January 13, 2012
NIH Podcast Episode #0150
Balintfy: Welcome to the 150th episode of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health – NIH . . . Turning Discovery Into Health®. I'm your host Joe Balintfy. Happy New Year! Coming up in this episode some teen-related stories: trends in cigarette and alcohol use, quitting smoking with their mobile phones, and a guide to help screen for teen drinkers; plus news on prostate cancer screening. But first, this news update. Here’s Craig Fritz.
Fritz: A new NIH study has found that children exposed to HIV before birth are at risk for language impairments. The study also found that these children may benefit from routine screening for language impairment, even if they don’t have any obvious signs of a language problem. Researchers found that 35 percent of a group of school-age children born to women with an HIV infection during pregnancy have difficulty understanding spoken words and expressing themselves verbally. The study could not determine if the high rates of language impairment in the HIV-exposed children can be attributed solely to HIV exposure or to other unidentified factors.
An NIH study shows that more than 32 million people in the United States have autoantibodies, which are proteins made by the immune system that target the body’s tissues and define a condition known as autoimmunity. Scientists explain that the body’s immune system makes large numbers of antibodies to help the body fight off infections. In some cases, antibodies are produced that are directed against one's own tissues. These are referred to as autoantibodies. Autoantibodies are frequently markers for detecting autoimmune diseases, but their presence does not necessarily mean a person will get an autoimmune disease. Scientists say future studies should look at changes in the prevalence of autoantibodies over time and the factors associated with their development.
For this NIH news update – I’m Craig Fritz
Balintfy: News updates are compiled from information at www.nih.gov/news. Coming up teen drug use, drinking and smoking, plus quitting, and a prostate cancer update; that’s next on NIH Research Radio.
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Panel endorses active monitoring and delay of treatment for low-risk prostate cancer
Balintfy: For men diagnosed with localized, low-risk prostate cancer, a strategy of close monitoring and delayed treatment may be a better option than immediate surgery or radiation therapy. An independent panel convened by the NIH has concluded that patients with low-risk prostate cancer should be offered the option of active surveillance, meaning observation with intent to cure.
Ganz: We feel confident that in the very low-risk patients that this is a reasonable thing to offer men when they are being told that they have this diagnosis.
Balintfy: Dr. Patricia A. Ganz is the panel chairperson, and director of the Division of Cancer Prevention and Control Research at the Jonsson Comprehensive Cancer Center at the University of California in Los Angeles. She explains that more men are being identified as having very low-risk, slow-growing prostate cancer who may not choose surgery or radiation at the time of their diagnosis, but want to be followed.
Ganz: And if at some time their disease pattern changes, they would like to then go ahead with active treatment at that time.
Balintfy: However, approximately 90 percent of patients receive immediate treatment, such as surgery or radiation therapy. For many of these patients, treatment has serious short- and long-term side effects, such as diminished sexual function and loss of urinary control. And the immediate treatments in these cases do not have clear benefits, such as improved survival. Dr. Ganz says that by reviewing current scientific data, the panel learned about this substantial part of the prostate cancer population.
Ganz: Men may be getting treatments that are not necessarily going to change their life course and their survival and lead to significant morbidities such as sexual and urinary problems that are very common after surgery or bowel and urinary and sexual problems that can occur with radiation, and that men will have problems with this as a result even though the cancer may not have ever caused them troubles. So that by taking an approach that delays or perhaps never requires that kind of intervention, they may be spared that.
Balintfy: Prostate cancer is common in men in the United States. Estimates for 2011 are that approximately 240,000 men will be newly diagnosed with prostate cancer and 33,000 will die of the disease. More than half of these cancers are confined to the prostate, not aggressive at diagnosis, and unlikely to become life-threatening. But Dr. Ganz points out that a big challenge is the word ‘cancer’ itself.
