AAP PRESS ROOM - JANUARY 2009 MEDIA MAILING

(Please do not reply directly to this e-mail, as you will not receive a response. Contact Debbie Linchesky at dlinchesky@aap.org if you have questions about the contents of this mailing.)

Information in this mailing is embargoed for release: Monday, December 29, 2008 at 12:01 am ET, unless otherwise specified.

PLEASE RESPECT THE EMBARGO DATE.

The Table of Contents (TOC) from the December issue of Pediatrics, the peer-reviewed scientific journal of the American Academy of Pediatrics (AAP), and Pediatrics electronic pages, the Internet extension of Pediatrics. These are available electronically and can be viewed at:

AAP POLICIES AND REPORTS
1. AAP releases 2009 Childhood and Adolescent Immunization Schedule
2. AAP policy statement recommends improved insurance payment and benefit design for adolescent health care

STUDIES
3. Teens who take virginity pledges just as likely to have sex, less likely to use protection
4. Parental knowledge of thirdhand smoke dangers linked to in-home smoking bans
5. Family rejection of gay teens linked to later suicide attempts, depression, drug use and risky sexual behavior
6. Children with asthma more likely to miss school if parent has a chronic disease
7. A return to work after birth hinders breastfeeding success
8. Telemedicine improves rural care, evidence collection in sexual abuse cases
9. Gastric by-pass surgery can reverse type 2 diabetes in extremely obese teens

AAP SPECIAL ARTICLE
10. Article disputes efficacy and safety of alternative vaccine schedule

AAP REVIEW ARTICLE
11. Precautions, gradual return to play recommended after sports concussion

Below are news releases and briefs on articles appearing in the January issue of Pediatrics, the peer-reviewed, scientific journal of the American Academy of Pediatrics (AAP). To receive the full text of these articles, contact the AAP Department of Communications.

Note: Please attribute the source as �the journal, Pediatrics,� when covering information from this mailing.

The new recommended Childhood and Adolescent Immunization Schedule urges an annual influenza vaccine for all children, ages 6 months through age 18, all eligible close contacts of children 0 through age 4, and contacts of children ages 5 through 18 who have an underlying medical condition that predisposes them to influenza complications. The new schedule also includes the dosage schedule for a second oral rotavirus vaccine recently licensed by the Food and Drug Administration. The immunization schedule has been approved by the AAP, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, and the American Academy of Family Physicians.

[ Embargoed until Monday, December 29, at 12:01 am ET. For more information, contact Lorry Rubin, MD, FAAP, at 718-470-3480, or lrubin@lij.edu or Joseph Bocchini, Jr., MD, FAAP, at 318-675-6073, or jbocch@lsuhsc.edu ]

2. AAP POLICY STATEMENT RECOMMENDS IMPROVED INSURANCE PAYMENT AND BENEFIT DESIGN FOR ADOLESCENT HEALTH CARE

A new AAP policy statement recommends improved health plan payment for adolescent preventive, reproductive and behavioral care with optimal benefit design to address the comprehensive health care needs of adolescents. Nearly 14 percent of adolescents are uninsured, and many more underinsured, with 40 percent of adolescent health expenses paid out of pocket. The new policy statement, �Underinsurance of Adolescents: Recommendations for Improved Coverage of Preventive, Reproductive, and Behavioral Health Care Services,� outlines the challenges to optimal health plan coverage for adolescent care including issues related to inadequate payment, uncompensated care for confidential reproductive services, and disproportionate rejection by insurers of certain billing and diagnostic codes. The policy statement lists strategies focusing on the need for insurers to improve coverage of preventive, reproductive and behavioral care.

[ Embargoed until Monday, December 29, at 12:01 am ET. For more information, contact Margaret Blythe, MD, FAAP, at 317-278-7130, or mblythe@iupui.edu or Charles Barone, MD, FAAP, at 313-874-9591 (office), 586-918-8224 (cell), or cbarone1@hfhs.org ]

3. TEENS WHO TAKE VIRGINITY PLEDGES JUST AS LIKELY TO HAVE SEX, LESS LIKELY TO USE PROTECTION

Teens who take virginity pledges are not less sexually active than non-pledgers. However, they are less likely to protect themselves against disease and pregnancy during sex. In a new study, "Patient Teenagers? A Comparison of the Sexual Behavior of Virginity Pledgers and Matched Nonpledgers," researchers analyzed data from the National Longitudinal Study of Adolescent Health on high school students who at the beginning of the study had never had sex or taken a virginity pledge. Students who reported a pledge in the second year of the study were matched with non-pledging students so pledgers and matched non-pledgers did not differ on over 100 pre-pledge characteristics. Five years after pledging, pledgers and matched nonpledgers did not differ in premarital sex, sexually transmitted disease, and anal and oral sex activity. Pledgers had 0.1 fewer past-year partners, but did not differ in the number of lifetime sexual partners and age of first sexual experience. Pledgers were ten percentage points less likely to report using condoms in the past year than matched non-pledgers, and also less likely to report use of any form of birth control. The study authors recommend that clinicians provide birth control information to all adolescents, especially virginity pledgers.

