Archive for April, 2010

Study finds high rates of at-risk drinking among elderly adults

A new study by researchers at the David Geffen School of Medicine at UCLA has found that more than a third of drinkers 60 years old and older consume amounts of alcohol that are excessive or that are potentially harmful in combination with certain diseases they may have or medications they may be taking.

Basing their research on data from 3,308 older patients accessing primary care clinics around Santa Barbara, Calif., the authors report that just as many individuals were at risk from alcohol consumption in combination with comorbidities or medication as from alcohol consumption alone.

The study, published in the current online edition of the Journal of General Internal Medicine, also found that at-risk drinking was associated with being younger, white and less educated.

At-Risk Drinking

“Compared to the U.S. Census population over age 60, the sample studied was more likely to be white, married, well-educated and high-income,” said lead study author Andrew Barnes, a researcher in the UCLA School of Public Health’s department of health services. “However, the adjusted associations of patient demographics with at-risk drinking found in our research should be more generalizable than the descriptive data published previously.”

At-risk drinking was assessed using the Comorbidity Alcohol Risk Evaluation Tool (CARET), which categorizes older adults as at risk if they display at least one of the following drinking behaviors: they consume more than two drinks on most days; they consume one to two drinks on most days and have certain comorbidities, such as gout, hepatitis or nausea; they consume one to two drinks on most days and take select medications, such as antidepressants or sedatives.

The specific findings include:

  • 34.7 percent (1,147) of older adults were at risk due to drinking alone or to drinking in combination with comorbidities or medications, and 19.5 percent fell into multiple risk categories.
  • Of those at risk, 56.1 percent fell into at least two risk categories, and 31 percent fell into all three.
  • Participants who had not graduated from high school had 2.5 times the odds of at-risk drinking as those who had completed graduate school.
  • Respondents with annual household incomes between $80,000 and $100,000 had 1.5 times the odds of being at-risk as those with incomes under $30,000.
  • Respondents who were 80 or older had half the odds of at-risk drinking as those between the ages of 60 and 64.
  • Asians had less than half the odds of at-risk drinking as Caucasians.

Risk varied considerably, depending on patient characteristics. For example, a 62-year-old white male respondent who was married and had an annual household income of $90,000 was estimated to have a 57.1 percent adjusted probability of being an at-risk drinker, compared with an 8.1 percent adjusted probability for an 85-year-old Asian female patient who was widowed and had an annual income of $35,000.

One in Three At Risk

The study does have some limitations, the researchers noted. For instance, it relied on patients’ self-reported drinking frequency and quantity, so some participants may have been misclassified. Also, the sample was more likely to be white, married, well-educated and higher income than the over-60 U.S. population as a whole.

“In summary, even among our relatively advantaged study patients, as many as one in three who continued to consume alcohol into older adulthood were at risk of harm from drinking,” the researchers wrote. “Physicians may be less aware of other alcohol-related risk factors common among the elderly (e.g., interactions with select medications and comorbidities) than the risks associated with heavy drinking. Information suggesting which patients have the highest likelihood of at-risk drinking may assist physicians to better target patients for further screening and intervention.”

April 30th, 2010  in Alcohol No Comments »

Watching R-Rated Movies Linked to Early Drinking

Middle-school children whose parents restrict access to R-rated movies are substantially less likely to start drinking than their peers who are allowed to see such films, a new study suggests.

In a study of nearly 3,600 New England middle school students, researchers found that among kids who said their parents never allowed them to watch R movies, few took up drinking over the next couple years.

R-Rated Movies and Alcohol

Of that group, 3 percent said they had started drinking when questioned 13 to 26 months after the initial survey. That compared with 19 percent of their peers who’d said their parents “sometimes” let them see R-rated films, and one-quarter of students who’d said their parents allowed such movies “all the time.”

The researchers say the findings, reported in the May issue of the Journal of Studies on Alcohol and Drugs, underscore the importance of parents paying close attention to their children’s media exposure.

