Panel Has Mixed Thoughts on Multivitamins

An independent panel convened by the National Institutes of Health concluded May 17 that there is no evidence so far whether the multivitamin/minerals taken by half of all healthy American adults are protecting them against chronic diseases, or whether people may in fact be getting too much of some nutrients. Since people who take multivitamins usually engage in other positive health behaviors such as regular exercise and eating a healthy diet, it’s hard to tease out the effects of the vitamins themselves, the panel said. In those cases where benefits are known, however, the panel urged continued use of combined calcium and vitamin D supplementation for postmenopausal women to protect bone health, use of anti-oxidants and zinc by non-smoking adults to help prevent age-related macular degeneration, and use of daily folate by pregnant women to prevent neural tube defects in their babies. The panel found no evidence to recommend beta carotene supplements, a form of vitamin A, for the general population and strongly cautioned smokers against taking them because of a suspected link to lung cancer. The panel’s recommendations will be available online at http://consensus.nih.gov.

Program Deals with Teen Dating Violence

"Choose Respect," a program of the federal Centers for Disease Control and Prevention (CDC) aimed at helping teens to develop appropriate dating behavior, is being pioneered in 10 U.S. cities this summer, where the CDC is working with community agencies to create awareness of the issue in 11- to 14-year-olds and their parents. The CDC notes that one in 11 adolescents reported being hit, slapped, or physically hurt by a boyfriend or girlfriend in the 2003 Youth Risk Behavior Survey, and a study published in the May 17 issue of Morbidity and Mortality Weekly Report cited links between physical dating violence and other behaviors that can put students’ health and well-being at risk. Online materials available at www.chooserespect.org include games and interactive learning tools, a 30-minute video with stories of real teens who have experienced dating abuse, and television and radio spots.

Report Looks at Sub-Specialty Pediatric Care

Noting factors that make it hard to access sub-specialty care for children, a report published by the Maternal and Child Health Policy Research Center cites some promising approaches that address referral, consultation, and shared management of cases. A strategy for providing targeted child psychiatry services, for example, is described in detail, along with nine examples from other fields. The report, which includes evaluation findings, outcome results, and program contact information, is available online at www.mchpolicy.org.

May News Alerts

May 2, 2006
Growing Up in North America

A new report highlights the conditions of children in the three countries—Canada, Mexico, and the United States—that make up North America and finds that the 120 million North American children are one-quarter of the people who live on this continent. The United States and Canada are "receiving countries," with more than 200 different ethnic origins in Canada and 39 percent of U.S. children described as "of color." Mexico, on the contrary, has one of the world’s lowest percentages of foreign-born residents. Children in the three nations are increasingly exposed to similar consumer goods, media messages, and social trends, but it is the sheer scale of migration from Mexico to the United States and, to a lesser extent, Canada, that is most changing the face of the region and the lives of thousands of children, according to a report sponsored by the Annie E. Casey Foundation. In all three countries, most children live in two-parent households, though the number of single-parent households in Mexico continues to rise. Most children in the three countries live in urban areas. Serious disparities among groups of children persist: "Within nations, not all children have the same opportunity to thrive," the report points out. Infant mortality has declined in all three nations, and the rate of asthma in children has increased. Canadian children have universal access to publicly funded health services, but 11 percent of U.S. children under the age of 18 have no health coverage, and one-third of Mexican children had no access to either public or private health insurance in the year 2000. The report released today, "Growing Up in North America: Child Well-Being in Canada, the United States, and Mexico," is available online at www.childreninnorthamerica.org.

