Serving Substance Abuse Professionals Since 1993

Last Update: 11.07.11

C O R K O N L I N E

powerpoint presentations
CORK database search
resource materials
bibliographies
clinical tools
user services
newsletters
about cork
home

CORK Bibliography: Preadolescents

59 citations. 2010 to present

Prepared: June 2011

Abuzayan I; Paraskavi U; Turner SW. Changes to exhaled nitric oxide in asthmatic children after drinking a caffeine-containing cola drink. Pediatric Pulmonology 45(12): 1228-1232, 2010. (26 refs.)

Introduction: Exhaled nitric oxide (FENO) may be a biomarker for airway eosinophilia and of use in the management of childhood asthma. Caffeine ingestion has been associated with changes in FENO concentration in adults. The present study tested the hypothesis that ingestion of a caffeine-containing cola drink will increase FENO in asthmatic children. Methods: Exhaled NO was measured in children with asthma before, 30 and 60 min after taking a cola drink containing 0.7 mg/kg caffeine. Intrasubject changes in FENO and flow independent NO parameters were determined including bronchial wall NO flux (J'awNO). Results: Eleven children with asthma were recruited, 10 were prescribed inhaled corticosteroids and 9 were skin prick positive. The median [interquartile range, IQR] FENO at baseline was 47 parts per billion [9,64] and this rose to 56 ppb [11,66] after 30 min and returned to 46 ppb [9, 62] after 60 min, Friedman's test P=0.003. J'awNO rose from a median [IQR] 2,843 nl/sec [356, 4,247] at baseline to 3,304 nl/sec [479, 4,387] after 30 min and returned to 2,937 nl/sec [356, 4,153] after 60 min, Freidman's test P=0.003. There was no significant change in other flow independent NO parameters. Conclusions: Ingestion of a caffeine-containing cola drink was associated with a modest and transient rise in FENO which is mostly explained by increased NO production in the proximal airways. Ingestion of a caffeine-containing cola drink may result in clinically relevant acute changes in FENO for children with asthma.

Andrews JA; Hampson SE; Greenwald AG; Gordon J; Widdop C. Using the implicit association test to assess children's implicit attitudes toward smoking. Journal of Applied Social Psychology 40(9): 2387-2406, 2010. (36 refs.)

The development and psychometric properties of the Implicit Association Test (IAT) measuring implicit attitudes toward smoking among 5th-grade children were described. The IAT with sweets as the contrast category resulted in higher correlations with explicit attitudes than did the IAT with healthy foods as the contrast category. Children with family members who smoked (vs. nonsmoking) and children who were high in sensation seeking (vs. low) had significantly more favorable implicit attitudes toward smoking. Further, implicit attitudes became less favorable after engaging in tobacco-prevention activities targeting risk perceptions of addiction. The results support the reliability and validity of this version of the IAT and illustrate its usefulness in assessing young children's implicit attitudes toward smoking.

Armstrong KE; Bush HM; Jones J. Television and Video game viewing and its association with substance use by Kentucky elementary school students, 2006. Public Health Reports 125(3): 433-440, 2010. (20 refs.)

Objective. We sought to determine if the number of hours elementary school students viewed television (TV) and video games is associated with substance use. Methods. We distributed the California Healthy Kids Survey Elementary School Questionnaire to elementary schools in Kentucky in 2006. A total of 4,691 students, primarily fourth and fifth graders, completed the survey. The students provided responses to questions on topics such as drug use, alcohol use, TV and video game viewing time, and their home life. We analyzed the survey using Chi-square tests and logistic regression. Results. Approximately one-third of respondents indicated substance use, which was defined as alcohol use, illegal drug use, smoking/tobacco use, or sniffing solvents. Significantly more children (28% of those watching >= 3 hours of TV/video games compared with 20% of those watching greater than zero but <= 2 hours of TV/video games) reported alcohol use (p<0.05). Similar results were seen for sniffing solvents, with 9% of those watching >= 3 hours of TV/video games reporting they sniffed solvents compared with 4% who watched TV/video games for greater than zero but 2 hours (p<0.05). The results of the logistic regression indicated that the odds of drinking alcohol (odds ratio [OR] = 1.48, 95% confidence interval [CI] 1.23, 1.79) and sniffing solvents (OR=1.97, 95% Cl 1.42, 2.75) were significantly higher for those watching >= 3 hours of TV/video games compared with those who watched TV/video games for greater than zero but >= 2 hours. Conclusions. The hours of TV and video games viewed were associated with alcohol use and sniffing solvents for our sample. However, limitations exist due to the inability to separate TV viewing from video game viewing.

Asfar T; Klesges RC; Sanford SD; Sherrill-Mittleman D; Robison LL; Hudson MM et al. Trial design: The St. Jude Children's Research Hospital Cancer survivors tobacco quit line study. Contemporary Clinical Trails 31(1): 82-91, 2010. (79 refs.)

Nearly, one-fifth of childhood cancer survivors (CCSs) smoke cigarettes. Because CCSs are already at greater medical smoking-related risks, targeting them for smoking cessation efforts is a high priority. One of the major challenges with smoking cessation in CCSs is how to reach such a geographically dispersed population. This study aims to demonstrate that these challenges can be overcome through the use of telephone-based tobacco quit lines (QLs). This report describes the design of the St. Jude Cancer Survivor Tobacco QL study, which is a randomized controlled clinical trial that will examine the long-term (1-year) efficacy of a counselor initiated vs. participant initiated tobacco QL with adjunctive nicotine replacement therapy (NRT) in both groups. Participants (N=950) will be recruited nationally and randomly assigned to one of the two interventions. The counselor initiated intervention includes six scheduled telephone sessions of a behavioral intervention and provision of 8 weeks of NRT. The participant initiated intervention allows the participant to call the QL at their convenience, but includes the same six telephone sessions and provision of 2 weeks of NRT. Both groups will receive two follow-up phone calls at 8 weeks and 1 year after enrollment to assess their smoking status. The primary outcome measure is cotinine-validated self-reported smoking abstinence at 1-year follow-up. Results from this study will provide the first evidence about the efficacy of intensive QL cessation intervention in this high-risk population. Such evidence can lead as well to the dissemination of this intervention to other medically compromised populations.

Boyer EW; McCance-Katz EF; Marcus S. Methadone and buprenorphine toxicity in children. (review). American Journal on Addictions 19(1): 89-95, 2010. (31 refs.)

Recent years have seen very large increases in the prescribing of methadone and buprenorphine formulations for treatment of opioid addiction as well as the increasing utilization of methadone for the treatment of chronic pain. Coincident with the rise in the prescribing of these drugs has been a substantial increase in pediatric opioid toxicities and adverse events. This review will address the current state of methadone- and buprenorphine-related adverse events in children in the United States. We will also discuss treatment of opioid toxicity in pediatric populations and make recommendations aimed at reducing these occurrences.

Burge M; Hunsaker JC; Davis GJ. Death of a toddler due to ingestion of sulfuric acid at a clandestine home methamphetamine laboratory. Journal of Biological Chemistry 285(2): 298-301, 2010. (20 refs.)

Exposure to strong acids such as sulfuric acid to either the skin or the gastrointestinal or respiratory mucosa will result respectively in significant -- occasionally fatal -- cutaneous chemical burns as well as devastating corrosive damage to the respiratory and gastrointestinal tracts. Most injuries are accidental, but there are reports of using acids as weapons or as a means of suicide. The primary mechanism of acid injury is coagulative necrosis of the tissues. Sulfuric acid is a chemical often used in industrial and chemical laboratories, and it is an ingredient in household products like drain cleaner. Easily accessible, over-the-counter, household drain cleaner is one of several common materials used to manufacture methamphetamine. With increasing clandestine methamphetamine laboratories in the United States, exposure to methamphetamine and the toxic chemicals used for its production is a growing problem. In many instances, children living in these laboratories qua homes are at risk for injury and death. We report the death of an unattended toddler, who ingested sulfuric acid drain cleaner in his home. The gross and histopathological autopsy findings in this case are similar to those of previously described cases of sulfuric acid injury.

Cho SC; Kim BN; Hong YC; Shin MS; Yoo HJ; Kim JW et al. Effect of environmental exposure to lead and tobacco smoke on inattentive and hyperactive symptoms and neurocognitive performance in children. Journal of Child Psychology and Psychiatry 51(9): 1050-1057, 2010. (38 refs.)

Background: The present study assessed the association between blood lead and urinary cotinine levels and inattentive and hyperactive symptoms and neurocognitive performance in children. Methods: A total of 667 children (age range 8-11) were recruited from nine schools in five Korean cities. The teachers and parents completed the Korean version of the Attention-deficit/hyperactivity disorder Rating Scales (K-ARS), and the children performed neurocognitive tests. Blood lead and urinary cotinine levels were then measured. Results: The inattentive, hyperactive, and total scores of the teacher-rated K-ARS were positively associated with blood lead level, and the results of the continuous performance test (CPT), Stroop Color-Word Test, and Children's Color Trails Test were inversely associated with urinary cotinine level when controlled for age, gender, father's educational level, maternal IQ, child's IQ, residential area, birth weight, and cotinine (for lead) or lead (for cotinine). The association between blood lead level and commission errors score on the CPT disappeared when the effect of urinary cotinine level was controlled. Conclusions: These findings indicate that environmental exposure to tobacco smoke in children is associated with poor neurocognitive performance, and low levels of lead are associated with inattention and hyperactivity symptoms.