Ganz: If you are told you have cancer and the part of the body that's involved can be removed or treated effectively with some local treatment, you want to have it taken care of immediately. In fact, you would have liked to have had it done yesterday. And to get patients and doctors to think about delaying and not doing something as potentially “the best” or an equivalent strategy is hard to accept.
Balintfy: Yet, Dr. Ganz feels because of the opportunity to identify very low-risk patients, the option should be presented.
Ganz: We can feel confident about having a delay in therapy or no therapy at all that may emerge because the natural history of the cancer will declare itself to be either one that progresses or stays quiet.
Balintfy: Dr. Ganz also points out that there is need for more research.
Ganz: It's a true missed opportunity if the many thousands of men and literally over 200,000 men per year who are diagnosed with this disease do not in some way participate in research or have the opportunity to participate in research so we can learn more about who needs more intensive or less intensive treatment.
Cigarette and alcohol use at historic low among teens
Balintfy: Now we shift our focus to teens. A survey shows low use of cigarettes and alcohol, but high levels of marijuana and prescription drug abuse. It is an annual survey of eighth, 10th, and 12th-graders.
Volkow: The most positive news has to do with the very low rates of smoking that we are seeing among teenagers when compared with the prior years
Balintfy: Dr. Nora Volkow is an institute director at the NIH. She says that cigarette use among teens is at its lowest since the survey started in 1975.
Volkow: This really illustrates how prevention campaigns can have a big, big impact in terms of one of the behaviors that constitutes a serious public health problem.
Balintfy: Dr. Volkow adds that reducing smoking among teens is important because research shows that smoking in adolescence significantly increases risk of becoming addicted to nicotine, but also because exposure to nicotine may prime the brain to be more sensitive to the rewarding effects of other drugs.
Volkow: So by decreasing the number of kids exposed to nicotine it's a win-win because on the one hand we are going to prevent the adverse medical effects, but on the other one, we may be doing a prevention against substance abuse later on in life.
Balintfy: Other good news from the national NIH-funded survey is that teen drinking patters are changing. Again Dr. Volkow.
Volkow: Daily drinking has decreased by 50% from 1996, and binge drinking has decreased by 30% also for that time period. Again, extremely important because drinking accounts for one of the main causes of morbidity and mortality among teenagers because of the association of accidents and mortality while driving under the effects of alcohol.
Balintfy: Despite the alcohol and cigarette declines noted in the survey, use of marijuana has shown some increases in recent years and remains steady. For example, Dr. Volkow points out that 6.6 percent of 12th graders report smoking marijuana daily – that's actually one in 15 high school seniors.
Volkow: And knowing that marijuana intoxication interferes with the ability to learn and memorize, one can clearly predict that these very high rates of daily consumption are going to be associated with an impaired educational performance.
Balintfy: Another major concern from the survey is about the use of synthetic marijuana, known as K2 or spice. Included in the survey for the first time in 2011, already 11.4 percent of 12th-graders reported past year use.
Volkow: I was certainly very surprised because this is a new drug. We first heard about it in 2008 and 2009. So to get so rapidly such high rates of utilization among 12th graders when there's really very little information with respect to its toxic effects is worrisome. And what it does tell me is it highlights an urgency to create educational campaigns that alert teenagers, their parents and the public at large about what these drugs are really about.
Balintfy: Dr. Volkow warns that synthetic marijuana or spice can be addictive and dangerous. Severe medical consequences such as heart attack, irregular heartbeat and psychosis have been associated with its use. She adds that parents should not be complacent when it comes to teen use of alcohol and drugs.
Volkow: The sense of "No, this is not going to happen to my kid; it's going to happen to someone else but not mine" is an incorrect way to start. All of the adolescents are at great risk of experimenting with drugs, and even if parents have had a close dialogue with them, the kids are good students, while those are protective effects, they do not necessarily guarantee that they will completely protect an adolescent.
Balintfy: In addition to maintaining a dialogue with their children, Dr. Volkow also recommends parents be alert to personality or behavior changes in their teenagers.
