Sexual abuse in childhood increases the chances of high-risk pregnancy, shows a new study conducted by Prof. Rachel Lev-Wiesel, Head of the Graduate School of Creative Arts Therapies at the University of Haifa, Lee Yampolsky and Dr. Tzachi Ben Zion, Deputy Director of Soroka Hospital. “Even when a woman willingly and happily commences a pregnancy, it seems that the body relates the sexual act that created the pregnancy with the abuse trauma, evoking negative feelings which can then be expressed in physical and gynecological problems,” Prof. Lev-Wiesel explains.

The current study examined the possibility of sexual abuse experienced in childhood triggering retraumatization during wanted pregnancy. A group of 1,830 pregnant women participating in the study were divided into high- and low-risk groups, which were further divided into three subgroups: those who were victims of child sexual abuse, those who experienced other types of trauma in childhood, and those who had experienced no notable trauma. Compared with women who had not endured any notable trauma before, those who had been sexually abused in childhood, the study shows, suffered higher levels of depression and more post-traumatic symptoms.

According to Prof. Lev-Wiesel, the main post-traumatic symptoms that these women reported were detachment and avoidance. The study also found that the more severe the child sexual abuse, the stronger the correlation between the PTS symptoms and poor physical health during pregnancy. “Gynecological problems might be the body’s manifestation of the child sexual abuse trauma,” Prof. Lev-Wiesel explains.

“The current study’s findings have important practical implications for health care providers, practitioners and obstetrical gynecologists. There is a need to to recognize and address the psychological state of pregnant child sexual abuse survivors,” Prof. Lev-Wiesel says. “It is also important to remember that since the screening process itself may serve as a trigger to retraumatization, a specially trained team should provide a safe environment and psychological assistance.”

As all parents know, children often want to do exactly what their parents don’t want them to do. In three areas that children often consider parts of their personal domain – clothing, friendship, and leisure activities – having a degree of choice over decisions is important for children’s sense of identity and mental health. A new study that considered connections between control over issues within children’s personal domain, identity, and emotional well-being has found that children make important distinctions between different kinds of rules.

The study was carried out by researchers at the University of California, Davis, the University of Illinois, Chicago, and Brock University in Ontario, Canada. It is published in the March/April 2010 issue of the journal Child Development.

The researchers looked at the beliefs of 60 4- to 7-year-olds about how child characters in role-playing situations would act and feel when a parent forbids them from engaging in a desired activity. At times, the parent’s rule intruded on the child’s personal domain (as in, you shouldn’t play with a particular friend, take part in a certain activity, or wear certain clothes), while in others, the parent’s rule fell within the moral domain (as in, you shouldn’t hit or steal).

From ages 4 to 7, children’s predictions that the characters would comply with moral rules (such as prohibitions against stealing) and feel good about doing so rose significantly, suggesting that between these ages, children become increasingly aware of the limits to legitimate disobedience. In stark contrast, children of all ages predicted that the characters would frequently break parents’ rules when those rules intruded on the personal domain and that this disobedience would feel good, particularly when the desired activities were described as essential to the character’s sense of identity.

“The findings suggest that children make important distinctions between different kinds of rules when reasoning about decisions and emotions,” notes Kristin Hansen Lagattuta, associate professor of psychology and the Center for Mind and Brain at the University of California, Davis, who led the study. Previous research has shown that “although the particulars of what gets defined as the personal domain can vary across cultural settings, the establishment of a zone of personal choice and privacy appears to be culturally universal,” she adds.

“These results have practical implications for parents and educators,” Lagattuta suggests. “Foremost, they argue for balance in promoting morality in young children – not only restricting actions that they shouldn’t do, but helping them identify situations where they can assert personal control.”

Northwestern University researchers have found that even before infants begin to speak, words play an important role in their cognition. For 3-month-old infants, words influence performance in a cognitive task in a way that goes beyond the influence of other kinds of sounds, including musical tones.

The research by Alissa Ferry, Susan Hespos and Sandra Waxman in the psychology department in the Weinberg College of Arts and Sciences, will appear in the March/April edition of the journal Child Development. In the study, infants who heard words provided evidence of categorization, while infants who heard tone sequences did not.

Three-month-old infants were shown a series of pictures of fish that were paired with words or beeps. Infants in the word group were told, for example, “Look at the toma!” – a made-up word for fish, as they viewed each picture. Other infants heard a series of beeps carefully matched to the labeling phrases for tone and duration. Then infants were shown a picture of a new fish and a dinosaur side-by-side as the researchers measured how long they looked at each picture. If the infants formed the category, they would look longer at one picture than the other.

