Erik Goldman

OLD GREENWICH, CONN. — A PDA-based drug dose calculator system brought about a marked reduction in medication errors at a university's neonatal intensive care unit, Dr. M. Kabir Abubakar reported a meeting of the Eastern Society for Pediatric Research.

The error reduction, from 1.77 per 100 orders to 0.66 per 100 orders, occurred within a 12-month period after Georgetown University Hospital's NICU mandated that all staff use the Neofax drug database system. The improved performance was all the more remarkable because it occurred during a period of rapid growth in the hospital's neonatal and perinatal departments, with the number of NICU drug orders almost tripling from the previous year.

According to Dr. Abubakar, of Georgetown's division of neonatology, medication errors are a significant contributor to neonatal morbidity in the NICU setting. Neonates are highly vulnerable, and a misplaced decimal point in a dose calculation can have huge clinical implications.

As part of its ongoing quality improvement efforts, MedStar Health—the hospital system that owns Georgetown—put up the funds to provide PDA-based Neofax dose calculators to all NICU physicians, residents, fellows, nurse-practitioners, and dispensing pharmacists. Following a training period, staff was required to use the PDA for all NICU drug orders.

Pharmacists and bedside nurses cross-checked all physician dose calculations using the same system.

“It took about 3 months to get everyone trained and compliant with the system,” said Dr. Abubakar in an interview. “There was some resistance, of course, but the bigger problem was that initially a lot of people were forgetting or losing their PDAs. Eventually, we had to install them in stationary places by every four or five NICU beds.”

The ultimate payoff, in terms of reduced errors, was tremendous. In the 12 months following adoption of the system, the Georgetown team was able to reduce its total medication error rate from 1.77 to 0.66 per 100 orders. Prescription errors dropped from 1 per 100 orders to 0.3 per 100.

There was a 62% reduction in the number of 10-fold dosing errors, that is, errors of decimal point placement, in the year following implementation of the system. Dispensing and administration errors were also reduced, although the baseline numbers for these types of errors were fairly low.

The total number of drug orders at the NICU increased from 13,557 in the year prior to adoption of the PDA system to 31,680.

“The hospital system had a growing number of perinatologists, so our unit was seeing a big increase in the number of patients, and consequently, an increase in the number of drugs ordered,” Dr. Abubakar said at the meeting, cosponsored by the Children's Hospital of Philadelphia. “We would have expected this to increase the error rate, but we saw just the opposite.”

The Palm-based system itself deserves only part of the credit for the improvement, he noted.

Implementation of a system like this naturally prompts clinicians and other staff members to pay closer attention to the accuracy of their prescribing and dose calculations. “Just knowing they're being watched and cross-checked has an effect.” That said, there's no question that digitized dose calculators built on a reliable drug database can greatly reduce the margin of error.

OLD GREENWICH, CONN. — A PDA-based drug dose calculator system brought about a marked reduction in medication errors at a university's neonatal intensive care unit, Dr. M. Kabir Abubakar reported a meeting of the Eastern Society for Pediatric Research.

The error reduction, from 1.77 per 100 orders to 0.66 per 100 orders, occurred within a 12-month period after Georgetown University Hospital's NICU mandated that all staff use the Neofax drug database system. The improved performance was all the more remarkable because it occurred during a period of rapid growth in the hospital's neonatal and perinatal departments, with the number of NICU drug orders almost tripling from the previous year.

According to Dr. Abubakar, of Georgetown's division of neonatology, medication errors are a significant contributor to neonatal morbidity in the NICU setting. Neonates are highly vulnerable, and a misplaced decimal point in a dose calculation can have huge clinical implications.

As part of its ongoing quality improvement efforts, MedStar Health—the hospital system that owns Georgetown—put up the funds to provide PDA-based Neofax dose calculators to all NICU physicians, residents, fellows, nurse-practitioners, and dispensing pharmacists. Following a training period, staff was required to use the PDA for all NICU drug orders.

Pharmacists and bedside nurses cross-checked all physician dose calculations using the same system.

“It took about 3 months to get everyone trained and compliant with the system,” said Dr. Abubakar in an interview. “There was some resistance, of course, but the bigger problem was that initially a lot of people were forgetting or losing their PDAs. Eventually, we had to install them in stationary places by every four or five NICU beds.”

The ultimate payoff, in terms of reduced errors, was tremendous. In the 12 months following adoption of the system, the Georgetown team was able to reduce its total medication error rate from 1.77 to 0.66 per 100 orders. Prescription errors dropped from 1 per 100 orders to 0.3 per 100.

There was a 62% reduction in the number of 10-fold dosing errors, that is, errors of decimal point placement, in the year following implementation of the system. Dispensing and administration errors were also reduced, although the baseline numbers for these types of errors were fairly low.

The total number of drug orders at the NICU increased from 13,557 in the year prior to adoption of the PDA system to 31,680.

“The hospital system had a growing number of perinatologists, so our unit was seeing a big increase in the number of patients, and consequently, an increase in the number of drugs ordered,” Dr. Abubakar said at the meeting, cosponsored by the Children's Hospital of Philadelphia. “We would have expected this to increase the error rate, but we saw just the opposite.”

The Palm-based system itself deserves only part of the credit for the improvement, he noted.

Implementation of a system like this naturally prompts clinicians and other staff members to pay closer attention to the accuracy of their prescribing and dose calculations. “Just knowing they're being watched and cross-checked has an effect.” That said, there's no question that digitized dose calculators built on a reliable drug database can greatly reduce the margin of error.

OLD GREENWICH, CONN. — A PDA-based drug dose calculator system brought about a marked reduction in medication errors at a university's neonatal intensive care unit, Dr. M. Kabir Abubakar reported a meeting of the Eastern Society for Pediatric Research.

The error reduction, from 1.77 per 100 orders to 0.66 per 100 orders, occurred within a 12-month period after Georgetown University Hospital's NICU mandated that all staff use the Neofax drug database system. The improved performance was all the more remarkable because it occurred during a period of rapid growth in the hospital's neonatal and perinatal departments, with the number of NICU drug orders almost tripling from the previous year.

According to Dr. Abubakar, of Georgetown's division of neonatology, medication errors are a significant contributor to neonatal morbidity in the NICU setting. Neonates are highly vulnerable, and a misplaced decimal point in a dose calculation can have huge clinical implications.

As part of its ongoing quality improvement efforts, MedStar Health—the hospital system that owns Georgetown—put up the funds to provide PDA-based Neofax dose calculators to all NICU physicians, residents, fellows, nurse-practitioners, and dispensing pharmacists. Following a training period, staff was required to use the PDA for all NICU drug orders.

Pharmacists and bedside nurses cross-checked all physician dose calculations using the same system.

“It took about 3 months to get everyone trained and compliant with the system,” said Dr. Abubakar in an interview. “There was some resistance, of course, but the bigger problem was that initially a lot of people were forgetting or losing their PDAs. Eventually, we had to install them in stationary places by every four or five NICU beds.”

The ultimate payoff, in terms of reduced errors, was tremendous. In the 12 months following adoption of the system, the Georgetown team was able to reduce its total medication error rate from 1.77 to 0.66 per 100 orders. Prescription errors dropped from 1 per 100 orders to 0.3 per 100.

There was a 62% reduction in the number of 10-fold dosing errors, that is, errors of decimal point placement, in the year following implementation of the system. Dispensing and administration errors were also reduced, although the baseline numbers for these types of errors were fairly low.

The total number of drug orders at the NICU increased from 13,557 in the year prior to adoption of the PDA system to 31,680.

“The hospital system had a growing number of perinatologists, so our unit was seeing a big increase in the number of patients, and consequently, an increase in the number of drugs ordered,” Dr. Abubakar said at the meeting, cosponsored by the Children's Hospital of Philadelphia. “We would have expected this to increase the error rate, but we saw just the opposite.”

The Palm-based system itself deserves only part of the credit for the improvement, he noted.

Implementation of a system like this naturally prompts clinicians and other staff members to pay closer attention to the accuracy of their prescribing and dose calculations. “Just knowing they're being watched and cross-checked has an effect.” That said, there's no question that digitized dose calculators built on a reliable drug database can greatly reduce the margin of error.

OLD GREENWICH, CONN. — A PDA-based drug dose calculator system brought about a marked reduction in medication errors at a university's neonatal intensive care unit, Dr. M. Kabir Abubakar reported a meeting of the Eastern Society for Pediatric Research.

The error reduction, from 1.77 per 100 orders to 0.66 per 100 orders, occurred within a 12-month period after Georgetown University Hospital's NICU mandated that all staff use the Neofax drug database system. The improved performance was all the more remarkable because it occurred during a period of rapid growth in the hospital's neonatal and perinatal departments, with the number of NICU drug orders almost tripling from the previous year.

According to Dr. Abubakar, of Georgetown's division of neonatology, medication errors are a significant contributor to neonatal morbidity in the NICU setting. Neonates are highly vulnerable, and a misplaced decimal point in a dose calculation can have huge clinical implications.

As part of its ongoing quality improvement efforts, MedStar Health—the hospital system that owns Georgetown—put up the funds to provide PDA-based Neofax dose calculators to all NICU physicians, residents, fellows, nurse-practitioners, and dispensing pharmacists.

Following a training period, staff was required to use the PDA for all NICU drug orders. Pharmacists and bedside nurses cross-checked all physician dose calculations using the same system.

“It took about 3 months to get everyone trained and compliant with the system,” said Dr. Abubakar in an interview. “There was some resistance, of course, but the bigger problem was that initially a lot of people were forgetting or losing their PDAs. Eventually, we had to install them in stationary places by every four or five NICU beds.”

The ultimate payoff, in terms of reduced errors, was tremendous. In the 12 months following adoption of the system, the Georgetown team was able to reduce its total medication error rate from 1.77 to 0.66 per 100 orders. Prescription errors dropped from 1 per 100 orders to 0.3 per 100.

There was a 62% reduction in the number of 10-fold dosing errors, that is, errors of decimal point placement, in the year following implementation of the system. Dispensing and administration errors were also reduced, although the baseline numbers for these types of errors were fairly low.

The total number of drug orders at the NICU increased from 13,557 in the year prior to adoption of the PDA system to 31,680.

“The hospital system had a growing number of perinatologists, so our unit was seeing a big increase in the number of patients, and consequently, an increase in the number of drugs ordered,” Dr. Abubakar said at the meeting, cosponsored by the Children's Hospital of Philadelphia.

“We would have expected this to increase the error rate, but we saw just the opposite.”

The Palm-based system itself deserves only part of the credit for the improvement, he noted.

Implementation of a system like this naturally prompts clinicians and other staff members to pay closer attention to the accuracy of their prescribing and dose calculations.

OLD GREENWICH, CONN. — A PDA-based drug dose calculator system brought about a marked reduction in medication errors at a university's neonatal intensive care unit, Dr. M. Kabir Abubakar reported a meeting of the Eastern Society for Pediatric Research.

The error reduction, from 1.77 per 100 orders to 0.66 per 100 orders, occurred within a 12-month period after Georgetown University Hospital's NICU mandated that all staff use the Neofax drug database system. The improved performance was all the more remarkable because it occurred during a period of rapid growth in the hospital's neonatal and perinatal departments, with the number of NICU drug orders almost tripling from the previous year.

According to Dr. Abubakar, of Georgetown's division of neonatology, medication errors are a significant contributor to neonatal morbidity in the NICU setting. Neonates are highly vulnerable, and a misplaced decimal point in a dose calculation can have huge clinical implications.

As part of its ongoing quality improvement efforts, MedStar Health—the hospital system that owns Georgetown—put up the funds to provide PDA-based Neofax dose calculators to all NICU physicians, residents, fellows, nurse-practitioners, and dispensing pharmacists.

Following a training period, staff was required to use the PDA for all NICU drug orders. Pharmacists and bedside nurses cross-checked all physician dose calculations using the same system.

“It took about 3 months to get everyone trained and compliant with the system,” said Dr. Abubakar in an interview. “There was some resistance, of course, but the bigger problem was that initially a lot of people were forgetting or losing their PDAs. Eventually, we had to install them in stationary places by every four or five NICU beds.”

The ultimate payoff, in terms of reduced errors, was tremendous. In the 12 months following adoption of the system, the Georgetown team was able to reduce its total medication error rate from 1.77 to 0.66 per 100 orders. Prescription errors dropped from 1 per 100 orders to 0.3 per 100.

There was a 62% reduction in the number of 10-fold dosing errors, that is, errors of decimal point placement, in the year following implementation of the system. Dispensing and administration errors were also reduced, although the baseline numbers for these types of errors were fairly low.

The total number of drug orders at the NICU increased from 13,557 in the year prior to adoption of the PDA system to 31,680.

“The hospital system had a growing number of perinatologists, so our unit was seeing a big increase in the number of patients, and consequently, an increase in the number of drugs ordered,” Dr. Abubakar said at the meeting, cosponsored by the Children's Hospital of Philadelphia.

“We would have expected this to increase the error rate, but we saw just the opposite.”

The Palm-based system itself deserves only part of the credit for the improvement, he noted.

Implementation of a system like this naturally prompts clinicians and other staff members to pay closer attention to the accuracy of their prescribing and dose calculations.

