Recreational Use of Prescription Drugs Among Teens

Twenty percent of high school students in the United States have taken a prescription drug, such as OxyContin, Percocet, Vicodin, Adderall, Ritalin, or Xanax, without a doctor’s prescription, according to the 2009 National Youth Risk Behavior Survey (YRBS). This is the first year the survey assessed prescription drug abuse among high school students. The 2009 YRBS shows that many high school students engage in risk behaviors that are harmful to their overall health and increase their risk of disease and injury.

The Centers for Disease Control (CDC) and YRBS’s recently released issue brief, “Unintentional Drug Poisoning in the United States” highlight a serious public health problem with non-medical use of prescription drugs. The issue brief points out that drug overdose rates have risen steadily in the United States since 1999, with most of the increase due to prescription drugs.

Data from the Drug Abuse Warning Network (DAWN), operated by the Substance Abuse and Mental Health Services Administration (SAMHSA), estimate that in 2008 people 12-20 years old accounted for an estimated 141,417 (14.5 percent) of the 971,914 emergency department visits for nonmedical use of pharmaceuticals. These numbers do not include suicide attempts.

“Our Nation faces many public health threats that deserve our immediate attention. Among them, there is the pressing reality of drug overdoses. Teens and others have a false assumption that prescription drugs are a safer high,” said Grant Baldwin, PhD, MPH, Director of CDC’s Injury Center Division of Unintentional Injury Prevention. “These data and that from other sources show us that prescription drug misuse is a significant problem in both adolescents and adults.”

The CDC recommendations in the issue brief are based on promising interventions and expert opinion to help health care providers, state and federal agencies, as well as private insurance providers and pharmacy benefit managers, to better understand the impact and cost of unintentional poisoning. CDC continues to respond to this problem through surveillance activities, epidemiologic research, and evaluation of interventions with the greatest promise of creating a public health impact.

Source: CDC, June 3, 2010

Twenty Percent of American Teens Have Abnormal Lipid Levels

Twenty percent of young people aged 12-19 years in the United States have at least one abnormal lipid level, according to a study from the Centers for Disease Control and Prevention.  Abnormal lipid levels are major risk factors for heart disease, the leading cause of death among adults in the United States.

The report, “Prevalence of Abnormal Lipid Levels among Youths —United States, 1999–2006,” was published today in CDC’s Morbidity and Mortality Weekly Report (MMWR).

The report examined data for 1999–2006 from the National Health and Nutrition Examination Survey (NHANES), an ongoing study that explores the health and nutritional status of about 6,000 participants every year.  Researchers analyzed measurements of low-density lipoprotein, or “bad,” cholesterol (LDL-C); high-density lipoprotein, or “good,” cholesterol (HDL-C); and triglycerides.

The researchers found that young people who were overweight or obese were more likely to have one or more abnormal lipid levels compared to normal weight youth.  Fourteen percent of normal weight, 22 percent of overweight, and 43 percent of obese youth had one or more abnormal lipid levels.

The study also found that 32 percent of these young people would be candidates for lipid screening based on American Academy of Pediatrics (AAP) guidelines.  The AAP recommends lipid screening for young people with a family history of high blood cholesterol or premature cardiovascular disease, or the presence of at least one major risk factor for heart disease, such as smoking, high blood pressure, diabetes, or overweight/obesity.

Reviewing health indicators for 3,125 youths, researchers found that differences in lipid levels were associated with sex, age, and race/ethnicity. Specifically:

  • More boys (24 percent) than girls (16 percent) had at least one abnormal lipid level.
  • Fourteen- and 15-year-olds (9 percent) and 18- and 19-year-olds (10 percent) were more likely to have low HDL cholesterol levels than 12- and 13-year-olds (5 percent).
  • Non-Hispanic white youths were more likely to have low levels of HDL cholesterol (8 percent) and high triglycerides (12 percent), compared to non-Hispanic black youths (5 percent and 4 percent, respectively).

Typically, heart disease develops in adulthood. But its risk factors, such as abnormal lipid levels and overweight/obesity often emerge during childhood and adolescence.