[ Embargoed until Monday, December 29, at 12:01 am ET. For more information, contact Janet E. Rosenbaum, PhD, at 857-453-0348 (between Dec. 22 and 26), or 410-585-1687 (on or after Dec. 29), or jerosenb@jhsph.edu ]

A new study links in-home smoking bans with parental understanding of the negative effects of thirdhand smoke � the residual tobacco contamination that remains after a cigarette is extinguished. In �Beliefs About the Health Effects of Thirdhand Smoke and Home Smoking Bans,� researchers conducted phone surveys of more than 1,500 households to assess the level of agreement with the statements that breathing air in a room today where people smoked yesterday could harm the health of children. Overall, 95.4 percent of nonsmokers versus 84.1 percent of smokers agreed that secondhand smoke harms the health of children, and 65.2 percent of nonsmokers versus 43.3 percent of smokers, that thirdhand smoke harms children. Strict rules prohibiting smoking in the home were more prevalent among nonsmokers � 88.4 percent versus 26.7 percent. Belief that thirdhand smoke harms the health of children was independently associated with rules prohibiting smoking in the home. Health messages about thirdhand smoke contamination should be incorporated into tobacco control campaigns, programs, and routine clinical practice.

[ Embargoed until Monday, December 29, at 12:01 am ET. For more information, contact Jonathan Winickoff, MD, FAAP, at 617-724-1062 (office) or 617-724-5700, ext. 33073 (pager) or jwinickoff@partners.org ]

5. FAMILY REJECTION OF GAY TEENS LINKED TO LATER SUICIDE ATTEMPTS, DEPRESSION, DRUG USE AND RISKY SEXUAL BEHAVIOR

For the first time, a new study directly links family rejection with an increased risk of suicide, depression, drug use, and risky behavior in lesbian, gay and bisexual young adults. In �Family Rejection as a Predictor of Negative Health Outcomes in White and Latino Lesbian, Gay, and Bisexual Youth,� researchers surveyed 224 white and Latino young adults, ages 21 to 25, on nine negative health indicators including mental health, substance abuse and sexual risk. The results showed that young adults who were rejected by their families as teens were 8.4 times more likely to attempt suicide, 5.9 times more likely to report high levels of depression, 3.4 times more likely to use illegal drugs, and 3.4 times more likely to report having engaged in unprotected sexual intercourse compared to their peers who had experienced little or no family rejection. The study authors recommend counseling and early intervention to better educate families on the long-term impact of rejecting a child for sexual orientation or behavior.

[ Embargoed until Monday, December 29, at 12:01 am ET. For more information, contact Caitlin Ryan, PhD, via Cathy Renna at 917-757-6123 or cathy@rennacommunications.com ]

6. CHILDREN WITH ASTHMA MORE LIKELY TO MISS SCHOOL IF PARENT HAS A CHRONIC DISEASE

Compared with other children with asthma, children whose parents have a chronic disease � especially children with more severe asthma -- were more likely to miss school. In the study, �School Absenteeism, Health Status, and Health Care Utilization Among Children With Asthma: Associations With Parental Chronic Disease,� researchers analyzed the 2003 National Health Interview Survey (NHIS) records of children with asthma, ages 5 to 17. The children of a parent with a chronic disease missed an average of 1.3 additional school days each year. In addition, the parents had a more negative perception of their child�s health status. Understanding a child�s health in the context of their parent�s health could help providers to better work with parents to more effectively manage their child�s asthma, and to ensure that the child does not unnecessarily miss school or other activities because of their condition, according to the study authors.

[ Embargoed until Monday, December 29, at 12:01 am ET. For more information, contact Ellen Lipstein, MD, at 617-724-3392, or elipstein@partners.org or Karen Kuhlthau, PhD, at 617-724-2842, or kkuhlthau@partners.org ]

A maternity leave of six weeks or less, or between six and 12 weeks, was associated with a fourfold and twofold higher risk, respectively, of non-established breastfeeding. In �Juggling Work and Breastfeeding: Effects of Maternity Leave and Occupational Characteristics,� researchers examined breastfeeding duration in new mothers � age 18 or older, who gave birth to a single child (all in southern California) without abnormalities -- between July 2002 and December 2003. The study found that women with maternity leaves ending within six weeks of giving birth were three times more likely to stop breastfeeding, compared to women who did not return to work. Women working in inflexible or non-managerial jobs, and those with high psychosocial distress, were at greatest risk of breastfeeding cessation. Maternity leave after delivery but not prior to delivery influenced breastfeeding success. The AAP recommends that babies be breastfed during the first year of life, and for as long as is mutually desired. The study authors recommend that pediatricians encourage women to take maternity leave, and advocate for extended, paid postpartum leave; and more flexibility in working conditions for breastfeeding women.