The results, say the authors, were striking. The researchers found that although infants who heard in the word and tone groups saw exactly the same pictures for exactly the same amount of time, those who heard words formed the category fish; those who heard tones did not.

“For infants as young as three months of age, words exert a special influence that supports the ability to form a category,” said Hespos, associate professor of psychology and one of the authors of the study. These findings offer the earliest evidence to date for a link between words and object categories.”

Participants included 46 healthy, full-term infants, from 2 to 4 months of age. Half of the infants within each age bracket were randomly assigned to the word group. All infants in the language group were from families where English was the predominant language spoken in the home. The remaining infants were in the tone group.

“We suspect that human speech, and perhaps especially infant-directed speech, engenders in young infants a kind of attention to the surrounding objects that promotes categorization,” said Waxman, a co-author and professor of psychology. “We proposed that over time, this general attentional effect would become more refined, as infants begin to cull individual words from fluent speech, to distinguish among individual words and kinds of words, and to map those words to meaning.”

The quality of the relationship between children and their parents is important to children’s development, but past research on the link between attachment and development has been inconsistent. Now a new analysis concludes that children, especially boys, who are insecurely attached to their mothers in the early years have more behavior problems later in childhood.

The meta-analysis of 69 studies involving almost 6,000 children ages 12 and younger was conducted by researchers at the University of Reading (in the United Kingdom), the University of Leiden (in the Netherlands), the Barnet, Enfield & Haringey Mental Health National Health Service Trust (also in the U.K.), and the University of Illinois at Urbana-Champaign. It is published in the March/April 2010 issue of the journal Child Development.

According to attachment theory, children with secure attachments have repeated experiences with caregivers who are responsive to their needs and thus expect their caregivers to be available and comforting when called upon. In contrast, children with insecure attachments have experiences in which requests are discouraged, rejected, or responded to inconsistently, which is thought to make them vulnerable to developing behavioral problems.

The researchers sought to clarify the extent to which bonds between children and their moms early in life affect children’s later behavioral problems, such as aggression or hostility; behavior problems were measured up to age 12. The studies included in their review used a range of methods for assessing children’s behavior problems, including parent and teacher questionnaires and direct observations.

“The results suggest that the effects of attachment are reliable and relatively persistent over time,” notes Pasco Fearon, associate professor of psychology at the University of Reading, who was the study’s lead author. “More specifically, children who seem unable to maintain a coherent strategy for coping with separation are at greatest risk for later behavior problems and aggression.”

Children with brain injuries may use gesture to signal they need help in developing language, research at the University of Chicago shows. The children who make the fewest gestures early in development also develop spoken vocabulary more slowly.

A research team studied 11 children with brain lesions, areas of damaged tissue, to determine the relationship between gesture and language development. They compared the children’s development to language development in 53 children without brain injuries.

Researchers found that eight of the 11 children with brain injuries had vocabulary development below the 25th percentile at 18 months, but only five of the children still had delayed language development four months later.

“The striking result of our study is that these five children with language delays were the same five who were low gesture producers at 18 months,” said Susan Goldin-Meadow, the Beardsley Ruml Distinguished Service Professor in Psychology and an expert on gesture.

“Thus early gesture may provide clinicians with a way to identify children who may end up having persistent language difficulties, even before those difficulties appear in the children’s speech,” she added. “Our results also raise the possibility that encouraging children with brain lesions to gesture may prove an effective intervention to prevent language delay.”

Goldin-Meadow is an author of the paper, “Early Gesture Predicts Language Delay in Children with Pre- or Perinatal Brain Lesions,” published in the March issue of Child Development, along with lead author Eve Sauer, a University researcher, and Susan Levine, the Stella M. Rowley Professor in Psychology.

The team studied 11 children from age 18 months to 30 months. All of the children had suffered brain injuries prenatally or during birth.

The children were observed in their homes three times a year for 90 minutes while they interacted with their primary caregivers in normal, everyday activities. Researchers tape-recorded the interactions, which included children’s gestures and their speech.

Although as a group the children with lesions produced as many gestures as the typically developing children, “there was a great deal of variability within the group of children with pre- and perinatal brain lesions,” Sauer said. Of the 11 children in the sample, five were found to be using many fewer gestures.

