.

Such a visit would "assist an adolescent in negotiating entry into the health care system when she has a specific reproductive health care need," the authors wrote. In a news release, Dr. Diane F. Merritt, chairwoman of American College of Obstetricians and Gynecologists' committee on adolescent health care, added: "Given the high pregnancy and STD rates among adolescent girls in the U.S. compared with other developed countries, we continue to encourage parents to bring their daughters to an ob-gyn for their first visit earlier rather than later."

The American College of Obstetricians and Gynecologists has a resource for teens and their parents called Tool Kit for Teen Care.

-- Shari Roan

Photo credit: Mark Boster  /  Los Angeles Times


Killings in the neighborhood take toll on young minds

June 18, 2010 |  8:08 pm

In the week that a homicide has occurred on their block, school-aged African American kids in predominately low-income neighborhoods suffer a steep slide in verbal and language skills that are key to reading, learning and thriving, a new study has found.

The study found that faced with similar levels of mayhem in their neighborhoods, Latino children did not appear to experience significant declines in academic performance. And slayings in study neighborhoods populated by white children were so rare the study could not discern an effect.

The effect was seen among African American children even when they were not directly exposed to the violence, suggesting that the fear and anxiety caused by proximity to an act of violence can, in some communities, ripple outward across social networks and disrupt the intellectual circuitry of entire neighborhoods. In neighborhoods where violence is endemic, the study suggests that children's academic progress can be severely stunted.

"The pattern of findings is consistent with the literature on acute stress disorder, which is defined as a response to a threatening event that induces fear, helplessness or horror," writes Patrick Sharkey, a New York University sociologist and author of the study, published this week in the Proceedings of the National Academy of Sciences. "Among other symptoms are reduced awareness and difficulties in concentration for a period last at least two days and as long as one month after the stressor."

The study combined several databases to arrive at its striking findings. It cross-checked data on all reported homicides between 1984 and 2002 in Chicago neighborhoods with children's performance on cognitive tests administered in the course of two University of Michigan studies: the Project on Human Development in Chicago Neighborhoods, and a three-city study of welfare, children and families (of which only Chicago-based children were scrutinized). 

Chicago's 6,041 homicides recorded during that period afforded lots of opportunities to discern the effects of such violence on children who lived on the block where it took place and within the census tract of the crime. Some of those assessments of language and verbal skills took place within days of the violence. Others happened to have been administered a week or later after the event.

The result allowed Sharkey to discern not only a proximity effect of neighborhood violence -- that the cognitive function of black children closer to a killing was more significantly affected than that of children farther away. The results also showed a temporal effect -- that in the days after a homicide, the effect of the violence on cognitive performance was dramatic. But a week after a slaying, African American schoolchildren began to regain their cognitive composure.

In the days after a slaying, however, the effects on children who lived nearby was profound and far-reaching. The performance of these African American children slid dramatically on several tests that are reliable predictors of a child's academic performance in the long term. In total, data from some 1,100 African American children 5 to 17 were used in the study.

For a helpful guide to the lasting effects that witnessing a horrific event can have, check out this well-written article. If a child you know has witnessed violence, check out this site, and this helpful guide to choosing a mental health professional who can help. 

--Melissa Healy

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Hospital ER visits related to underage drinking, drug use jump sharply on Memorial Day weekends

May 28, 2010 |  5:40 pm

Visits to hospital emergency rooms triggered by underage drinking rise on Memorial Day weekends, while visits related to both underage alcohol and drug abuse rise even more, according to the U.S. Substance Abuse and Mental Health Services Administration. The agency attributed the increase to partying to celebrate the begining of summer.

On an average day in 2008, the most recent year for which data is available, the agency said, there were typically about 519 hospital ER visits linked to underage drinking nationwide.  On the three days of Memorial Day weekend, the daily average rose to 577. Similarly, the average daily number of visits for alcohol and drug use combined was 156, but on Memorial Day weekend the number rose to 199 visits. The figures are based on data from the 2008 Drug Abuse Warning Network report, which monitors drug-related ER visits nationwide.

"Underage drinking poses an enormous public health risk -- approximately 5,000 people die each year from alcohol-related injuries connected to underaged drinking," SAMHSA administrator Pamela S. Hyde said in a statement. "Moreover, studies have shown that children who begin drinking before age 15 are six times more likely to develop alcohol problems than people who start drinking after age 21."

