Best Information for Health Educators

23 Apr 2008

A new study by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) presents results on the first onset of substance use disorders (i.e., alcohol and drug abuse and dependence) and major mood and anxiety disorders, based on Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

This landmark survey is the first conducted in the U.S. to identify rates of first episodes (i.e., incidence) of these disorders in the U.S. population. In addition, it provides information on sociodemographic and psychopathologic risk factors for those disorders – information critical for developing evidence-based preventive interventions – and estimates risk for subsequent comorbid disorders.

Bridget Grant, Ph.D., Chief of NIAAA’s Laboratory of Biometry and Epidemiology, and her colleagues found that 1-year incidence rates were highest for DSM-IV alcohol dependence (1.70%), alcohol abuse (1.02%), major depressive disorder (1.51%) and generalized anxiety disorder (1.12%), followed by panic disorder (0.62%), bipolar I disorder (0.53%) and specific phobia (0.44%). One-year incidence rates of DSM-IV social phobia (0.32%), bipolar II (0.21%) and drug abuse (0.28%) and drug dependence (0.32%) were lower but not insignificant. These rates are comparable to or exceed corresponding incidence rates for other common medical diseases such as lung cancer (0.06%), stroke (0.45%) and cardiovascular disease (1.5%).

The study found that men were at greater risk of first onset alcohol abuse, alcohol dependence and drug dependence, and 1-year incidence rates were greatest among 20- to 29-year-olds and individuals who had been separated/divorced/widowed or never married. By contrast, the risk of most incident DSM-IV anxiety disorders, including panic disorder, specific but not social phobia, and generalized anxiety disorder, was greatest among women, and all anxiety disorder incidence rates were greater in the youngest age groups (20- to 54-year-olds). Among DSM-IV mood disorders examined in this study, the risk of first onset of major depressive disorder (MDD) was greatest among women, and no sex differences in incidence were found for bipolar I and II disorders. Taken together, these results highlight age as an important general risk factor for first onset DSM-IV substance use, mood and anxiety disorders, whereas the effects of sex and marital status appear to be disorder-specific.

Consistent with earlier studies, baseline dysthymia in this study predicted incident MDD, and baseline MDD predicted incident bipolar II disorder, suggesting that MDD precedes hypomania in the development of bipolar II disorder. Consistent with other prospective studies, alcohol abuse and dependence showed strong reciprocal temporal relationships, whereas drug abuse predicted only incident drug dependence. “The reciprocal relationship between alcohol abuse and dependence suggests that strong common factors may underlie the relationship and provides support for eliminating the hierarchy between the disorders in future DSM revisions,” state the authors. Other intriguing findings include reciprocal temporal relationships between MDD and GAD, and GAD and panic disorder, suggesting that common causes underlie those disorders. In addition, substance use disorders did not predict any incident mood or anxiety disorder, the authors note.

“Information on psychiatric risk factors prospectively identified in this study can begin to inform a new class of preventive interventions aimed at preventing a second disorder or set of disorders,” said Grant. “As to clinical implications, this study helps to clarify the risk of future disorders posed by chronologically primary disorders, information that may be used to improve treatment planning and counsel patients at risk of developing secondary disorders.”

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Filed under: Just Reading

22 Apr 2008

The human brain responds to being treated fairly the same way it responds to winning money and eating chocolate, UCLA scientists report. Being treated fairly turns on the brain’s reward circuitry.

“We may be hard-wired to treat fairness as a reward,” said study co-author Matthew D. Lieberman, UCLA associate professor of psychology and a founder of social cognitive neuroscience.

“Receiving a fair offer activates the same brain circuitry as when we eat craved food, win money or see a beautiful face,” said Golnaz Tabibnia, a postdoctoral scholar at the Semel Institute for Neuroscience and Human Behavior at UCLA and lead author of the study, which appears in the April issue of the journal Psychological Science.

The activated brain regions include the ventral striatum and ventromedial prefrontal cortex. Humans share the ventral striatum with rats, mice and monkeys, Tabibnia said.

“Fairness is activating the same part of the brain that responds to food in rats,” she said. This is consistent with the notion that being treated fairly satisfies a basic need, she added.

In the study, subjects were asked whether they would accept or decline another person’s offer to divide money in a particular way. If they declined, neither they nor the person making the offer would receive anything. Some of the offers were fair, such as receiving $5 out of $10 or $12, while others were unfair, such as receiving $5 out of $23.

“In both cases, they were being offered the same amount of money, but in one case it’s fair and in the other case it’s not,” Tabibnia said.