Volkow: And also, parents many times dismiss the use of alcohol and they say, "Well, after all, it's a legal drug." Or even sometimes for cigarettes, "After all, it's a legal drug." Well, they have to be cautious because what we are now understanding first of all is that the effects of drugs, whether it's legal or illegal, on an adolescent brain are different from those of an adult brain because the brain of the adolescents is much more plastic. It has not been fully developed and therefore may be more sensitive to some of the effects of drugs of abuse including those of illicit substances.
Balintfy: This goes for prescription medications as well says Dr. Volkow. The survey also showed mixed news regarding in the non-medical use of prescription drugs like the opioid painkillers Vicodine and OxyContin, as well as non-medical use of the ADHD medicines Adderall and Ritalin. For more information on the 2011 Monitoring the Future Survey, visit www.drugabuse.gov.
NIH releases clinician’s guide for screening underage drinkers
Balintfy: To help spot teenagers and children who may be at risk for alcohol-related problems health care professionals have a new tool. Wally Akinso reports on a newly released guide that uses just two questions.
Akinso: Research shows that underage drinking has immediate and long term consequences: they include academic and social problems, injuries, and death, as well as risk for alcohol dependence and both functional and structural changes in the brain. To help find children and teenagers at risk for alcohol-related problems, the NIH has released a guide for health care professionals to screen for underage drinkers.
Faden: The name of the new guide is Alcohol Screening and Brief Intervention for Youth: A Practitioner's Guide
Akinso: Dr. Vivian Faden is from the NIH.
Faden: The new guide introduces a two question screening tool and an innovative youth alcohol risk estimator; the ideas that we help clinicians overcome the time constraints and other common barriers that keep them from doing as much youth alcohol screening as we would like.
Akinso: The American Academy of Pediatrics, clinical researchers, and health practitioners developed the guide together. Dr. Faden describes the two questions.
Faden: The two questions being asked, one asked about personal drinking frequency. And the other asked about friends drinking. They vary slightly for elementary, middle and high school ages. So the question on friends drinking which is the first question asked of the younger kids, might be like this—do you have any friends who drank beer, wine, or any drink containing alcohol in the past year. And then that might be followed by this—how about you in the past year on how many days have you had more than a few sips of beer, wine or any drink containing alcohol.
Akinso: Dr. Faden explains why asking these questions are important for the screening process.
Faden: It's important to ask both of these questions because the friends drinking question is an early warning signal and it's a very good predictor of future drinking. The personal drinking question or the frequency question is the best predictor of current risk for problems from current drinking in adolescence who are already drinking.
Akinso: Research has shown that over the course of adolescence, the proportion of youth who have had more than just a few sips of alcohol increases dramatically, from 7 percent of 12 year-olds to nearly 70 percent of 18-years-olds. Dr. Faden hopes the new guide will help develop new interventions for underage drinkers. For more information on the guide, visit www.niaaa.nih.gov. This is Wally Akinso from the NIH, Bethesda, Maryland.
Balintfy: Helping teens quit smoking with their mobile phones. That’s next on NIH Research Radio.
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NCI launches smoking cessation support for teens
Balintfy: A new effort to help teens quit smoking is using one of their most constant companions — the mobile phone. I’m talking with Dr. Yvonne Hunt a program director in tobacco control research at the NIH. Dr. Hunt, how and why is teen smoking a problem?
Hunt: Well, nearly 20% of teens are current smokers, and unless we make efforts to intervene today, they will most likely continue smoking into adulthood. And we actually know that most adult smokers started smoking when they were teens. So this is a time in their teenage years and adolescents, it's a time of heightened vulnerability for smoking. And there is an opportunity there to intervene.
Balintfy: Why is it important to quit smoking, what are the dangers?
Hunt: Smoking is the leading preventable cause of death in the United States. And greater exposure to cigarettes over one's lifetime, the health consequences build up and those would include a number of different forms of cancer, heart disease and respiratory diseases, just to name a few of the leading consequences. So by intervening with teens, we're able to catch people before those consequences really have a chance to fully accumulate, and so this is a population that would have a great benefit from stopping early.