“We think this is a very important aspect of parenting, and one that is often overlooked,” said Dr. James D. Sargent, a professor of pediatrics at Dartmouth Medical School in Hanover, New Hampshire.

Exposure to Adult Content

The current findings build on evidence linking children’s exposure to R-rated movies and onscreen “adult” content in general not only to early drinking but also to early smoking and kids’ likelihood of having sex or behaving violently.

“The research to date suggests that keeping kids from R-rated movies can help keep them from drinking, smoking and doing a lot of other things that parents don’t want them to do,” Sargent said.

He pointed out that it could be argued that parents who restrict access to R movies are simply more careful in general — keeping tabs on their children’s friends or making sure their kids have no access to alcohol at home, for instance. However, Sargent and his colleagues accounted for this in the current study by asking students questions that gauge “authoritative parenting” — which gauges the adolescent’s perception of parental responsiveness (ability to respond to the adolescent’s point of view) and demandingness (ability to set and enforce limits).

The researchers found that, even with such factors considered, exposure to R-rated movies was still linked to the likelihood of early drinking.

Drinking in R-Rated Movie

Ninety percent of R-rated films have depictions of drinking, and that may be one reason that middle-schoolers who see the films are more vulnerable to early drinking. But Sargent said that the R-rated movie effect goes beyond that. Other research suggests that children who see R-rated movies become more prone to “sensation seeking” and risk taking. “We think seeing the adult content actually changes their personality,” Sargent said.

The bottom line, according to the researcher, is that parents should restrict their kids from seeing R-rated films. But he also pointed out that PG-13 movies, as well as many TV shows, often portray drinking and other adult situations — and that supports limiting children’s media time in general.

The American Academy of Pediatrics currently recommends that children watch no more than one to two hours of “quality” media, including movies, TV and videos, each day.

April 27th, 2010  in Alcohol No Comments »

Adolescent drinking adds to risk of breast cancer

Girls and young women who drink alcohol increase their risk of benign (noncancerous) breast disease, says a study by researchers at Washington University School of Medicine in St. Louis and Harvard University. Benign breast disease increases the risk for developing breast cancer.

“Our study clearly showed that the risk of benign breast disease increased with the amount of alcohol consumed in this age group,” says Graham Colditz, MD, DrPH, associate director of prevention and control at the Siteman Cancer Center at Washington University School of Medicine and Barnes-Jewish Hospital. “The study is an indication that alcohol should be limited in adolescence and early adult years and further focuses our attention on these years as key to preventing breast cancer later in life.”

Alcohol and Breast Cancer

The study was published in the journal Pediatrics.

About 80 percent of breast lumps are benign. But these benign breast lesions can be a step in a pathway leading from normal breast tissue to invasive breast cancer, so the condition is an important marker of breast cancer risk, Colditz indicates.

The researchers studied girls aged 9 to 15 years at the study’s start and followed them using health surveys from 1996 to 2007. A total of 6,899 participants reported on their alcohol consumption and whether they had ever been diagnosed with benign breast disease. The participants were part of the Growing Up Today Study of more than 9,000 girls from all 50 states who are daughters of participants in the Nurses’ Health Study II, one of the largest and longest-running investigations of factors that influence women’s health.

The study showed that the more alcohol consumed, the more likely the participants were to have benign breast disease. Girls and young women who drank six or seven days a week were 5.5 times more likely to have benign breast disease than those who didn’t drink or who had less than one drink per week. Participants who reported drinking three to five days per week had three times the risk.

The participants who were diagnosed with benign breast disease on average drank more often, drank more on each occasion and had an average daily consumption that was two times that of those who did not have benign breast disease. They also had more episodes of binge drinking.

Drinking Increases Breast Cancer Risks

The study is unique because it asked about alcohol intake while participants were adolescents instead of asking them to recall many years later how often they drank.

