Pulse
Briefs
A Measure of Hope
Physicians ought to be screening teens about their perceived risk of dying young. That’s one of the take-home messages of a study led by University of Minnesota pediatrician Iris Wagman Borowsky, M.D., Ph.D., that found young people who believe they’ll die prematurely are more likely to engage in risky behaviors.
The researchers looked at interviews with youths done in 1995, 1996, and 2001-2002 as part of the National Longitudinal Study of Adolescent Health, a nationally representative sample of more than 20,000 seventh through 12th graders. One in seven thought they had a 50/50 chance or greater of dying before age 35. That belief was found to predict their engaging in behaviors such as using illicit drugs, having unsafe sex, and fighting. Also, those believing they would die early had over seven times the odds of receiving a diagnosis of HIV/AIDS.
Particularly disturbing to Borowsky were the disparities between groups: 10 percent of white youths thought they were at risk for an early death compared with 25 percent of black and 29 percent of Native American youths. “Encouragingly, most young people are able to change their view over time,” she says. Half of those who said they didn’t expect to live long at their first interview were more optimistic by their second.
Borowsky and her co- authors say doctors need to consider a fatalistic view as a marker for poor health outcomes and that they should screen teens for their beliefs about their life expectancy. She says the best time to do this is during a conversation about their hopes and dreams. When physicians discover a teen with a negative outlook, they should ask additional questions about their home, school, and neighborhood and about whether they are engaging in risky behaviors. Then, they need to assist the youth with finding help.
Borowsky asserts that it’s not only physicians who need to be concerned when a young person says they believe they might die young. “Any adult in the life of a teen should pay attention to this unusually common negative view.”
—Carmen Peota
Doctors’ Work
The American Academy of Pediatrics (AAP) has reaffirmed its position that violence prevention needs to be a top priority for pediatricians, policy it has held since 1999. A statement published in the July issue of Pediatrics noted that homicide remains the second leading cause of death for children ages 1 to 19 years and that the United States leads the industrialized world in youth homicide and suicide rates.
New in the revised statement is a section on bullying that cites research showing that 30 percent of children are either bullied or being bullied. The section also points out how digital devices—cameras and cell phones—and social networking sites are now used in bullying. Also included in the statement is a section on dating violence that calls for physicians to do early anticipatory guidance related to relationship dynamics.
The AAP promotes use of its Connected Kids: Safe, Strong, Secure approach to integrating violence prevention into primary care. Its website, www.aap.org/ConnectedKids/, includes resources on topics such as bullying, discipline, interpersonal skills, parenting, suicide, and television violence. The AAP’s statement is available online at http://pediatrics.aappublications.org/.
Mixed News
Arecent Minnesota Department of Health analysis of data on sexual violence in Minnesota revealed mixed news: Although hospital treatment of injuries related to sexual violence increased in recent years, victimization has decreased or remained constant.
A review of hospital data found that more than 1,500 Minnesotans received care for sexual violence-related injuries in 2007, and between 2002 and 2007, the annual rate of increase was 6 percent, or about 68 additional cases each year.
The vast majority (more than 93 percent) of patients were female. Seventy-six percent of the females and 61 percent of the males were younger than 30 years of age. Rates of victimization in urban areas were up to three times higher than those in rural areas. Nearly all sexual violence patients (98 percent) were treated in emergency departments and released. Those admitted to the hospital for at least one day were 10 times more likely to have been diagnosed with traumatic brain injury (3.24 percent) than those who were treated in the emergency department (0.3 percent) during the study period.
The Minnesota Student Survey, which is administered every three years to 6th, 9th, and 12th graders, showed a decrease in incidents of sexual violence from 8.9 to 6.0 percent between the early 1990s and 2007. The Minnesota Crime Survey shows reports of sexual violence dropping from 1.6 to 0.4 percent among respondents. The Minnesota Uniform Crime Report also shows that reports to law enforcement and arrests for crimes related to sexual violence have remained relatively constant over the last 10 years.
The increase in the number of people being treated for sexual violence-related injuries may be because they are more willing to go to the hospital after an assault and because of better recognition and documentation by hospital staff. The Minnesota Legislature’s 2003 mandate that counties pay for rape exams, regardless of whether victims report the assault to law enforcement, may also be partially responsible for the increase.
Health officials and physicians understand that most sexual violence occurs between people known to each other and that rape and other forms of sexual violence are no longer strictly law enforcement concerns. The medical community is increasingly recognized as being important in the response to and prevention of sexual violence.
—Jon Roesler, M.S., and Christen Glass, Minnesota Department of Health
To read the complete report, go to www.health.state.mn.us/injury/pub/ViolenceDataBrief_2002-2007.pdf.