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Research Roundup
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March 2, 2010, Volume 56, No. 24

Sexual Activity in Tweens Delayed By Abstinence-only Program

A study weighs in on the controversy over sex education, finding that an abstinence-only intervention for pre-teens was more successful in delaying the onset of sexual activity than a health-promotion control intervention. After two years, one-third of the abstinence-only group reported having sex, compared to one-half of the control group. The study by researchers at the University of Pennsylvania appears in the February 1 edition of the Archives of Pediatrics & Adolescent Medicine.

While abstinence-only intervention did not eliminate sexual activity all together, this is the first randomized controlled study to demonstrate that an abstinence-only intervention reduced the percentage of adolescents who reported any sexual intercourse for a long period, in this case two years, following the intervention.

“It is extremely important to find an effective intervention that delays sexual activity; the younger someone is when they have sex for the first time, the less likely they are to use condoms,” said lead author John B. Jemmott III, professor of communication in psychiatry and of communication at the School of Medicine and Annenberg School for Communication.

There was a 33% reduction in self-reported sexual intercourse from the abstinence-only group, compared to the control group, by the end of the study. Of the students who reported that they were sexually active during the study, there were fewer reports of recent sexual activity from the abstinence-only intervention participants (20.6%) compared to the control participants (29%).

The authors cautioned that before any policy issues are discussed, more research is needed to determine the efficacy of abstinence-only education for different populations, including replication of a study like this in young African Americans.

A total of 662 African American students in grades 6 and 7 participated in this randomized controlled trial, which was held on Saturdays in classrooms at four public schools participating in the study.

Researchers determined that none of the interventions had significant effects on consistent condom use or unprotected sex. For those who lost their virginity during the two-year study, there was no difference in consistent condom use between the abstinence-only intervention and the control group.

The researchers noted that, in the United States, the consequences of early sexual involvement—including HIV, other STIs, and unintended pregnancies—are especially great among African American adolescents. An effective abstinence-only intervention could stave off unwanted consequences until adolescents mature and are prepared to handle the consequences of sex.

Other study authors were from Penn Nursing and the University of Waterloo.

Examining the Protective Effects of Mindfulness Training

A University of Pennsylvania-led study in which training was provided to a high-stress US military group preparing for deployment to Iraq has demonstrated a positive link between mindfulness training, or MT, and improvements in mood and working memory. Mindfulness is the ability to be aware and attentive of the present moment without emotional reactivity or volatility. The study was published in the journal Emotion.

The study found that the more time participants spent engaging in daily mindfulness exercises the better their mood and working memory, the cognitive term for complex thought, problem-solving and cognitive control of emotions. The study also suggests that sufficient MT practice may protect against functional impairments associated with high-stress challenges that require a tremendous amount of cognitive control, self-awareness, situational awareness and emotional regulation.

To study the protective effects of mindfulness training on psychological health in individuals about to experience extreme stress, cognitive neuroscientist Amishi Jha of the department of psychology and Center for Cognitive Neuroscience at Penn and Elizabeth A. Stanley of Georgetown University, and a former US Army officer, provided mindfulness training for the first time to US Marines before deployment. Dr. Jha and her research team investigated working memory capacity and affective experience in individuals participating in a training program developed and delivered by Dr. Stanley, a former US Army officer and security-studies professor with extensive experience in mindfulness techniques.

The program, called Mindfulness-based Mind Fitness Training (MMFT™), aims to cultivate greater psychological resilience or “mental armor” by bolstering mindfulness.

“Our findings suggest that, just as daily physical exercise leads to physical fitness, engaging in mindfulness exercises on a regular basis may improve mind-fitness,” Dr. Jha said. “Working memory is an important feature of mind-fitness. Not only does it safeguard against distraction and emotional reactivity, but it also provides a mental workspace to ensure quick-and-considered decisions and action plans. Building mind-fitness with mindfulness training may help anyone who must maintain peak performance in the face of extremely stressful circumstances, from first responders, relief workers and trauma surgeons, to professional and Olympic athletes.”