“We know from many other studies of adult women that alcohol intake later in life increases breast cancer risk,” Colditz says. “But many women begin drinking alcohol as adolescents right at the time in which breast tissue is going through stages of rapid proliferation. So we wanted to see if the effect of alcohol on breast cancer risk was operative in this younger group.”

The results of this study provide more evidence that steps can be taken to prevent breast cancer.

“There’s growing evidence that physical activity can lower breast cancer risk,” Colditz says. “We also know that diet and weight are important factors. Now it is clear that drinking habits throughout life affect breast cancer risk, as well.”

April 17th, 2010  in Alcohol No Comments »

New test could identify smokers at risk of emphysema

Using CT scans to measure blood flow in the lungs of people who smoke may offer a way to identify which smokers are most at risk of emphysema before the disease damages and eventually destroys areas of the lungs, according to a University of Iowa study.

The study found that smokers who have very subtle signs of emphysema, but still have normal lung function, have very different blood flow patterns in their lungs compared to non-smokers and smokers without signs of emphysema.

Smokers and Emphysema

This difference could be used to identify smokers at increased risk of emphysema and allow for early intervention. The findings appear this week in the Early Edition of the Proceedings of the National Academy of Sciences.

“We have developed a new tool to detect early emphysema-related changes that occur in smokers who are susceptible to the disease,” said lead study author Eric Hoffman, Ph.D., UI professor of radiology, internal medicine and biomedical engineering. “Our discovery may also help researchers understand the underlying causes of this disease and help distinguish this type of emphysema from other forms of chronic obstructive pulmonary disease. This type of CT scan could even be a tool to test the effectiveness of new therapies by looking at the changes in lung blood flow.”

Targeting COPD

As many as 24 million Americans have chronic obstructive pulmonary disease (COPD) — a group of serious lung diseases that includes emphysema — and COPD is the fourth leading cause of death nationwide. Because COPD is a group of different diseases, identifying more effective treatments may hinge on distinguishing between these diseases and targeting them separately.

The team used multi-detector row CT imaging to measure blood flow patterns in the lungs of 41 study participants — 17 non-smokers and 24 smokers. All the participants had normal lung function, but 12 of the smokers had very subtle signs of emphysema. The CT scans showed that these 12 individuals had the most disrupted patterns of blood flow compared to the other participants.

The findings also support the idea that abnormal blood flow occurs before emphysema develops.

“Although the underlying causes of emphysema are not well understood, smoking increases the risk of developing the disease,” Hoffman said. “Our study suggests that some smokers have an abnormal response to inflammation in their lungs; instead of sending more blood to the inflamed areas to help repair the damage, blood flow is turned off and the inflamed areas deteriorate.”

Repairing the Damage

The cellular pathway that turns off blood flow is helpful when an area of the lung has become permanently blocked and cannot be rescued. In that case, the lung “optimizes gas exchange” and stops supplying the area with blood. However, lung inflammation caused by smoking can be resolved and resultant damage repaired by increased blood flow, which brings oxygen and helpful cellular components to the site of injury.

This study suggests that the ability to distinguish when to turn off or when to ramp up blood flow is defective in some people — probably due to genetic differences. If this genetic difference is coupled with smoking, which increases lung inflammation, that could increase the risk of developing emphysema.

April 9th, 2010  in Tobacco No Comments »

Fetal alcohol spectrum disorder linked to epilepsy

Fetal alcohol spectrum disorder (FASD) refers to a range of negative developmental outcomes that result from maternal drinking during pregnancy. Children with FASD can suffer from many problems, including epilepsy, a disorder characterized by spontaneous recurrence of unprovoked seizures that affects 0.6 percent of the general population. A new study has found a much higher prevalence of epilepsy or history of seizures in individuals with FASD.

Results will be published in Alcoholism: Clinical & Experimental Research.