“At 18 months, it was not possible to reliably distinguish the two groups on the basis of their speech use, only their gesture use,” Levine said. The five children who used fewer gestures later had delayed language development, she said.

Other research, including work by Goldin-Meadow, has shown a strong relationship between gesture and language development in children without brain injuries. The new research shows that this relationship also exists in children with early brain lesions.

Gesture reflects the speed at which children develop language, but gesture may play a role in speeding up language development, Goldin-Meadow said. For example, parents may respond to a child’s pointing at an object by providing a label for the object. This would give the child just the right linguistic input at just the right moment.

Extreme obesity is affecting more children at younger ages, with 12 percent of black teenage girls, 11.2 percent of Hispanic teenage boys, 7.3 percent of boys and 5.5 percent of girls now classified as extremely obese, according to a Kaiser Permanente study of 710,949 children and teens that appears online in the Journal of Pediatrics.

This is the first study to provide a snapshot of the prevalence of extreme obesity in a contemporary cohort of children ages 2 – 19 years from a large racially and ethnically diverse population using the recent 2009 U.S. Centers for Disease Control and Prevention extreme obesity definition. Previous research was based on recent National Health and Nutrition Examination Survey (NHANES) data and included information on obesity but not extreme obesity.

“Children who are extremely obese may continue to be extremely obese as adults, and all the health problems associated with obesity are in these children’s futures. Without major lifestyle changes, these kids face a 10 to 20 years shorter life span and will develop health problems in their twenties that we typically see in 40 – 60 year olds,” said study lead author Corinna Koebnick, PhD, a research scientist at the Kaiser Permanente Southern California’s Department of Research and Evaluation in Pasadena, Calif. “For example, children who are extremely obese are at higher risk for heart disease, type 2 diabetes, fatty liver disease and joint problems, just to name a few.”

Researchers used measured height and weight in electronic health records to conduct a cross-sectional study of 710,949 children ages 2 – 19 years in the Kaiser Permanente Southern California integrated health plan in 2007 and 2008. Children in the study had an average of 2.6 medical visits per year where height and weight were measured.

The study found that 7.3 percent of boys and 5.5 percent of girls were extremely obese, translating into more than 45,000 extremely obese children in this cohort. The percentage of extreme obesity peaked at 10 years in boys and at 12 years in girls. The heaviest children were black teenage girls and Hispanic boys. The percentage of extreme obesity was lowest in Asian-Pacific Islanders and non-Hispanic white children.

According to the recent CDC recommendations, extreme obesity is defined as more than 1.2 times the 95th percentile, or a body mass index (BMI) of more than 35 kilograms/meter squared. Obesity is defined as more than the 95th percentile or a BMI of more than 30 kg/m(2). Overweight is defined as more than the 85th percentile or a BMI of more than 25 kg/m(2). The BMI is a reliable indicator of body fatness and calculated based on height and weight. For children, BMI percentiles are the most commonly used indicator to assess the size and growth patterns of individual children. The percentile indicates the relative position of the child’s BMI number among children of the same sex and age.

“Our focus and concern is all about health and not about appearance. Children who are morbidly obese can do anything they want — they can be judges, lawyers, doctors — but the one thing they cannot be is healthy,” said study co-author Amy Porter, MD, a Kaiser Permanente Baldwin Park pediatrician who leads the Pediatric Weight Management Initiative for Kaiser Permanente’s Southern California Region.

“The most important advice to parents of extremely obese children is that this has to be addressed as a family issue. There is rarely one extremely obese kid in a house where everyone else is extremely healthy. It’s important that everyone in the family is invested in achieving a healthier lifestyle,” Porter said.

“This publication is only the beginning. Now we are trying to quantify the health risks and long-term effects associated with extreme obesity, determine which groups are affected most, and develop strategies for population care management to reduce these health risks. Children’s health is important and we have a long way to go,” Koebnick said.
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Getting children involved in finding ways to become more physically active can not only make them more aware of local recreational opportunities, but can even help increase their own physical activity.

That’s the result of a study examining the role of seven national parks in contributing to the health of today’s youth. The study was conducted by researchers from a variety of disciplines at North Carolina State University and other U.S. universities and funded by the National Park Service.

The researchers developed pilot programs aimed at increasing the awareness of health benefits from participating in recreational activities at national parks and increasing physical activity by park visitors.

Dr. Myron Floyd, professor of parks, recreation and tourism management at NC State, specifically examined the use of Cuyahoga Valley National Park in Ohio by studying area middle-school students.