Chowdhury F; Chisti MJ; Hossain MI; Malek MA; Salam MA; Faruque AG. Association between paternal smoking and nutritional status of under-five children attending Diarrhoeal Hospital, Dhaka, Bangladesh. Acta Paediatrica 100(3): 390-395, 2011. (20 refs.)

Aim: The study aimed at determining whether there is an association between paternal smoking and nutritional status of children aged 0-59 months. Furthermore, the study looked at the presence of any nutritional differentials within different socio-economic groups. Methods: Secondary analysis of data on children aged 0-59 months enrolled in the Hospital Surveillance System of International Centre for Diarrhoeal Disease Research, Dhaka Hospital, Bangladesh, during 1996-2006. Results: Among 13,555 under-five children, fathers of 49% were smokers. In multivariate logistic regression models adjusting for potential confounders, fathers' smoking was significantly associated with increased risk of moderate underweight (OR 1.16, 95% CI 1.08-1.25), severe underweight (OR 1.15, 95% CI 1.06-1.26), moderate stunting (OR 1.15, 95% CI 1.06-1.23) and severe stunting (OR 1.13, 95% CI 1.03-1.25). In middle and lower socio-economic strata, risk of moderate and severe child malnutrition was found to be significantly increased in the group where the father was a smoker. Conclusion: Results indicate that there is an association between fathers' smoking and malnutrition of under-five children particularly in lower socio-economic group. A possible mechanism - if this association is causal - may be through a negative effect on family economy.

Christerson S; Stromberg B. Childhood stroke in Sweden I: incidence, symptoms, risk factors and short-term outcome. Acta Paediatrica 99(11): 1641-1649, 2010. (31 refs.)

Aim: To evaluate the incidence, presenting symptoms, diagnostic delay, risk factors and short-term outcome of childhood stroke in a population-based cohort of Swedish children. Methods: We retrospectively reviewed the records of children experiencing their first stroke during a 7-year period in Uppsala-Orebro Health Care Region covering one-fifth of the Swedish population. Arterial ischaemic stroke (AIS), cerebral sinus venous stroke and nontraumatic haemorrhagic stroke (HS) in children aged > 28 days and < 18 years were included. Results: We identified 51 children (23 boys and 28 girls; median age 13). The average annual incidence of stroke was 1.8 per 100,000 children. AIS was found in 51% of the children, HS in 41% and cerebral sinus venous stroke in 8%. One-third of the children had underlying diseases, and one-third had vascular malformations. Six girls used oral contraceptives, three of these were smokers and two had iron deficiency anaemia. Two children died in the acute stage (4%), and 40/49 (82%) had some neurological dysfunction at discharge. Conclusion: The incidence of childhood stroke was 1.8 per 100,000 children and year, and the primary mortality was 4%. Risk factors of importance were oral contraceptives, smoking and anaemia in combinations.

Corte C; Szalacha L. Self-cognitions, risk factors for alcohol problems, and drinking in preadolescent urban youths. Journal of Child & Adolescent Substance Abuse 19(5): 406-423, 2010. (60 refs.)

In this study we examine relationships between self-structure and known precursors for alcohol problems in 9- to 12-year-old primarily black and Latino youths (N=79). Parental alcohol problems and being female predicted few positive and many negative self-cognitions and a future-oriented self-cognition related to alcohol (drinking possible self). Nineteen percent of the sample reported ever drinking, but 40% of those with a drinking possible self reported ever drinking. Compared to never drinkers, youths who reported ever drinking had fewer self-cognitions. The self-structure may be an important mechanism through which parental alcohol problems and antisocial behavior lead to early alcohol use, and a viable target of interventions aimed at preventing early alcohol use.

Cranford JA; Zucker RA; Jester JM; Puttler LI; Fitzgerald HE. Parental alcohol involvement and adolescent alcohol expectancies predict alcohol involvement in male adolescents. Psychology of Addictive Behaviors 24(3): 386-396, 2010. (103 refs.)

Current models of adolescent drinking behavior hypothesize that alcohol expectancies mediate the effects of other proximal and distal risk factors. This longitudinal study tested the hypothesis that the effects of parental alcohol involvement on their children's drinking behavior in mid-adolescence are mediated by the children's alcohol expectancies in early adolescence. A sample of 148 initially 9-11 year old boys and their parents from a high-risk population and a contrast group of community families completed measures of drinking behavior and alcohol expectancies over a 6-year interval. We analyzed data from middle childhood (M age = 10.4 years), early adolescence (M age = 13.5 years), and mid-adolescence (M age = 16.5 years). The sample was restricted only to adolescents who had begun to drink by mid-adolescence. Results from zero-inflated Poisson regression analyses showed that 1) maternal drinking during their children's middle childhood predicted number of drinking days in middle adolescence; 2) negative and positive alcohol expectancies in early adolescence predicted odds of any intoxication in middle adolescence; and 3) paternal alcoholism during their children's middle childhood and adolescents' alcohol expectancies in early adolescence predicted frequency of intoxication in middle adolescence. Contrary to predictions, child alcohol expectancies did not mediate the effects of parental alcohol involvement in this high-risk sample. Different aspects of parental alcohol involvement, along with early adolescent alcohol expectancies, independently predicted adolescent drinking behavior in middle adolescence. Alternative pathways for the influence of maternal and paternal alcohol involvement and implications for expectancy models of adolescent drinking behavior were discussed.

de Leeuw RNH; Engels RCME; Scholte RHJ. Parental smoking and pretend smoking in young children. Tobacco Control 19(3): 200-205, 2010. (33 refs.)

Objective: To investigate whether parental smoking was associated with smoking-related play behaviour in young children. Design: Children were asked to pretend that they were grown-ups having dinner. They were invited to act out this situation in a play corner with a toy kitchen and a child-sized dining area, including a package of fake cigarettes on the table. Setting: Children were tested individually at their school during regular school hours. Participants The sample consisted of 100 children between 4 and 8 years of age (mean=5.28, SD=0.94) of which 57% were boys. The majority of the children were born in The Netherlands (99%). Measurements The main outcome measure was whether or not a child pretended to be smoking a cigarette. Child and parent reports were used to assess parental smoking. Findings: Findings revealed that 37% of the children had at least one 'puff' during their play. Children were more likely to pretend to smoke if they reported having smoking parents (OR=3.16, p=0.02; 95% CI=1.22 to 8.18). Analyses for the model with parent reports on parental smoking did not yield any direct association. Children's explicit attitudes were unrelated to their smoking-related play behaviour. Conclusions These findings indicate that young children, who reported having parents who smoke, already associate having dinner with a (after-dinner) cigarette.

DeGarmo DS; Reid JB; Leve LD; Chamberlain P; Knutson JF. Patterns and predictors of growth in divorced fathers' health status and substance use. American Journal of Men's Health 4(1): 60-70, 2010. (57 refs.)

Health status and substance use trajectories are described over 18 months for a county sample of 230 divorced fathers of young children aged 4 to 11. One third of the sample was clinically depressed. Health problems, drinking, and hard drug use were stable over time for the sample, whereas depression, smoking, and marijuana use exhibited overall mean reductions. Variance components revealed significant individual differences in average levels and trajectories for health and substance use outcomes. Controlling for fathers' antisociality, negative life events, and social support, fathering identity predicted reductions in health-related problems and marijuana use. Father involvement reduced drinking and marijuana use. Antisociality was the strongest risk factor for health and substance use outcomes. Implications for application of a generative fathering perspective in practice and preventive interventions are discussed.

Ding D; Wahlgren DR; Liles S; Jones JA; Hughes SC; Hovell MF. Secondhand smoke avoidance by preteens living with smokers: To leave or stay? Addictive Behaviors 35(11): 989-994, 2010. (53 refs.)

Introduction: Secondhand smoke (SHS) is hazardous to children's health. Designing interventions to reduce exposure requires understanding children's behavior in the presence of smokers, yet little is known about this behavior. Purpose: To determine whether children's avoidance of SHS is associated with lower exposure and to explore predictors of avoidance based on a behavioral ecological model. Method: Preteens aged 8-13 (N = 358) living with a smoker identified their primary source of SHS exposure, and reported whether they left (avoided exposure) or stayed the last time they were exposed to that person's smoke. The SHS avoidance measure was validated by examining associations with SHS exposure. Multiple Logistic Regression was used to determine predictors of SHS avoidance. Results: Based on urine cotinine and reported exposure, preteens who left the presence of SHS had lower exposure than those who stayed. Preteens were more likely to leave SHS if they were less physically mature, had not tried smoking, had a firm commitment not to smoke, did not assist family smoking, had family/friends who discouraged breathing SHS, or had friends who disliked smoking. Discussion: Most SHS exposure reduction interventions have targeted changes in smokers' behavior. Reductions can also be achieved by changing exposed nonsmokers' behavior, such as avoiding the exposure. Future studies should measure young people's SHS avoidance and test interventions to increase their avoidance practices.