May 4, 2006
Bottlers Agree to Limit Soft Drinks in Schools

In an agreement with organizations committed to reducing childhood obesity, three beverage companies that supply 95 percent of the soft drinks now sold in schools said May 3 that they will remove sweetened beverages such as Coke and Pepsi from school cafeterias and vending machines and will reduce serving sizes of lower-calorie and nutritional beverages. The bottlers said, however, that their initiative depends on the willingness of school boards to amend existing contracts with soft drink manufacturers and distributors, some of which extend for five years or more. A coalition of the William J. Clinton Foundation, the American Heart Association, and the Robert Wood Johnson Foundation noted that the voluntary guidelines now adopted by the bottlers will affect at least 35 million students across the country. Former President Clinton said the coalition, called "Alliance for a Healthier Generation," has been talking to the beverage companies for months to gain their cooperation. Other groups active in the beverage-reform movement note that the bottlers may also have been motivated by the threat of litigation by a group of lawyers who succeeded in obtaining a settlement with tobacco companies several years ago. A public interest attorney warned school boards that they may be subject, as a group and individually, to liability if they fail to go along with the industry’s proposals. Noting that the agreement represents the first "clear consensus" that sale of sugary soft drinks in schools is a health hazard to children, Professor John Banzhaf of George Washington University cautioned school boards and attorneys that, if they fail to take action, "the lawyers committed to ending the sale of such beverages—previously by suing the bottlers—will now be free to turn their attention and legal actions to any recalcitrant school boards and their members."

May 4, 2006
Food Marketing to Children Linked to Obesity

In the second report in six months to criticize the way the food industry markets high-calorie and high-sugar products to children, the Federal Trade Commission FTC), which monitors advertising in the U.S., and the Department of Health and Human Services (HHS) recommended May 2 that food companies take a variety of steps, including:

• adopting minimum nutrition standards for foods they market to children;
• reviewing and revising policies for foods sold in schools;
• exploring ways to educate the public about nutrition and fitness;
• creating new products and reformulating existing ones to make them lower in calories and more nutritious;
• including smaller portion sizes in single-serving food items.

FTC Chairman Deborah Platt Majoras, while noting that the report calls only for voluntary self-regulation on the part of food companies, said the FTC "plans to monitor the industry efforts closely" and expects to see "real improvement." HHS Secretary Mike Leavitt said, "Businesses need to work with mothers and fathers to bring America’s epidemic of childhood overweight under control." The FTC/HHS recommendations follow a report by the Institute of Medicine last year that found 80 percent to 97 percent of the food products aimed at children and teenagers were of "poor nutritional quality." The full text of the FTC/HHS report is available at http://ftc.gov/opa/2006/childhoodobesity.htm.

May 5, 2006
HHS Funds Push for Cell-based Influenza Vaccines

The U.S. Department of Health and Human Services (HHS) announced yesterday that it has awarded more than a billion dollars in grants to five pharmaceutical companies to speed up development of a cell-based influenza vaccine. The technique of manufacturing vaccines in a cell culture is already used to make a number of vaccines, but so far flu vaccine has been produced by cultivating the virus in specialized chicken eggs, a process that would be too slow to assure a supply of vaccine in the case of a flu pandemic, HHS Secretary Mike Leavitt said. In the cell-based process, the virus grows in large tanks containing cells that float in a nutrient broth, a process sometimes likened to brewing beer. The five new grants are in addition to $97 million the HHS awarded in April 2005 to the pharmaceutical company Sanofi Pasteur to develop the cell-based method.The companies named as grantees yesterday are GlaxoSmithKline, MedImmune (the company currently makes the nasal flu vaccine FluMist), Novartis Vaccines and Diagnostics, DynPort Vaccine, and Solvay Pharmaceuticals. Together, if all goes well, the companies, most of which do their manufacturing in countries other than the United States, may be able to make some 300 million doses of vaccine in a timeframe of six months--which would be enough to immunize every U.S. resident. The grants awarded yesterday, however, do not actually buy any vaccine and are intended simply to accelerate the development of the new manufacturing techniques.

