Effects of atomoxetine on attention-deficit/hyperactivity disorder in clinical pediatric treatment settings: a naturalistic study.

BACKGROUND: Observational studies involving atomoxetine hydrochloride in the treatment of attention-deficit/hyperactivity disorder (ADHD) complement randomized controlled trials by assessing treatment effects in a usual-care setting and including a more heterogeneous patient population. OBJECTIVE: To provide data on the effectiveness of atomoxetine in a naturalistic treatment setting according to both physician and parent ratings. DESIGN AND METHODS: A prospective, observational (non-interventional), longitudinal, open-label study of patients (N = 627; mean age = 11 years) with ADHD (from 60 physicians' offices in the United States and Puerto Rico) whose physicians had decided to prescribe atomoxetine either as initial treatment or after trying another ADHD treatment (e.g., stimulants, antidepressants). Patients with a baseline visit and one post-baseline visit for up to 1 year were eligible. Atomoxetine administration, dosing, and timing of follow-up visits were at each physician's discretion. Physicians evaluated the effectiveness of atomoxetine using a single-item rating scale: the Physician Global Impression: ADHD Severity (PGI-ADHD-S) scale. RESULTS: The average reported duration of treatment was 21.2 (range 0-89) weeks. Over this period, treatment significantly lowered ADHD severity compared with baseline, with a mean change of -0.91 (95% confidence interval: -1.00 to -0.82; p < 0.001) on the PGI-ADHD-S scale. Physician-rated improvement was more marked in patients with more severe ADHD at baseline (p < 0.001). Most patients (59-69%) experienced consistent symptom control at all times of the day. ADHD severity was improved similarly in patients across comorbid conditions (e.g., anxiety, depression, learning disorders), chief complaints (e.g., school problems, emotional problems), and prior treatment with stimulants or other medications. By parent reports, 49% of patients had improved grades following atomoxetine therapy while 35% stayed the same, and improvement in behavior (according to parents' ratings) occurred in 49% of patients following atomoxetine therapy, whereas 31% stayed the same. CONCLUSION: Data captured in this study support the conclusion that atomoxetine was effective in reducing symptom severity, and improving progress toward treatment goals, in children and adolescents with ADHD treated in a naturalistic treatment setting. However, given the open-label, observational (non-interventional) design of this study, certain biases cannot be excluded.

Family characteristics and sexual risk behaviors among black men in the United States.

CONTEXT: Past research indicates that family characteristics are associated with sexual risk-taking behaviors in adolescence and adulthood Because the prevalence of sexually transmitted diseases is higher among black males than among males of other races, it is important to understand factors associated with sexual risk in this group. METHODS: Data from 1,125 black men participating in the 1991 National Survey of Men were used in structural equation modeling to examine the association of individual and family characteristics with age at sexual initiation and the lifetime number of sexual partners. RESULTS: Men whose mothers worked were likely to have first intercourse at a younger age than others (beta, -.104), whereas those raised by both parents were likely to delay sexual initiation (.072) and to have fewer partners during their lifetime (-.062). Men who were married or had had first intercourse at an old erage were likely to have a lower total number of partners than others (-.297 and -.369, respectively). CONCLUSIONS: School and community programs should provide culturally appropriate and accessible activities for black youth, and should reach black males early, while they are still in elementary school. Programming targeted at parents mayhelp them learn skills for communicating effectively with children about sexuality-related issues.