Almost half the time, people agreed to accept offers of just 20 to 30 percent of the total money, but when they accepted these unfair offers, most of the brain’s reward circuitry was not activated; those brain regions were activated only for the fair offers. Less than 2 percent accepted offers of 10 percent of the total money.

The study group consisted of 12 UCLA students, nine of them female, with an average age of 21. They had their brains scanned at UCLA’s Ahmanson-Lovelace Brain Mapping Center. The subjects saw photographs of various people who were said to be making the offers.

“The brain’s reward regions were more active when people were given a $5 offer out of $10 than when they received a $5 offer out of $23,” Lieberman said. “We call this finding the ’sunny side of fairness’ because it shows the rewarding experience of being treated fairly.”

A region of the brain called the insula, associated with disgust, is more active when people are given insulting offers, Lieberman said.

When people accepted the insulting offers, they tended to turn on a region of the prefrontal cortex that is associated with emotion regulation, while the insula was less active.

“We’re showing what happens in the brain when people swallow their pride,” Tabibnia said. “The region of the brain most associated with self-control gets activated and the disgust-related region shows less of a response.”

“If we can regulate our sense of insult, we can say yes to the insulting offer and accept the cash,” Lieberman said. UCLA is California’s largest university, with an enrollment of nearly 37,000 undergraduate and graduate students. The UCLA College of Letters and Science and the university’s 11 professional schools feature renowned faculty and offer more than 300 degree programs and majors. UCLA is a national and international leader in the breadth and quality of its academic, research, health care, cultural, continuing education and athletic programs. Four alumni and five faculty have been awarded the Nobel Prize.

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Filed under: Psychology

20 Apr 2008

It’s a question that bedevils virtually every parent with a kid who plays sports: Is there anything you can do to keep your young athlete on the field and off the disabled list?

It turns out the answer is yes. Tony Breitbach, Ph.D., assistant professor and director of athletic training education at Saint Louis University’s Doisy College of Health Sciences, says there are five things every parent can do to help their kids stay healthy and injury-free while playing sports this summer.

“These are important, common-sense steps that many parents overlook or aren’t aware of,” Breitbach says. “But as summer approaches, it’s more important than ever that parents be aware of the steps they can take to make the coming sports season fun, healthy and injury-free for their kids.”

Following are Breitbach’s five tips for helping young athletes avoid injury:

1: Make sure equipment fits properly. Kids generally grow fast, which means the gear that fit perfectly last year may be too small now.

“Ill-fitting shoes can be an especially big problem,” says Breitbach. “Last summer’s baseball cleats will likely not be right for this summer.” Protective equipment, in particular, must fit properly and be appropriate for the sport, he adds. “If it doesn’t fit, it won’t protect.”

2: Watch their diet. To stay healthy while playing sports, kids need to eat a proper and balanced diet low in fat, with moderate amounts of lean protein and high in complex carbohydrates. Athletes need lots of the latter what Breitbach calls “high-energy foods” right before and after a game or workout.

For athletes, Breitbach says, a key part of a proper diet is staying well-hydrated during and after a big game. “People place way too much emphasis on energy and sports drinks, when good cool water will do just fine and it’s even preferable in most cases.”

He urges that you make sure your child has enough water for the particular sport or activity. “Don’t give him a bottle of water for a long game,” Breitbach says. “In that case, a jug would be better.”

3: Keep them well-rested …and not overbooked. The right amount of sleep and rest is critical to simply function day to day. Athletes also need it to help them recover from the stress or exertion of their game or activity. This is particularly true for kids who play multiple sports sometimes in the same day, Breitbach says.

“Parents need to be really careful about overscheduling their kids,” he says. “They need as much time as possible between games so their bodies can rest and recover.”

4: Help them stay physically fit. In general, Breitbach says, the more fit someone is, the less likely they are to be injured playing sports. The best way to keep your kid in shape is to never let him or her get out of shape. Make sure they’re active all year-round, and don’t rely on sports to keep your kid fit.

Furthermore, Breitbach cautions, don’t sign your child up for a sport just so he or she can lose weight.

“They need to love the sport,” he says. “The truth is, lots of sports aren’t conducive to weight loss anyway in baseball, for instance, there’s a lot of standing around. If your kid needs to lose weight, put him on a healthy diet and join a fitness center where there are personalized fitness programs.”

5: Take care of injuries right away. Listen to your kid’s body, Breitbach says. Take scrapes, pains and aches seriously and if your child is hurt, make sure the injury gets immediate medical attention.