Dove MS; Dockery DW; Connolly GN. Smoke-free air laws and asthma prevalence, symptoms, and severity among nonsmoking youth. Pediatrics 127(1): 102-109, 2011. (42 refs.)

OBJECTIVE: We investigated the association between smoke-free laws and asthma prevalence, symptoms, and severity among nonsmoking youth (aged 3-15 years). METHODS: We examined data from the 1999 - 2006 National Health and Nutrition Examination Survey, a cross-sectional survey designed to monitor the health and nutritional status of the US population. Survey locations were dichotomized as having or not having at least 1 smoke-free workplace, restaurant, or bar law at the county or state level that covered the entire county population. Asthma prevalence was assessed as self-reported current asthma and as ever having asthma with current symptoms. Asthmatic symptoms included persistent wheeze, chronic night cough, and wheeze-medication use. We also examined asthma severity (asthma attack or emergency-department visit for asthma) and persistent ear infection. RESULTS: Smoke-free laws were not associated with current asthma but were significantly associated with lower odds of asthmatic symptoms (odds ratio [OR]: 0.67 [95% confidence interval (CI): 0.48-0.93]) among nonsmoking youth. The association between smoke-free laws and ever having asthma with current symptoms approached significance (OR: 0.74 [95% CI: 0.53-1.03]). Smoke-free laws were associated with lower odds of asthma attacks (OR: 0.66 [95% CI: 0.28-1.56]) and emergency-department visits for asthma (OR: 0.55 [95% CI: 0.27-1.13]), although these results were not statistically significant. CONCLUSIONS: Our results suggest that smoke-free laws reduce asthmatic symptoms, including persistent wheeze, chronic night cough, and wheeze-medication use in nonsmoking youth.

Fallu JS; Janosz M; Briere FN; Descheneaux A; Vitaro F; Tremblay RE. Preventing disruptive boys from becoming heavy substance users during adolescence: A longitudinal study of familial and peer-related protective factors. Addictive Behaviors 35(12): 1074-1082, 2010. (76 refs.)

Childhood disruptiveness is one of the most important antecedents of heavy substance use in adolescence, especially among boys. The first aim of the present study is to verify whether parental monitoring and friend conventionality protect disruptive boys from engaging in heavy substance-use in adolescence. The second purpose is to examine whether these protective effects are strengthened by attachment to parents or friends respectively. Finally, the third objective is to verify whether the expected protective effect of parental monitoring could be mediated through exposure to conventional friends. A sample of 1037 boys from low socioeconomic neighbourhoods was followed from childhood (age 6) to adolescence (age 15). Parent, teacher, and self-reported measures were used to measure disruptiveness, parental monitoring, family attachment, friend conventionality, and attachment to friends. Results suggest that parental monitoring and friends' conventionality mitigated the relationship between childhood disruptiveness and adolescence heavy substance use. Exposure to conventional friends further mediated the protective effect of parent monitoring. The postulated enhancement of attachment quality on the protective effect of parents or peer behaviors was not confirmed, but low attachment was related to heavier substance use in highly monitored disruptive boys. Parental monitoring, family attachment, and peer conventionality are factors amenable to intervention, and thus represent promising targets for future prevention strategies aimed at-risk boys. Our results underscore the importance of simultaneously addressing the behavioral and the affective dimensions in interventions with parents.

Goldman RD. ADHD stimulants and their effect on height in children. (editorial). Canadian Family Physician 56(2): 145-146, 2010. (10 refs.)

QUESTION Many more children today are diagnosed and treated for attention deficit hyperactivity disorder. Parents frequently ask me if the stimulant medications their children receive might affect their height as adults. What should I tell them? ANSWER Stimulant medications, including methylphenidate and amphetamine, are safe and effective in children and adolescents with attention deficit hyperactivity disorder. Research on the issue of growth suppression is lacking, mostly owing to insufficient follow-up on patients' final heights. In general, the rate of height loss seems relatively small and is likely reversible with withdrawal of treatment. Clinical presentation and academic achievements should be the key to determining which drug to prescribe, the preparation, and the dose.

Grant P; Bell K; Stewart D; Paulson J; Rogers K. Evidence of methamphetamine exposure in children removed from clandestine methamphetamine laboratories. Pediatric Emergency Care 26(1): 10-14, 2010. (16 refs.)

Objective: To determine whether asymptomatic children removed from clandestine methamphetamine laboratories have evidence of exposure to methamphetamine. Methods: Retrospective chart review of children removed from law enforcement-certified clandestine methamphetamine laboratories in the Tulsa area of Oklahoma and Sacramento County, California. Exposure was determined by positive urine toxicology for methamphetamine. Results: One hundred four children were evaluated after removal from clandestine methamphetamine laboratories. Forty-eight children (46%) tested positive for methamphetamine. Timed urine results were known for 68 of 104, with no child testing positive after 6.5 hours from being removed from the laboratory. No child required emergency medical treatment at the time urine samples were obtained. Conclusions: Almost half of the children in this sample had evidence of exposure to methamphetamine soon after removal from methamphetamine manufacturing environments. Further research is indicated to determine the health effects of subclinical methamphetamine exposure.

Haight W; Black J; Sheridan K. A mental health intervention for rural, foster children from methamphetamine-involved families: Experimental assessment with qualitative elaboration. Children and Youth Services Review 32(10): 1446-1457, 2010. (80 refs.)

This mixed method study describes the cultural adaptation, implementation and impact of a mental health intervention for individual rural children aged 7-17 from methamphetamine-involved families who are in foster care. Features of the culturally-shaped intervention include: 1) close collaboration with local professionals who provide the intervention over a seven month period; 2) provision of the intervention in and around children's homes; and 3) the use of local storytelling traditions in a narrative- and relationship-based intervention. As a group, children (N= 15) showed problematic levels of Childhood Behavior Checklist (CBCL) externalizing and total problem behaviors and symptoms of PTSD/dissociation during the pretest. Children were randomly assigned to an experimental group who received the intervention immediately (n = 8). or a wait-list control group (n = 7) who received the intervention at the end of the study. There was a significant interaction effect of time (pre and post test) and group on externalizing behavior with the trajectory of the experimental group improving while that of the control group worsened. Gains made by the experimental group were maintained over a seven month follow-up period. Comparative case studies, individual qualitative interviews and open-ended questionnaires provided rich elaboration of participants' experiences and illuminated complexities and challenges of the intervention.

Haight W; Marshall J; Hans S; Black J; Sheridan K. "They mess with me, I mess with them": Understanding physical aggression in rural girls and boys from methamphetamine-involved families. Children and Youth Services Review 32(10): 1223-1234, 2010. (89 refs.)

This mixed method study examines the mental health and experiences of physical aggression in 41 children aged six to 14 years from rural families involved with methamphetamine misuse and the child welfare system. Each child was seen for a minimum of 3 h total by experienced clinicians on at least three sessions conducted at the child's home. Fifty percent of children scored in the clinical range (98th percentile and above) on externalizing and 26% on aggression scales of the Child Behavior Checklist (CBCL). More girls (75%) scored in the clinical range on CBCL externalizing behaviors than did boys (32%). During individual, semi-structured interviews, 17 children spontaneously produced 58 narratives of past physical aggression. These were primarily set at home and involved adults and the children themselves. Children primarily attributed physical aggression to anger and adult substance misuse, and described negative outcomes of the aggression. In contrast, a subgroup of girls with clinically significant levels of CBCL externalizing behaviors characterized their own physical aggression as appropriate retaliation with emotionally satisfying consequences. Many of these girls also scored in the clinically significant range on CBCL internalizing behaviors and total problems. Clinicians who collected the data expressed concern about these girls, in particular because they were ostracized from non delinquent peer groups, viewed others' continuing physical aggression against them as an inevitable part of their future, and described their own physical aggression as unavoidably driven by that violence. The perspectives of this subgroup of girls are elaborated through a case study of a physically aggressive 12-year-old. Implications for intervention are discussed.

Hanley SM; Ringwalt C; Ennett ST; Vincus AA; Bowling JM; Haws SW; Rohrbach LA. The prevalence of evidence-based substance use prevention curricula in the nation's elementary schools. Journal of Drug Education 40(1, special issue): 51-60, 2010. (21 refs.)