OLD GREENWICH, CONN. — A PDA-based drug dose calculator system brought about a marked reduction in medication errors at a university's neonatal intensive care unit, Dr. M. Kabir Abubakar reported a meeting of the Eastern Society for Pediatric Research.

The error reduction, from 1.77 per 100 orders to 0.66 per 100 orders, occurred within a 12-month period after Georgetown University Hospital's NICU mandated that all staff use the Neofax drug database system. The improved performance was all the more remarkable because it occurred during a period of rapid growth in the hospital's neonatal and perinatal departments, with the number of NICU drug orders almost tripling from the previous year.

According to Dr. Abubakar, of Georgetown's division of neonatology, medication errors are a significant contributor to neonatal morbidity in the NICU setting. Neonates are highly vulnerable, and a misplaced decimal point in a dose calculation can have huge clinical implications.

As part of its ongoing quality improvement efforts, MedStar Health—the hospital system that owns Georgetown—put up the funds to provide PDA-based Neofax dose calculators to all NICU physicians, residents, fellows, nurse-practitioners, and dispensing pharmacists.

Following a training period, staff was required to use the PDA for all NICU drug orders. Pharmacists and bedside nurses cross-checked all physician dose calculations using the same system.

“It took about 3 months to get everyone trained and compliant with the system,” said Dr. Abubakar in an interview. “There was some resistance, of course, but the bigger problem was that initially a lot of people were forgetting or losing their PDAs. Eventually, we had to install them in stationary places by every four or five NICU beds.”

The ultimate payoff, in terms of reduced errors, was tremendous. In the 12 months following adoption of the system, the Georgetown team was able to reduce its total medication error rate from 1.77 to 0.66 per 100 orders. Prescription errors dropped from 1 per 100 orders to 0.3 per 100.

There was a 62% reduction in the number of 10-fold dosing errors, that is, errors of decimal point placement, in the year following implementation of the system. Dispensing and administration errors were also reduced, although the baseline numbers for these types of errors were fairly low.

The total number of drug orders at the NICU increased from 13,557 in the year prior to adoption of the PDA system to 31,680.

“The hospital system had a growing number of perinatologists, so our unit was seeing a big increase in the number of patients, and consequently, an increase in the number of drugs ordered,” Dr. Abubakar said at the meeting, cosponsored by the Children's Hospital of Philadelphia.

“We would have expected this to increase the error rate, but we saw just the opposite.”

The Palm-based system itself deserves only part of the credit for the improvement, he noted.

Implementation of a system like this naturally prompts clinicians and other staff members to pay closer attention to the accuracy of their prescribing and dose calculations.

OLD GREENWICH, CONN. — Be on the lookout for hypertension among obese children and teenagers. The problem is very common and it starts early, Dr. Mala Puri reported at a meeting of the Eastern Society for Pediatric Research.

Dr. Puri and her colleagues at the Montefiore Medical Center, N.Y., found that nearly one-third of a cohort of 167 obese, mostly black and Hispanic adolescents had elevated blood pressure, compared with only 3% in nonobese control subjects from the same community.

As a whole, the study cohort had a mean age of 14 years. The investigators defined hypertension as resting systolic over diastolic blood pressure at or above the 95th percentile for age. The 167 obese youths had a mean BMI of 38 kg/m

Thirty-one percent of the obese teens met the criteria for hypertension, versus only 3.2% of controls—a nearly tenfold difference. The obese subgroup had a mean systolic pressure of 121 mm Hg, compared with 105 mm Hg in the control group, and the systolic over diastolic index was 0.95 among the obese kids vs. 0.83 among the controls.

The heavier teens also had markedly lower HDL (48 mg/dL vs. 66 mg/dL), and elevated triglycerides (113 mg/dL vs. 78 mg/dL).

Dr. Puri and her colleagues looked more closely at the obese cohort itself, comparing those who were hypertensive with those who were normotensive. They found that Hispanic and Caribbean teens who were obese were more likely to be hypertensive than African Americans (21% vs. 10%), and this was true of both males and females. Eighty percent of the hypertensive obese youth had family histories of hypertension.

“The vast majority of our obese patients have obese parents, and I'd say that the majority of the predisposing factors are related to diet and lifestyle,” Dr. Puri told attendees at the conference, cosponsored by the Children's Hospital of Philadelphia.

While it is clear that inner-city black, Hispanic, and Caribbean youth are at high risk, there are other studies suggesting that the prevalence of hypertension among obese/overweight teens is similarly high in other communities. She noted that one study looked at public school populations in suburban, largely white communities in Texas and found similar rates of hypertension among the obese teens.

“Obese young people are clearly showing elevated blood pressure and early-stage hypertension. We really need good strategies for treating this problem, especially among minority youth.” However, Dr. Puri stressed that the Montefiore staff physicians, like most pediatricians, hesitate to start young teens on long-term drug therapies unless there are no other options.

She acknowledged the limitations of this study; it relied solely on office-based blood pressure measurements taken by nurses, and it can be difficult to know with certainty that these measurements reflect day-to-day blood pressure. The Montefiore team is starting a study of obese teens using 24-hour blood pressure monitoring to get a better sense of their overall cardiovascular health.

In addition, the Montefiore group is studying polycystic ovary syndrome (PCOS) in a cohort of obese teen girls, comparing them with a similar group of obese girls without PCOS. They are trying to determine if PCOS correlates with impaired glucose tolerance, insulin resistance, and diabetes among teens, as it does in adult women.

Dr. Puri noted that 30% to 40% of adults with PCOS show impaired glucose tolerance (IGT) or type 2 diabetes.

The Montefiore cohort comprises 92 girls with a mean age of 14 and a mean BMI of 37 kg/m

OLD GREENWICH, CONN. — Be on the lookout for hypertension among obese children and teenagers. The problem is very common and it starts early, Dr. Mala Puri reported at a meeting of the Eastern Society for Pediatric Research.

Dr. Puri and her colleagues at the Montefiore Medical Center, N.Y., found that nearly one-third of a cohort of 167 obese, mostly black and Hispanic adolescents had elevated blood pressure, compared with only 3% in nonobese control subjects from the same community.

As a whole, the study cohort had a mean age of 14 years. The investigators defined hypertension as resting systolic over diastolic blood pressure at or above the 95th percentile for age. The 167 obese youths had a mean BMI of 38 kg/m

Thirty-one percent of the obese teens met the criteria for hypertension, versus only 3.2% of controls—a nearly tenfold difference. The obese subgroup had a mean systolic pressure of 121 mm Hg, compared with 105 mm Hg in the control group, and the systolic over diastolic index was 0.95 among the obese kids vs. 0.83 among the controls.

The heavier teens also had markedly lower HDL (48 mg/dL vs. 66 mg/dL), and elevated triglycerides (113 mg/dL vs. 78 mg/dL).

Dr. Puri and her colleagues looked more closely at the obese cohort itself, comparing those who were hypertensive with those who were normotensive. They found that Hispanic and Caribbean teens who were obese were more likely to be hypertensive than African Americans (21% vs. 10%), and this was true of both males and females. Eighty percent of the hypertensive obese youth had family histories of hypertension.

“The vast majority of our obese patients have obese parents, and I'd say that the majority of the predisposing factors are related to diet and lifestyle,” Dr. Puri told attendees at the conference, cosponsored by the Children's Hospital of Philadelphia.

While it is clear that inner-city black, Hispanic, and Caribbean youth are at high risk, there are other studies suggesting that the prevalence of hypertension among obese/overweight teens is similarly high in other communities. She noted that one study looked at public school populations in suburban, largely white communities in Texas and found similar rates of hypertension among the obese teens.

“Obese young people are clearly showing elevated blood pressure and early-stage hypertension. We really need good strategies for treating this problem, especially among minority youth.” However, Dr. Puri stressed that the Montefiore staff physicians, like most pediatricians, hesitate to start young teens on long-term drug therapies unless there are no other options.

She acknowledged the limitations of this study; it relied solely on office-based blood pressure measurements taken by nurses, and it can be difficult to know with certainty that these measurements reflect day-to-day blood pressure. The Montefiore team is starting a study of obese teens using 24-hour blood pressure monitoring to get a better sense of their overall cardiovascular health.

In addition, the Montefiore group is studying polycystic ovary syndrome (PCOS) in a cohort of obese teen girls, comparing them with a similar group of obese girls without PCOS. They are trying to determine if PCOS correlates with impaired glucose tolerance, insulin resistance, and diabetes among teens, as it does in adult women.

Dr. Puri noted that 30% to 40% of adults with PCOS show impaired glucose tolerance (IGT) or type 2 diabetes.

The Montefiore cohort comprises 92 girls with a mean age of 14 and a mean BMI of 37 kg/m

OLD GREENWICH, CONN. — Be on the lookout for hypertension among obese children and teenagers. The problem is very common and it starts early, Dr. Mala Puri reported at a meeting of the Eastern Society for Pediatric Research.

Dr. Puri and her colleagues at the Montefiore Medical Center, N.Y., found that nearly one-third of a cohort of 167 obese, mostly black and Hispanic adolescents had elevated blood pressure, compared with only 3% in nonobese control subjects from the same community.

As a whole, the study cohort had a mean age of 14 years. The investigators defined hypertension as resting systolic over diastolic blood pressure at or above the 95th percentile for age. The 167 obese youths had a mean BMI of 38 kg/m

Thirty-one percent of the obese teens met the criteria for hypertension, versus only 3.2% of controls—a nearly tenfold difference. The obese subgroup had a mean systolic pressure of 121 mm Hg, compared with 105 mm Hg in the control group, and the systolic over diastolic index was 0.95 among the obese kids vs. 0.83 among the controls.

The heavier teens also had markedly lower HDL (48 mg/dL vs. 66 mg/dL), and elevated triglycerides (113 mg/dL vs. 78 mg/dL).

Dr. Puri and her colleagues looked more closely at the obese cohort itself, comparing those who were hypertensive with those who were normotensive. They found that Hispanic and Caribbean teens who were obese were more likely to be hypertensive than African Americans (21% vs. 10%), and this was true of both males and females. Eighty percent of the hypertensive obese youth had family histories of hypertension.

“The vast majority of our obese patients have obese parents, and I'd say that the majority of the predisposing factors are related to diet and lifestyle,” Dr. Puri told attendees at the conference, cosponsored by the Children's Hospital of Philadelphia.

While it is clear that inner-city black, Hispanic, and Caribbean youth are at high risk, there are other studies suggesting that the prevalence of hypertension among obese/overweight teens is similarly high in other communities. She noted that one study looked at public school populations in suburban, largely white communities in Texas and found similar rates of hypertension among the obese teens.

“Obese young people are clearly showing elevated blood pressure and early-stage hypertension. We really need good strategies for treating this problem, especially among minority youth.” However, Dr. Puri stressed that the Montefiore staff physicians, like most pediatricians, hesitate to start young teens on long-term drug therapies unless there are no other options.

She acknowledged the limitations of this study; it relied solely on office-based blood pressure measurements taken by nurses, and it can be difficult to know with certainty that these measurements reflect day-to-day blood pressure. The Montefiore team is starting a study of obese teens using 24-hour blood pressure monitoring to get a better sense of their overall cardiovascular health.

In addition, the Montefiore group is studying polycystic ovary syndrome (PCOS) in a cohort of obese teen girls, comparing them with a similar group of obese girls without PCOS. They are trying to determine if PCOS correlates with impaired glucose tolerance, insulin resistance, and diabetes among teens, as it does in adult women.

Dr. Puri noted that 30% to 40% of adults with PCOS show impaired glucose tolerance (IGT) or type 2 diabetes.

The Montefiore cohort comprises 92 girls with a mean age of 14 and a mean BMI of 37 kg/m

OLD GREENWICH, CONN. — The neonatal intensive care unit is an ideal setting for delivering the trivalent influenza vaccine to parents of high-risk infants, Dr. Shetal Shah said at a meeting of the Eastern Society for Pediatric Research.

Flu vaccination rates among U.S. adults remain very low. Even among high-risk adult populations, such as the elderly or health care workers, full immunization rates run between 25% and 33%. Influenza is a very common and growing problem among infants in the NICU setting; the babies pick up the virus from adult caretakers. There has been a 10% increase in flu-related hospitalizations among vulnerable infants, said Dr. Shah of the Neonatal Intensive Care Unit at New York University, New York.

“If adults need to be immunized in order to protect their children, but they're not getting the vaccines, we need to look at the reasons why,” he said. Although vaccine shortages have played a role, by far the most common reason for failure to receive the shots is inconvenience. Busy parents are preoccupied with so many other concerns that obtaining flu shots tends to fall to the bottom of the priority pile.

“Last year, we surveyed the parents of our NICU patients, and the flu vaccine rate was only around 33%. More than half who were not immunized cited inconvenience as the main reason.” This prompted Dr. Shah and his colleagues to consider making the shots available right in the NICU.

“It really is an ideal setting for this type of intervention. For one, we're dealing with the highest risk babies with the greatest need for protection. Most NICUs, like ours, are adopting a family-centered care model that actively engages the parents in the care of their babies. We have very liberal visiting hours at NYU: Parents can be in the NICU with their children for 22 out of every 24 hours. And we're open at times when other clinics or care delivery settings are closed,” he said.