May 9, 2006
FDA Looks at New Studies of Artificial Sweetener Aspartame

Responding to a European study that has found the low-calorie artificial sweetener aspartame—the ingredient of popular products such as NutraSweet and Splenda—to be carcinogenic, the U.S. Food and Drug Administration (FDA) said May 8 that it continues to believe aspartame is safe for human use. The agency said, however, that is reviewing data it has received on the European Food Safety Authority’s findings and will announce its conclusions when the review is complete. As of now, the FDA said in a press release, "the agency has not been presented with scientific information that would support a change in our conclusions about the safety of aspartame." Aspartame is the most popular of a class of sugar substitutes known as high-intensity sweeteners; the group includes saccharine and five other artificially derived sugar substitutes that have been approved by the FDA. Aspartame was reportedly discovered in 1965 by a scientist working on an anti-ulcer drug who accidentally spilled some aspartame on his hand and when licking his finger, noticed that it had a sweet taste. Since that time, there have been questions about its safety, but the FDA says its current approval of aspartame is based on more than 100 toxicological and clinical studies of the sweetener’s safety.

May 10, 2006
Almost Half of Preschoolers Are Minorities, Census Bureau Says

The Census Bureau said today that 45 percent of the U.S. population under the age of five years belong to minorities. The Census describes as "minority" persons who are other than single-race non-Hispanic white. The new figures make preschoolers the largest and fastest growing group of minorities in the U.S. population, with implications for education, the workforce, and Social Security in the coming decades. The Census Bureau reported U.S. population as a whole was 296.4 million in 2005, with Hispanics the largest minority group (42.7 million), followed by blacks (39.7 million), Asians (14.4 million), American Indians and Alaska natives (4.5 million), and native Hawaiians and other Pacific islanders (990,000). Hispanics are the fastest-growing group, increasing by 3.3 percent between July 1, 2004, and July 2, 2005, largely as the result of "natural increase" (births minus deaths) of 800,000 persons, plus immigration of 500,000. The Census Bureau report with tables is available at www.census.gov/Press-Release/www/releases/archives/population/006808.html.

May 11, 2006
In Preschoolers, Inhaled Medication Does Not Prevent Later Asthma

Treatment with inhaled corticosteroids "is associated with significant improvement in various measures of asthma control" in school-age children, and researchers wondered if receiving an inhaled corticosteroid would also reduce the likelihood of asthma in preschoolers who have frequent wheezing or other risk factors for asthma. But a multicenter, double-blind, placebo-controlled, parallel-group trial of inhaled fluticasone in children two to three years old found that, while the children had more episode-free days during treatment, when the treatment was stopped after two years there was no significant difference in the later development of asthma symptoms. "These findings do not provide support for a subsequent disease-modifying effect of inhaled corticosteroids after the treatment is discontinued," researchers said. They noted that studies of the natural history of asthma show that initial symptoms commonly occur during the first year of life, and children who have frequent wheezing without colds or who have personal or family histories of asthma or atopic dermatitis are believed to be at special risk of developing asthma. The research report, "Long-Term Inhaled Corticosteroids in Preschool Children at High Risk for Asthma," is published in the May 11, 2006, issue of the New England Journal of Medicine.

May 12, 2006
Study Finds Delays in Diagnosing Autism

Children are often first diagnosed as having autism spectrum disorders (ASD) after they display language or general developmental delays, and 24 percent of the children diagnosed with ASDs are identified at schools, according to a study reported in an April supplement to the Journal of Developmental and Behavioral Pediatrics. The study also found that there is often a long delay—an average of 13 months—between the time the children are initially evaluated and the time they are actually diagnosed as having autism. Children with the more severe symptoms tended to be diagnosed somewhat earlier, but even for those children the average age of diagnosis is three and a half years, and many are not diagnosed until age four and a half. This is of concern, said the federal Centers for Disease Control and Prevention (CDC), because early identification of ASD can lead to earlier entrance into intervention programs that can improve developmental outcome. "It is important for parents and healthcare professionals to recognize early symptoms of ASDs," the CDC said. "It is also important that children with identified delays be administered routine developmental and autism-specific screenings." The Journal of Developmental and Behavioral Pediatrics can be accessed at www.jmidbp.com. Information about the early signs of autism is available at www.cdc.gov/actearly.