“We decided early on that engaging the community in activities the park had to offer would be crucial in developing this pilot program,” Floyd said. “We had local 6th and 7th graders actually create the tagline to promote the program: Get Up, Get Out and Go!. The students also helped us determine what types of activities would get them interested enough to head out to the park.”

The program comprised a series of events at Cuyahoga Valley National Park that began with a kickoff event, featured weekly activities such as scavenger hunts and fishing lessons, and concluded with a festival. Advertisements of the program and its events – designed by the students themselves – were placed in local papers, on bus boards and at health fairs.

Floyd’s team compared awareness levels before and after the program and found out that the Get Up, Get Out and Go! worked. The study showed a significant increase in the level of awareness of Cuyahoga Valley National Park and its different offerings – 31 percent before the program was implemented versus 65 percent after the program – among the targeted youth population, with a reported increase in the percentage of participants who intended to visit a national park in the future – 18 percent before the program versus 51 percent after the program. Researchers also reported evidence of an increase in physical activity that was associated with the program’s activities.

“This study was important because it showed that engaging kids early on in the program planning process was important. A lot of the ideas we had for park activities, we quickly found out were not of interest to the children,” Floyd said. “It is imperative that we engage children in finding solutions that get them to be more physically active – whatever environment that may be in.”

R-rated movies portray violence and other behaviors deemed inappropriate for children under 17 year of age. A new study finds one more reason why parents should not let their kids watch those movies: adolescents who watch R-rated movies are more likely to try alcohol at a young age.

Published in the March issue of Prevention Science, a scientific journal of the Society for Prevention Research, the study of 6,255 children examined the relationship between watching R-rated movies and the probability of alcohol use across different levels of “sensation seeking,” which is a tendency to seek out risky experiences. The study was funded by the National Institute on Alcohol Abuse and Alcoholism and conducted by James D. Sargent, MD, a pediatrician at Dartmouth Medical School. The children were surveyed every 8 months for a period of two years from 2003 through 2005.

“The study found that watching R-rated movies affected the level of sensation seeking among adolescents. It showed that R-rated movies not only contain scenes of alcohol use that prompt adolescents to drink, they also jack up the sensation seeking tendency, which makes adolescents more prone to engage in all sorts of risky behaviors” Sargent said.

“There is another take home point in the findings. When it comes to the direct effect on alcohol use, the influence of R-rated movies depends on sensation seeking level. High sensation seekers are already at high risk for use of alcohol, and watching a lot of R-rated movies raises their risk only a little. But for low sensation seekers, R-rated movies make a big difference. In fact, exposure to R-rated movies can make a low sensation seeking adolescent drink like a high sensation seeking adolescent.” Sargent explained.

The Dartmouth pediatrician said that one possible explanation is high sensation seeking adolescents tend to get their experiences out on the street. They hang around other high sensation seekers, who are also engaging in risky behaviors, so there is less room for movies to make a difference in their risk for alcohol use.

R-rated movies and alcohol

“The message to parents is clear. Take the movie ratings literally. Under 17 should not be permitted to see R-rated movies,” Sargent said.

The study was based on telephone surveys of 6,522 adolescents aged 10-14 years. Parental consent and adolescent consent was obtained prior to interviewing each respondent. To protect confidentiality, adolescents indicated their answers to sensitive questions by pressing numbers on the telephone, rather than speaking aloud. The study sample mirrored the U.S. adolescent population with respect to age, sex, household income and census region, but with a slightly higher percentage of Hispanics and a slightly lower percentage of Blacks.

Sensation seeking was based on how individual subjects identified with statements like: “I like to do scary things, I like to do dangerous things, I often think there is nothing to do, and I like to listen to loud music.” Adolescents were also asked if they had ever tried alcohol that their parents were not aware of. This excluded adolescents who initiated drinking with sips of alcohol provided by parents. R-rated movie watching was measured by asking respondents if they had watched a random selection of movie titles drawn from box office hits during 2003 that had grossed at least $15 million. The movie titles included movies that had G (general audience), P/G (parental guidance) and R (restricted) ratings.

Researchers at UC Irvine and the Charles Drew University of Medicine & Science (CDU) will monitor the day-to-day health of low-birth-weight babies and their parents as part of a comprehensive initiative designed to combat chronic illnesses associated with low-weight births.

Gillian Hayes, UCI informatics professor, and Karen Cheng, CDU psychiatry & human behavior professor, were awarded a $480,000 grant from the Robert Wood Johnson Foundation (RWJF) to explore how recorded observations of daily living (ODLs) can be used to improve clinical care for low-weight babies.