“There are very few studies that have examined the relationship between seizures and epilepsy among individuals with FASD,” noted James Reynolds, a senior scientist with the department of pharmacology and toxicology and the Centre for Neuroscience Studies, at Queens University. Reynolds is one of the study’s authors.

Alcohol Exposure and Epilepsy

“Many patients with epilepsy have a history of exposure to a prenatal insult, so we reasoned that prenatal exposure to alcohol could be such an epileptogenic insult,” added Peter Carlen, a neurologist and senior scientist for the division of fundamental neurobiology at the Toronto Western Hospital, another of the study’s authors. “Secondly, there is a significant overlap in brain structures that suffer from deficits as a result of chronic prenatal alcohol exposure and those that are associated with seizures, specifically in the brain’s hippocampus. Thirdly, previous studies had failed to examine other complications that occur in mothers who drink alcohol during pregnancy, such as the effects of drinking on seizure activity. Finally, previous studies used small sample sizes and failed to clearly define seizures and FASD.”

“Recently, scientists have begun investigating whether fetal alcohol exposure increases the risk for developing other behavioral health and neurological problems,” added Dan Savage, Regents’ Professor and chair of neurosciences at the University of New Mexico. “Indeed, evidence has begun to suggest that children with FASD are at greater risk for alcoholism, substance abuse or depression later in life. While it is too soon in the relatively young history of this research field to assess whether maternal drinking during pregnancy increases the risk of aging-related neurologic disorders, such as stroke or Parkinson’s disease, several recent large-scale retrospective studies have examined whether fetal alcohol exposure increases the risk of developing epilepsy.”

Fetal Alcohol Syndrome Diagnosis

For this study, researchers examined the histories of 425 individuals (254 males, 171 females), between the ages of two and 49 years, from two FASD clinics. Relationships between a confirmed FASD diagnosis and other risk factors – such as exposure to alcohol or other drugs, type of birth, and trauma – were examined for the co-occurrence of epilepsy or a history of seizures.

“This study revealed a much higher prevalence of epilepsy and seizure history in individuals with a diagnosis of FASD,” said Stephanie H. Bell, a researcher with the Centre for Neuroscience Studies at Queens University and corresponding author for the study. “In the general population, less than one percent are expected to develop epilepsy; of those with FASD, six percent had epilepsy and 12 percent had one or more seizures in their life. Subjects were more likely to have epilepsy, or a history of seizures, if exposure to alcohol had occurred in the first trimester or throughout the entire pregnancy.”

“While this report supports a growing impression that fetal alcohol exposure may predispose the immature brain to the development of epilepsy, the results do not establish a direct cause-effect relationship between FASD and epilepsy,” cautioned Savage. “Establishing a direct link between these clinical conditions will be a difficult challenge given our incomplete understanding of how ethanol damages the developing brain and what neuropathological changes in brain tissue lead to the development of different types of epilepsy.”

Nonetheless, Savage added that it is clear that alcohol can damage the fetal brain. “The extent to which this damage leads to adverse neurobehavioral consequences likely depends upon a multitude of factors, including the amount and patterns of drinking during pregnancy, the presence of other pregnancy risk factors, such as cigarette smoking, substance abuse, or poor prenatal care, and the presence of other diseases affecting a mother’s health, such as diabetes or high blood pressure,” he said. “As risk factors accumulate, the risk of adverse neurodevelopmental outcomes also increases.”

Alcohol During Pregnancy

“Epilepsy and/or seizures in children are often missed in clinical assessments,” noted Carlen, “and if it is untreated it can lead to increased or unrecognized cognitive problems. In the long-term, it can also result in problems in attention and memory and the risk of unattended and dangerous seizures. Many children may not have a predisposition to epilepsy and do not have the physical signs of FASD, but the physician should be aware of alcohol exposure during pregnancy when considering their patient’s health and the etiology of particular diagnoses.”