Persistent and intensive demands, such as those experienced during high-stress intervals, have been shown to deplete working memory capacity and lead to cognitive failures and emotional disturbances. The research team hypothesized that MMFT may mitigate these deleterious effects by bolstering working memory capacity.

Team-based Approach Improves ICU Outcomes

The severe shortage of specially-trained intensivist physicians has hospital intensive care units (ICUs) nationwide struggling to staff units with critical care teams led by intensivists, even though the presence of these specially trained physicians reduces the risk of death for patients in the ICU. A new report found that replacing intensivist-led teams with multidisciplinary care teams can also reduce the risk of dying in intensive care units. The study appears in the February 22 edition of the Archives of Internal Medicine.

The study authors examined data from 112 hospitals in Pennsylvania, comparing outcomes from ICUs that both were and were not staffed by intensivists. The researchers found that a multidisciplinary approach to care teams, with or without an intensivist, was associated with a 16% reduction in the odds of death. When hospitals employed both a multidisciplinary care team and an intensivist physician, there was a 22% reduction in the risk of death during an ICU stay.

Perhaps most importantly, a multidisciplinary approach in the absence of a trained intensivist was associated with a significant 12% reduction in mortality. “Given our findings, having ICU clinicians work better together is a key strategy to improving survival in the ICU,” said Dr. Jeremy Kahn, assistant professor of medicine at the School of Medicine.

Researchers noted a few explanations for the impact of the multidisciplinary care team model. Multidisciplinary care may facilitate implementation of best practices, including the application of evidence-based treatments, pharmacists identifying potential adverse drug indications, and implementation of respiratory therapy and nurse-driven protocols to reduce ventilation time and shorten ICU length of stay.

Health care providers and administrators can use these results to help organize their critical care services and potentially improve outcomes for critically ill patients in hospitals where intensivist staffing is not available.

The study also included authors from the Health Care Management and Economics program at Wharton and the University of Pittsburgh.

Longer Use of Nicotine Patch Improves Abstinence from Smoking

Research from the School of Medicine may help more smokers keep their New Year’s resolution by helping them quit smoking. Extended use of a nicotine patch—24 weeks versus the standard eight weeks recommended by manufacturers—boosts the number of smokers who maintain their cigarette abstinence and helps more of those who backslide into the habit while wearing the patch, according to a study published in the February 2 issue of Annals of Internal Medicine.

Lead author Robert Schnoll, an associate professor of psychiatry at Penn, and senior author Caryn Lerman, a Mary W. Calkins Professor of Psychiatry and deputy director of the Abramson Cancer Center, studied 568 adult smokers who smoked 10 or more cigarettes per day for at least the past year. At the end of the 24-week study, smokers who used a nicotine patch throughout the whole trial were about two times as likely to have been successful in their quitting attempts than those who received a placebo patch after the eighth week of the study. The benefits also extended to those who relapsed during the study.

When the researchers followed up with participants at week 52, however, they found no difference in the main measures of smoking abstinence between those who had used the extended patch therapy (14.5%) and those who used the standard regimen (14.3%), though the extended patch users were more likely (29.1% vs. 21.3%) to have reported no periods of smoking lasting more than 7 days in a row—during the entire year.

Though drug therapies including Zyban and Chantix produce similar results to extended patch therapy, the authors say their findings provide a cessation option to more smokers, since nicotine patches are available over the counter and can be used even by people with seizure disorders or mental health problems like depression, who are generally advised not to use those drugs. The authors estimate that the cost per quitter for extended therapy is $2,482, which is similar to other drug-related cessation aids. However, cost may remain a barrier to accessing proven smoking cessation tools: Just 8.6% of US health insurers fully cover the cost of nicotine patches, and only 33 states pay for Medicaid patients to use the patch.

“While we have documented that extended therapy is more efficacious overall than standard therapy, not everyone benefits equally,” Dr. Lerman says. “Therefore, our team is using genetic approaches to identify smokers who will achieve the greatest benefit from an extended or maintenance therapy approach.”

Almanac - March 2, 2010, Volume 56, No. 24