In addition, the NICU may be one of the few places to reach fathers. In general, men are far less likely than women to get regular medical checkups, and they tend to avoid physicians, hospitals, and clinics. “The ob.gyn. community is doing a much better job of getting the flu shots to women than the pediatric or family practice communities,” Dr. Shah said at the meeting, cosponsored by the Children's Hospital of Philadelphia. In part, this has to do with the success of prenatal care programs, which seldom reach the fathers.

The NYU NICU team undertook a pilot project to provide trivalent flu vaccines for all NICU parents from November 2005 to March 2006. As part of the admission process, staff told parents that it was possible to get the flu vaccine, free of charge, right there in the NICU, and tried to get the parents to consent prior to delivery or soon thereafter. In addition, they also posted signs right on the babies' warmers, stating that the hospital strongly recommended that parents obtain the shot. They also posted reminders in common areas and breast-feeding rooms.

During the 4-month period, the NYU staff admitted 273 parents of 158 babies. They were able to counsel 220 about the importance of immunization and actually gave shots to 157 (71%). Fifty-two (24%) of the parents counseled had already been immunized, and 11 (5%) refused.

Of those vaccinated in the NICU, 61% got their shots within 2 days after their babies were admitted. “We got to most of them within 72 hours, and after that, it tended to drop off.”

They also were most successful with parents of babies who were less than 28–32 weeks' gestational age at delivery. Dr. Shah attributed this to the much longer lengths of stay for this extremely premature subgroup.

Most of the parents accepted the importance of getting the shots, and Dr. Shah noted something of a peer-pressure effect. “People bond in the NICU with other people going through the same ordeal. So if one couple went for the shots, the others they had connected with often followed.”

Despite the usually frantic pace of activity in the NICU, the staff took the flu shot endeavor quite seriously and managed to find the time to talk often with the parents. “We kept track of who was and who was not getting the shots, and we would talk to the ones who had not—to see if they had any questions or concerns that we could address.”

Among the 11 who refused the vaccine, 5 stated that they simply did not believe in immunization, and 2 said they feared that the shots might induce autism. Others cited religious objections or a reluctance to add anything else to whatever medical care they were already receiving. One cited an allergy to eggs, which is a legitimate concern because the vaccine contains some egg proteins.

Overall, the NYU NICU-based flu shot program was highly successful. Dr. Shah and colleagues hope to do a follow-up to see if the program had any impact on the rate of influenza among the neonates. He cautioned, however, that the sample size may be too small to support any definitive conclusion.

This pilot program did, however, prove that flu shots can be effectively distributed in the NICU setting to parents, who for a variety of reasons, had not previously gotten immunized. The program created very little additional strain on NICU physicians or nursing staff.

“Administration of the trivalent vaccine is very possible in a busy NICU, and implementation markedly increased compliance with recommendations aimed at protecting high-risk neonates,” Dr. Shah told conference participants. “There will always be a small subset of parents who will refuse, no matter what. But we can get to many parents who are willing to take the shots.” He added that this type of program is highly replicable and could be quickly implemented in any family-centered NICU.

OLD GREENWICH, CONN. — The neonatal intensive care unit is an ideal setting for delivering the trivalent influenza vaccine to parents of high-risk infants, Dr. Shetal Shah said at a meeting of the Eastern Society for Pediatric Research.

Flu vaccination rates among U.S. adults remain very low. Even among high-risk adult populations, such as the elderly or health care workers, full immunization rates run between 25% and 33%. Influenza is a very common and growing problem among infants in the NICU setting; the babies pick up the virus from adult caretakers. There has been a 10% increase in flu-related hospitalizations among vulnerable infants, said Dr. Shah of the Neonatal Intensive Care Unit at New York University, New York.

“If adults need to be immunized in order to protect their children, but they're not getting the vaccines, we need to look at the reasons why,” he said. Although vaccine shortages have played a role, by far the most common reason for failure to receive the shots is inconvenience. Busy parents are preoccupied with so many other concerns that obtaining flu shots tends to fall to the bottom of the priority pile.

“Last year, we surveyed the parents of our NICU patients, and the flu vaccine rate was only around 33%. More than half who were not immunized cited inconvenience as the main reason.” This prompted Dr. Shah and his colleagues to consider making the shots available right in the NICU.

“It really is an ideal setting for this type of intervention. For one, we're dealing with the highest risk babies with the greatest need for protection. Most NICUs, like ours, are adopting a family-centered care model that actively engages the parents in the care of their babies. We have very liberal visiting hours at NYU: Parents can be in the NICU with their children for 22 out of every 24 hours. And we're open at times when other clinics or care delivery settings are closed,” he said.

In addition, the NICU may be one of the few places to reach fathers. In general, men are far less likely than women to get regular medical checkups, and they tend to avoid physicians, hospitals, and clinics. “The ob.gyn. community is doing a much better job of getting the flu shots to women than the pediatric or family practice communities,” Dr. Shah said at the meeting, cosponsored by the Children's Hospital of Philadelphia. In part, this has to do with the success of prenatal care programs, which seldom reach the fathers.

The NYU NICU team undertook a pilot project to provide trivalent flu vaccines for all NICU parents from November 2005 to March 2006. As part of the admission process, staff told parents that it was possible to get the flu vaccine, free of charge, right there in the NICU, and tried to get the parents to consent prior to delivery or soon thereafter. In addition, they also posted signs right on the babies' warmers, stating that the hospital strongly recommended that parents obtain the shot. They also posted reminders in common areas and breast-feeding rooms.

During the 4-month period, the NYU staff admitted 273 parents of 158 babies. They were able to counsel 220 about the importance of immunization and actually gave shots to 157 (71%). Fifty-two (24%) of the parents counseled had already been immunized, and 11 (5%) refused.

Of those vaccinated in the NICU, 61% got their shots within 2 days after their babies were admitted. “We got to most of them within 72 hours, and after that, it tended to drop off.”

They also were most successful with parents of babies who were less than 28–32 weeks' gestational age at delivery. Dr. Shah attributed this to the much longer lengths of stay for this extremely premature subgroup.

Most of the parents accepted the importance of getting the shots, and Dr. Shah noted something of a peer-pressure effect. “People bond in the NICU with other people going through the same ordeal. So if one couple went for the shots, the others they had connected with often followed.”

Despite the usually frantic pace of activity in the NICU, the staff took the flu shot endeavor quite seriously and managed to find the time to talk often with the parents. “We kept track of who was and who was not getting the shots, and we would talk to the ones who had not—to see if they had any questions or concerns that we could address.”

Among the 11 who refused the vaccine, 5 stated that they simply did not believe in immunization, and 2 said they feared that the shots might induce autism. Others cited religious objections or a reluctance to add anything else to whatever medical care they were already receiving. One cited an allergy to eggs, which is a legitimate concern because the vaccine contains some egg proteins.

Overall, the NYU NICU-based flu shot program was highly successful. Dr. Shah and colleagues hope to do a follow-up to see if the program had any impact on the rate of influenza among the neonates. He cautioned, however, that the sample size may be too small to support any definitive conclusion.

This pilot program did, however, prove that flu shots can be effectively distributed in the NICU setting to parents, who for a variety of reasons, had not previously gotten immunized. The program created very little additional strain on NICU physicians or nursing staff.

“Administration of the trivalent vaccine is very possible in a busy NICU, and implementation markedly increased compliance with recommendations aimed at protecting high-risk neonates,” Dr. Shah told conference participants. “There will always be a small subset of parents who will refuse, no matter what. But we can get to many parents who are willing to take the shots.” He added that this type of program is highly replicable and could be quickly implemented in any family-centered NICU.

OLD GREENWICH, CONN. — The neonatal intensive care unit is an ideal setting for delivering the trivalent influenza vaccine to parents of high-risk infants, Dr. Shetal Shah said at a meeting of the Eastern Society for Pediatric Research.

Flu vaccination rates among U.S. adults remain very low. Even among high-risk adult populations, such as the elderly or health care workers, full immunization rates run between 25% and 33%. Influenza is a very common and growing problem among infants in the NICU setting; the babies pick up the virus from adult caretakers. There has been a 10% increase in flu-related hospitalizations among vulnerable infants, said Dr. Shah of the Neonatal Intensive Care Unit at New York University, New York.

“If adults need to be immunized in order to protect their children, but they're not getting the vaccines, we need to look at the reasons why,” he said. Although vaccine shortages have played a role, by far the most common reason for failure to receive the shots is inconvenience. Busy parents are preoccupied with so many other concerns that obtaining flu shots tends to fall to the bottom of the priority pile.

“Last year, we surveyed the parents of our NICU patients, and the flu vaccine rate was only around 33%. More than half who were not immunized cited inconvenience as the main reason.” This prompted Dr. Shah and his colleagues to consider making the shots available right in the NICU.

“It really is an ideal setting for this type of intervention. For one, we're dealing with the highest risk babies with the greatest need for protection. Most NICUs, like ours, are adopting a family-centered care model that actively engages the parents in the care of their babies. We have very liberal visiting hours at NYU: Parents can be in the NICU with their children for 22 out of every 24 hours. And we're open at times when other clinics or care delivery settings are closed,” he said.

In addition, the NICU may be one of the few places to reach fathers. In general, men are far less likely than women to get regular medical checkups, and they tend to avoid physicians, hospitals, and clinics. “The ob.gyn. community is doing a much better job of getting the flu shots to women than the pediatric or family practice communities,” Dr. Shah said at the meeting, cosponsored by the Children's Hospital of Philadelphia. In part, this has to do with the success of prenatal care programs, which seldom reach the fathers.

The NYU NICU team undertook a pilot project to provide trivalent flu vaccines for all NICU parents from November 2005 to March 2006. As part of the admission process, staff told parents that it was possible to get the flu vaccine, free of charge, right there in the NICU, and tried to get the parents to consent prior to delivery or soon thereafter. In addition, they also posted signs right on the babies' warmers, stating that the hospital strongly recommended that parents obtain the shot. They also posted reminders in common areas and breast-feeding rooms.

During the 4-month period, the NYU staff admitted 273 parents of 158 babies. They were able to counsel 220 about the importance of immunization and actually gave shots to 157 (71%). Fifty-two (24%) of the parents counseled had already been immunized, and 11 (5%) refused.

Of those vaccinated in the NICU, 61% got their shots within 2 days after their babies were admitted. “We got to most of them within 72 hours, and after that, it tended to drop off.”

They also were most successful with parents of babies who were less than 28–32 weeks' gestational age at delivery. Dr. Shah attributed this to the much longer lengths of stay for this extremely premature subgroup.

Most of the parents accepted the importance of getting the shots, and Dr. Shah noted something of a peer-pressure effect. “People bond in the NICU with other people going through the same ordeal. So if one couple went for the shots, the others they had connected with often followed.”

Despite the usually frantic pace of activity in the NICU, the staff took the flu shot endeavor quite seriously and managed to find the time to talk often with the parents. “We kept track of who was and who was not getting the shots, and we would talk to the ones who had not—to see if they had any questions or concerns that we could address.”

Among the 11 who refused the vaccine, 5 stated that they simply did not believe in immunization, and 2 said they feared that the shots might induce autism. Others cited religious objections or a reluctance to add anything else to whatever medical care they were already receiving. One cited an allergy to eggs, which is a legitimate concern because the vaccine contains some egg proteins.

Overall, the NYU NICU-based flu shot program was highly successful. Dr. Shah and colleagues hope to do a follow-up to see if the program had any impact on the rate of influenza among the neonates. He cautioned, however, that the sample size may be too small to support any definitive conclusion.

This pilot program did, however, prove that flu shots can be effectively distributed in the NICU setting to parents, who for a variety of reasons, had not previously gotten immunized. The program created very little additional strain on NICU physicians or nursing staff.

“Administration of the trivalent vaccine is very possible in a busy NICU, and implementation markedly increased compliance with recommendations aimed at protecting high-risk neonates,” Dr. Shah told conference participants. “There will always be a small subset of parents who will refuse, no matter what. But we can get to many parents who are willing to take the shots.” He added that this type of program is highly replicable and could be quickly implemented in any family-centered NICU.

OLD GREENWICH, CONN. — Metformin gave only a modest additional benefit to a 12-week program of nutritional counseling for obese nondiabetic children and their families, Dr. Radhika Purushothaman reported at a meeting of the Eastern Society for Pediatric Research.

Given the rising incidence of obesity, insulin resistance, and diabetes among children and adolescents, physicians and clinical researchers are trying just about everything to get a handle on these problems. Metformin and other insulin-sensitizing drugs may be helpful, but the high prevalence of gastrointestinal side effects and the fact that these drug therapies are more or less lifelong commitments mean that they should be used very carefully.

A 2002 study of more than 3,200 obese nondiabetic adults who had impaired glucose tolerance showed that metformin could improve insulin sensitivity and delay progression to diabetes. “There's no question that insulin sensitizers can delay progression in adults, but so can lifestyle interventions if you get to the patients in the early stages of insulin resistance and impaired glucose tolerance,” said Dr. Purushothaman of the Infants and Children's Hospital, Brooklyn, N.Y.

The jury is still out on the value of metformin in the pediatric population.

Dr. Purushothaman and her colleagues set out to determine if the addition of metformin would improve clinical outcomes of a 12-week diet and lifestyle intervention in a cohort of 51 obese but nondiabetic children and early adolescents.