May 15, 2006
HIV Vaccine ‘Eludes Us,’ NIH Says

Basic research has shown how HIV causes AIDS and how the immune system tries to contain infection, but despite almost 100 clinical trials since 1987, "an effective vaccine eludes us," the director of the federal National Institutes of Health said in a statement today. Noting that May 18 will be the 9^th annual HIV Vaccine Awareness Day, Dr. Anthony Fauci called for continued basic and clinical research to design promising new vaccine candidates and to test their potential for preventing HIV infection. He urged supporters to show support for HIV vaccine research by wearing their AIDS ribbon upside-down to symbolize a "V" for vaccine. "Please take this opportunity to learn more about HIV vaccine research and to educate someone you know about the importance of developing a vaccine for HIV," Fauci said. Further information about HIV Vaccine Awareness Day is available at http://www3.niaid.nih.gov/new/events/HVAD.

May 17, 2006
Calories In, Calories Out: A Report on Food and Exercise in Public Elementary Schools

Noting that one way to address obesity among school-age children is to emphasize an "energy balance" approach—calories in, calories out--the National Center for Education Statistics in the U.S. Department of Education in 2005 surveyed a statistically representative sample of public elementary schools to see what foods are available outside of full school meals, the opportunities students have to engage in physical activity, and whether schools measure the height, weight, or body mass index of students.

Some of the survey findings:

• 88 percent of public elementary schools offered both healthy and less nutritious foods for sale outside of full school meals at one or more locations in the school, with many offering the food in the cafeteria or lunchroom;
• 22 percent of elementary schools offered at least one nondairy beverage or snack food in vending machines and 31 percent sold the food at snack bars or school stores. In schools with vending machines, 33 percent had vending machine food available during mealtimes;
• Across elementary grades, 7 percent to 13 percent of schools had no scheduled recess;
• 99 percent of elementary schools reported that they scheduled physical education, but only between 17 percent and 22 percent of schools said physical education was offered daily, with an average of 2.4 to 2.6 times per week;
• 64 percent of schools said they used nontraditional physical education such as dance or kick-boxing to make physical education enjoyable, and at least half used other types of programs during or outside the school day to encourage physical activity;
• Two-thirds of schools never calculated students’ body mass index (BMI) in 2005 and 28 percent never measured students’ weight;
• Of public elementary schools that measured students’ height or weight, 39 percent sent this information to parents, and 49 percent of schools that measured BMI sent that information to parents.

An executive summary and the full text of the report, "Calories In, Calories Out: Food and Exercise in Public Elementary Schools," are available online at http://nces.ed.gov.

May 18, 2006
As Asthma Inhalers Are Phased Out, Shortages, Price Rises Expected

The leading prescription treatment to open constricted airways during an asthma attack will be phased out by the end of 2008, which is the federal government’s deadline for ending use of an ozone-depleting propellant gas currently found in almost all inhalers. The federal Food and Drug Administration (FDA) alerted consumers in March that a transition to other drugs may cause spot shortages of inhalers, and consumers also report that prices of inhalers are rising as the result of the change, in which albuterol containing chlorofluocarbons (CFC) is being replaced with albuterol containing the more ozone-friendly propellant hydrofluoroalkane (HFC). CFCs are being phased out to comply with the Montreal Protocol, a global treaty to save the earth’s outer ozone layer. Any rise in the price of inhalers may affect especially families living below the poverty level, in which asthma prevalence is high, but many asthma patient groups say they see the transition as an opportunity to move to drugs such as inhaled steroids that can prevent asthma attacks in the first place. For more information, go to http://www.fda.gov/bbs/topics/ANSWERS/2005/ANSO1349.html and http://www.fda.gov/cder/md/default.htm.