Current guidelines for school-based substance use prevention suggest that prevention efforts should begin in elementary grades, before students begin using substances. Previous research suggests, however, that the use of evidence-based curricula in these grades may be low. Using a 2005 survey of public school districts in the United States that include elementary grades (n = 1563), we assessed the prevalence of elementary curricula use, particularly those designated as evidence-based. We found that although 72% of districts administer a substance use prevention curriculum to their elementary students, only about 35% are using one that is evidence-based and only about 14% are using an evidence-based curriculum more so than any other prevention curriculum. We present prevalence estimates for specific evidence-based curricula and conclude by discussing possible reasons for and implications of our findings.

Hansen WB; Bishop DC; Jackson-Newsom J. Impact of a classroom behavior management intervention on teacher risk ratings for student behavior. Journal of Drug Education 40(1, special issue): 81-90, 2010. (20 refs.)

Classroom behavior management interventions have been used successfully with drug prevention programs to prevent subsequent antisocial behavior and substance use among youth. This article presents results from implementation of the All Stars Challenge, a classroom-based behavior management component to a drug prevention program for fifth graders. Risk ratings for shyness and lack of awareness of social norms among high-risk students who received the All Stars Challenge were reduced compared with fifth graders who did not receive the intervention. In contrast, physical and social aggressivity among low-risk students who received the program increased when compared to similar control students.

Hatzis CM; Papandreou C; Kafatos AG. School health education programs in Crete: Evaluation of behavioural and health indices a decade after initiation. Preventive Medicine 51(3-4): 262-267, 2010, 2010. (32 refs.)

Objective. To assess the long-term effectiveness of a school-based health education intervention program 10 years after its initiation. Method. In 1992 the total population of first grade students from three counties of Crete participated in the study. Over 1000 students were randomly selected for initial and periodic evaluation. Biochemical and behavioural parameters (anthropometric, lipoproteins, blood pressure, physical activity, dietary record and health habits) were measured. Re-evaluation of the program was performed at 3, 6 and 10 years after its initiation. Results. Ten years after the initiation of the program, the results showed that BMI had increased significantly less (p<0.001) and performance in the shuttle run test was significantly better (p<0.001) in the intervention group as compared to the control group. The reduction in total cholesterol noted in both groups was significantly greater in the intervention group than in the control group (p<0.001). The incidence of smoking was also significantly lower in the intervention group (intervention group 7%, control group 13%, p<0.005). Conclusion. This program appears to improve children's health and decrease risk factors for chronic diseases. If these positive effects are maintained in the forthcoming decades, the risk of chronic diseases may well be reduced.

Isaacs D. A smoking toddler. (editorial). Journal of Paediatrics and Child Health 46(12): 707-707, 2010. (0 refs.)

This brief communication centers on a heart-wrenching photograph of a two-year old from Indonesia, smoking a cigarette as he sits on a toy truck. The caption is as follows: Two-year-old Ardi Rizal from Indonesia was given his first cigarette at 18 months old by his father, an Indonesian fishmonger, and now smokes 40 cigarettes a day and has tantrums if he is denied them. He also weighs 25 kg and gets around on a toy truck as he cannot keep up with the other children, so there may be a slight problem with parental limit-setting. He has become a media sensation and a symbol of Indonesia's failure to regulate tobacco use. An estimated 1 million Indonesian children ess than 10 years old are smokers, and Indonesia is the world's third largest consumer of tobacco after China and India.

Jackson KM. Progression through early drinking milestones in an adolescent treatment sample. Addiction 105(3): 438-449, 2010. (50 refs.)

Aims: Research using nationally representative and community samples demonstrates a robust association between early onset of drinking and increased likelihood of numerous adverse outcomes. However, little is known about the subsequent drinking that occurs early in the drinking career. The present study dissects the transition from any alcohol use to treatment entry by taking a fine-grained approach to examining the attainment and progression of drinking events in a sample of adolescents in substance use treatment. Design/Setting: Data were taken from the Drug Abuse Treatment Outcome Study for Adolescents (DATOS-A), a multi-site, community-based study of adolescents entering treatment. Participants: Respondents included 3331 youth aged 12-18 years (mean = 15.75) admitted to treatment in 1993-95 (74% male, 52% white, 24% African American, 20% Hispanic). Measurements: Age of attainment was obtained for five drinking-related milestones, including first drink of alcohol, first time drunk, first monthly drinking, first drank five or more drinks/day on a weekly basis and first drank five or more drinks/day on a daily basis. Findings: Most milestones were attained at a very early age, and average progression through adjacent drinking events was relatively swift. Movement through early drinking milestones was accelerated in girls and white youth. Youth who reported their first drink at an early age (age 10 or younger) showed slower progression, suggesting the existence of distinct processes underlying early use and drinking transitions within an individual. Conclusions: This study provides data relevant to understanding drinking progression/natural history in a large clinical sample, especially for differences by gender and ethnicity. The findings have implications for the identification of intermediate stages that might benefit from selected intervention programs.

Jaspers M; de Winter AF; de Meer G; Stewart RE; Verhulst FC; Ormel Jsas et al. Early findings of preventive child healthcare professionals predict psychosocial problems in preadolescence: The TRAILS Study. Journal of Pediatrics 157(2): 316+, 2010. (65 refs.)

Objective: To develop and validate a prediction model for psychosocial problems in preadolescence using data on early developmental factors from routine Preventive Child Healthcare (PCH). Study design The data come from the 1692 participants who take part in the TRacking Adolescents' Individual Lives Survey, a longitudinal study. Information on early developmental factors (ages 0 to 4 years) was collected from the PCH file. Parents complete the Child Behavior Checklist when their child is age 11. To examine the predictive value of PCH-registered developmental factors on preadolescent problems, several multiple logistic regression analysis were performed, in a derivation sample (n = 1058). The predictive performance of the models was then assessed with area under the curve (AUC) in a validation sample (n = 643) to evaluate the validity of these models. Results PCH-registered behavioral problems, attention/hyperactivity problems, enuresis, education level of the father, and being male were found to significantly predict externalizing problems (odds ratios [OR] between 1.4 and 3.7). Internalizing problems were predicted by maternal smoking during pregnancy, sleep problems, and being male (ORs between 1.7 and 3.0). The model for externalizing problems had a modest discriminatory power (AUC 0.66, 95% confidence interval 0.59-0.72). However, for internalizing problems the AUC was 0.54 (95% confidence interval 0.47-0.60), indicating poor discriminatory power. Conclusions Findings on early development as registered by PCH are modestly predictive for externalizing problems in preadolescents, but only slightly for internalizing problems.

Kim DS; Kim HS. Early initiation of alcohol drinking, cigarette smoking, and sexual intercourse linked to suicidal ideation and attempts: Findings from the 2006 Korean Youth Risk Behavior Survey. Yonsei Medical Journal 51(1): 18-26, 2010. (21 refs.)

Purpose: This study examined the association between early initiation of problem behaviors (alcohol drinking, cigarette smoking, and sexual intercourse) and suicidal behaviors (suicidal ideation and suicide attempts), and explored the effect of concurrent participation in these problem behaviors on suicidal behaviors among Korean adolescent males and females. Materials and Methods: Data were obtained from the 2006 Korean Youth Risk Behavior Survey, a nationally representative sample of middle and high school students (32,417 males and 31,467 females) in grades seven through twelve. Bivariate and multivariate logistic analyses were conducted. Several important covariates, such as age, family living structure, household economic status, academic performance, current alcohol drinking, current cigarette smoking, current butane gas or glue sniffing, perceived body weight, unhealthy weight control behaviors, subjective sleep evaluation, and depressed mood were included in the analyses. Results: Both male and female preteen initiators of each problem behavior were at greater risk for suicidal behaviors than non-initiators, even after controlling for covariates. More numerous concurrent problematic behaviors were correlated with greater likelihood of seriously considering or attempting suicide among both males and females. This pattern was more clearly observed in preteen than in teen initiators although the former and latter were engaged in the same frequency of problem behavior Conclusion: Early initiation of alcohol drinking, cigarette smoking, and sexual intercourse, particularly among preteens, represented an important predictor of later suicidal ideation and suicide attempts in both genders. Thus, early preventive intervention programs should be developed and may reduce the potential risks for subsequent suicidal behaviors.

Konghom S; Verachai V; Srisurapanont M; Suwanmajo S; Ranuwattananon A; Kimsongneun N et al. Treatment for inhalant dependence and abuse. (review). Cochrane Database of Systematic Reviews 12: e-article CD007537, 2010. (13 refs.)