The program comprised weekly sessions that involved parents and caregivers teaching the children the basics of nutrition, healthy diet, and exercise. This was followed by monthly maintenance sessions for another 3 months. Fifteen of the 51 subjects also took metformin, 1,000 mg, twice daily during the study period. The investigators did full endocrine, behavioral, and nutritional assessments at baseline, at the close of the 12-week program and at 6 months from baseline.

Neither the lifestyle intervention alone nor the lifestyle program plus metformin had statistically significant impact on body mass index (BMI), although both produced measurable BMI reductions. Among the 15 patients taking metformin, mean BMI went from 36 to 35; among those in the lifestyle change program alone, BMI went from 30.7 to 29.1.

The lifestyle change program did produce significant effects on triglyceride levels, which went from a baseline mean of 147 mg/dL down to 100 mg/dL at the close of the study. Fasting insulin levels also dropped, from a baseline of 20.7 μU/mL down to 14 μU/mL. Somewhat surprisingly, this did not translate into a significant change in fasting blood glucose levels. High-density lipoprotein cholesterol levels were essentially unchanged in the lifestyle intervention alone group.

Among those taking metformin, triglyceride levels also dropped, from a baseline mean of 208 to 144 at 6 months. Fasting insulin levels also dropped, from a baseline of 35.3 down to 28.1. However, mean fasting glucose levels actually increased in this group, from a baseline of 84 mg/dL to 91 mg/dL. “This was totally surprising,” said Dr. Purushothaman at the meeting cosponsored by Children's Hospital of Philadelphia. Metformin did produce a statistically significant increase in HDL cholesterol levels, from 36.8 mg/dL to 40.0 mg/dL.

This study confirms that a carefully planned lifestyle change program that involves the families of obese children and teens can have measurable benefits on overall health, although it may not substantially reduce BMI.

For metformin, the results “were definitely not as clear-cut as we had expected,” she said. “Metformin can be considered as an adjunct for obese adolescents, as it has good effects on lipids and insulin, but it did not change the BMI.” That said, the drug should be used only when truly necessary. “There was lots of diarrhea, bloating, and nausea among the kids taking metformin.”

OLD GREENWICH, CONN. — Metformin gave only a modest additional benefit to a 12-week program of nutritional counseling for obese nondiabetic children and their families, Dr. Radhika Purushothaman reported at a meeting of the Eastern Society for Pediatric Research.

Given the rising incidence of obesity, insulin resistance, and diabetes among children and adolescents, physicians and clinical researchers are trying just about everything to get a handle on these problems. Metformin and other insulin-sensitizing drugs may be helpful, but the high prevalence of gastrointestinal side effects and the fact that these drug therapies are more or less lifelong commitments mean that they should be used very carefully.

A 2002 study of more than 3,200 obese nondiabetic adults who had impaired glucose tolerance showed that metformin could improve insulin sensitivity and delay progression to diabetes. “There's no question that insulin sensitizers can delay progression in adults, but so can lifestyle interventions if you get to the patients in the early stages of insulin resistance and impaired glucose tolerance,” said Dr. Purushothaman of the Infants and Children's Hospital, Brooklyn, N.Y.

The jury is still out on the value of metformin in the pediatric population.

Dr. Purushothaman and her colleagues set out to determine if the addition of metformin would improve clinical outcomes of a 12-week diet and lifestyle intervention in a cohort of 51 obese but nondiabetic children and early adolescents.

The program comprised weekly sessions that involved parents and caregivers teaching the children the basics of nutrition, healthy diet, and exercise. This was followed by monthly maintenance sessions for another 3 months. Fifteen of the 51 subjects also took metformin, 1,000 mg, twice daily during the study period. The investigators did full endocrine, behavioral, and nutritional assessments at baseline, at the close of the 12-week program and at 6 months from baseline.

Neither the lifestyle intervention alone nor the lifestyle program plus metformin had statistically significant impact on body mass index (BMI), although both produced measurable BMI reductions. Among the 15 patients taking metformin, mean BMI went from 36 to 35; among those in the lifestyle change program alone, BMI went from 30.7 to 29.1.

The lifestyle change program did produce significant effects on triglyceride levels, which went from a baseline mean of 147 mg/dL down to 100 mg/dL at the close of the study. Fasting insulin levels also dropped, from a baseline of 20.7 μU/mL down to 14 μU/mL. Somewhat surprisingly, this did not translate into a significant change in fasting blood glucose levels. High-density lipoprotein cholesterol levels were essentially unchanged in the lifestyle intervention alone group.

Among those taking metformin, triglyceride levels also dropped, from a baseline mean of 208 to 144 at 6 months. Fasting insulin levels also dropped, from a baseline of 35.3 down to 28.1. However, mean fasting glucose levels actually increased in this group, from a baseline of 84 mg/dL to 91 mg/dL. “This was totally surprising,” said Dr. Purushothaman at the meeting cosponsored by Children's Hospital of Philadelphia. Metformin did produce a statistically significant increase in HDL cholesterol levels, from 36.8 mg/dL to 40.0 mg/dL.

This study confirms that a carefully planned lifestyle change program that involves the families of obese children and teens can have measurable benefits on overall health, although it may not substantially reduce BMI.

For metformin, the results “were definitely not as clear-cut as we had expected,” she said. “Metformin can be considered as an adjunct for obese adolescents, as it has good effects on lipids and insulin, but it did not change the BMI.” That said, the drug should be used only when truly necessary. “There was lots of diarrhea, bloating, and nausea among the kids taking metformin.”

OLD GREENWICH, CONN. — Metformin gave only a modest additional benefit to a 12-week program of nutritional counseling for obese nondiabetic children and their families, Dr. Radhika Purushothaman reported at a meeting of the Eastern Society for Pediatric Research.

Given the rising incidence of obesity, insulin resistance, and diabetes among children and adolescents, physicians and clinical researchers are trying just about everything to get a handle on these problems. Metformin and other insulin-sensitizing drugs may be helpful, but the high prevalence of gastrointestinal side effects and the fact that these drug therapies are more or less lifelong commitments mean that they should be used very carefully.

A 2002 study of more than 3,200 obese nondiabetic adults who had impaired glucose tolerance showed that metformin could improve insulin sensitivity and delay progression to diabetes. “There's no question that insulin sensitizers can delay progression in adults, but so can lifestyle interventions if you get to the patients in the early stages of insulin resistance and impaired glucose tolerance,” said Dr. Purushothaman of the Infants and Children's Hospital, Brooklyn, N.Y.

The jury is still out on the value of metformin in the pediatric population.

Dr. Purushothaman and her colleagues set out to determine if the addition of metformin would improve clinical outcomes of a 12-week diet and lifestyle intervention in a cohort of 51 obese but nondiabetic children and early adolescents.

The program comprised weekly sessions that involved parents and caregivers teaching the children the basics of nutrition, healthy diet, and exercise. This was followed by monthly maintenance sessions for another 3 months. Fifteen of the 51 subjects also took metformin, 1,000 mg, twice daily during the study period. The investigators did full endocrine, behavioral, and nutritional assessments at baseline, at the close of the 12-week program and at 6 months from baseline.

Neither the lifestyle intervention alone nor the lifestyle program plus metformin had statistically significant impact on body mass index (BMI), although both produced measurable BMI reductions. Among the 15 patients taking metformin, mean BMI went from 36 to 35; among those in the lifestyle change program alone, BMI went from 30.7 to 29.1.

The lifestyle change program did produce significant effects on triglyceride levels, which went from a baseline mean of 147 mg/dL down to 100 mg/dL at the close of the study. Fasting insulin levels also dropped, from a baseline of 20.7 μU/mL down to 14 μU/mL. Somewhat surprisingly, this did not translate into a significant change in fasting blood glucose levels. High-density lipoprotein cholesterol levels were essentially unchanged in the lifestyle intervention alone group.

Among those taking metformin, triglyceride levels also dropped, from a baseline mean of 208 to 144 at 6 months. Fasting insulin levels also dropped, from a baseline of 35.3 down to 28.1. However, mean fasting glucose levels actually increased in this group, from a baseline of 84 mg/dL to 91 mg/dL. “This was totally surprising,” said Dr. Purushothaman at the meeting cosponsored by Children's Hospital of Philadelphia. Metformin did produce a statistically significant increase in HDL cholesterol levels, from 36.8 mg/dL to 40.0 mg/dL.

This study confirms that a carefully planned lifestyle change program that involves the families of obese children and teens can have measurable benefits on overall health, although it may not substantially reduce BMI.

For metformin, the results “were definitely not as clear-cut as we had expected,” she said. “Metformin can be considered as an adjunct for obese adolescents, as it has good effects on lipids and insulin, but it did not change the BMI.” That said, the drug should be used only when truly necessary. “There was lots of diarrhea, bloating, and nausea among the kids taking metformin.”

OLD GREENWICH, CONN. — Vitamin D deficiency, sometimes quite severe, is common in obese adolescents, according to a recent study by Dr. Margarita Smotkin-Tangorra and colleagues at Maimonides Medical Center, N.Y.

Speaking at a meeting of the Eastern Society for Pediatric Research, Dr. Smotkin-Tangorra, of the department of pediatric endocrinology and diabetes at the medical center, said that 55% of a cohort of 217 obese children and adolescents were deficient in serum 25-hydroxyvitamin D (OH D), with blood levels of less than 20 ng/mL; 22% were severely deficient, with serum levels below 10 ng/mL.

Though there are published reports showing correlations between vitamin D deficiency and obesity in adults, there are no prior studies in children or teens. “We know vitamin D deficiency is prevalent in all age groups, including healthy adolescents. In obese adults, we know that it correlates with insulin resistance, progression to diabetes mellitus, metabolic and endocrine problems, and increased risk of cancer. We wanted to see if there were similar correlations in obese kids,” she told attendees at the meeting, cosponsored by Children's Hospital of Philadelphia.

The study group included 118 females and 99 males, ranging in age from 7 to 18 years, and with a mean BMI of 32.2 kg/m

They found strong correlations between low vitamin D level and elevated BMI, increased systolic blood pressure, lower HDL, and lower alkaline phosphatase. The correlation between vitamin D status and BMI was particularly striking. Those patients who were vitamin D deficient had a mean BMI of 36.2, compared with a mean of 30.6 among patients whose vitamin D levels were sufficient. The association with systolic hypertension was also noteworthy; vitamin D deficient patients had a mean systolic blood pressure of 117 mm Hg, while those with sufficient vitamin D had a mean systolic blood pressure of 111 mm Hg. Mean HDL was 40 mg/dL in the vitamin deficient group, compared with 42 mg/dL in the vitamin sufficient group.

There was no correlation between vitamin D status and fasting blood glucose or thyroid hormone levels. Insulin sensitivity as indicated by a quantitative insulin sensitivity check index score showed a marginally significant correlation with vitamin D, with the deficient children showing a slightly lower score than the sufficient ones.

Vitamin D deficiency is disturbingly common, even among healthy children. Best current estimates are that roughly 20% of all school-age children are deficient. If Dr. Smotkin-Tangorra's data prove to be representative of obese children nationwide, the problem may be greater than previously imagined, especially given what is now known about the long-term impact of chronic vitamin D deficiency.

Increased prevalence of deficiency reflects several general trends, most importantly the diminishing quality of children's diets and lack of outdoor exercise. How it fits into the pathophysiology and etiology of obesity is an open-ended question at this point. Lower levels of vitamin D could well be an indicator of poor overall nutritional status. Dr. Smotkin-Tangorra's team did not study blood levels of any other vitamins or minerals, but their research suggests that the more obese a child is, the more likely that the child's overall nutritional status will be poor.

Fortunately, vitamin D deficiency is one of the few common correlates of childhood obesity that is easy to rectify. “We are routinely supplementing all of our obese kids with Os-Cal, 500 mg, thrice daily, and we are starting to collect data on the outcomes.” She advised clinicians working with children and adolescents to stay vigilant for vitamin D deficiency, especially in obese patients, and to supplement with vitamin D and calcium when the levels are low. There's little risk, it is inexpensive, and the potential long-term benefits could be great.

OLD GREENWICH, CONN. — Vitamin D deficiency, sometimes quite severe, is common in obese adolescents, according to a recent study by Dr. Margarita Smotkin-Tangorra and colleagues at Maimonides Medical Center, N.Y.

Speaking at a meeting of the Eastern Society for Pediatric Research, Dr. Smotkin-Tangorra, of the department of pediatric endocrinology and diabetes at the medical center, said that 55% of a cohort of 217 obese children and adolescents were deficient in serum 25-hydroxyvitamin D (OH D), with blood levels of less than 20 ng/mL; 22% were severely deficient, with serum levels below 10 ng/mL.

Though there are published reports showing correlations between vitamin D deficiency and obesity in adults, there are no prior studies in children or teens. “We know vitamin D deficiency is prevalent in all age groups, including healthy adolescents. In obese adults, we know that it correlates with insulin resistance, progression to diabetes mellitus, metabolic and endocrine problems, and increased risk of cancer. We wanted to see if there were similar correlations in obese kids,” she told attendees at the meeting, cosponsored by Children's Hospital of Philadelphia.

