For Parents: Knowing Your Adolescent
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and Carcinoma Risk
Artificial tanning devices such as sunlamps are gaining popularity —
especially among young adults and women — in spite of the fact
that their use is linked to skin cancer. The UV radiation emitted from
these devices, along with the sunburns they elicit, are risk factors
for two of the most common types of skin cancer: basal cell carcinoma
(BCC) and squamous cell carcinoma (SCC). Though the link between carcinomas
and artificial tanning devices is generally accepted, there are few data
connecting the two. So investigators in New Hampshire studied the risk
of BCC and SCC associated with such methods. The results were published
in the February 6, 2002, issue of the Journal of the National Cancer
Subjects were BCC and SCC patients, ages 25–74. They answered
questions on their sun sensitivity, sun exposure, and artificial tanning
methods, if any. Those who had either used a sunlamp or tanning bed,
or gone to a tanning salon also gave their ages at first and last use.
Participants who used tanning devices were 2.5 times more likely to
develop SCC and 1.5 times more likely to develop BCC than those who did
not use the devices. Even after participants' past sunburns and sun exposure
were taken into account, the excess risk for SCC and BCC associated with
artificial tanning devices was still present. What's more, for every
ten years earlier that a person started artificial tanning, the risk
of BCC and SCC increased by 20% and 10%, respectively.
The study supports earlier suggestions that tanning device use may be
contributing to the increasing incidence of BCC and SCC. Future research
will hopefully help assess the link between frequency of tanning lamp
use and carcinoma risk, an issue that was not addressed in this study.
May 2002 Update
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Bicycle Helmets Save Lives
Although bicycling is one of the most popular sports, injuries
associated with bicycling are the leading cause of emergency room visits
for children and adolescents. Unfortunately, many of these injuries include
Previous studies have shown helmets can sharply reduce the serious head
injuries that can occur with cycling. But the majority of children (and
their parents) still don't use helmets regularly. Why? Reasons suggested
include discomfort, lack of style, peer pressure, and not recognizing
the importance of helmets on short rides.
The American Academy of Pediatrics recently published a statement emphasizing
the importance of correct bicycle helmet use. In these recommendations,
all bicyclists (children and parents alike) should wear proper helmets
every time they ride. A helmet made after March 1999 should be used.
These newer helmets meet US Consumer Product Safety Commissions standards.
Children should be properly fitted because helmets come in several sizes.
Keep in mind that:
February 2002 Update
- In its correct position, the helmet should sit low on the forehead
and be parallel to the ground.
- Velcro pads should be placed in, or removed from, the inside of
the helmet as needed to make the helmet fit snugly.
- The chinstrap should be adjusted so that no more than two fingers
can be placed between the strap and the chin.
- The helmet should not shift or come off when the child shakes his
- All helmets should be replaced every five years.
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Meningococcal Disease Prevention for
Meningococcal disease is an inflammation of the membranes
that encase and protect the brain and spinal cord. When caused by a bacterial
infection, meningococcal disease can be fatal. Survivors can suffer significant
lifelong impairments, including permanent brain damage or hearing loss.
In recent years, the incidence of meningococcal disease has been on the
rise in 15- to 24-year-olds in the United States. And the Centers for
Disease Control and Prevention (CDC) has revealed that U.S. college students
living in a dormitory setting are more than three times as likely to
contract meningococcal disease than those in the same age group who do
not live in a dormitory setting. Freshmen face the greatest risk.
Sixty percent or more of these cases could be prevented with an existing,
available vaccine. Adverse reactions to the vaccine have been shown to
be mild, and serious reactions are rare. Based on findings from recent
studies and on input from expert committees, the American Academy of
Pediatrics advises physicians to inform college-bound patients who intend
to live in a dormitory of the increased risk for meningococcal disease
and of the benefits and limitations of the vaccine. Physicians are also
advised to make the vaccine available to those patients who then request
U.S. military recruits have been routinely vaccinated against meningococcal
disease since 1971, in response to a high incidence of the disease in
February 2001 Update
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Carbonated Beverages and the Risk
of Bone Fractures in Teenaged Girls
Osteoporosis, or the loss of bone density, is usually thought
of as a geriatric condition. But the disease may have its roots in adolescence
as bone mass reaches its peak level. Factors that affect the accumulation
of bone mass during this time can increase the risk of bone fractures
and osteoporosis. In this context, teenaged girls may be jeopardizing
their current and future health by drinking too many carbonated beverages.
Past results indicate that consumption of carbonated beverages is associated
with bone fractures among teenaged girls. A recent cross-sectional study
involving 460 9th- and 10th-grade girls confirmed these findings. The
teenagers completed a questionnaire describing their physical activities
and personal and behavioral habits. Researchers analyzed the results
to determine an association between consumption of carbonated beverages
and bone fractures.