Background: Inhalants are being abused by large numbers of people throughout the world, particularly socio-economically disadvantaged children and adolescents. The neuropsychological effects of acute and chronic inhalant abuse include motor impairment, alterations in spontaneous motor activity, anticonvulsant effects, anxiolytic effects, sensory effects, and effects and learning, memory and operant behaviour (e. g., response rates and discriminative stimulus effects). Objectives: To search and determine risks, benefits and costs of a variety treatments for inhalant dependence or abuse. Search strategy: We searched MEDLINE (1966 - February 2010), EMBASE (Januray 2010) and Cochrane Central Register of Controlled Trials (CENTRAL) (February 2010). We also searched for ongoing clinical trials and unpublished studies via Internet searches. Selection criteria: Randomised-controlled trials and controlled clinical trails (CCTs) comparing any intervention in people with inhalant dependence or abuse. Data collection and analysis: Two reviewers independently selected studies for inclusion, assessed trial quality and extracted data. Main results: No studies fulfilling the inclusion criteria have been retrieved. Authors' conclusions: Implications for practice: due to the lack of studies meeting the inclusion criteria, no conclusion can be drawn for clinical practice. Implications for research: as a common substance abuse with serious health consequences, treatment of inhalant dependence and abuse should be a priority area of substance abuse research.

Kupersmidt JB; Scull TM; Austin EW. Media literacy education for elementary school substance use prevention: Study of Media Detective. Pediatrics 126(3): 525-531, 2010. (32 refs.)

OBJECTIVES: Media Detective is a 10-lesson elementary school substance use prevention program developed on the basis of the message interpretation processing model designed to increase children's critical thinking skills about media messages and reduce intent to use tobacco and alcohol products. The purpose of this study was to conduct a short-term, randomized, controlled trial to evaluate the effectiveness of Media Detective for achieving these goals. METHODS: Elementary schools were randomly assigned to conditions to either receive the Media Detective program (n = 344) or serve in a waiting list control group (n = 335). RESULTS: Boys in the Media Detective group reported significantly less interest in alcohol-branded merchandise than boys in the control group. Also, students who were in the Media Detective group and had used alcohol or tobacco in the past reported significantly less intention to use and more self-efficacy to refuse substances than students who were in the control group and had previously used alcohol or tobacco. CONCLUSIONS: This evaluation provides evidence that Media Detective can be effective for substance use prevention in elementary school-aged children. Notably, media-related cognitions about alcohol and tobacco products are malleable and relevant to the development and maintenance of substance use behaviors during late childhood. The findings from this study suggest that media literacy-based interventions may serve as both a universal and a targeted prevention program that has potential for assisting elementary school children in making healthier, more informed decisions about use of alcohol and tobacco products.

Lando HA; Hipple BJ; Muramoto M; Klein JD; Prokhorov AV; Ossip DJ et al. Tobacco control and children: An international perspective. Pediatric Allergy, Immunology and Pulmonology 23(2): 99-103, 2010. (42 refs.)

Tobacco use currently claims >5 million deaths per year worldwide and this number is projected to increase dramatically by 2030. The burden of death and disease is shifting to low- and middle-income countries. Tobacco control initiatives face numerous challenges including not being a high priority in many countries, government dependence upon immediate revenue from tobacco sales and production, and opposition of the tobacco industry. Tobacco leads to environmental harms, exploitation of workers in tobacco farming, and increased poverty. Children are especially vulnerable. Not only do they initiate tobacco use themselves, but also they are victimized by exposure to highly toxic secondhand smoke. Awareness of tobacco adverse health effects is often superficial even among health professionals. The tobacco industry continues to aggressively promote its products and recognizes that children are its future. The tools and knowledge exist, however, to dramatically reduce the global burden of tobacco. In 2003 the World Health Organization adopted the Framework Convention on Tobacco Control. Aggressive tobacco control initiatives have been undertaken not only in high-income countries but also in less-wealthy countries such as Uruguay and Thailand. Stakeholders must come together in coordinated efforts and there must be a broad and sustained investment in global tobacco control.

Lawrence D; Mitrou F; Sawyer MG; Zubrick SR. Smoking status, mental disorders and emotional and behavioural problems in young people: Child and adolescent component of the National Survey of Mental Health and Wellbeing. Australian and New Zealand Journal of Psychiatry 44(9): 805-814, 2010. (42 refs.)

Objective: To examine the relationship between smoking behaviour, mental disorders and emotional and behavioural problems in a nationally representative sample of young people. Method: Data were taken from the child and adolescent component of the National Survey of Mental Health and Wellbeing which assessed mental health problems in two main ways: using a fully structured interview (the Diagnostic Interview Schedule for Children) and using the Child Behaviour Checklist and the Youth Self Report, which assess emotional and behavioural problems on a dimensional scale. The relationship between smoking and mental health problems was assessed using logistic regression. Results: Among young people with conduct disorder 72% had smoked in the last 30 days, 46% of young people with depressive disorder, and 38% among young people with attention deficit hyperactivity disorder. This compared with 21% of young people with none of these disorders. Odds ratios (OR) for current smoking were consistently elevated for young people with mental health problems after adjusting for demographic and socio-economic factors across all measures of mental health used. The OR for current smoking in young people with parent-reported externalizing behaviours in the clinical range was 4.5 (95% CI: 3.1-6.8), and for young people with parent-reported internalizing problems in the clinical range the OR was 2.7 (95% CI: 1.8-4.0). Young people with mental health problems started smoking on average at a younger age, were more likely to progress to current smoking, and smoked on average a higher number of cigarettes per day. Conclusions: After adjusting for demographic and socio-economic factors, young people with mental health problems were more likely to start smoking, progress to daily smoking, and smoke more heavily. Mental illness is an important issue to consider in tobacco control in young people.

Lorberg B; Wilens TE; Martelon M; Wong P; Parcell T. Reasons for substance use among adolescents with bipolar disorder. American Journal on Addictions 19(6): 474-480, 2010. (45 refs.)

We examined whether children and adolescents with bipolar disorder (BPD) "self-medicate" with cigarettes, alcohol, or other substances of abuse. One hundred and five adolescents with BPD and 98 controls were comprehensively assessed with a structured psychiatric diagnostic interview for psychopathology and the Drug Use Screening Inventory (DUSI) for self-medication. Thirteen control (mean +/- standard deviation [SD] = 15.31 +/- 1.18 years) and 27 BPD (15.30 +/- 2.09 years) subjects endorsed use of one of the listed drugs in the DUSI Section A within the past year and were included in all analyses. BPD adolescents were more likely than nonmood disordered, substance-using controls to report starting to use their preferred drug for mood-altering effects. There were no differences between groups in motivation for use with respect to starting substances to sleep better or get high, or in continuing substances to change mood, sleep better, or get high. These data may contribute to increased prevention of substance use disorders and to the treatment of adolescent BPD. Further studies clarifying the characteristics of self-medication are necessary.

Lowry JA. Opiate-positive immunoassay screen in a pediatric patient. (commentary). Clinical Chemistry 56(8): 1224-1225, 2010. (1 refs.)

Lynch RE; Hack RA. Methadone-Induced rigid-chest syndrome after substantial overdose. Pediatrics 126(1): E232-E234, 2010. (13 refs.)

We report here the case of an infant who developed life-threatening rigid-chest syndrome after receiving an accidental overdose of methadone. The child responded to narcotic reversal. Pediatrics physicians should be aware of this possible complication.

Mackay D; Haw S; Ayres JG; Fischbacher C; Pell JP. Smoke-free legislation and hospitalizations for childhood asthma. New England Journal of Medicine 363(12): 1139-1145, 2010. (20 refs.)

Background: Previous studies have shown that after the adoption of comprehensive smoke-free legislation, there is a reduction in respiratory symptoms among workers in bars. However, it is not known whether respiratory disease is also reduced among people who do not have occupational exposure to environmental tobacco smoke. The aim of our study was to determine whether the ban on smoking in public places in Scotland, which was initiated in March 2006, influenced the rate of hospital admissions for childhood asthma. Methods: Routine hospital administrative data were used to identify all hospital admissions for asthma in Scotland from January 2000 through October 2009 among children younger than 15 years of age. A negative binomial regression model was fitted, with adjustment for age group, sex, quintile of socioeconomic status, urban or rural residence, month, and year. Tests for interactions were also performed. Results: Before the legislation was implemented, admissions for asthma were increasing at a mean rate of 5.2% per year (95% confidence interval [CI], 3.9 to 6.6). After implementation of the legislation, there was a mean reduction in the rate of admissions of 18.2% per year relative to the rate on March 26, 2006 (95% CI, 14.7 to 21.8; P<0.001). The reduction was apparent among both preschool and school-age children. There were no significant interactions between hospital admissions for asthma and age group, sex, urban or rural residence, region, or quintile of socioeconomic status. Conclusions: In Scotland, passage of smoke-free legislation in 2006 was associated with a subsequent reduction in the rate of respiratory disease in populations other than those with occupational exposure to environmental tobacco smoke.

Maisonet M; Christensen KY; Rubin C; Holmes A; Flanders WD; Heron J et al. Role of prenatal characteristics and early growth on pubertal attainment of British girls. Pediatrics 126(3): E591-E600, 2010. (43 refs.)