The study group included 118 females and 99 males, ranging in age from 7 to 18 years, and with a mean BMI of 32.2 kg/m

They found strong correlations between low vitamin D level and elevated BMI, increased systolic blood pressure, lower HDL, and lower alkaline phosphatase. The correlation between vitamin D status and BMI was particularly striking. Those patients who were vitamin D deficient had a mean BMI of 36.2, compared with a mean of 30.6 among patients whose vitamin D levels were sufficient. The association with systolic hypertension was also noteworthy; vitamin D deficient patients had a mean systolic blood pressure of 117 mm Hg, while those with sufficient vitamin D had a mean systolic blood pressure of 111 mm Hg. Mean HDL was 40 mg/dL in the vitamin deficient group, compared with 42 mg/dL in the vitamin sufficient group.

There was no correlation between vitamin D status and fasting blood glucose or thyroid hormone levels. Insulin sensitivity as indicated by a quantitative insulin sensitivity check index score showed a marginally significant correlation with vitamin D, with the deficient children showing a slightly lower score than the sufficient ones.

Vitamin D deficiency is disturbingly common, even among healthy children. Best current estimates are that roughly 20% of all school-age children are deficient. If Dr. Smotkin-Tangorra's data prove to be representative of obese children nationwide, the problem may be greater than previously imagined, especially given what is now known about the long-term impact of chronic vitamin D deficiency.

Increased prevalence of deficiency reflects several general trends, most importantly the diminishing quality of children's diets and lack of outdoor exercise. How it fits into the pathophysiology and etiology of obesity is an open-ended question at this point. Lower levels of vitamin D could well be an indicator of poor overall nutritional status. Dr. Smotkin-Tangorra's team did not study blood levels of any other vitamins or minerals, but their research suggests that the more obese a child is, the more likely that the child's overall nutritional status will be poor.

Fortunately, vitamin D deficiency is one of the few common correlates of childhood obesity that is easy to rectify. “We are routinely supplementing all of our obese kids with Os-Cal, 500 mg, thrice daily, and we are starting to collect data on the outcomes.” She advised clinicians working with children and adolescents to stay vigilant for vitamin D deficiency, especially in obese patients, and to supplement with vitamin D and calcium when the levels are low. There's little risk, it is inexpensive, and the potential long-term benefits could be great.

OLD GREENWICH, CONN. — Vitamin D deficiency, sometimes quite severe, is common in obese adolescents, according to a recent study by Dr. Margarita Smotkin-Tangorra and colleagues at Maimonides Medical Center, N.Y.

Speaking at a meeting of the Eastern Society for Pediatric Research, Dr. Smotkin-Tangorra, of the department of pediatric endocrinology and diabetes at the medical center, said that 55% of a cohort of 217 obese children and adolescents were deficient in serum 25-hydroxyvitamin D (OH D), with blood levels of less than 20 ng/mL; 22% were severely deficient, with serum levels below 10 ng/mL.

Though there are published reports showing correlations between vitamin D deficiency and obesity in adults, there are no prior studies in children or teens. “We know vitamin D deficiency is prevalent in all age groups, including healthy adolescents. In obese adults, we know that it correlates with insulin resistance, progression to diabetes mellitus, metabolic and endocrine problems, and increased risk of cancer. We wanted to see if there were similar correlations in obese kids,” she told attendees at the meeting, cosponsored by Children's Hospital of Philadelphia.

The study group included 118 females and 99 males, ranging in age from 7 to 18 years, and with a mean BMI of 32.2 kg/m

They found strong correlations between low vitamin D level and elevated BMI, increased systolic blood pressure, lower HDL, and lower alkaline phosphatase. The correlation between vitamin D status and BMI was particularly striking. Those patients who were vitamin D deficient had a mean BMI of 36.2, compared with a mean of 30.6 among patients whose vitamin D levels were sufficient. The association with systolic hypertension was also noteworthy; vitamin D deficient patients had a mean systolic blood pressure of 117 mm Hg, while those with sufficient vitamin D had a mean systolic blood pressure of 111 mm Hg. Mean HDL was 40 mg/dL in the vitamin deficient group, compared with 42 mg/dL in the vitamin sufficient group.

There was no correlation between vitamin D status and fasting blood glucose or thyroid hormone levels. Insulin sensitivity as indicated by a quantitative insulin sensitivity check index score showed a marginally significant correlation with vitamin D, with the deficient children showing a slightly lower score than the sufficient ones.

Vitamin D deficiency is disturbingly common, even among healthy children. Best current estimates are that roughly 20% of all school-age children are deficient. If Dr. Smotkin-Tangorra's data prove to be representative of obese children nationwide, the problem may be greater than previously imagined, especially given what is now known about the long-term impact of chronic vitamin D deficiency.

Increased prevalence of deficiency reflects several general trends, most importantly the diminishing quality of children's diets and lack of outdoor exercise. How it fits into the pathophysiology and etiology of obesity is an open-ended question at this point. Lower levels of vitamin D could well be an indicator of poor overall nutritional status. Dr. Smotkin-Tangorra's team did not study blood levels of any other vitamins or minerals, but their research suggests that the more obese a child is, the more likely that the child's overall nutritional status will be poor.

Fortunately, vitamin D deficiency is one of the few common correlates of childhood obesity that is easy to rectify. “We are routinely supplementing all of our obese kids with Os-Cal, 500 mg, thrice daily, and we are starting to collect data on the outcomes.” She advised clinicians working with children and adolescents to stay vigilant for vitamin D deficiency, especially in obese patients, and to supplement with vitamin D and calcium when the levels are low. There's little risk, it is inexpensive, and the potential long-term benefits could be great.

NEW YORK — Macrophage migration inhibitory factor, a newly characterized cytokine that inhibits cortisol and increases production of inflammatory cytokines, may be the key to understanding depression during pregnancy, Brad D. Pearce, Ph.D., said at a symposium sponsored by the National Alliance for Research on Schizophrenia and Depression.

Pregnant women seeking treatment for major depression have markedly higher levels of macrophage migration inhibitory factor (MIF) than do nondepressed pregnant women of similar age. In general, MIF levels are slightly elevated in pregnant vs. nonpregnant women, but the difference is insignificant compared with the difference between depressed and nondepressed pregnant women, said Dr. Pearce of the department of psychology at Emory University, Atlanta.

“We all hear that pregnancy is a time of joy, a natural high, and that pregnancy- related hormones are protective. The data, however, collide with these truisms,” said Dr. Pearce, noting that roughly 7% of all American women experience episodes of major depression during their first pregnancies. The proportion increases to 12%-14% for second and third pregnancies.

The prevalence of major depression among nonpregnant women is roughly 8%. So, on a statistical basis, pregnancy is hardly protective and may actually increase the incidence of depression, he said.

“There are some very big changes in body chemistry during pregnancy. The shift in the balance of hormones, cytokines, cortisol, and many other things can be huge and complex. Some women feel bliss; many others become depressed,” he noted.

Depression during pregnancy can have significant complications: It is predictive of preterm labor and delivery, as well as other obstetrical complications, and is linked to an increased risk of behavioral and social problems in the children. “The physiological changes caused by depression during pregnancy result in changes in maternal- fetal interaction, which can have adverse effects on the fetal brain,” Dr. Pearce said.

Antidepressant drug therapy, however, is not a neutral, risk-free proposition. Although none of the major antidepressant drug classes is considered strongly teratogenic, many commonly used agents have been linked to adverse obstetrical outcomes, including preterm delivery.

Dr. Pearce and his colleagues at Emory have been looking at potential biologic mediators involved in depression during pregnancy. They've focused largely on inflammatory cytokines, many of which are consistently elevated in people with major depression. Patients with chronic inflammatory disorders, characterized by elevated cytokine levels, often have comorbid depression. Some cytokines used as drugs in the treatment of cancer can induce symptoms of depression if given intravenously.

MIF is a fairly recent discovery, and it has attracted wide attention among immunologists and infectious-disease researchers. “It is a very unique protein. It is not like any of the other cytokines. It is really in its own family,” Dr. Pearce said.

MIF is produced by different immune cells and appears to block the action of cortisol. This results in an overall up-regulation of inflammation because cortisol normally inhibits inflammatory signaling molecules. MIF is also modulates catecholamine metabolism. Interestingly, MIF is also produced in large quantities by the hippocampus. “Nobody knows yet what it is doing there in the brain,” he said.

If studies bear out the connection between higher MIF levels and depression, he believes MIF may be useful as a prognostic marker for both depression and pregnancy complications like preterm labor. Prepregnancy depression predicts depression during and after pregnancy, Dr. Pearce said.

NEW YORK — Macrophage migration inhibitory factor, a newly characterized cytokine that inhibits cortisol and increases production of inflammatory cytokines, may be the key to understanding depression during pregnancy, Brad D. Pearce, Ph.D., said at a symposium sponsored by the National Alliance for Research on Schizophrenia and Depression.

Pregnant women seeking treatment for major depression have markedly higher levels of macrophage migration inhibitory factor (MIF) than do nondepressed pregnant women of similar age. In general, MIF levels are slightly elevated in pregnant vs. nonpregnant women, but the difference is insignificant compared with the difference between depressed and nondepressed pregnant women, said Dr. Pearce of the department of psychology at Emory University, Atlanta.

“We all hear that pregnancy is a time of joy, a natural high, and that pregnancy- related hormones are protective. The data, however, collide with these truisms,” said Dr. Pearce, noting that roughly 7% of all American women experience episodes of major depression during their first pregnancies. The proportion increases to 12%-14% for second and third pregnancies.

The prevalence of major depression among nonpregnant women is roughly 8%. So, on a statistical basis, pregnancy is hardly protective and may actually increase the incidence of depression, he said.

“There are some very big changes in body chemistry during pregnancy. The shift in the balance of hormones, cytokines, cortisol, and many other things can be huge and complex. Some women feel bliss; many others become depressed,” he noted.

Depression during pregnancy can have significant complications: It is predictive of preterm labor and delivery, as well as other obstetrical complications, and is linked to an increased risk of behavioral and social problems in the children. “The physiological changes caused by depression during pregnancy result in changes in maternal- fetal interaction, which can have adverse effects on the fetal brain,” Dr. Pearce said.

Antidepressant drug therapy, however, is not a neutral, risk-free proposition. Although none of the major antidepressant drug classes is considered strongly teratogenic, many commonly used agents have been linked to adverse obstetrical outcomes, including preterm delivery.

Dr. Pearce and his colleagues at Emory have been looking at potential biologic mediators involved in depression during pregnancy. They've focused largely on inflammatory cytokines, many of which are consistently elevated in people with major depression. Patients with chronic inflammatory disorders, characterized by elevated cytokine levels, often have comorbid depression. Some cytokines used as drugs in the treatment of cancer can induce symptoms of depression if given intravenously.

MIF is a fairly recent discovery, and it has attracted wide attention among immunologists and infectious-disease researchers. “It is a very unique protein. It is not like any of the other cytokines. It is really in its own family,” Dr. Pearce said.

MIF is produced by different immune cells and appears to block the action of cortisol. This results in an overall up-regulation of inflammation because cortisol normally inhibits inflammatory signaling molecules. MIF is also modulates catecholamine metabolism. Interestingly, MIF is also produced in large quantities by the hippocampus. “Nobody knows yet what it is doing there in the brain,” he said.

If studies bear out the connection between higher MIF levels and depression, he believes MIF may be useful as a prognostic marker for both depression and pregnancy complications like preterm labor. Prepregnancy depression predicts depression during and after pregnancy, Dr. Pearce said.

NEW YORK — Macrophage migration inhibitory factor, a newly characterized cytokine that inhibits cortisol and increases production of inflammatory cytokines, may be the key to understanding depression during pregnancy, Brad D. Pearce, Ph.D., said at a symposium sponsored by the National Alliance for Research on Schizophrenia and Depression.

Pregnant women seeking treatment for major depression have markedly higher levels of macrophage migration inhibitory factor (MIF) than do nondepressed pregnant women of similar age. In general, MIF levels are slightly elevated in pregnant vs. nonpregnant women, but the difference is insignificant compared with the difference between depressed and nondepressed pregnant women, said Dr. Pearce of the department of psychology at Emory University, Atlanta.

“We all hear that pregnancy is a time of joy, a natural high, and that pregnancy- related hormones are protective. The data, however, collide with these truisms,” said Dr. Pearce, noting that roughly 7% of all American women experience episodes of major depression during their first pregnancies. The proportion increases to 12%-14% for second and third pregnancies.

The prevalence of major depression among nonpregnant women is roughly 8%. So, on a statistical basis, pregnancy is hardly protective and may actually increase the incidence of depression, he said.

“There are some very big changes in body chemistry during pregnancy. The shift in the balance of hormones, cytokines, cortisol, and many other things can be huge and complex. Some women feel bliss; many others become depressed,” he noted.

Depression during pregnancy can have significant complications: It is predictive of preterm labor and delivery, as well as other obstetrical complications, and is linked to an increased risk of behavioral and social problems in the children. “The physiological changes caused by depression during pregnancy result in changes in maternal- fetal interaction, which can have adverse effects on the fetal brain,” Dr. Pearce said.

Antidepressant drug therapy, however, is not a neutral, risk-free proposition. Although none of the major antidepressant drug classes is considered strongly teratogenic, many commonly used agents have been linked to adverse obstetrical outcomes, including preterm delivery.