[ Embargoed until Monday, December 29, at 12:01 am ET. For more information, contact Sylvia Guendelman, PhD, MSW, at 510-642-2848 or sylviag@berkeley.edu ]

Telemedicine � the use of videoconferencing to link physicians and medical experts from one hospital to another � can significantly improve the examination procedure and treatment of child sexual abuse victims, and prevent further abuse, in rural areas. Each year, approximately 900,000 children are victims of child abuse and neglect, and 10 percent of these children are sexually assaulted. In rural areas, where children are often at greater risk of sexual abuse, many hospitals have neither the resources nor expertise to optimally examine and treat these children, putting them at risk of further abuse. In a new study, �Using Telemedicine to Improve the Care Delivered to Sexually Abused Children in Rural, Underserved Hospitals,� researchers linked child abuse experts from a university children�s hospital via teleconference to clinicians at two rural, underserved hospitals. Forty-two live telemedicine consultations were analyzed. In 86 percent of the cases, the consultations resulted in the use of multi-method examination techniques; and in 47 percent of the cases, changes in interview methods. Eighty-nine percent of the acute sexual assault consultations resulted in improved forensic evidence collection. The research supports the feasibility of telemedicine in the care of pediatric sexual abuse and assault cases, according to the study authors.

[ Embargoed until Monday, December 29, at 12:01 am ET. For more information, contact Kristen Rogers, PhD, at 916-734-5647 or kristen.rogers@ucdmc.ucdavis.edu or Kristi MacLeod, at 773-303-7731 ]

Gastric by-pass weight loss surgery can successfully reverse type 2 diabetes in extremely obese adolescents and reduce cardiac and other risk factors, according to a new study. In �Reversal of Type 2 Diabetes Mellitus and Improvements in Cardiovascular Risk Factors After Surgical Weight Loss in Adolescents,� researchers studied the effects of Roux-en Y gastric bypass surgery on 11 extremely obese adolescents (BMI = 50) with type 2 diabetes and numerous cardiovascular risk factors, compared to 67 overweight adolescents with type 2 diabetes receiving non-surgical treatment. In 10 of the 11 patients, the type 2 diabetes had gone into remission within one year of the surgery. The teens who did not receive surgery had stable body weight and no significant reduction in blood pressure or need for diabetic medication use. While the long-term effects and success of gastric bypass surgery are unknown, the study results suggest that surgery is an effective option for the treatment of extremely obese adolescents with type 2 diabetes.

[ Embargoed until Monday, December 29, at 12:01 am ET. For more information, contact Thomas Inge, MD, PhD, FAAP, at 513-636-4371 or thomas.inge@cchmc.org or Stephen Daniels, MD, PhD, FAAP, at 720-777-2766 or daniels.stephen@tchden.org ]

"Dr. Bob�s Alternative Vaccine Schedule," a formula that allegedly allows parents to delay, withhold, separate, or space out vaccines, puts children at risk of vaccine-preventable diseases, according to a new special article. �The Problem With Dr Bob�s Alternative Vaccine Schedule,� reviews the vaccine schedule � which differs from that recommended by the AAP, the American Academy of Family Physicians, and the Centers for Disease Control and Prevention, offered by Dr. Robert Sears in his popular publication, �The Vaccine Book: Making the Right Decision for Your Child.� The article explains the popularity of the book, deconstructs the logic behind its recommendations (most notably that delaying vaccines extends the time that children are vulnerable to disease), and describes how Dr. Sears� misrepresentation of vaccine science misinforms parents who are trying to make the right decision for their child.

[ Embargoed until Monday, December 29, at 12:01 am ET. For more information, contact Paul Offit, MD, FAAP, at 215-590-2020, or offit@email.chop.edu ]

A new review article looks at the common problem of child and adolescent sport concussions, which often go unreported, making these injuries difficult to optimally treat and monitor. �Sport-Related Concussion� recommends a careful and accurate assessment of these injuries, which should be classified as either simple or complex based on the child�s symptoms, which often take days to appear. Optimal management of the concussion requires neurological testing. Neuropsychological testing is idea. Once the child is fully recovered (has no symptoms at play or rest) he or she should gradually return to sports play and continue to be closely monitored. Younger athletes often require a longer recovery time.

[ Embargoed until Monday, December 29, at 12:01 am ET. For more information, contact William Meehan, MD, FAAP, at 617-355-3501 or William.Meehan@childrens.harvard.edu ]

Parents magazine and the American Legacy Foundation launch a special quit plan for moms and dads. Help parents who smoke plan to quit. ParentsQuitForGood.com, powered by Becomeanex.com, offers step-by-step assistance for smokers to identify their own smoking triggers, advice on ways to get through the day without cigarettes and opportunities to connect with other parents trying to quit. The AAP Richmond Center website also offers other resources to help clinicians and parents protect children from tobacco and secondhand smoke: http://www.aap.org/richmondcenter/

The tips can be found in both English and Spanish at: http://www.aap.org/advocacy/releases/jankidstips.cfm

The FAAP designation following a pediatrician’s name stands for Fellow of the American Academy of Pediatrics. Pediatricians with a FAAP designation have obtained board certification in pediatrics and made an ongoing commitment to lifelong learning and advocacy for children.