Nutritional rickets in African American breast-fed infants.

OBJECTIVE: To analyze the characteristics of infants and children diagnosed with nutritional rickets at two medical centers in North Carolina in the 1990s. STUDY DESIGN: The physical and radiographic findings, calcium, phosphorus, alkaline phosphatase, and 25-hydroxyvitamin D levels of infants and children diagnosed with nutritional rickets at two medical centers were reviewed. Breast-feeding data were obtained from the North Carolina Women, Infants and Children Program (WIC). RESULTS: Thirty patients with nutritional rickets were first seen between 1990 and June of 1999. Over half of the cases occurred in 1998 and the first half of 1999. All patients were African American children who were breast fed without receiving supplemental vitamin D. The average duration of breast-feeding was 12.5 months. The age at diagnosis was 5 to 25 months, with a median age of 15.5 months. Growth failure was common: length was <5th percentile in 65% of cases, and weight was <5th percentile in 43%. CONCLUSION: Factors that may have contributed to the increase in referrals of children with nutritional rickets include more African American women breast-feeding, fewer infants receiving vitamin D supplements, and mothers and children exposed to less sunlight. We recommend that all dark-skinned breast-fed infants and children receive vitamin D supplementation.

Gender differences in risk behaviors among adolescents who experience date fighting.

OBJECTIVE: Although dating violence frequently begins during adolescence, few studies have focused on date fighting in middle and high school students. Fewer studies have studied gender differences in date violence. This study examines whether gender-specific patterns of risk behaviors exist among adolescents who report date fighting. DESIGN: The study was conducted on data collected from 21 297 students in grades 8 through 12 participating in the Vermont 1995 Youth Risk Behavior Survey. Data were analyzed on 20 724 students (females = 50.1%) who reported: 1) never having been involved in a physical fight (n = 8737); 2) that their last physical fight was with a girlfriend, boyfriend, or other dating partner (n = 432); and 3) that their last fight was with someone other than a dating partner (n = 11 555). Indicators of violence (weapon carrying, being threatened, and fighting), suicide attempts, substance use, sexual behavior, and pregnancy were analyzed with chi(2) tests. Significant variables were analyzed with stepwise logistic regression. RESULTS: Of the males, 1.8% and of the females, 4.2% reported that their last fight was with a boyfriend, girlfriend, or dating partner. Risk behaviors significantly associated among females who only experienced date fighting included the number of male sexual partners in the past 3 months (adjusted odds ratio: 1. 48; 95% confidence interval: 1.26-1.74), number of suicide attempts in the past 12 months (1.55; 1.30-1.85), riding in a car with a drinking driver (1.23; 1.10-1.37), injection of illegal drugs (2.87; 1.10-7.50), use of alcohol before last sexual encounter (1.53; 1. 27-1.86), number of pregnancies (1.66; 1.26-2.21), forced sex (2.92; 2.18-3.91), and inhalant use (1.19; 1.06-1.34). Risk behaviors significantly associated among males who experienced only date fighting were sexual activity (4.11; 2.24-7.53), number of male partners in the past 3 months (1.40; 1.12-1.75), number of times of getting someone pregnant (1.68; 1.17-2.40), experiencing forced sex (2.38; 1.11-5.13), and the number of times threatened with physical violence in past 12 months (1.82; 1.53-2.17). When compared with adolescents who reported fighting with someone other than a date, risk factors significantly associated with date fighting among females were the number of male sexual partners in the past 3 months (1.21; 1.10-1.34), older age (1.21; 1.10-1.34), carrying a weapon in the past 30 days (.77;.66-.90), experiencing forced sex (1.70; 1. 30-2.22), condom non-use (1.96; 1.60-2.41), and number of times of being threatened with physical violence in past 12 months (1.11; 1. 01-1.22). The risk factors among males were the number of male sexual partners in the past 3 months (1.43; 1.28-1.60), experiencing forced sex (1.91; 1.02-3.60), and older age (1.34; 1.14-1.57). CONCLUSIONS: The patterns of risk behaviors differed among male and female adolescents reporting dating violence. Females who reported date fighting were more likely than were nonfighters to have attempted suicide, to engage in sexual and human immunodeficiency virus risk behaviors (use of injectable drugs), to have been pregnant, experienced forced sex, and to have ridden in a car with a drinking driver. Sexual behaviors, including same-gender sexual partners, forced sex, and having been threatened with physical violence, were associated with date fighting among males. These findings are important in screening adolescents at risk for date violence.date fighting, adolescence, risk behaviors, gender.

The relationship between early age of onset of initial substance use and engaging in multiple health risk behaviors among young adolescents.