May 22, 2006
Child Trends Cites Data on Teen Childbearing

While teen birth rates have declined continuously since 1991, the downward trend has slowed, giving reason to remain concerned about teen sexual activity and childbearing, according to a summary of recent data released by the organization Child Trends. Here are some of the facts reported by Child Trends:

• The U.S. teen birth rate varies greatly by state, ranging from a low of 18 births per 1000 females 15 to 19 years old in New Hampshire to a high of 63 in Texas;
• Between 2003 and 2004, the number of births to teens under age 15 and to teens ages 18-19 increased, as did the number of births to Hispanic teens. In addition, the percentage of teen births that are repeat births increased slightly between 2003 and 2004;
• One-quarter of females and 28 percent of males ages 15-17 have not talked with parents or guardians about saying no to sex or about birth control, condoms, or sexually transmitted diseases;
• The proportion of teen births that occur within marriage decreased from 49 percent in 1982 to 18 percent in 2002, reflecting the decreasing proportion of nonmarital conceptions that result in a marital birth (that is, fewer unmarried pregnant teens are marrying the fathers of their babies);
• Young people between the ages of 15 and 24 account for almost one-half of all newly acquired sexually transmitted diseases in the United States.

Child Trends also reported some positive trends, noting that in 2003, more than half of students in grades 9-12 reported that they had abstained from sex, and two-thirds of students in those grades who were sexually active said they had used a condom the last time they had sex. The publication "Facts at a Glance" is available at www.childtrendsdatabank.org.

May 24, 2006
Studies See Link Between Sleep Loss and Obesity

A report in today’s issue of the Journal of the American Medical Association notes that while it’s "far from conclusive" that lack of sleep contributes to weight gain and obesity, we do know that Americans are sleeping fewer hours per night at the same time that obesity is increasing. A study has shown that individuals with "partial sleep deprivation," meaning they slept less than seven hours a night, had higher body mass index (BMI) and were more likely to be obese than persons who reported sleeping seven hours or more, researchers pointed out; and studies first reported in 1999 show partial sleep deprivation disrupts edocrine, metablic, and immune function. The researchers explained that sleep loss alters the ability of leptin (a hunger-suppressing hormone) to accurately signal caloric need and increases appetite for high-carbohydrate calorie-dense foods such as cake, chips, and bread. That fact, along with other aspects of the environment, including lack of opportunities for exercise in schools and elsewhere, and home air-conditioning that keeps people inactive indoors for long periods of time, may be contributing to current rises in obesity, they said. The article, "Rx for Obesity: Eat Less, Exercise More and—Maybe—Get More Sleep," appears in the May 24/31 issue of the Journal of the American Medical Association.

May 30, 2006
Shortage Defers Meningococcal Vaccination of 11-12-Year-Olds

Faced with a shortage of a recently licensed new vaccine against meningococcal disease, the Centers for Disease Control and Prevention (CDC) last week asked providers to postpone vaccinating 11- and 12-year-old children in order to make the vaccine available for adolescents at high school entry and college freshmen living in dormitories. It’s expected that demand will outpace supplies of the vaccine, tetravalent polysaccharide-protein conjugate (MCV4), marketed as Menactra, at least through summer this year, said the manufacturer, Sanofi Pasteur, Inc., of Swiftwater, Pennsylvania. Providers are asked to track the 11- and 12-year-olds whose vaccinations are deferred and recall them when the supply of vaccine improves. The CDC said that for most persons, MCV4 is preferable to an earlier tetravalent meningococcal polysaccharide vaccine (MPSV4), marketed as Menomune, which is also made by Sanofi Pasteur; but the CDC pointed out that Menomune is also highly effective in preventing certain types of meningococcal disease and "is an acceptable alternative" to the newer vaccine, particularly for persons who have brief elevations in risk, such as travel to places where meningococcal disease is epidemic. The CDC said, however, that supplies of MPSV4 are also limited. Periodic updates of vaccine supply will be available at http://cdc.gov/nip/news/shortages/default.htm.