Research update

CrossCurrents

Mark de la Hey

 

Caring and inclusive schools curb student smoking

Schools that promote caring and inclusiveness can significantly reduce the incidence of smoking among students, according to research from the Medical Research Council Social and Public Health Sciences Unit in Glasgow, Scotland. The study looked at 5,092 students, aged 13–16 who attended 24 Scottish schools. Researchers correlated smoking behaviour with indicators of school culture and student satisfaction, such as school size, school affluence, quality of teacher­student relationships, dropout rates and attendance. Overall, smoking was reported by 39 per cent of females and 25 per cent of males, but these rates varied considerably from school to school. Individual socioeconomic and sociocultural factors accounted for only a portion of this variation. To fully account for the variation, the researchers had to look at measures of school culture. It turned out that students were less likely to smoke where schools emphasized caring and inclusiveness rather than purely academics. In addition, rates of smoking were higher when students gave poor ratings to teacher­student relationships and when they had a negative attitude toward the school. Surprisingly, smoking rates for boys were higher in affluent schools with poor teacher­student relation­ships. These results suggest that shifting a school’s culture towards a greater emphasis on caring and inclusiveness and improved teacher­student relationships could have a positive effect on smoking rates.

BMC Public Health, June 20, 2008, v. 8, doi: 10.1186/1471­2458­8­218. Marion Henderson et al., MRC Social and Public Health Sciences Unit, Glasgow, United Kingdom.

 

An active social life may protect against dementia

People with active social lives later in life are less likely to develop dementia, according to research from Kaiser Permanente Southern California in Pasadena. Researchers recruited 2,249 women age 78 or older and followed them for four years. At recruitment all participants were free of dementia. Data on cognitive status and social networks were collected through annual telephone interviews and medical record reviews. During the study 268 participants developed dementia. Participants with larger social networks were 26 per cent less likely than those with smaller social networks to develop dementia. Participants who had daily contact with their social network were 43 per cent less likely to develop dementia. The researchers suggest several possible explanations: Social networks may help to prevent brain pathology by facilitating access to health care and encouraging healthy behaviours. Another possibility is that social engagement may reduce stress and depression. Future research will be needed to determine whether it is possible to improve the prospects of relatively isolated individuals through the creation of synthetic social networks. Further study is also required to determine precisely which aspects of social networks help to reduce dementia risk.

American Journal of Public Health, July 2008, v. 98: 1221–1227. Valerie C. Crooks et al., Department of Research and Education, Kaiser Permanente Southern California, Pasadena, California.

 

Early detection limits long-term impact of schizophrenia

People with schizophrenia often experience negative symptoms such as social isolation, apathy, emotional flattening and decreased attention to personal hygiene. A new study from Ulleval University in Oslo, Norway, has found that early detection of psychosis can help to prevent the onset of negative symptoms and improve functioning in people who ultimately develop schizophrenia. The study followed 231 individuals for two years after a first episode of psychosis, 118 of whom lived in an area that had an early detection (ED) system and 113 who lived in an area that did not have an ED system. The ED system included public information campaigns about psychotic symptoms and their treatment, as well as special teams whose task was to detect low-threshold psychosis. Participants in both groups received comparable treatment over the two years of the study. At the beginning of the study, researchers found that participants who were treated in the ED area had a lower average duration of untreated psychosis (5 weeks, compared with 16 weeks for those in the non-ED area), better clinical status and milder negative symptoms. At the one- and two-year follow-ups, the ED group maintained its advantage in terms of negative symptoms and continued to display better functional and social outcomes. Given that the ED group had no advantage in terms of treatment, the researchers conclude that this difference may be due to the fact that early detection reduces the duration of untreated psychosis and therefore helps to prevent symptoms from significantly worsening. These findings are particularly significant given the limited effectiveness of current treatments for schizophrenia with respect to negative symptoms.

Archives of General Psychiatry, June 2008, v. 65: 634–640. Ingrid Melle et al., Division of Psychiatry, Ulleval University Hospital, Oslo, Norway.

 

Bipolar disorder increases risk of substance abuse in teens

Bipolar disorder significantly increases the risk of substance abuse among adolescents, according to research from Massachusetts General Hospital in Boston. Researchers interviewed 203 adolescents with an average age of just under 14. Of these, 105 had a diagnosis of bipolar disorder, while 98 controls were free of the disorder. After adjusting for age, it was found that 34 per cent of participants with bipolar disorder had a substance use disorder (SUD), compared with only four per cent of controls. Study participants with bipolar disorder were almost nine times more likely than controls to have any SUD, almost eight times as likely to report alcohol abuse, 19 times as likely to report other drug abuse, 12 times as likely to report drug dependence and 12 times as likely to smoke cigarettes. None of the controls had both alcohol and other drug use problems compared with 14 per cent of participants with bipolar disorder. The increased risk of cigarette smoking and SUD among those with bipolar disorder was found to be independent of the presence of conduct disorder, attention deficit/hyperactive disorder or anxiety disorders. The authors speculate that the poor judgment, limited self-control and lack of inhibition typical of bipolar disorder make adolescents with the disorder particularly vulnerable to the development of a SUD. Adolescents with bipolar disorder may use alcohol and other drugs to medicate their irritable mood, aggressive tendencies and “affective storms.” The authors recommend that adolescents with bipolar disorder be carefully screened for cigarette smoking and substance use.

Drug and Alcohol Dependence, June 1, 2008, v. 95: 188–198. Timothy E. Wilens et al., Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston, Massachusetts.

 

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