BACKGROUND: Previous research based on problem-behavior theory has found that early age of onset of substance use is associated with engaging in multiple health risk behaviors among high school students. It is unknown whether these relationships begin during early adolescence. OBJECTIVE: To examine the relationships between early age of onset of cigarette, alcohol, marijuana, and cocaine use and engaging in multiple risk behaviors among middle school students. METHODS: A modified version of the Centers for Disease Control and Prevention Youth Risk Behavior Survey was administered to 2227 sixth through eighth grade students attending 53 randomly selected middle schools in North Carolina. A Health Risk Behavior Scale was constructed from 16 behaviors, including indicators of violence and weapon carrying; current substance use; nonuse of helmets when biking, in-line skating or skateboarding; not wearing a seat belt; riding with a driver who had been drinking; and suicide plans. Among this sample of middle school students, the scale had a mean (SD) of 4.1 (2.7) (range=O-15), and had a high internal reliability coefficient (alpha(=0.74). The independent variables included first time use of cigarettes, alcohol, marijuana, and cocaine at age 11 years or earlier; actual age of onset of each substance; race and ethnicity; family composition; sex; school grade; academic ranking; and older age for school grade. These data were analyzed with analysis of variance, Spearman r, and multiple linear regression. RESULTS: All the independent variables were found to be associated (P<.005) with the Health Risk Behavior Scale during the bivariate analyses. When each of these significant variables were entered into a multiple regression model, having smoked at age 11 years or younger accounted for 21.9% of the variation in the Health Risk Behavior Scale. Male sex, early marijuana or cocaine use, older age, lower academic rank, white race, and living in a 1-parent family explained an additional 19.1% of variation in the model (adjusted R2=0.41, P<.001). When the actual ages of onset of the use of substances were analyzed, in order of magnitude; age of onset of smoking; male sex; age of onset of alcohol and marijuana use; age; lower academic ranking; age of onset of cocaine use; white race; and lower academic rating accounted for 52.8% (P<.001) of the variation in the Health Risk Behavior Scale. CONCLUSION: Even when considering sociodemographic factors, early age of onset of cigarette use was the strongest correlate of the number of health risk behaviors in which these young adolescents had engaged. Early onset of use of other substances was also associated with a clustering of health risk behaviors among this sample of middle school students. The findings suggest that screening for early experimentation with tobacco and other substance use will help identify young adolescents at increased risk for engaging in multiple health risk behaviors.

Problem dieting behaviors among young adolescents.

OBJECTIVE: To examine dieting, eating and exercise behaviors, use of diet pills, and vomiting or use of laxatives to lose weight among younger adolescents. DESIGN: Analysis of data from a modified version of the Youth Risk Behavior Survey administered to middle school students in North Carolina in 1995. SETTING: Fifty-three randomly selected middle schools in North Carolina. SUBJECTS: Two thousand three hundred thirty-one students in the sixth, seventh, and eighth grades. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Responses to questions regarding weight control practices, including vomiting or laxative use, dieting, exercise, or diet pill use. RESULTS: Of the students surveyed, 110 (9.7%) of the girls and 46 (4.0%) of the boys reported vomiting or using laxatives to lose weight. Among the girls, vomiting or laxative use was associated with feeling overweight, other weight loss practices, older age, being a poor student, smoking, eating more salads or vegetables, and eating more candy or other sweets (P< or =.01). A logistic regression model consisting of diet pill use, dieting to lose weight, lower academic achievement, and currently trying to lose weight correctly classified 92% of female students who had or had not vomited or used laxatives. Among boys, vomiting or laxative use was associated with feeling overweight, other weight loss practices, minority racial status, smoking, frequency of eating hamburgers or other high-fat meats, and frequency of eating french fries or potato chips (P< or =.01). A model consisting of diet pill use, minority race, dieting to lose weight, smoking, feeling overweight, and number of servings of hamburgers, hot dogs, or barbecue correctly classified 97% of the boys who had or had not vomited or used laxatives. CONCLUSION: Younger adolescents trying to lose weight engage in a variety of problem dieting and weight loss behaviors that can compromise health and may be associated with eating disorders.

Morphological and steroidogenic changes in cultured adrenal tumor cells induced by a subunit of cholera enterotoxin.

A purified subunit of the cholera enterotoxin molecule was found to have morphological and steroidogenic inducing effects similar to those induced by the native enterotoxin on monolayer tissue cultures of Y1 adrenal tumor cells, although 1,000 times more subunit than toxin (weight basis) was required for maximal effects. In contrast to the whole toxin, the effects of the active subunit could not be prevented by prior incubation with either Gm1 ganglioside or with antibodies directed against choleragenoid (the binding subunit). These results suggest that different receptor sites may exist on cells for the binding and for the active subunits of cholera enterotoxin and/or that the active toxin fragment may exert its effects after gaining access to the intracellular compartment.