Balintfy: How can you reach this population of teens to help them stop early, Dr. Hunt?
Hunt: Well, that's a great question. First of all, I think the most important thing to remember about teens is that they are not mini adults. Teens have different smoking patterns than adults. Many teens don't smoke on a daily basis. They might have more intermittent smoking patterns, yet, they are still addicted to cigarettes. They still need assistance with quitting. And developmentally, teens have different needs than adults.
To help teens quit, we really need our interventions to be relevant to them, to resonate with the things that they feel are important to make sense within the context of their everyday lives. And so we need approaches that are perhaps a little different from our standard adult cessation approaches.
Balintfy: And a different use of technology as well.
Hunt: Yes. So we started thinking about this. How do we engage teens with proven cessation tools? And we thought well, mobile phones may be part of the solution because ask any teen, they are very connected to their phones. In the words of one of our focus group teens, “Texting is my life.” So their phones are really an extension of them and we thought what better way to connect teens who want to quit with proven tools and strategies that really make sense in the context of their everyday lives.
Balintfy: Dr. Hunt, do you have a feel of how many teens have mobile phones?
Hunt: Yeah. We actually have some great data from the Pew Internet Project or the Pew Research Center has given us some data that shows that 75% of teens between the ages of 12 and 17 own a cell phone; and we also know that the typical American teen uses that cell phone to send about 50 texts per day. A sizable proportion of teens actually send double or more that amount of texts per day.
Balintfy: So there is a new program for helping teens quit smoking with text message on a mobile phone. How does that work?
Hunt: What we do is for teens who are interested in quitting can sign up to receive daily step-by-step coaching on their cell phones to help them quit smoking. They'll receive automated messages timed around to their quit day so they'll be able to select a day that they would like to quit. They'll receive messages that include teen-oriented advice, encouragement, and specific concrete strategies for quitting that will come directly to their phone; and that will continue for about six weeks so that even beyond those first couple of weeks of quitting, they're getting the additional support that they need to stay quit.
And teens can reach out to us as well. So although we provide them with daily support, if they have a need that occurs in real time, for example a strong craving that they'd like a little extra support for, they can text us a keyword and they will receive a tip or a strategy or a message that's really tailored to whatever that immediate need is that they're experiencing.
Balintfy: It sounds like this is using a combination of technology, language and support. Dr. Hunt is there also research to back this?
Hunt: Yeah. There's certainly an emerging evidence base among adults with this approach. The evidence for text messaging changing behavior among teens is less clear at this point. It's still somewhat of an untested approach but there's every reason to believe given the engagement that teens already have with their mobile phones that this could have immense potential to change behavior.
Balintfy: So if I’m a teen or know a teen, where do I go to get this information or sign up for this program?
Hunt: Well, there are two ways to sign up. Teens can go online to our website, which is teen.smokefree.gov, and on that website they'll see a place to enroll in the SmokefreeTXT program. If teens want to enroll on the go using their mobile phone, they can also text QUIT to the short code iQUIT which is 47848.
Balintfy: Thanks to Dr. Yvonne Hunt at the National Cancer Institute here at NIH. Again the website is teen.smokefree.gov or text QUIT to the short code: iQUIT or 47848. To learn more about the dangers of smoking and the latest research on smoking cessation and cancer prevention, visit www.cancer.gov.
Balintfy: And that’s it for this episode of NIH Research Radio. Please join us again on Friday, January 27th when our next edition will be available. In that episode:
I like “eating plan” better than “diet” because really this is a change for life. It’s how you eat.
If you have any questions or comments about this program, or have story suggestions for a future episode, please let me know. Send an email to NIHRadio@mail.nih.gov. Also, please consider following NIH Radio via Twitter @NIHRadio, or on Facebook. Until next time, I'm your host, Joe Balintfy. Thanks for listening.
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