OBJECTIVES: The objective of this study was to explore the influence of maternal prenatal characteristics and behaviors and of weight and BMI gain during early childhood on the timing of various puberty outcomes in girls who were enrolled in the Avon Longitudinal Study of Parents and Children. METHODS: Repeated self-assessments of pubertal development were obtained from similar to 4000 girls between the ages of 8 and 14. Data on prenatal characteristics and weight at birth and 2, 9, and 20 months of age were obtained from questionnaires, birth records, and clinic visits. Infants' weights were converted to weight-for-age and BMI SD scores (SDSs; z scores), and change values were obtained for the 0- to 20-month and other intervals within that age range. We used parametric survival models to estimate associations with age of entry into Tanner stages of breast and pubic hair and menarche. RESULTS: Maternal initiation of menarche at age <12, smoking during pregnancy, and primiparity were associated with earlier puberty. A 1-unit increase in the weight SDS change values for the 0- to 20-month age interval was associated with earlier ages of entry into pubertal outcomes (0.19-0.31 years). Increases in the BMI SDS change values were also associated with earlier entry into pubertal outcomes (0.07-0.11 years). CONCLUSIONS: Many of the maternal prenatal characteristics and weight and BMI gain during infancy seemed to have similar influences across different puberty outcomes. Either such early factors have comparable influences on each of the hormonal processes involved in puberty, or processes are linked and awakening of 1 aspect triggers the others.

Marmorstein NR; White HR; Loeber R; Stouthamer-Loeber M. Anxiety as a predictor of age at first use of substances and progression to substance use problems among boys. Journal of Abnormal Child Psychology 38(2): 211-224, 2010. (47 refs.)

This study examined associations of generalized and social anxiety with (1) age at first use of tobacco, alcohol, and marijuana and (2) interval from first use to first problem use of each substance. Participants were 503 males who comprised the youngest cohort (first assessed in the first grade) of the Pittsburgh Youth Study, a longitudinal community-based study of boys. Annual assessments of generalized and social anxiety, delinquency, and substance use from first grade through high school were included. Both types of anxiety predicted earlier first use of alcohol and tobacco, and generalized anxiety predicted earlier first use of marijuana. Both types of anxiety predicted the progression from first use to problems related to marijuana. The effect of generalized anxiety tended to be significant above and beyond the effect of delinquency, while the effect of social anxiety on risk for first use of substances was not. Overall, the associations between anxiety and substance use and related problems depend on the class of substance and the type of anxiety.

Maruska K; Morgenstern M; Isensee B; Hanewinkel R. Influencing antecedents of adolescent risk-taking behaviour in elementary school: Results of a 4-year quasi-experimental controlled trial. Health Education Research 25(6): 1021-1030, 2010. (39 refs.)

Effects of the life skills programme 'Eigenstandig werden' (Becoming independent) on life skills and on identified antecedents of adolescent health risk behaviour, childhood internalizing and externalizing behaviour were tested in an elementary school setting. A quasi-experimental controlled trial with five repeated measures was conducted. Participants were 919 students from 50 elementary schools in Saxony, Germany. Outcomes were assessed by teachers' ratings. Growth-curve models revealed that the rate of decline in internalizing and externalizing behaviour was significantly higher in the intervention group-especially for students with high baseline levels of externalizing behaviour (P < 0.01). No general programme effects on the development of skills could be found (P = 0.22). The current study provides evidence that life skills programmes in elementary school may be an effective strategy in reducing antecedents of adolescent risk-taking behaviour.

Njord L; Merrill RM; Njord R; Lindsay R; Pachano JDR. Drug use among street children and non-street children in the Philippines. Asia-Pacific Journal of Public Health 22(2): 203-211, 2010. (40 refs.)

This study characterizes the prevalence of drug use among Filipino street children compared with Filipino non street children. A cross-sectional survey was administered to 311 street children and 528 non street children aged 13 to 17 years. Participants were enrolled through 4 nonprofit organizations and 3 high schools located in Manila, Philippines. After adjustment for age and sex, street children with little or no contact with their families were 2.0 (95% confidence interval [CI] = 1.7-2.3) times more likely to smoke tobacco, 1.3 (95% Cl = 1.2-1.5) times more likely to use alcohol, 36.7 (95% CI = 16.4-82.0) times more likely to use inhalants, and 5.5 (95% Cl = 3.6-8.2) times more likely to use illegal drugs than their non street counterparts. Street children who maintained contact with their families, compared with non street children, were 8.7 (95% CI = 3.9-19.4) times more likely to use inhalants and 2.8 (95% Cl = 1.7-4.6) times more likely to use illegal drugs. There was no significant difference in tobacco or alcohol use between street children who maintained contact with their families and non street children. All street children were significantly more likely to have been given or sold a drug in the past 30 days and to have received drug education compared with non street children. Filipino street children are at greater risk of abusing drugs than are non street children, with street children who do not maintain family contact being at greatest risk.

Opler M; Sodhi D; Zaveri D; Madhusoodanan S. Primary psychiatric prevention in children and adolescents. (review). Annals of Clinical Psychiatry 22(4): 220-234, 2010. (177 refs.)

BACKGROUND: Approximately 21% of US children age 9 to 17 have a diagnosable mental illness with some degree of impairment. As early-onset mental illness may persist throughout the life span, effective primary mental health prevention programs are of paramount importance. METHODS: We conducted a literature review of various preventive programs targeting childhood-onset psychopathology. We attempted to select those programs that present the strongest data on efficacy and those that are most commonly cited. RESULTS: Modifiable and nonmodifiable risk factors and different primary prevention strategies with positive outcomes have been identified for anxiety disorders, eating disorders, substance abuse, disruptive behavior disorders, and suicide in children. The reported results for attention-deficit/hyperactivity disorder (ADHD) and early-onset schizophrenia are neither uniform nor encouraging. CONCLUSIONS: Based on our review, there is ample evidence to conclude that primary preventive intervention has the potential to be effective for some mental health disorders, promoting positive development, particularly in children of all ages in high-risk environments. Additional research is needed to further investigate the validity and reliability of various preventive strategies.

Pieters S; van der Vorst H; Engels RCME; Wiers RW. Implicit and explicit: Cognitions related to alcohol use in children. Addictive Behaviors 35(5): 471-478, 2010. (45 refs.)

Research has indicated that implicit and explicit alcohol-related cognitions jointly predict alcohol use in adolescents and adults. Only few studies assessed these cognitions in children. Associations between alcohol cognitions and alcohol use were tested in two studies with 10 year olds (Study 1: N = 99) and 11-12 year olds (Study 2: N = 35). Furthermore, the role of parental alcohol use was examined. Implicit alcohol cognitions were assessed in an Implicit Association Test (IAT) using pictures of alcohol and soft drinks as target stimuli and happy versus angry faces as attribute stimuli (children's faces in Study 1, adults' faces in Study 2). Explicit expectancies and parental alcohol use were assessed with questionnaires. Children demonstrated a relatively stronger association between alcohol and negative facial expressions, and in Study 2, this association was negatively related to alcohol use. In Study 2, paternal drinking was related to implicit negative associations and explicit arousal associations. These studies show that young children have both implicit and explicit alcohol-related cognitions and both appear to play a role in explaining emerging alcohol use of elementary schoolchildren.

Porter WH. Opiate-positive immunoassay screen in a pediatric patient. (commentary). Clinical Chemistry 56(8): 1223-1224, 2010. (0 refs.)

Schneider S; Loeber S; Janssen M; Roehrig S; Solle D. What prevents young adolescents from smoking? Self-reported motives of 12-15-year-old non-smokers. Health Policy 95(1): 36-40, 2010. (19 refs.)

Objectives: This study investigated the real motives of German non-smokers. Methods: In the German SToP ("Sources of Tobacco for Pupils") Study 707 non-smoking pupils were asked to write down their motives for being non-smokers. A total of 1324 partially very elaborate free text statements (mean/range: 1.9/1-7 distinguishable motives) were evaluated in a qualitative content analysis. Results: The most important and frequently mentioned motives for not smoking were health-related arguments (78.1%). Except for cancer significant main health risks of tobacco consumption like cardio- and cerebrovascular diseases or COPD were hardly perceived. Further important reasons were an aesthetic aversion (38.6%), missing perception of a benefit (25.2%), and economic motives (20.8%). Girls and pupils from academic high schools named aesthetic motives significantly more often than boys and pupils from secondary schools respectively. A historical comparison shows that the motive "lacking benefit" reached a higher rank in our study than in the 1990s. Conclusions: When non-smokers are asked directly, extrinsic reasons (restrictions, smoking bans) do not seem to be relevant for them. Reasons concerning health, good physical shape, and beauty should be a central argument in the medical practise with young smokers.

Schultz ASH; Nowatzki J; Dunn DA; Griffith EJ. Effects of socialization in the household on youth susceptibility to smoking: A secondary analysis of the 2004/05 Canadian Youth Smoking Survey. Chronic Diseases in Canada 30(3): 71-77, 2010. (21 refs.)