Information on how to help prevent underage drinking is available here.

-- Thomas H. Maugh II.


Call it "self-injury," call it "cutting," but doctors need to recognize it

May 25, 2010 |  4:16 pm

Xray Known as "self-injury," "self-mutilation" or the more direct and simple "cutting," the act of deliberately and physically hurting oneself is surprisingly common and surprisingly varied. And, as such, it needs to be better detected.

So says a Cornell University researcher exploring the phenomenon in a paper published Tuesday in the journal PLoS Medicine.

An estimated 12% to 37% of youths in secondary school are believed to have hurt themselves in such a fashion; 6% to 7% of adolescents say they do it regularly. And though  the behavior isn't intended to be suicidal, the distress that provokes it can ultimately lead to suicide or suicidal thoughts. Further, the actions themselves can lead to accidental suicide.

Paper author Janis Whitlock explores the prevalence of self-injury, the reasons for the behavior, its (still somewhat muddy) connection to suicide, its potential for contagion, the treatments -- and the signs.

She writes in conclusion:

"Because [non-suicidal self-injury] research is nascent, unanswered research questions abound. Those most pressing for clinicians and allied medical health professionals include (a) discerning individuals with [non-suicidal self-injury] history at elevated risk for suicide from those not at elevated risk, (b) effective treatment regimes, (c) effective prevention strategies in school and community settings, and (d) assessment and referral protocols likely to result in effective treatment and abatement of [non-suicidal self-injury] behavior."

We apparently have a long way to go.

Here, staff writer Shari Roan details one radiologist's X-ray evidence of a particular form of self-injury known as embedding: Turning the hurt toward the self

There are many types of self-injury; cutting is but one. Helpguide.org offers this self-injury explainer, with resources. It states (and is worth repeating):

"The person who self-injures may not recognize the connection, but this act usually occurs after an overwhelming or distressing experience and is a result of not having learned how to identify or express difficult feelings in a healthy way."

The paper offers a place for clinicians to start. The Helpguide page is a place for parents and teenagers to start.

-- Tami Dennis

Photo: An X-ray reveals metal pieces in a teenage girl's wrist, left there in a form of self-injury known as embedding. (Here's the accompanying article.)

Credit: Dr. William E. Shiels II


State teen pregnancy prevention efforts garner praise

May 21, 2010 | 10:51 am

Crib California has distinguished itself among states for its strong teen pregnancy prevention strategy dating back to the early 1990s, says the author of a paper published this week in the Guttmacher Policy Review. The state achieved these results by being bold enough to carve out its own strategy on teen pregnancy prevention and by bucking the popular politics of the last decade that promoted abstinence-only sex education, the report states.

The state's Department of Public Health reported in February that births to teen mothers reached a record low in 2008 of about 35 births per every 1,000. Nationwide, however, teen pregnancy rates have risen in recent years.

According to the report in the Guttmacher journal by Heather Boonstra, a senior public policy associate for the Guttmacher Institute, California's program was notable because the state made teen pregnancy prevention a priority and because the effort encompassed comprehensive sex education, healthcare services and counseling to prevent pregnancy. California is the only state that did not accept federal abstinence-only funds. Moreover, Boonstra said, California's 1997 launch of the Family PACT (Family Planning, Access, Care, and Treatment) program to provide reproductive health services and contraception free to low-income individuals was particularly successful in meeting the health needs of adolescents. Private sector foundations in the state also played a large role in teen pregnancy prevention efforts.

Further, the policy was bipartisan. The state's efforts to prevent teen pregnancy have spanned three administrations -- two Republicans and one Democratic. But this strong politic will be tested in the future with state budget cutbacks, Boonstra warned.

"The California experience demonstrates what can happen when there is long-term bipartisan support for a concerted, statewide effort, involving various actors from both the public and private sections, all working in the same direction," Boostra wrote. " ... In California, the whole of the effort clearly added up to more than the sum of its parts."

I like to think of the success of this program in terms of the teenagers. Because of fact-based sex education and access to reproductive health services, thousands of young women have been able to proceed with their education, jobs and lives without the premature responsibility of pregnancy and motherhood.

-- Shari Roan

Photo credit: Louie Balukoff  /  Associated Press



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