“Overweight and obese young people are at far greater risk of having abnormal lipid levels than are youths with normal weights,” said Ashleigh May, Ph.D.,  Epidemic Intelligence Service Officer in CDC’s Division for Heart Disease and Stroke Prevention, and lead author of the report.  “The current epidemic of childhood obesity makes this a matter of significant and urgent concern.”

In the past three decades, obesity among American youths has increased from 5 percent to more than 17 percent.  In light of this, the study’s authors suggested that clinicians should be aware of guidelines for lipid screening and treatment among youths.

Source: Centers for Disease Control (Jan. 21, 2010)

Health of Obese Teens Better After Laparoscopic Surgery

The results of a new study show that the overall health of obese teenagers improved after they underwent laparoscopic gastric banding surgery.

The study’s lead author, Ilene Fennoy, MD, a pediatric endocrinologist at Morgan Stanley Children’s Hospital of NewYork-Presbyterian and clinical professor of pediatrics at Columbia University College of Physicians and Surgeons, said that this type of surgery – called the Lap Band procedure – is a safe and effective way for morbidly obese teens to lose weight. The procedure has been approved for use in adults by the FDA, but not yet for teenagers.

Dr. Fennoy observed that obesity-related health problems, such as diabetes and high blood pressure, are common in extremely obese teenagers, who have had to rely on non-surgical methods or high-risk surgeries to lose weight; and to date few treatments have been effective in helping adolescents. “Laparoscopic gastric banding offers the possibility of a new therapy for morbidly obese adolescents who have medical complications,” Dr. Fennoy said.

The study involved 14 morbidly obese adolescents, 6 boys and 8 girls, aged between 14 and 17 years, with the objective of documenting the impact of Lap-Band on the medical complications of obesity or their risk factors.

In order to shrink the stomach without using staples, a band goes round the upper part of the stomach, to create a small pouch that restricts food intake. The surgeon implants a small access port, and after the surgery the doctor periodically adjusts the gastric band by inflating or deflating a saline-filled balloon that lies inside the band. If desired, the procedure is reversible.

Dr. Fennoy stated that patients lost an average of 20 pounds within 6 months of the operation. While blood pressure remained virtually unchanged, major improvements were noted, including levels of fat in the blood, average blood sugar, liver function and a measure of immune response.

“Laparoscopic gastric banding provides a reasonable solution for obese young people who need to lose a large amount of weight,” Fennoy said.

Source: Endocrine Society, 9th Annual Meeting, June, 2008

TV in Teens’ Bedrooms Promotes Poor Diet and Exercise Routines

University of Minnesota School of Public Health researchers have found that a television in the bedroom promotes poor dietary, study and exercise habits among teenagers. 62% of a sample of 781 teenagers aged 15 to 18 in the Minneapolis area had a television in their bedroom, and spent 4 to 5 hours per week watching television. Bedroom TV owners ranked as heavy watchers, at least 5 hours a day—twice the amount of teenagers without one.

Boys among the television owners achieved a lower grade point average, had less fruit and ate fewer meals with the family than boys without one. Girls owning television sets spent only 1.8 hours per week exercising (versus 2.5 hours for girls without one), consumer less vegetables, ate fewer family meals and drank more sweetened soft drinks.

Daheia Barr-Anderson, one of the research team, was quoted as saying that these results showed that there were clear advantages to banning a TV from a teenager’s bedroom. This view was supported by the American Academy of Pediatrics, which encouraged the removal of TV sets by parents from their childrens’ bedrooms. The findings of the study were published in the Academy’s journal, Pediatrics.

Statistically, the study showed that 68% of boys, compared with 58% of girls, would probably have a bedroom TV, while children from the highest income families were less likely to have one. 82% of black teenagers had a television in their bedroom, while only 66% of Hispanic teens and 60% of whites had one. 39% of Asian American teens reported ownership.

In this study, body mass index was not found to influence teenage obesity, although Barr-Andersen quoted previous studies that showed that ownership of a bedroom TV was a strong predictor of obesity. Both boys and girls with bedroom TV’s admitted to devoting less time to reading and homework, although the differences were not statistically significant, said the researchers.

Teen Pregnancy May Be Reduced by Sex Education in Schools, Says Study

Sex education may reduce teen pregnancy without increasing the amount of sexual intercourse among teens, or the incidence of sexually transmitted diseases among them, according to new research.