Objective: To determine associations between younger youths' susceptibility to smoking and four household variables related to tobacco socialization: parental and sibling smoking, restrictions on smoking in the home and exposure to smoking in vehicles. Methods: A secondary analysis of the 2004/05 Canadian Youth Smoking Survey used logistic regression to investigate the relationships between youth susceptibility to smoking, gender, and four household variables related to tobacco socialization. Susceptibility to smoking was operationalized by three levels of smoking experience and intention: non-susceptible non-smoker, susceptible non-smoker and experimenter/smoker. The national survey included 29 243 grade 5 to 9 students from randomly sampled public and private schools in ten provinces. Results: For non-smokers, the odds of being susceptible to smoking increased with having a sibling who smokes, a lack of a total household smoking ban and riding in a vehicle with a smoker in the previous week, when adjusting for all other variables in the model. These variables also increased the odds of being an experimenter/smoker versus a susceptible non-smoker. Parent smoking status was not significant in these models. Conclusion: Denormalization messages, through enforced home and vehicle smoking bans, appear to support youth in maintaining a resolve to not smoke, regardless of parental smoking status.

Seyidov TH; Elemen L; Solak M; Tugay M; Toker K. Passive smoke exposure is associated with perioperative adverse effects in children. Journal of Clinical Anesthesia 23(1): 47-52, 2011. (23 refs.)

Study Objective: To evaluate the frequency of respiratory adverse events during general anesthesia in children passively exposed to cigarette smoke (PSE). Design: Prospective, double blinded, observational study. Setting: Operating room and recovery room of a university hospital. Measurements: Data were collected from 385 children who underwent elective surgery during general anesthesia from June to November, 2008. PSE was identified by using the child's caregivers' information. Respiratory adverse events were recorded during anesthesia and post-anesthesia. Main Results: Technique of anesthesia induction and management, distribution of patients' age, gender, surgical procedures, and perioperative analgesic methods were similar in the PSE and non-PSE groups. Respiratory adverse events were reported in 58 patients (15.1%): 50 patients (21.4%) were in the PSE and 8 patients (5.3%) were in the non-PSE group (P = 0.00). The frequency of laryngospasm during anesthesia (P = 0.03) and hypersecretions in the recovery room (P = 0.00) were significantly increased in the PSE group. Conclusions: Children who are exposed to environmental tobacco smoke and who undergo general anesthesia seem to have an increased risk of respiratory complications in the recovery period rather than during anesthesia.

Sprang G; Clark JJ; Staton-Tindall M. Caregiver substance use and trauma exposure in young children. Families In Society. The Journal of Contemporary Social Services 91(4): 401-407, 2010. (70 refs.)

This study examines the differential experiences of three groups of children: children living in homes with caregivers who had used methamphetamine, those living in homes with caregivers who used other drugs, and those in homes where there was no evidence of caregiver substance misuse. A random sample of 1127 children was selected from the public child welfare log of open cases in fiscal year 2005-2006. Results indicate that caregiver methamphetamine use was a robust correlate of trauma exposure, with interpersonal violence being the most prevalent form of trauma exposure. Practice and policy implications are presented for a wide range of professionals working with these children.

Strasburger VC; Jordan AB; Donnerstein E. Health effects of media on children and adolescents. Pediatrics 125(4): 756-767, 2010. (144 refs.)

Youth spend an average of >7 hours/day using media, and the vast majority of them have access to a bedroom television, computer, the Internet, a video-game console, and a cell phone. In this article we review the most recent research on the effects of media on the health and well-being of children and adolescents. Studies have shown that media can provide information about safe health practices and can foster social connectedness. However, recent evidence raises concerns about media's effects on aggression, sexual behavior, substance use, disordered eating, and academic difficulties. We provide recommendations for parents, practitioners, the media, and policy makers, among others, for ways to increase the benefits and reduce the harm that media can have for the developing child and for adolescents.

Straseski JA; Stolbach A; Clarke W. Opiate-positive immunoassay screen in a pediatric patient. (case study). Clinical Chemistry 56(8): 1220-1223, 2010. (6 refs.)

This article presents the case of a 3 year old patient found shivering and unattended outside a large shopping mall. She was transferred to a large urban hospital emergency room, was slipping in and out of consciousness. A physical exam found multiple bruises abrasions. A bolus of Narcan (naloxone) was administered. Later an immunoassay indicated the presence of opiates. This subsequently proved to be false positive. The authors note that immunoassays used to screen for the presence of drugs of abuse may not be specific for the intended drug or class and may cross-react with other prescription and nonprescription drugs. (2) Confirmatory testing with a second method with greater analytical specificity and lower detection limits is useful when a screening result is questioned or needs to be verified. Confirmatory testing is commonly required in legally sensitive cases. (3) Both screening and confirmatory tests use cutoff concentrations to distinguish between positive and negative results. The results of drug or drug metabolite tests may be truly negative, or the drugs or their metabolites may be present at concentrations below the cutoff value used and thus be reported as negative or not detected. and (4) Drugs and drug metabolites that share structural similarities with the target compound may cross-react with the antibodies used in screening immunoassays.. Cross-reactivity experiments may be useful in confirming conflicting clinical results. It is noted that when interpreting toxicology results, clinicians and laboratory scientists should remember that pediatric patients have a different pharmacokinetic profile than adults for many substances. Copyright 2010, American Association of Clinical Chemistry

Taes Y; Lapauw B; Vanbillemont G; Bogaert V; De Bacquer D; Goemaere S et al. Early smoking is associated with peak bone mass and prevalent fractures in young, healthy men. Journal of Bone and Mineral Research 25(2): 379-387, 2010. (45 refs.)

Smoking is associated with lower areal bone mineral density (aBMD) and higher fracture risk, although most evidence has been derived from studies in elderly subjects. This study investigates smoking habits in relation to areal and volumetric bone parameters and fracture prevalence in young, healthy males at peak bone mass. Healthy male siblings (n = 677) at the age of peak bone mass (25 to 45 years) were recruited in a cross-sectional population-based study. Trabecular and cortical bone parameters of the radius and cortical bone parameters of the tibia were assessed using peripheral quantitative computed tomography (pQCT). Areal bone mass was determined using dual energy X-ray absorptiometry (DXA). Sex steroids and bone markers were determined using immunoassays. Prevalent fractures and smoking habits were assessed using questionnaires. Self-reported fractures were more prevalent in the current and early smokers than in the never smokers (p<.05), with a fracture prevalence odds ratio for early smokers of 1.96 (95% confidence interval 1.18-3.24) after adjustment for age, weight, educational level, and alcohol use and exclusion of childhood fractures. Current smoking was associated with a larger endosteal circumference (beta = 0.027 +/- 0.009, p = .016) and a decreased cortical thickness (beta = -0.034 +/- 0.01, p = .020) at the tibia. In particular, early smokers (<= 16 years) had a high fracture risk and lower areal BMD, together with a lower cortical bone area at the tibia and lower trabecular and cortical bone density at the radius. An interaction between free estradiol and current smoking was observed in statistical models predicting cortical area and thickness (beta = 0.29 +/- 0.11, p = .01). In conclusion, smoking at a young age is associated with unfavorable bone geometry and density and is associated with increased fracture prevalence, providing arguments for a disturbed acquisition of peak bone mass during puberty by smoking, possibly owing to an interaction with sex steroid action.

Tarokh L; Carskadon MA. Sleep electroencephalogram in children with a parental history of alcohol abuse/dependence. Journal of Sleep Research 19(Supplement 1): 165-174, 2010. (51 refs.)

We examined the sleep electroencephalogram (EEG) in 9- and 10-year-old children with (PH+) and without (PH-) a parental history of alcohol abuse/dependence to determine whether sleep disturbances associated with alcohol precede the onset of alcohol use. Participants: slept on a fixed sleep schedule that ensured at least a 10-h time in bed for 1 week before an adaptation and baseline night. Data were collected in a four-bed sleep research laboratory. Thirty healthy boys and girls aged 9 or 10 years were classified as either PH+ or PH- based on DSM-IV criteria applied to structured parental interviews. All-night polysomnography was performed, sleep data were scored visually in 30-s epochs, and EEG power spectra were calculated for each epoch. All-night EEG spectra were calculated for rapid eye movement (REM) and non-REM (NREM) sleep, and cycle-by-cycle spectra were calculated for NREM sleep. The two groups did not differ on any sleep stage variable. All-night analyses revealed normalized power in the delta band and spindle range were lower in PH+ children. Within NREM sleep cycles PH+ children exhibited less normalized power in the delta band and spindle range compared with PH- children. This effect occurred in the first four cycles and was most pronounced in the first sleep cycle of the night. We found no signs of sleep disruption in sleep stages for PH+ children. Sleep EEG spectral differences, however, suggest that certain circuits responsible for 'protecting' sleep may be impaired in PH+ children, which may lead to disrupted sleep later in life.

Thomas DP; Glover M. Smoking and Aboriginal and Torres Strait Islander and Maori children. Journal of Paediatrics and Child Health 46(9): 516-520, 2010. (40 refs.)

