April 2007
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:: Archives :: Publications :: News Room :: Research :: PDF Version Research Screening teens for drugs, In his own words James Mandell, MD, Gratitudes This month's scoop |
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Research
Screening teens for substance abuse
In confidential surveys, 40 percent of 12th graders report having used an illicit drug within the past year. Yet despite health care guidelines, fewer than half of primary-care pediatricians screen adolescents for substance abuse annually. Two studies from Children's Hospital Boston's Center for Adolescent Substance Abuse Research highlight the difficulties in identifying teen substance abuse.Shari Van Hook, MPH, John Knight, MD, and colleagues conducted focus groups with 38 pediatric doctors and nurses at six primary-care sites. Their report, published in the online Journal of Adolescent Health in February, identified six main barriers to substance abuse screening: lack of time, lack of training to deal with positive results, lack of familiarity with screening tools, parents' refusal to leave the room for a confidential doctor-patient discussion, other conditions competing for medical attention and lack of resources to treat substance abuse problems.
Some policymakers—as well as test manufacturers—are pushing for random school- and home-based drug testing as a way of detecting or deterring teen substance abuse. But a study in the April Pediatrics, led by Sharon Levy, MD, MPH, found that drug testing carries a substantial risk for error, even when performed as part of an established adolescent substance abuse program.
The researchers reviewed 710 random urine drug tests and compared the results with confirmatory laboratory tests. (All the teens had agreed to random testing as part of their treatment.) Overall, 12 percent of the random tests had results that were subject to misinterpretation. Of 480 negative tests, 8 percent were from urine samples that were too dilute to reliably interpret, despite being collected under controlled conditions. Of 217 positive test results, 21 percent were thought to indicate illicit drugs but turned out to reflect prescribed or over-the-counter medications. Finally, of the samples confirmed positive for oxycontin use, two thirds had initially tested negative.
Two-pronged protection against melanoma
When it comes to skin cancer, the protein p53 appears doubly protective. It not only guards against cancer-causing DNA damage from the sun, it also kick-starts the tanning process, spurring production of melanin, the pigment that darkens skin."The number one risk factor for melanoma is fair skin that doesn't tan," says David Fisher, MD, PhD, of Children's Hospital Boston and Dana-Farber Cancer Institute, and the study's senior author. "People who tan easily or have dark pigmentation are far less likely to develop the disease."
The researchers found that p53 revs up production of a protein called pro-opiomelanocortin, chemical precursor of the hormone that spurs melanin production. Fisher and colleagues are trying to determine how this finding could be used to prevent melanoma, the fastest-increasing form of cancer in the world, even in people who don't tan well.
Interestingly, p53 also increases production of beta-endorphin, a natural opiate in the body. A desire for more of this feel-good chemical may drive people to spend time in the sun, Fisher speculates.
The research also has implications for skin conditions in which groups of cells begin producing pigment in response to repeated stress or irritation of the skin, mimicking the tanning response, but unrelated to sun exposure. The resulting darks spots aren't harmful, but can be a cosmetic problem.
The study appears in the March 9 issue of Cell. Its lead author is Rutao Cui, MD, PhD, also of Children's and Dana-Farber.
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