"It is not harmful to teach teens about birth control in addition to abstinence," said study lead author Pamela Kohler, a program manager at the University of Washington in Seattle.

Which approach will postpone sexual experience? Instruction on birth control, or advice on how to say No. That’s the longstanding debate between sex educators and parents. The findings of a study analyzing the response from 1,719 teens, heterosexual and aged between 15 and 19, and the 2002 national survey, found that one in four teens received abstinence-only education, 9%—primarily those living in rural areas and the poor%—received no sex education at all, while the remaining two-thirds received comprehensive instruction with discussion of birth control.

Predictably, those teens receiving comprehensive sex education were 60% less likely to become pregnant or impregnating someone than those receiving no sex education at all. The one in four teens receiving abstinence-only education were 30% less likely to become pregnant than those receiving no sex education at all, although this number was dismissed as statistically insignificant by the researchers because so few teens fit the categories researchers analyzed.

The findings support comprehensive sex education, Kohler said. "There was no evidence to suggest that abstinence-only education decreased the likelihood of ever having sex or getting pregnant." Don Operario, Ph.D., a professor at Oxford University in England, said the study provides "further compelling evidence" about the value of comprehensive sex education and the "ineffectiveness" of the abstinence-only approach.

Still, the study does not show how educators should implement comprehensive sex education in the classroom, said Operario, who studies sex education. "We need a better understanding of the most effective ways of delivering this type of education in order to maximize audience comprehension and community acceptability."

The study appeared in the April, 2008 issue of the Journal of Adolescent Health.

Insufficient Sleep Could Lead to Overweight Kids

Research findings from the University of Michigan C.S. Mott Children’s Hospital indicate that kids who don’t get enough sleep may be at increased risk of being overweight.

A study researching the connection between length of sleep and weigh for third and sixth grade children showed that kids who got less than 9 hours sleep per day were at greater risk of being overweight—regardless of their gender, race, socioeconomic status, or home environment quality.

The study showed that sixth graders short on sleep were more likely to be overweight. Third graders who got fewer hours of sleep—regardless of their BMI—were more likely to become overweight in sixth grade. The findings of this study appear in the November issue of the journal Pediatrics.

"Many children aren’t getting enough sleep, and that lack of sleep may not only be making them moody or preventing them from being alert and ready to learn at school, it may also be leading to a higher risk of being overweight," says study lead author Julie C. Lumeng, M.D., assistant research scientist at the U-M Center for Human Growth and Development. "This study suggests that an increased risk for overweight is yet another potential consequence of short sleep duration, providing an additional reason to ensure that children are receiving adequate sleep, primarily through enforcing an age-appropriate bed time."

Data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development on reported sleep problems, sleep duration and BMI for 785 elementary school children, aged 9 to 12, was reviewed . 50% were male, 81% were white, 18% were overeight in the sixth grade. The overweight sixth grade lids slept fewer hours than those were not overweight, with boys in the majority of overweight sixth grade children.

"Even more important," Lumeng says, "is emerging research that shows a connection between sleep disruption and the hormones that regulate fat storage, appetite and glucose metabolism. Short sleep duration alters carbohydrate metabolism, and leads to impaired glucose tolerance, which can affect a person’s weight. Circadian rhythms, too, affect the body’s leptin, glucose and insulin levels."

So weight gain may not be a result of sleep’s effect on behavior, notes Dr. Lumeng, but rather sleep’s effect on hormone secretion in the body, specifically leptin and grehlin.

The National Sleep Foundation recommends these basic daily sleep requirements for children, adolescents, pre-teens and teens:

  • Preschoolers: 11-13 hours
  • Elementary school students: 10-12 hours
  • Pre-teens: 9 – 11 hours
  • Teens: 8 ½ – 9 hours

In addition to Lumeng, co-authors from the U-M Center for Human Growth and Development are Deepak Somashekar, B.S., and Niko Kaciroti, Ph.D.; Danielle Appugliese, MPH, with the Data Coordinating Center, Boston University; and Robert F. Corwyn, Ph.D., and Robert H. Bradley, Ph.D., with the Center for Applied Studies in Education, University of Arkansas.

