Cardiovascular disease risk factors in adolescents: do negative emotions and hypothalamic-pituitary-adrenal axis function play a role?

PURPOSE OF REVIEW: Negative emotions such as depression and hostility/anger are important risk factors for cardiovascular disease in adults, but are often neglected in treatment or prevention programs. Adolescence is a stage of life when negative emotions often first become problematic and is also a time when the pathogenesis of cardiovascular disease appears to accelerate. The literature on negative emotions and cardiovascular disease risk factors in adolescents is reviewed here. RECENT FINDINGS: Research indicates that negative emotions are associated with cardiovascular disease risk factors in adolescence. Negative emotions are also associated with several types of hypothalamic-pituitary-adrenal axis dysregulation. Such dysregulation appears to have a facilitatory effect on cardiovascular disease development and progression in adults. Thus, it is possible that negative emotions in adolescents may be risk factors for the development of cardiovascular disease via dysregulation of the hypothalamic-pituitary-adrenal axis. Although this hypothesis has not been directly tested, some studies indirectly support the hypothesis. SUMMARY: Negative emotions are associated with cardiovascular disease risk factors in adolescents; it is possible that hypothalamic-pituitary-adrenal axis dysregulation is an important mechanism. This hypothesis merits further research. If the hypothesis is valid, it has significant implications for early prevention of cardiovascular disease.     

Adolescents and sports: risk or benefit?

In order to begin to compensate for a lack of data on the effects of athletic participation in the development of adolescent mental health patterns, as well as to assess general health of the adolescent population, the Juvenile Wellness and Health Inventory (JWHS-76) was administered to 1,769 high school students. Our results indicate that sports participation is associated with self-reported lower total risk scores, mental and physical health benefits, and an increased risk of injury. This suggests a positive role for organized sports participation in youth populations. Prospective studies are needed to assess the impact of different sports, mounting performance pressure, and transition into collegiate levels of participation.     

Anabolic steroid education and adolescents: do scare tactics work?

The opinions (level of agreement) of high school varsity football players with regard to reported effects of anabolic steroids were assessed before and after two different education interventions. Lectures and handouts of a balanced education program (potential risks and benefits) were compared with a risks-only (negative or "scare tactics") presentation, in a controlled manner. Those receiving the balanced review significantly increased their agreement with 5 of 10 targeted adverse effects, while no change occurred for any risks among those taught by the negative intervention. A teaching model that only emphasizes the untoward consequences of anabolic steroids is ineffective, even in the short-term. A balanced education approach can improve understanding of the potential adverse effects of these drugs. Additional strategies may be required to change young athletes' attitudes toward anabolic androgenic steroid use.     

Do protective factors reduce the risk of hospitalization in infants of teenaged mothers?

OBJECTIVE: To determine the risk of hospitalization associated with prenatal care use and indicators of socioeconomic status and social support among infants of teenage mothers. DESIGN: Population-based case-control study. SETTING: Nonfederal hospitals in Washington State. PARTICIPANTS: Infants born from 1987 to 1995 to mothers younger than 20 years were identified using linked birth certificate-state hospital discharge data. Cases consisted of 8052 infants who were hospitalized during the first year of life at least 2 days after birth hospitalization discharge. An equal number of controls, frequency matched on birth year and maternal age group, were randomly sampled from among nonhospitalized infants. MAIN OUTCOME MEASURE: Hospitalization in the first year of life. RESULTS: Infants with a father listed on the birth certificate or whose mothers had commercial health insurance had a decreased risk of hospitalization (adjusted odds ratios, 0.91 and 0.78, respectively; 95% confidence intervals, 0.83-0.99 and 0.71-0.85, respectively). Participation in state-funded pregnancy programs, adequacy of prenatal care, or marital status did not affect the risk of hospitalization, except among infants whose mothers received more than adequate prenatal care (adjusted odds ratio, 1.15; 95% confidence interval, 1.03-1.29). CONCLUSION: Our results suggest that teenaged mothers who list a father on the birth certificate or who have insurance, indicative of higher socioeconomic status, may have a reduced risk of hospitalization for their infants. Teenaged mothers who receive more than adequate prenatal care may have pregnancy complications that place their infants at increased risk of hospitalization. The effect of these protective factors should be clarified in future studies.