Hayes and Cheng were among five research teams in the nation selected by RWJF through its Project HealthDesign: Rethinking the Power and Potential of Personal Health Records national program to receive two-year grants that will test how health information technology can help people become more informed patients and better healthcare consumers. The grantees will work with patients to explore how day-to-day information – such as stress levels of caregivers of premature infants and medication-taking routines of seniors at risk of cognitive decline – can be collected, interpreted and acted upon by patients as well as clinicians in real-world clinical settings.

For their project, Hayes and Cheng will use mobile technology to collect and report ODLs that can enable changes in clinical practices and alert healthcare providers earlier to potential problems. The team will develop a mobile application for parents of preterm infants, called FitBaby, which builds on Hayes’ past work with Dr. Dan Cooper, a UCI professor of pediatrics. The system enables parents to easily record ODLs on smartphones, including feeding times, weight measurements, baby’s activity and how parents deal with the stress of caring for an at-risk infant. The system also automatically tracks some observations through sensors in the environment.

“This work is particularly innovative in that we make it convenient for parents to record daily information about their babies by automatically sensing a number of important indicators,” Hayes said. “Pediatricians will have access to the information to make earlier diagnoses, which can improve the health outcomes of babies and caregivers.”

“Parent well-being is often ignored in infant care,” Cheng said. “By helping parents monitor and understand the patterns of their own emotional and physical well-being, we believe that parents will be encouraged to take better care for themselves, leading to better quality of care for the babies.”

Earlier Project HealthDesign work revealed that the data needed to inform day-to-day health decisions came less often from information contained in official medical records and more from information gained by monitoring health in everyday life. The new projects will build on that work.

“We know patients want better relationships with their clinicians and to make the most of their time during a doctor’s visit. Through Project HealthDesign, the patients and the clinicians will be working together to collect and interpret insights from the patient’s everyday life. This process will help empower people to be more informed patients and allow clinicians to determine if their care plan is working,” said Stephen Downs, S.M., assistant vice president for RWJF’s Health Group.

Since its launch in 2006, RWJF has committed $9.5 million in grants and technical assistance to the program, led by a team of experts working in health information technology and patient-centered care at the University of Wisconsin-Madison. Project HealthDesign is supported by RWJF’s Pioneer Portfolio, which funds innovative ideas and projects that can lead to significant breakthroughs in the future of health and health care.

In addition, the program provides legal and regulatory compliance support to grantees and contributes to the public discourse on the legal and regulatory aspects of capturing ODLs and integrating them into care processes. The program will develop resources around the cross-cutting issues regarding use and safe integrations of ODLs as well as specifically advise grantee teams on applicable law and regulations that may alter the consequences of data-sharing between patients and clinicians.

Hayes’ research interests are in human-computer interaction and ubiquitous computing. She studies record-keeping technologies, particularly in natural settings, such as the home. She also focuses on the application and uses of ubiquitous computing and collaborative technologies in the areas of education and healthcare.

Cheng is a social psychologist whose research focuses on the issues affecting use of computer technology in healthcare settings. Her work evaluates the efficacy of electronic versus paper-based data collection, and the acceptance of mobile health technologies among underserved populations, locally and in developing countries.

New research published in the March/April issue of the American Journal of Health Promotion shows that teens drinking 100 percent fruit juice have more nutritious diets overall compared to non-consumers.

According to the findings, adolescents ages 12-18 that drank any amount of 100 percent juice had lower intakes of total dietary fat and saturated fat and higher intakes of key nutrients, including Vitamins C and B6, folate, potassium and iron. Those who drank greater than six ounces of 100 percent juice a day also consumed more whole fruit and fewer added fats and sugars. Milk consumption was not affected by juice intake.

In addition, the study found no association between 100 percent fruit juice consumption and weight status in the nearly 4,000 adolescents examined – even among those who consumed the most juice.

According to the study’s lead researcher, Dr. Theresa Nicklas of the USDA/ARS Children’s Nutrition Research Center at Baylor College of Medicine, encouraging consumption of nutrient-rich foods and beverages such as 100 percent juice is particularly critical during adolescence – a unique period of higher nutrient demands.

“One hundred percent juice is a smart choice,” Nicklas said. “It provides important nutrients that growing teens need and the research consistently shows that drinking fruit juice is not linked to being overweight.”