The study was supported by the American Heart Association Fellow-to-Faculty Transition Award, and the American Heart Association Midwest Affiliate Grant-in-Aid.

Reference: Pediatrics, November 2007, Vol. 120, Issue 5.

Counseling Plus Medication May Help Teens Quit Smoking

A clinical trial of 312 teenagers aged 14 to 17 who smoked six or more cigarettes a day and had tried quitting at least twice, found that counseling and medication may help teens quit smoking, though in some cases (26-week time period), the placebo group had higher quit-rates than those taking the drug tested in the study, bupropion.

The subjects were divided into three groups and administered 150 milligrams (105 teens) or 300 milligrams (104 teens) of bupropion daily, or a placebo (103 teens).

Students received six weeks of treatment and one week of post-treatment, in addition to 10-20 minutes of individual counseling. Followup interviews were conducted by phone after 12 weeks, and in person after 26 weeks.

Quit rates were higher for the 300 milligram group every week except the fourth week. After six weeks, 5.6 percent of subjects in the placebo group, 10.7 percent taking 150 milligrams of bupropion, and 14.5 percent taking 300 milligrams of bupropion had quit smoking. At 26 weeks, 10.3 percent of placebo subjects, 3.1 percent of those taking 150 milligrams of bupropion, and 13.9 percent who took 300 milligrams were still not smoking.

The results indicate that although 300 milligrams of bupropion plus counseling were effective in helping teens quit smoking in the short term, quit rates at the end of the treatment were lower than for adults taking the same medication.

The high rate of relapse after medication stopped suggests the need for a longer treatment period than the 12 weeks recommended for adults may be needed.

"This study provides hope for helping a generation of smokers to quit before they become adults," the authors conclude. "These results are critically important because few effective treatment options are available for adolescent smokers who want to quit."

This study noted that fully one fourth of U.S. high school student currently smoke cigarettes.

The study was conducted by Myra L. Muramoto, M.D., M.P.H., Scott Leischow, Ph.D., and colleagues at the University of Arizona, Tucson, and supported by a National Cancer Institute grant, The Robert Wood Johnson Foundation (financial support for all aspects of the study) and GlaxoSmithKline (maker of bupropion).

Source: Arch Pediatr Adolesc Med. 2007;161(11):1068-1074

Eliminate Your Kid’s Backpack – Try a “Wheelie” Instead

Even before they hit middle school, kids are cramming more and more pounds into their backpacks. What started out as a place to carry lunch, a few notepads and a mathematics text has turned into a portable library.

Unfortunately, your child’s back wasn’t designed to carry a day’s worth of textbooks, lunch and supplies.
Even with a backpack properly carried on both shoulders, more and more kids are complaining of back pain.

The solution? Talk to your child’s teachers about cutting the textbook load. And consider buying one of the newer backpacks that come with wheels. No longer the realm of "geeks," they’re the right fashion statement for the upwardly mobile student.

Smoking Hooks Kids Almost Immediately, New Study Shows

According to a study published in the July issue of the Archives of Pediatrics and Adolescent Medicine, 10% of 217 studied children who inhaled cigarettes "lost autonomy over their tobacco" use within two days of their first cigarette. Another quarter became addicted within thirty days, and a full half were addicted after smoking only seven cigarettes per month.

The conclusions contradict "conventional wisdom" which believed that it took multiple cigarettes (at least five to six) per day to become addicted to nicotine.

It isn’t long term use that causes addiction, a study author noted, but it is the addiction that causes the heavy use.

Archives of Pediatric and Adolescent Medicine 

Trading Prescription Medications Among Teens

With an increase in the number of psychotropic prescriptions for adolescents there are increased chances of these prescriptions ending up in the wrong hands.

Results of a survey of school students show that 1% of all prescriptions that caregivers write for teenagers are used for non-medical purposes. 6 out 10 students with legitimate psychotropic prescriptions are contacted to redirect their prescriptions. 1% of them agree to do it and some even sell them. As many as 25% have reported that they divert the prescriptions to family and friends.

Critics hold doctors responsible for giving out too many prescriptions to teenagers. However, researchers say that the real problem might be that doctors do not adequately discuss the matter of diverted prescriptions with patients and their families.