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Health of Adolescents
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For Parents: Knowing Your Adolescent Child

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Artificial Tanning 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 Institute.

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 head trauma.

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:

  • 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 head.
  • All helmets should be replaced every five years.
February 2002 Update

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Meningococcal Disease Prevention for College Students

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 it.

U.S. military recruits have been routinely vaccinated against meningococcal disease since 1971, in response to a high incidence of the disease in that population.
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 hadn’t.

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 child’s 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 one’s 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 13–24% 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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