“This report builds on a growing body of evidence that maternal drinking during pregnancy may put a child at greater risk for an even wider variety of neurologic and behavioral health problems than we had appreciated before,” said Savage. “The consensus recommendation of scientists and clinical investigators, along with public health officials around the world, is very clear – a woman should abstain from drinking during pregnancy as part of an overall program of good prenatal care that includes good nutrition, adequate exercise, sufficient rest, and proper prenatal health care.”

April 6th, 2010  in Alcohol No Comments »

Cocaine use a significant HIV risk factor for teens

Teens with a history of crack or cocaine use are significantly more likely to engage in unprotected sex than youth who have never used these drugs, putting themselves at increased risk for HIV, according to a study in the April issue of the Journal of Child and Adolescent Substance Abuse.

Researchers from the Bradley Hasbro Children’s Research Center report that teens in psychiatric care who used crack and/or cocaine at least once were six times more likely to use condoms inconsistently, which was defined as “sometimes,” “never” or “rarely.” The findings suggest that crack cocaine appears to have more of an influence on risky teen behaviors than other factors, like alcohol and marijuana use, which are more routinely incorporated into adolescent HIV prevention interventions.

Cocaine and Unprotected Sex

The study is one of the first to look at the link between crack and cocaine use and HIV risk behaviors in adolescents. Previous research has demonstrated this association in adults.

“Unprotected sex is the most common way that HIV is transmitted among teens, so if we can develop a clearer picture of why some kids engage in high-risk sexual behaviors, we will be better prepared to educate them about safe sex,” says lead author Marina Tolou-Shams, PhD, of the Bradley Hasbro Children’s Research Center. “Our findings suggest that future HIV prevention interventions should include content specific to crack and cocaine use, just as they do with drugs that are more commonly used by teens, like alcohol and marijuana.”

Overall, nearly 280 teens between the ages of 13 and 18 from therapeutic psychiatric day programs took part in the study. Participants exhibited a range of psychiatric diagnoses, including mood disorders, post-traumatic stress disorder and disruptive behavior disorders. More than half of all adolescents were male, and more than three-quarters were Caucasian. Approximately 13 percent of teens in the study reported trying crack or cocaine at least once.

Not Using Condoms

After controlling for known adolescent HIV risk factors, such as gender, race, age and psychiatric status, researchers found that only 47 percent of teens with a history of crack and/or cocaine use said they used condoms “always or almost always.” In addition, 15 percent of these adolescents have a history of sexually transmitted diseases (STD), nearly three-quarters reported using alcohol at least once and more than half indicated prior marijuana use.

In comparison, 71 percent of teens who never used crack or cocaine reported using condoms consistently.

Tolou-Shams says it was important to look at the association between crack and cocaine use and HIV risk behavior in adolescents with psychiatric disorders, since previous research has shown that teens in mental health treatment have high rates of risky sexual behavior and are more likely to engage in substance use.

“Our study clearly shows that youth in psychiatric treatment are using other drugs – and not just alcohol or marijuana – at high rates and that a history of drug use should alert clinicians to a wide variety of possible behavioral risks in their young patients,” she adds.

Provide Interventions

The authors recommend that all clinicians who treat adolescents – including pediatricians, social workers and psychologists – routinely discuss their patients’ mental health history, lifetime use of all substances and sexual activity, as well as provide appropriate interventions when necessary in order to reduce their HIV risk.

The research is supported by grants from the National Institute of Mental Health and the Lifespan/Tufts/Brown Center for AIDS Research (CFAR).

Tolou-Shams is also an assistant professor of psychiatry at The Warren Alpert Medical School of Brown University. Study co-authors include Larry K. Brown, MD, and Nicholas Tarantino, BS, both from the Bradley Hasbro Children’s Research Center and Alpert Medical School, and Sarah W. Feldstein Ewing, PhD, at the University of New Mexico.

April 1st, 2010  in Illegal Drugs No Comments »