Dr. Pearce and his colleagues at Emory have been looking at potential biologic mediators involved in depression during pregnancy. They've focused largely on inflammatory cytokines, many of which are consistently elevated in people with major depression. Patients with chronic inflammatory disorders, characterized by elevated cytokine levels, often have comorbid depression. Some cytokines used as drugs in the treatment of cancer can induce symptoms of depression if given intravenously.

MIF is a fairly recent discovery, and it has attracted wide attention among immunologists and infectious-disease researchers. “It is a very unique protein. It is not like any of the other cytokines. It is really in its own family,” Dr. Pearce said.

MIF is produced by different immune cells and appears to block the action of cortisol. This results in an overall up-regulation of inflammation because cortisol normally inhibits inflammatory signaling molecules. MIF is also modulates catecholamine metabolism. Interestingly, MIF is also produced in large quantities by the hippocampus. “Nobody knows yet what it is doing there in the brain,” he said.

If studies bear out the connection between higher MIF levels and depression, he believes MIF may be useful as a prognostic marker for both depression and pregnancy complications like preterm labor. Prepregnancy depression predicts depression during and after pregnancy, Dr. Pearce said.

NEW YORK — Macrophage migration inhibitory factor, a newly characterized cytokine that inhibits cortisol and increases production of inflammatory cytokines, may be the key to understanding depression during pregnancy, Brad D. Pearce, Ph.D., said at a symposium sponsored by the National Alliance for Research on Schizophrenia and Depression.

Pregnant women seeking treatment for major depression have markedly higher levels of macrophage migration inhibitory factor (MIF) than do nondepressed pregnant women of similar age. In general, MIF levels are slightly elevated in pregnant vs. nonpregnant women, but the difference is insignificant compared with the difference between depressed and nondepressed pregnant women, said Dr. Pearce of the department of psychology at Emory University, Atlanta.

“We all hear that pregnancy is a time of joy, a natural high, and that pregnancy-related hormones are protective. The data, however, collide with these truisms,” said Dr. Pearce, noting that roughly 7% of all American women experience episodes of major depression during their first pregnancies. The proportion increases to 12%-14% for second and third pregnancies.

The prevalence of major depression among nonpregnant women is roughly 8%. So, on a statistical basis, pregnancy is hardly protective and may actually increase the incidence of depression, particularly in multiparous women, he said.

“There are some very big changes in body chemistry during pregnancy. The shift in the balance of hormones, cytokines, cortisol, and many other things can be huge and very complex. Some women feel bliss; many others become depressed,” he noted.

Depression during pregnancy can have significant complications: It is predictive of preterm labor and delivery, as well as other obstetrical complications, and is linked to an increased risk of behavioral and social problems in the children. “The physiological changes caused by depression during pregnancy result in changes in maternal-fetal interaction, which can have adverse effects on the fetal brain,” Dr. Pearce said.

Antidepressant drug therapy, however, is not a neutral, risk-free proposition during pregnancy. Although none of the major antidepressant drug classes is considered strongly teratogenic, many commonly used medications have been linked to adverse obstetrical outcomes, including preterm delivery.

Dr. Pearce and his colleagues at Emory have been looking at potential biologic mediators involved in depression during pregnancy with the hope of eventually identifying targets for novel treatment strategies.

They've focused largely on inflammatory cytokines, many of which are consistently elevated among individuals with major depression. Patients with chronic inflammatory disorders, characterized by elevated cytokine levels, often have comorbid depression. Some cytokines used as drugs in the treatment of serious illnesses like cancer can actually induce symptoms of depression if given intravenously.

MIF is a fairly recent discovery, and it has attracted considerable attention among immunologists and infectious-disease researchers. “It is a very unique protein. It is not like any of the other cytokines. It is really in its own family,” Dr. Pearce said.

MIF is produced endogenously by a number of different immune cells and appears to block the action of cortisol. This results in an overall up-regulation of inflammation because cortisol normally inhibits inflammatory signaling molecules. MIF is also a modulator of catecholamine metabolism. Interestingly, MIF is also produced in large quantities by the hippocampus. “Nobody knows yet what it is doing there in the brain,” he said.

If the connection between elevated MIF levels and depression in pregnancy is borne out in future studies, Dr. Pearce believes that MIF may be useful as a prognostic marker for both depression and pregnancy complications like preterm labor. Prepregnancy depression predicts depression during and after pregnancy, he said.

“It seems that MIF levels predict postpartum outcomes,” Dr. Pearce commented.

NEW YORK — Macrophage migration inhibitory factor, a newly characterized cytokine that inhibits cortisol and increases production of inflammatory cytokines, may be the key to understanding depression during pregnancy, Brad D. Pearce, Ph.D., said at a symposium sponsored by the National Alliance for Research on Schizophrenia and Depression.

Pregnant women seeking treatment for major depression have markedly higher levels of macrophage migration inhibitory factor (MIF) than do nondepressed pregnant women of similar age. In general, MIF levels are slightly elevated in pregnant vs. nonpregnant women, but the difference is insignificant compared with the difference between depressed and nondepressed pregnant women, said Dr. Pearce of the department of psychology at Emory University, Atlanta.

“We all hear that pregnancy is a time of joy, a natural high, and that pregnancy-related hormones are protective. The data, however, collide with these truisms,” said Dr. Pearce, noting that roughly 7% of all American women experience episodes of major depression during their first pregnancies. The proportion increases to 12%-14% for second and third pregnancies.

The prevalence of major depression among nonpregnant women is roughly 8%. So, on a statistical basis, pregnancy is hardly protective and may actually increase the incidence of depression, particularly in multiparous women, he said.

“There are some very big changes in body chemistry during pregnancy. The shift in the balance of hormones, cytokines, cortisol, and many other things can be huge and very complex. Some women feel bliss; many others become depressed,” he noted.

Depression during pregnancy can have significant complications: It is predictive of preterm labor and delivery, as well as other obstetrical complications, and is linked to an increased risk of behavioral and social problems in the children. “The physiological changes caused by depression during pregnancy result in changes in maternal-fetal interaction, which can have adverse effects on the fetal brain,” Dr. Pearce said.

Antidepressant drug therapy, however, is not a neutral, risk-free proposition during pregnancy. Although none of the major antidepressant drug classes is considered strongly teratogenic, many commonly used medications have been linked to adverse obstetrical outcomes, including preterm delivery.

Dr. Pearce and his colleagues at Emory have been looking at potential biologic mediators involved in depression during pregnancy with the hope of eventually identifying targets for novel treatment strategies.

They've focused largely on inflammatory cytokines, many of which are consistently elevated among individuals with major depression. Patients with chronic inflammatory disorders, characterized by elevated cytokine levels, often have comorbid depression. Some cytokines used as drugs in the treatment of serious illnesses like cancer can actually induce symptoms of depression if given intravenously.

MIF is a fairly recent discovery, and it has attracted considerable attention among immunologists and infectious-disease researchers. “It is a very unique protein. It is not like any of the other cytokines. It is really in its own family,” Dr. Pearce said.

MIF is produced endogenously by a number of different immune cells and appears to block the action of cortisol. This results in an overall up-regulation of inflammation because cortisol normally inhibits inflammatory signaling molecules. MIF is also a modulator of catecholamine metabolism. Interestingly, MIF is also produced in large quantities by the hippocampus. “Nobody knows yet what it is doing there in the brain,” he said.

If the connection between elevated MIF levels and depression in pregnancy is borne out in future studies, Dr. Pearce believes that MIF may be useful as a prognostic marker for both depression and pregnancy complications like preterm labor. Prepregnancy depression predicts depression during and after pregnancy, he said.

“It seems that MIF levels predict postpartum outcomes,” Dr. Pearce commented.

NEW YORK — Macrophage migration inhibitory factor, a newly characterized cytokine that inhibits cortisol and increases production of inflammatory cytokines, may be the key to understanding depression during pregnancy, Brad D. Pearce, Ph.D., said at a symposium sponsored by the National Alliance for Research on Schizophrenia and Depression.

Pregnant women seeking treatment for major depression have markedly higher levels of macrophage migration inhibitory factor (MIF) than do nondepressed pregnant women of similar age. In general, MIF levels are slightly elevated in pregnant vs. nonpregnant women, but the difference is insignificant compared with the difference between depressed and nondepressed pregnant women, said Dr. Pearce of the department of psychology at Emory University, Atlanta.

“We all hear that pregnancy is a time of joy, a natural high, and that pregnancy-related hormones are protective. The data, however, collide with these truisms,” said Dr. Pearce, noting that roughly 7% of all American women experience episodes of major depression during their first pregnancies. The proportion increases to 12%-14% for second and third pregnancies.

The prevalence of major depression among nonpregnant women is roughly 8%. So, on a statistical basis, pregnancy is hardly protective and may actually increase the incidence of depression, particularly in multiparous women, he said.

“There are some very big changes in body chemistry during pregnancy. The shift in the balance of hormones, cytokines, cortisol, and many other things can be huge and very complex. Some women feel bliss; many others become depressed,” he noted.

Depression during pregnancy can have significant complications: It is predictive of preterm labor and delivery, as well as other obstetrical complications, and is linked to an increased risk of behavioral and social problems in the children. “The physiological changes caused by depression during pregnancy result in changes in maternal-fetal interaction, which can have adverse effects on the fetal brain,” Dr. Pearce said.

Antidepressant drug therapy, however, is not a neutral, risk-free proposition during pregnancy. Although none of the major antidepressant drug classes is considered strongly teratogenic, many commonly used medications have been linked to adverse obstetrical outcomes, including preterm delivery.

Dr. Pearce and his colleagues at Emory have been looking at potential biologic mediators involved in depression during pregnancy with the hope of eventually identifying targets for novel treatment strategies.

They've focused largely on inflammatory cytokines, many of which are consistently elevated among individuals with major depression. Patients with chronic inflammatory disorders, characterized by elevated cytokine levels, often have comorbid depression. Some cytokines used as drugs in the treatment of serious illnesses like cancer can actually induce symptoms of depression if given intravenously.

MIF is a fairly recent discovery, and it has attracted considerable attention among immunologists and infectious-disease researchers. “It is a very unique protein. It is not like any of the other cytokines. It is really in its own family,” Dr. Pearce said.

MIF is produced endogenously by a number of different immune cells and appears to block the action of cortisol. This results in an overall up-regulation of inflammation because cortisol normally inhibits inflammatory signaling molecules. MIF is also a modulator of catecholamine metabolism. Interestingly, MIF is also produced in large quantities by the hippocampus. “Nobody knows yet what it is doing there in the brain,” he said.

If the connection between elevated MIF levels and depression in pregnancy is borne out in future studies, Dr. Pearce believes that MIF may be useful as a prognostic marker for both depression and pregnancy complications like preterm labor. Prepregnancy depression predicts depression during and after pregnancy, he said.

“It seems that MIF levels predict postpartum outcomes,” Dr. Pearce commented.

Men tend to obtain higher plasma cocaine levels from a given dose of inhaled substance, and they tend to experience more euphoria. They are more likely to become addicted and have a far more difficult time shaking cocaine addiction. On average, women absorb less cocaine from a given intranasal dose and experience much less euphoria. This is especially true during the luteal phase of the menstrual cycle.

Women who do use cocaine, however, are much more likely than men to experience cardiotoxic effects. At any given inhaled dose, women absorb less, but they have heart rate changes that are nearly identical to those seen in men, said Dr. Lukas, professor of psychiatry and pharmacology at Harvard Medical School, Boston.

Tachycardia, sometimes life threatening, is a very common effect of cocaine use in women. “Emergency room admissions for cocaine-related heart palpitations are on the order of six females for every one male,” he said.

He and other researchers studying gender response to illicit drugs believe that these differences are largely influenced by sex hormones. In 1971, pioneering stress physiologist Hans Selye suggested that hormones regulate resistance to various drugs and toxins. The hormonal effects, however, can cut both ways.

Dr. Lukas explained that the nasal mucosa is under sex hormone control, just as the uterine mucosa is. Estrogen increases nasal mucosal thickness, as well as the viscosity of nasal mucosal secretions. Presumably, this would lower intranasal absorption of cocaine.

A study published in 1999 by other investigators documented gender-based differences in response to 0.9-mg/kg doses of intranasal cocaine. The data showed that men consistently had higher plasma levels and reported more intense subjective experiences of the cocaine high.

At the 0.9-mg/kg dose, men showed plasma levels of 150 ng/mL at 30–40 minutes, while women in the follicular phase had plasma levels of only 70 ng/mL from the same intranasal dose.

Women who were in the luteal phase had even lower plasma concentrations. The men and women had equivalent changes in heart rate.

“Men have a pretty immediate euphoric response to cocaine, and then an hour later they have a marked crash characterized by a lot of dysphoria. Women get a lot less euphoria, especially during the luteal phase,” he said at the meeting cosponsored by the New York Academy of Medicine

Given this differential in dose absorption, it is fairly easy to understand how this translates into cardiac problems for women who use cocaine. Dr. Lukas asked attendees to imagine a young couple out on a date.

“He wants to do some coke, and he's very excited about it. He snorts a line or two and gives the same to his girlfriend. He's immediately revved up, while she's not feeling very much. So he keeps giving her more and more, hoping she'll reach his level of euphoria.” All too often, though, the young woman ends up reaching a frightening level of tachycardia and has to go to the hospital, he said.