Of the girls surveyed, 80% drank carbonated beverages, and nearly two-thirds
of the girls drank cola. One-fifth of the girls reported having had bone
fractures. Analysis showed that the risk of bone fracture in girls who
drink carbonated beverages is three times that of girls who do not. The
risk is highest, seven times greater, among physically active girls who
drink both cola and noncola.
The results suggest a strong association between consumption of carbonated
beverages and bone fractures in teenaged girls, but the researchers caution
that a cause and effect relationship cannot be assumed. Despite that,
they have a few theories that may explain the association. Laboratory
research has shown that the high phosphorous concentration in cola can
cause bone loss that may lead to a greater risk of bone fractures. Another
plausible theory is that the consumption of carbonated beverages takes
the place of consumption of milk, an important source of calcium. Low
calcium intake can increase the risk of osteoporosis. Between 1970 and
1997, the consumption of carbonated beverages increased by 118% per capita
in the United States, while milk consumption declined 23%.
The study, however, did not include questions concerning the amounts
of milk and carbonated beverages consumed. Long-term studies that include
these factors may help to assess the effect of milk and carbonated beverage
consumption. Also, the use of bone density measurements may demonstrate
a cause and effect relationship between carbonated beverage consumption
and bone fractures. Research is necessary to determine how carbonated
beverages may lead to bone fractures among physically active girls. Despite
the need for further studies, the current body of evidence suggests that
education on the health impact of carbonated beverage consumption may
be a possible way to promote optimal bone development in teenaged girls
and prevent osteoporosis.
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Is Your Child at High Risk for Knee Osteoarthritis?
Are the teen years too early to start taking steps to prevent osteoarthritis
of the knee? Apparently not, according to the Johns Hopkins Precursors
Study. This study followed a group of 1,337 (mostly white male) medical
students for an average of 36 years. All participants were asked at the
outset if they had suffered a knee injury. Most who had did so while
playing a sport (a few had sustained their knee injuries in a car crash,
though one suspects that number would be higher if the study were conducted
today). Over the course of the study, it became clear that the participants
who had sustained a knee injury in their adolescence or young adulthood
(the average age at the time of injury was 16) were three times as likely
to suffer from knee osteoarthritis by middle age as those who hadnt.
Nowadays, with more and more adolescents of both sexes playing sports
at younger and younger ages, it makes sense to be aware of the potential
health risks that are involved later in life. Parents may think that
their childs knee injury, once healed, is no longer a problem,
but this research suggests that adolescents and young adults who have
experienced a traumatic injury to the knee make up a high-risk group
and should be considering ways to try to prevent osteoarthritis. Prevention
can involve using the proper sports equipment correctly and under safe
conditions, temporarily modifying high-impact exercise, and, in the future,
perhaps early intervention drug therapy. The adolescent and young adult
years are not too early to consider ones future health.
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Young Men and Women with Anorexia Nervosa or Inflammatory
Bowel Disease at Greater Risk for Osteoporosis
We usually think of osteoporosis as a condition that primarily strikes
older women as a result of the aging process. However, certain disorders
and medications can also lead to bone loss in younger people, both male
and female. Two recent studies from the Annals of Internal Medicine show
that bone loss is significantly more likely to occur in young men and
women suffering from anorexia nervosa or inflammatory bowel disease than
in the general population.
Researchers evaluated the loss of bone tissue in women with the eating
disorder anorexia nervosa by measuring bone mineral density at different
regions of the skeleton. More than 90% of the women had significant bone
loss at one or more skeletal regions. Depending on the region measured,
this bone loss put 1324% of the women at risk for fractures. Physicians
commonly prescribe estrogen to slow bone loss in postmenopausal women.
Estrogen is also given to women who do not menstruate regularly, which
is the case for many women with anorexia. Interestingly, in this study,
women who used estrogen experienced the same levels of bone loss as women
who did not. The researchers theorized that poor nutrition might decrease
the effectiveness of estrogen in preserving bone. The results also showed
that current weight, independent of other factors, is the best predictor
of bone density in anorectic women.
In a separate study, researchers sought to determine the risk of bone
fractures associated with osteoporosis in patients with inflammatory
bowel disease. Results of the study showed that patients with the disease
had a 40% greater risk of hip, spine, wrist, or rib fractures than healthy
people. Researchers are still uncertain what factors contribute to bone
loss in these patients. They speculate that corticosteroids, which are
used to treat inflammatory bowel disease, may play a role, and that cigarette
smoking, lower levels of sex hormones, and low dietary intake of calcium
and vitamin D may also contribute to bone loss.
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