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Filed under: Sports Injury

18 Apr 2008

A child’s innocence and vulnerability presents a target for a sexual predator’s abusive behavior. University of Missouri researchers are beginning to understand the communication process by which predators lure victims into a web of entrapment. This information could better equip parents and community members to prevent, or at least interrupt, the escalation of child sexual abuse.

“Our children are our greatest gift and our greatest responsibility. The fact that they could be abused in any way, shape or form is horrific–both in the moment of the abuse and in the long-term effect,” said Loreen Olson, MU associate professor of communication in the College of Arts and Science. “It’s a social problem with grave consequences that is prevalent and needs attention. It’s incomprehensible, but it’s happening. The sexual abuse of children has dramatic negative consequences to their emotional well-being throughout their lives.”

According to the researchers, in order for the process of entrapment to take place, the perpetrator must first gain access to the potential victim through various exploitive means. Olson and her team identified several communicative elements in the cycle of entrapment, including the core phenomenon of “deceptive trust development.” Deceptive trust development describes the predator’s ability to build a trusting relationship with the victim in order to improve the likelihood of sexual encounter.

Deceptive trust development is central to other manipulative strategies used by the predator such as grooming. Grooming sets the stage for abuse by desensitizing the victim to sexual contact. Grooming may include activities such as sitting on a child’s bed and watching them get into their bedclothes; “accidentally” touching the child inappropriately; showing the child pornographic images; and making contact or sex play with implicit sexual suggestions.

As perpetrators are grooming their victims and building deceptive trust, they also work to isolate them both physically and emotionally from their support network. Isolation strategies may include offers to baby sit, giving the child a ride home, and taking advantage of fragile family and friend relationships. Isolation causes the victim to become more and more dependent on the perpetrator.

A third strategy is approach, which is the initial physical contact or verbal lead-ins that occur just prior to the sexual act. Examples of approach strategies include suggestions to play sex games, more explicit discussions about sexual issues, giving a child a “rubdown,” bathing or undressing a child, and instigating wrestling and other physical games as a means to escalate sexual physical contact.

Olson, and her co-authors analyzed existing published material on pedophilia and child sexual abuse and proposed their theory that explains the communication process used by child sexual predators. Their theory of luring communication is part of a new area of study which Olson calls “the communication of deviance.”

“The more we know about how these adults are entrapping children and building a sexual relationship with them, the better we can either intervene and stop the cycle from happening, or de-escalate it,” Olson said.

According to the study, the theory of luring communication also may offer important insight into social, deviant and communicative problems plaguing society, such as how con-artists lure victims and the recruitment strategies of gang or cult members.

The study, “Entrapping the Innocent: Toward a Theory of Child Sexual Predators’ Luring Communication,” co-authored by Joy Daggs, Barbara Ellevold and Teddy Rogers, was recently published by the International Communication Association journal, Communication Theory.

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Filed under: Adolescent Health

15 Apr 2008

When young people dress according to the customs of their own ethnic group, they may be less likely to have mental health problems later in life.

Adolescents are especially prone to mental health problems, and often, their identities are displayed in clothing and in their choices of friends. As a result, it is valuable to understand how this clothing and kinship can influence mental health status.

These findings were based on an investigation of approximately 1,000 white British and Bangladeshi students between the ages of 11 and 14 in schoos in East London. These schools display some of the highest levels of population diversity in the United Kingdom. The pupils were asked about their culture, social life, and health in 2001. Then, two years later, they were surveyed again with a focus on mental health.

Having friends from their own and other cultures, called integrated friendships, or having friends exclusively with the same culture made no difference in the mental health of the student. However, clothing choices did: those Bangladeshi students who wore traditional clothing were less likely to have problems with their mental health than those whose dress tended to mid traditional styles with British/North American tastes. In comparing the genders, females in particular showed this association. The white British pupils who wore a mixture still enjoyed relatively good mental health.

The authors state that cultural integration is generally the healthiest option for young people confronted with today’s increasingly multicultural society. However, social pressures towards changes in lifestyle, attitudes, or behaviors can cause added stress. They conclude from this study that retaining cultural identity through clothing in particular may be an important way to contribute to better mental health of adolescents.

Cultural identity, clothing and common mental disorder: a prospective school-based study of white British and Bangladeshi adolescents
K Bhui, Y Khatib, R Viner, E Klineberg, C Clark, J Head, S Stansfeld
Epidemiol Community Health 2008; 62: 435-441.

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Filed under: Adolescent Health