Progesterone appears to exacerbate the cardiotoxic effects of cocaine. This has been shown in rodent experiments and in studies of pregnant women using cocaine. Dr. Lukas said the progesterone effect might account in part for the observation that women have heart rate changes similar to those in men despite having lower plasma levels.

Because men are more likely to have immediate euphoric responses to cocaine, they are naturally more inclined to repeat an initial positive experience, leading to an increased risk of addiction.

According to James Anthony, Ph.D., chairman of epidemiology at Michigan State University, East Lansing, national statistics show that men are far more likely to become cocaine dependent, and they are also more likely than women to try crack cocaine.

Dr. Lukas cited a single-photon emission computed tomography study of brain changes in cocaine-dependent men and women. The study showed that men had far more detectable brain damage than the women.

“In effect, the men had lots of ministrokes all over the brain. Women had some, but far [fewer] of them,” Dr. Lukas said.

Men showed more cerebral vasoconstriction, compared with women, and overall, they were more sensitive to the brain-damaging effects of cocaine.

For reasons that are not entirely clear, men using cocaine have much greater difficulty with detoxification, he said, not that detoxification is easy for cocaine-dependent women. In general, however, women become drug free more quickly and have better long-term, drug-free response rates.

Dr. Lukas, who has conducted several studies of drug abuse among women, stressed the importance of doing this kind of research, while also acknowledging the considerable difficulties of doing drug studies in females.

“The female body is so much more complex than the male's. Men are far easier to study. With women, there are more hormonal cycles going on, menstrual cycle phases, and pregnancy, body mass, and dosing issues.

“And there are the issues related to prepubertal vs. childbearing age vs. menopausal stages of life. And of course, you have to take into account use of oral contraceptives or hormone replacement therapy,” he said.

Drug research on women is expensive. He noted that it costs between $1,200 and $1,500 in pretrial blood work just to determine whether a woman can participate in a trial.

And there's the ongoing need for pregnancy testing.

“I can't say enough about this. Testing once at the beginning of a yearlong study is not sufficient. In our lab, we're doing cocaine and alcohol studies. Anytime a woman in one of our studies comes to my lab, she gets a pregnancy test. “In the last decade, I've detected six women who [came] to the lab to take cocaine or alcohol and did not know they were pregnant. Testing adds to the cost of a study, but it is money well spent. You don't want to unwittingly give cocaine to a woman who's pregnant,” Dr. Lukas said.

Men tend to obtain higher plasma cocaine levels from a given dose of inhaled substance, and they tend to experience more euphoria. They are more likely to become addicted and have a far more difficult time shaking cocaine addiction. On average, women absorb less cocaine from a given intranasal dose and experience much less euphoria. This is especially true during the luteal phase of the menstrual cycle.

Women who do use cocaine, however, are much more likely than men to experience cardiotoxic effects. At any given inhaled dose, women absorb less, but they have heart rate changes that are nearly identical to those seen in men, said Dr. Lukas, professor of psychiatry and pharmacology at Harvard Medical School, Boston.

Tachycardia, sometimes life threatening, is a very common effect of cocaine use in women. “Emergency room admissions for cocaine-related heart palpitations are on the order of six females for every one male,” he said.

He and other researchers studying gender response to illicit drugs believe that these differences are largely influenced by sex hormones. In 1971, pioneering stress physiologist Hans Selye suggested that hormones regulate resistance to various drugs and toxins. The hormonal effects, however, can cut both ways.

Dr. Lukas explained that the nasal mucosa is under sex hormone control, just as the uterine mucosa is. Estrogen increases nasal mucosal thickness, as well as the viscosity of nasal mucosal secretions. Presumably, this would lower intranasal absorption of cocaine.

A study published in 1999 by other investigators documented gender-based differences in response to 0.9-mg/kg doses of intranasal cocaine. The data showed that men consistently had higher plasma levels and reported more intense subjective experiences of the cocaine high.

At the 0.9-mg/kg dose, men showed plasma levels of 150 ng/mL at 30–40 minutes, while women in the follicular phase had plasma levels of only 70 ng/mL from the same intranasal dose.

Women who were in the luteal phase had even lower plasma concentrations. The men and women had equivalent changes in heart rate.

“Men have a pretty immediate euphoric response to cocaine, and then an hour later they have a marked crash characterized by a lot of dysphoria. Women get a lot less euphoria, especially during the luteal phase,” he said at the meeting cosponsored by the New York Academy of Medicine

Given this differential in dose absorption, it is fairly easy to understand how this translates into cardiac problems for women who use cocaine. Dr. Lukas asked attendees to imagine a young couple out on a date.

“He wants to do some coke, and he's very excited about it. He snorts a line or two and gives the same to his girlfriend. He's immediately revved up, while she's not feeling very much. So he keeps giving her more and more, hoping she'll reach his level of euphoria.” All too often, though, the young woman ends up reaching a frightening level of tachycardia and has to go to the hospital, he said.

Progesterone appears to exacerbate the cardiotoxic effects of cocaine. This has been shown in rodent experiments and in studies of pregnant women using cocaine. Dr. Lukas said the progesterone effect might account in part for the observation that women have heart rate changes similar to those in men despite having lower plasma levels.

Because men are more likely to have immediate euphoric responses to cocaine, they are naturally more inclined to repeat an initial positive experience, leading to an increased risk of addiction.

According to James Anthony, Ph.D., chairman of epidemiology at Michigan State University, East Lansing, national statistics show that men are far more likely to become cocaine dependent, and they are also more likely than women to try crack cocaine.

Dr. Lukas cited a single-photon emission computed tomography study of brain changes in cocaine-dependent men and women. The study showed that men had far more detectable brain damage than the women.

“In effect, the men had lots of ministrokes all over the brain. Women had some, but far [fewer] of them,” Dr. Lukas said.

Men showed more cerebral vasoconstriction, compared with women, and overall, they were more sensitive to the brain-damaging effects of cocaine.

For reasons that are not entirely clear, men using cocaine have much greater difficulty with detoxification, he said, not that detoxification is easy for cocaine-dependent women. In general, however, women become drug free more quickly and have better long-term, drug-free response rates.

Dr. Lukas, who has conducted several studies of drug abuse among women, stressed the importance of doing this kind of research, while also acknowledging the considerable difficulties of doing drug studies in females.

“The female body is so much more complex than the male's. Men are far easier to study. With women, there are more hormonal cycles going on, menstrual cycle phases, and pregnancy, body mass, and dosing issues.

“And there are the issues related to prepubertal vs. childbearing age vs. menopausal stages of life. And of course, you have to take into account use of oral contraceptives or hormone replacement therapy,” he said.

Drug research on women is expensive. He noted that it costs between $1,200 and $1,500 in pretrial blood work just to determine whether a woman can participate in a trial.

And there's the ongoing need for pregnancy testing.

“I can't say enough about this. Testing once at the beginning of a yearlong study is not sufficient. In our lab, we're doing cocaine and alcohol studies. Anytime a woman in one of our studies comes to my lab, she gets a pregnancy test. “In the last decade, I've detected six women who [came] to the lab to take cocaine or alcohol and did not know they were pregnant. Testing adds to the cost of a study, but it is money well spent. You don't want to unwittingly give cocaine to a woman who's pregnant,” Dr. Lukas said.

Men tend to obtain higher plasma cocaine levels from a given dose of inhaled substance, and they tend to experience more euphoria. They are more likely to become addicted and have a far more difficult time shaking cocaine addiction. On average, women absorb less cocaine from a given intranasal dose and experience much less euphoria. This is especially true during the luteal phase of the menstrual cycle.

Women who do use cocaine, however, are much more likely than men to experience cardiotoxic effects. At any given inhaled dose, women absorb less, but they have heart rate changes that are nearly identical to those seen in men, said Dr. Lukas, professor of psychiatry and pharmacology at Harvard Medical School, Boston.

Tachycardia, sometimes life threatening, is a very common effect of cocaine use in women. “Emergency room admissions for cocaine-related heart palpitations are on the order of six females for every one male,” he said.

He and other researchers studying gender response to illicit drugs believe that these differences are largely influenced by sex hormones. In 1971, pioneering stress physiologist Hans Selye suggested that hormones regulate resistance to various drugs and toxins. The hormonal effects, however, can cut both ways.

Dr. Lukas explained that the nasal mucosa is under sex hormone control, just as the uterine mucosa is. Estrogen increases nasal mucosal thickness, as well as the viscosity of nasal mucosal secretions. Presumably, this would lower intranasal absorption of cocaine.

A study published in 1999 by other investigators documented gender-based differences in response to 0.9-mg/kg doses of intranasal cocaine. The data showed that men consistently had higher plasma levels and reported more intense subjective experiences of the cocaine high.

At the 0.9-mg/kg dose, men showed plasma levels of 150 ng/mL at 30–40 minutes, while women in the follicular phase had plasma levels of only 70 ng/mL from the same intranasal dose.

Women who were in the luteal phase had even lower plasma concentrations. The men and women had equivalent changes in heart rate.

“Men have a pretty immediate euphoric response to cocaine, and then an hour later they have a marked crash characterized by a lot of dysphoria. Women get a lot less euphoria, especially during the luteal phase,” he said at the meeting cosponsored by the New York Academy of Medicine

Given this differential in dose absorption, it is fairly easy to understand how this translates into cardiac problems for women who use cocaine. Dr. Lukas asked attendees to imagine a young couple out on a date.

“He wants to do some coke, and he's very excited about it. He snorts a line or two and gives the same to his girlfriend. He's immediately revved up, while she's not feeling very much. So he keeps giving her more and more, hoping she'll reach his level of euphoria.” All too often, though, the young woman ends up reaching a frightening level of tachycardia and has to go to the hospital, he said.

Progesterone appears to exacerbate the cardiotoxic effects of cocaine. This has been shown in rodent experiments and in studies of pregnant women using cocaine. Dr. Lukas said the progesterone effect might account in part for the observation that women have heart rate changes similar to those in men despite having lower plasma levels.

Because men are more likely to have immediate euphoric responses to cocaine, they are naturally more inclined to repeat an initial positive experience, leading to an increased risk of addiction.

According to James Anthony, Ph.D., chairman of epidemiology at Michigan State University, East Lansing, national statistics show that men are far more likely to become cocaine dependent, and they are also more likely than women to try crack cocaine.

Dr. Lukas cited a single-photon emission computed tomography study of brain changes in cocaine-dependent men and women. The study showed that men had far more detectable brain damage than the women.

“In effect, the men had lots of ministrokes all over the brain. Women had some, but far [fewer] of them,” Dr. Lukas said.

Men showed more cerebral vasoconstriction, compared with women, and overall, they were more sensitive to the brain-damaging effects of cocaine.

For reasons that are not entirely clear, men using cocaine have much greater difficulty with detoxification, he said, not that detoxification is easy for cocaine-dependent women. In general, however, women become drug free more quickly and have better long-term, drug-free response rates.

Dr. Lukas, who has conducted several studies of drug abuse among women, stressed the importance of doing this kind of research, while also acknowledging the considerable difficulties of doing drug studies in females.

“The female body is so much more complex than the male's. Men are far easier to study. With women, there are more hormonal cycles going on, menstrual cycle phases, and pregnancy, body mass, and dosing issues.

“And there are the issues related to prepubertal vs. childbearing age vs. menopausal stages of life. And of course, you have to take into account use of oral contraceptives or hormone replacement therapy,” he said.

Drug research on women is expensive. He noted that it costs between $1,200 and $1,500 in pretrial blood work just to determine whether a woman can participate in a trial.

And there's the ongoing need for pregnancy testing.

“I can't say enough about this. Testing once at the beginning of a yearlong study is not sufficient. In our lab, we're doing cocaine and alcohol studies. Anytime a woman in one of our studies comes to my lab, she gets a pregnancy test. “In the last decade, I've detected six women who [came] to the lab to take cocaine or alcohol and did not know they were pregnant. Testing adds to the cost of a study, but it is money well spent. You don't want to unwittingly give cocaine to a woman who's pregnant,” Dr. Lukas said.

NEW YORK – The number of teenagers who experiment with recreational drugs is nearly the same as it was during its peak years in the early 1970s, reported James Anthony, Ph.D., at the annual conference of the Association for Research in Nervous and Mental Disease.

Dr. Anthony, who is chairman of the department of epidemiology at Michigan State University, East Lansing, said the trend in the past decade has been approximately 2.5 million new teenage cannabis users each year, an almost identical number as was seen in the early 1970s.

The number of people under the age of 18 years in the United States is also nearly identical to the figure from the early 1970s.

Abuse of prescription drugs such as stimulants, pain relievers, and sedatives appears to be even more common now than it was during the height of the post-1960s “drug culture” era, he noted at the conference, cosponsored by the New York Academy of Medicine.

So much for “Just say no.”

From a public health viewpoint, the important issue is not so much the absolute number of young people who try recreational drugs but the number of new users of those drugs who ultimately become dependent on them. This “conversion” rate from initial use to addiction is influenced by genetics, environmental factors, and most importantly, the nature of the drug itself. The statistics suggest that different substances have very different conversion rates.

According to data from the National Survey on Drug Use and Health (formerly the National Household Survey on Drug Abuse) and the National Comorbidity Survey databases, tobacco is by far the most addictive of the commonly abused substances. One in three individuals who tries tobacco will ultimately become dependent on it. Opiates are a close second, with one in four initial users becoming addicted. Crack and cocaine are next, inducing dependence in one in five and one in six first-time users, respectively. Alcohol causes dependence in one in seven to eight initial users, and stimulants cause dependence in one in nine. For cannabis, the figure is between 1 in 9 and 1 in 11.