Smoking and the deaths and suffering it causes are more common among Aboriginal and Torres Strait Islander peoples and Maori than other Australians and New Zealanders. While, many tobacco control activities that are not specifically targeted at children will have a positive impact on child health, this review concentrates on recent tobacco control research on pregnant women and children. The important tasks are to reduce smoking by pregnant Maori and Aboriginal and Torres Strait Islander women to reduce infant and child exposure to second-hand smoke and to reduce smoking initiation of children and adolescents. Health professionals who want to reduce the suffering caused by smoking among Maori and Aboriginal and Torres Strait Islander children can be guided by much new relevant research evidence and clear frameworks about how to approach tobacco control in these communities.

Umberson D; Crosnoe R; Reczek C. Social relationships and health behavior across the life course. Annual Review of Sociology 36: 139-157, 2010. (137 refs.)

Sociological theory and research point to the importance of social relationships in affecting health behavior. This work tends to focus on specific stages of the life course, with a division between research on childhood/adolescent and adult populations. Yet recent advances demonstrate that early life course experiences shape health outcomes well into adulthood. We synthesize disparate bodies of research on social ties and health behavior throughout the life course, with attention to explaining how various social ties influence health behaviors at different life stages and how these processes accumulate and reverberate throughout the life course.

Warzak WJ; Evans S; Floress MT; Gross AC; Stoolman S. Caffeine consumption in young children. Journal of Pediatrics 158(3): 508-509, 2011. (10 refs.)

Two hundred twenty-eight surveyed parents reported that their 5 to 7 year old children drank approximately 52 mg of caffeine daily and their 8 to 12 year old children drank 109 mg daily. Caffeine consumption and hours slept were significantly negatively correlated, but caffeine consumption and enuresis were not significantly correlated. Spanish-speaking parents reported fewer bedwetting events than their English-speaking peers.

Yabiku ST; Marsiglia FF; Kulis S; Parsai MB; Becerra D; Del-Colle M. Parental monitoring and changes in substance use among Latino/a and Non-Latino/a preadolescents in the Southwest. Substance Use & Misuse 45(14): 2524-2550, 2010. (73 refs.)

Prior research shows parental monitoring is associated with less substance use, but these studies have some limitations. Many examine older adolescents from White, Euro-American heritage, and cross-sectional studies are unable to test if parental monitoring decreases substance use over time. We address these limitations with longitudinal data of 2,034 primarily Latino preadolescents in Phoenix, Arizona, USA in 2004-2005. We use multilevel regression with multiple imputation of missing data. We find parental monitoring has beneficial, longitudinal effects on youth's substance use and related intentions, norms, and attitudes. Effects are invariant to gender or Latino ethnicity, except in the case of marijuana.

Yilmaz G; Karacan C; Besler HT; Yurdakok K; Coskun T. The urinary cotinine levels of infants and the determinants. Turkish Journal of Pediatrics 52(3): 294-300, 2010. (15 refs.)

The aim of this study was to determine the effect of the route of tobacco smoke exposure on urinary cotinine levels of infants. A cross-sectional analysis was done on 254 six-month-old infants. The infants were grouped according to the route of tobacco smoke exposure. The urinary cotinine/creatinine ratios were determined. Forty-nine percent (124/254) of mothers were smokers. Urinary cotinine levels in infants of smoking mothers were statistically significantly higher than levels in infants of non-smoking mothers. The highest mean cotinine/creatinine level was found in the breast-milk-exposed group. Linear regression analysis showed that maternal smoking increased urinary cotinine level by 541 times and breastfeeding increased it by 171 times, whereas early start of formula feeding decreased it by 63 times. Tobacco exposure by breastfeeding may be more harmful than other routes of exposure. Mothers should be encouraged to stop smoking during the breastfeeding period even if they avoid exposing their infants to passive tobacco smoke.

Yin S. Malicious use of pharmaceuticals in children. Journal of Pediatrics (5): 832-U180, 2010. (30 refs.)

Objective: To describe malicious administration of pharmaceutical agents to children. Study design: We performed a retrospective study of all pharmaceutical exposures involving children < 7 years old reported to the US National Poison Data System from 2000 to 2008 for which the reason for exposure was coded as "malicious.'' Results: A total of 1439 cases met inclusion criteria. The mean number of cases per year was 160 (range, 124 to 189) that showed an increase over time. The median (IQR) age was 2 (1.5) years. Outcome data were available for 1244 (86.4%) patients. Of these exposures, 172 resulted in moderate or major outcomes or death. 9.7% of cases involved > 1 exposed substance. The most common reported major pharmaceutical categories were analgesics, stimulants/street drugs, sedatives/hypnotics/antipsychotics, cough and cold preparations, and ethanol. In 51% of cases there was an exposure to at least one sedating agent. There were 18 (1.2%) deaths. Of these, 17 (94%) were exposed to sedating agents, including antihistamines (8 cases) and opioids (8 cases). Conclusions: Malicious administration of pharmaceuticals should be considered an important form of child abuse.

Yolton K; Xu YY; Khoury J; Succop P; Lanphear B; Beebe DW; Owens J. Associations between secondhand smoke exposure and sleep patterns in children. Pediatrics 125(2): E261-E268, 2010. (55 refs.)

OBJECTIVES: The objective of this study was to investigate the relationship between exposure to secondhand smoke (SHS) and child sleep patterns among a group of children with asthma who were exposed regularly to tobacco smoke at home. METHODS: We studied 219 children who were enrolled in an asthma intervention trial and were exposed regularly to SHS. Serum cotinine levels were used to measure exposure to tobacco smoke, and sleep patterns were assessed through parent reports using the Children's Sleep Habits Questionnaire. Covariates in adjusted analyses included gender, age, race, maternal marital status, education, and income, prenatal tobacco exposure, maternal depression, Home Observation for Measurement of the Environment total score, household density, asthma severity, and use of asthma medications. RESULTS: Exposure to SHS was associated with sleep problems, including longer sleep-onset delay (P = .004), sleep-disordered breathing (P = .02), parasomnias (P = .002), daytime sleepiness (P = .022), and overall sleep disturbance (P = .0002). CONCLUSIONS: We conclude that exposure to SHS is associated with increased sleep problems among children with asthma.

Zamani N; Sanaei-Zadeh H; Mostafazadeh B. Hallmarks of opium poisoning in infants and toddlers. Tropical Doctor 40(4): 220-222, 2010. (6 refs.)

Accidental opium intoxication in children is an extremely dangerous poisoning if it remains undiagnosed and untreated. The classic triad of miosis, decreased level of consciousness and bradypnea, which are the hallmarks of opiate intoxication, are used for the diagnosis of opium poisoning in adults and children. Little attention has been paid to the signs of opium intoxication in children and no published study has explored the frequency of hallmarks of this type of poisoning in the paediatric population. We conducted a study in order to evaluate the prevalence of major signs of opium poisoning in infants and toddlers. In this study, a total of 228 infants and 82 toddlers who had been admitted to Loghman Hakim Hospital as a result of opium poisoning between 2001 and 2009 were evaluated, retrospectively. The most usual sign of opium poisoning was miosis (90%) followed by a decreased level of consciousness (88.4%), bradypnea (28.4%) and seizure (10.3%). The prevalence of the triad of miosis, bradypnea and a decreased level of consciousness was 25.2%. Miosis in association with decreased level of consciousness was detected in 82.6% of our patients. Bradypnea was present in 74 infants and 14 toddlers, which shows a statistically significant difference (P = 0.01). The mean age and weight of the patients with bradypnea were significantly less than those without bradypnea (P = 0.008 and P = 0.0001, respectively). Bradypnea and seizure were significantly more common in females (36.7% versus 26%; P = 0.05 and 15.2% versus 6.5%; P = 0.01, respectively). Miosis in association with a decreased level of consciousness is the most useful indicator of opium poisoning in infants and toddlers. Furthermore, seizure is a more common feature of this type of poisoning in infants, especially in those who are less than 1 month old.

Zanin A; Masiero S; Severino MS; Calderone M; Da Dalt L; Laverda AM. A delayed methadone encephalopathy: Clinical and neuroradiological findings. Journal of Child Neurology 25(6): 748-751, 2010. (15 refs.)

Several studies on opiates demonstrated that selected brain areas as cerebellum and limbic system have the greatest density of opioid receptors. Recently, few cases of severe cerebellitis following methadone poisoning have been reported in children. We present the case of a 30-month-old girl who developed a delayed encephalopathy after methadone intoxication. She was admitted to our emergency department in coma, and after naloxone infusion, she completely recovered. Five days after intoxication, she developed psychomotor agitation, slurred speech, abnormal movements, and ataxia despite a negative neuroimaging finding. A repeat magnetic resonance imaging (MRI) performed 19 days after the intoxication for persistent symptoms showed signal abnormalities in the temporomesial regions, basal ganglia, and substantia nigra. To our knowledge, this is the first report of these delayed MRI findings associated with synthetic opioid intoxication.