Though many drug-avoidance programs that are aimed at teenagers identify cannabis as the “gateway” drug that leads young people to hard drug use, the statistics suggest that it is tobacco that really should carry that distinction, Dr. Anthony said. Dr. Anthony estimated that there are roughly 4.6 million actively drug-dependent individuals in the United States, and the vast majority go untreated for many years. Most people who do enter drug treatment programs have been drug dependent for an average of 10 years. In addition to alcohol and tobacco, cocaine is a major contributor to the problem.

“With cocaine, approximately 30% of the general population has the opportunity to try it, but only 50% of those who have the opportunity will try it. For cannabis, 85% of the population has the chance to try it, and 75% end up trying it,” he said.

Drug use and dependence patterns vary considerably from state to state. For example, estimates of the number of active adult cocaine users vary from 1.8% to 4%, with a U.S. average of 2.5%. The states with the highest prevalence are Nevada, Arizona, Ohio, North Carolina, Massachusetts, and Vermont.

Dr. Anthony said there are roughly 1.1 million new first-time cocaine users in the United States each year.

For cannabis, the number of users varies from 4.3% to 11% of the U.S. population, with an average of 6.2%. The highest-use states include Washington, Oregon, Nevada, Montana, Colorado, Utah, and New Hampshire. He estimated that there are roughly 14.6 million regular users of cannabis across the nation and 2.6 million first-time users each year.

The time frame for development of drug dependence seems to vary considerably for different drugs. With cocaine, between 5% and 6% of first-time users become dependent within the first 2 years of their initial experience.

This percentate rises to more than 16% within 6 years. “The pattern for tobacco looks a lot like cocaine,” Dr. Anthony said. With cannabis, between 3% and 4% of those who try the drug become dependent on it within the first 2 years, but the conversion factor drops off markedly after that. In this respect, alcohol is very similar to cannabis.

“If you're not addicted within the first 1 or 2 years, you probably will never be,” Dr. Anthony said.

Aside from the emergence of ecstasy (3,4-methylenedioxymethamphetamine) and related substances, the biggest change in patterns of drug abuse since the 1970s has to do with abuse of prescription drugs.

Simply put, there are many more of these kinds of drugs available now, and they are far more widely prescribed than they were.

“We're seeing very sharp rises in the numbers [of prescription drug abusers] in all age groups,” he said.

Crystal meth (methamphetamine) use has surged, but this trend has very particular regional variances. Often considered the “poor man's cocaine,” crystal meth use is quite prevalent in the Southwest, Southern California, and in rural areas of the Midwest. Though the specific population dynamics surrounding this problem are not entirely understood, Dr. Anthony said he suspects that the economics of drug dealing play a role. “Wherever you have an entrenched cocaine market, you don't have much of a crystal meth market because of the violence between the cocaine and the meth mobs,” he said.

As in almost all areas of medicine, the genomics revolution has sent many substance abuse researchers deep into the molecular realm in search of specific genes that predispose individuals to drug dependence.

Though he believes that this effort is an important direction for research, Dr. Anthony underscored the need to place equal emphasis on the environmental determinants of addiction. “The dichotomy between 'enviromics' and genomics is in many ways a false dichotomy. It is not an either/or situation, so we need to take an and/both attitude,” he said. “Just as we map the genetic material, we ought to be mapping the environmental conditions and processes that shape drug involvement.

NEW YORK – The number of teenagers who experiment with recreational drugs is nearly the same as it was during its peak years in the early 1970s, reported James Anthony, Ph.D., at the annual conference of the Association for Research in Nervous and Mental Disease.

Dr. Anthony, who is chairman of the department of epidemiology at Michigan State University, East Lansing, said the trend in the past decade has been approximately 2.5 million new teenage cannabis users each year, an almost identical number as was seen in the early 1970s.

The number of people under the age of 18 years in the United States is also nearly identical to the figure from the early 1970s.

Abuse of prescription drugs such as stimulants, pain relievers, and sedatives appears to be even more common now than it was during the height of the post-1960s “drug culture” era, he noted at the conference, cosponsored by the New York Academy of Medicine.

So much for “Just say no.”

From a public health viewpoint, the important issue is not so much the absolute number of young people who try recreational drugs but the number of new users of those drugs who ultimately become dependent on them. This “conversion” rate from initial use to addiction is influenced by genetics, environmental factors, and most importantly, the nature of the drug itself. The statistics suggest that different substances have very different conversion rates.

According to data from the National Survey on Drug Use and Health (formerly the National Household Survey on Drug Abuse) and the National Comorbidity Survey databases, tobacco is by far the most addictive of the commonly abused substances. One in three individuals who tries tobacco will ultimately become dependent on it. Opiates are a close second, with one in four initial users becoming addicted. Crack and cocaine are next, inducing dependence in one in five and one in six first-time users, respectively. Alcohol causes dependence in one in seven to eight initial users, and stimulants cause dependence in one in nine. For cannabis, the figure is between 1 in 9 and 1 in 11.

Though many drug-avoidance programs that are aimed at teenagers identify cannabis as the “gateway” drug that leads young people to hard drug use, the statistics suggest that it is tobacco that really should carry that distinction, Dr. Anthony said. Dr. Anthony estimated that there are roughly 4.6 million actively drug-dependent individuals in the United States, and the vast majority go untreated for many years. Most people who do enter drug treatment programs have been drug dependent for an average of 10 years. In addition to alcohol and tobacco, cocaine is a major contributor to the problem.

“With cocaine, approximately 30% of the general population has the opportunity to try it, but only 50% of those who have the opportunity will try it. For cannabis, 85% of the population has the chance to try it, and 75% end up trying it,” he said.

Drug use and dependence patterns vary considerably from state to state. For example, estimates of the number of active adult cocaine users vary from 1.8% to 4%, with a U.S. average of 2.5%. The states with the highest prevalence are Nevada, Arizona, Ohio, North Carolina, Massachusetts, and Vermont.

Dr. Anthony said there are roughly 1.1 million new first-time cocaine users in the United States each year.

For cannabis, the number of users varies from 4.3% to 11% of the U.S. population, with an average of 6.2%. The highest-use states include Washington, Oregon, Nevada, Montana, Colorado, Utah, and New Hampshire. He estimated that there are roughly 14.6 million regular users of cannabis across the nation and 2.6 million first-time users each year.

The time frame for development of drug dependence seems to vary considerably for different drugs. With cocaine, between 5% and 6% of first-time users become dependent within the first 2 years of their initial experience.

This percentate rises to more than 16% within 6 years. “The pattern for tobacco looks a lot like cocaine,” Dr. Anthony said. With cannabis, between 3% and 4% of those who try the drug become dependent on it within the first 2 years, but the conversion factor drops off markedly after that. In this respect, alcohol is very similar to cannabis.

“If you're not addicted within the first 1 or 2 years, you probably will never be,” Dr. Anthony said.

Aside from the emergence of ecstasy (3,4-methylenedioxymethamphetamine) and related substances, the biggest change in patterns of drug abuse since the 1970s has to do with abuse of prescription drugs.

Simply put, there are many more of these kinds of drugs available now, and they are far more widely prescribed than they were.

“We're seeing very sharp rises in the numbers [of prescription drug abusers] in all age groups,” he said.

Crystal meth (methamphetamine) use has surged, but this trend has very particular regional variances. Often considered the “poor man's cocaine,” crystal meth use is quite prevalent in the Southwest, Southern California, and in rural areas of the Midwest. Though the specific population dynamics surrounding this problem are not entirely understood, Dr. Anthony said he suspects that the economics of drug dealing play a role. “Wherever you have an entrenched cocaine market, you don't have much of a crystal meth market because of the violence between the cocaine and the meth mobs,” he said.

As in almost all areas of medicine, the genomics revolution has sent many substance abuse researchers deep into the molecular realm in search of specific genes that predispose individuals to drug dependence.

Though he believes that this effort is an important direction for research, Dr. Anthony underscored the need to place equal emphasis on the environmental determinants of addiction. “The dichotomy between 'enviromics' and genomics is in many ways a false dichotomy. It is not an either/or situation, so we need to take an and/both attitude,” he said. “Just as we map the genetic material, we ought to be mapping the environmental conditions and processes that shape drug involvement.

NEW YORK – The number of teenagers who experiment with recreational drugs is nearly the same as it was during its peak years in the early 1970s, reported James Anthony, Ph.D., at the annual conference of the Association for Research in Nervous and Mental Disease.

Dr. Anthony, who is chairman of the department of epidemiology at Michigan State University, East Lansing, said the trend in the past decade has been approximately 2.5 million new teenage cannabis users each year, an almost identical number as was seen in the early 1970s.

The number of people under the age of 18 years in the United States is also nearly identical to the figure from the early 1970s.

Abuse of prescription drugs such as stimulants, pain relievers, and sedatives appears to be even more common now than it was during the height of the post-1960s “drug culture” era, he noted at the conference, cosponsored by the New York Academy of Medicine.

So much for “Just say no.”

From a public health viewpoint, the important issue is not so much the absolute number of young people who try recreational drugs but the number of new users of those drugs who ultimately become dependent on them. This “conversion” rate from initial use to addiction is influenced by genetics, environmental factors, and most importantly, the nature of the drug itself. The statistics suggest that different substances have very different conversion rates.

According to data from the National Survey on Drug Use and Health (formerly the National Household Survey on Drug Abuse) and the National Comorbidity Survey databases, tobacco is by far the most addictive of the commonly abused substances. One in three individuals who tries tobacco will ultimately become dependent on it. Opiates are a close second, with one in four initial users becoming addicted. Crack and cocaine are next, inducing dependence in one in five and one in six first-time users, respectively. Alcohol causes dependence in one in seven to eight initial users, and stimulants cause dependence in one in nine. For cannabis, the figure is between 1 in 9 and 1 in 11.

Though many drug-avoidance programs that are aimed at teenagers identify cannabis as the “gateway” drug that leads young people to hard drug use, the statistics suggest that it is tobacco that really should carry that distinction, Dr. Anthony said. Dr. Anthony estimated that there are roughly 4.6 million actively drug-dependent individuals in the United States, and the vast majority go untreated for many years. Most people who do enter drug treatment programs have been drug dependent for an average of 10 years. In addition to alcohol and tobacco, cocaine is a major contributor to the problem.

“With cocaine, approximately 30% of the general population has the opportunity to try it, but only 50% of those who have the opportunity will try it. For cannabis, 85% of the population has the chance to try it, and 75% end up trying it,” he said.

Drug use and dependence patterns vary considerably from state to state. For example, estimates of the number of active adult cocaine users vary from 1.8% to 4%, with a U.S. average of 2.5%. The states with the highest prevalence are Nevada, Arizona, Ohio, North Carolina, Massachusetts, and Vermont.

Dr. Anthony said there are roughly 1.1 million new first-time cocaine users in the United States each year.

For cannabis, the number of users varies from 4.3% to 11% of the U.S. population, with an average of 6.2%. The highest-use states include Washington, Oregon, Nevada, Montana, Colorado, Utah, and New Hampshire. He estimated that there are roughly 14.6 million regular users of cannabis across the nation and 2.6 million first-time users each year.

The time frame for development of drug dependence seems to vary considerably for different drugs. With cocaine, between 5% and 6% of first-time users become dependent within the first 2 years of their initial experience.

This percentate rises to more than 16% within 6 years. “The pattern for tobacco looks a lot like cocaine,” Dr. Anthony said. With cannabis, between 3% and 4% of those who try the drug become dependent on it within the first 2 years, but the conversion factor drops off markedly after that. In this respect, alcohol is very similar to cannabis.

“If you're not addicted within the first 1 or 2 years, you probably will never be,” Dr. Anthony said.

Aside from the emergence of ecstasy (3,4-methylenedioxymethamphetamine) and related substances, the biggest change in patterns of drug abuse since the 1970s has to do with abuse of prescription drugs.

Simply put, there are many more of these kinds of drugs available now, and they are far more widely prescribed than they were.

“We're seeing very sharp rises in the numbers [of prescription drug abusers] in all age groups,” he said.

Crystal meth (methamphetamine) use has surged, but this trend has very particular regional variances. Often considered the “poor man's cocaine,” crystal meth use is quite prevalent in the Southwest, Southern California, and in rural areas of the Midwest. Though the specific population dynamics surrounding this problem are not entirely understood, Dr. Anthony said he suspects that the economics of drug dealing play a role. “Wherever you have an entrenched cocaine market, you don't have much of a crystal meth market because of the violence between the cocaine and the meth mobs,” he said.

As in almost all areas of medicine, the genomics revolution has sent many substance abuse researchers deep into the molecular realm in search of specific genes that predispose individuals to drug dependence.

Though he believes that this effort is an important direction for research, Dr. Anthony underscored the need to place equal emphasis on the environmental determinants of addiction. “The dichotomy between 'enviromics' and genomics is in many ways a false dichotomy. It is not an either/or situation, so we need to take an and/both attitude,” he said. “Just as we map the genetic material, we ought to be mapping the environmental conditions and processes that shape drug involvement.