Child's Play
By promoting good health in childhood, researchers hope they can help kids become healthier adults.
A good mom takes her son to the doctor for regular checkups. A caring father makes sure his daughter looks both ways before crossing the street. A grandmother preaches the virtues of brushing teeth after every meal.
Yet, despite their vigilance, parents and caregivers know they cannot safeguard children from every danger that may come their way.
Fortunately, though, a cadre of physicians and researchers is trying to make the world a little less perilous for children. By dealing with issues from asthma to diabetes, they carry out a singular mission: to protect and ensure kids’ healthy passage to adulthood.
Air, asthma and allergens
A soupy haze clings to the mountainsides, dulling vivid greens to pale grays. The culprit: smog.
But poor air quality does more than just dim scenic views. Environ-mental health researchers at the Keck School of Medicine of USC are finding connections between air pollution and children’s respiratory health.
Because these studies are used to guide decisions on state, federal and international air quality standards, the work potentially may protect the health of children worldwide.
The centerpiece of this research is the Children’s Health Study, a USC-led investigation begun in 1993 that annually monitors the health of more than 6,000 children across 12 Southern California communities.
Regional air quality monitoring agencies continuously measure the air in the 12 communities, tracking levels of the ingredients in smog, such as ozone, nitrogen dioxide, particulate matter—bits of smoke and soot—and acid vapors.
At the same time, researchers measure the health of children in the study to see how well their lungs grow and if they develop respiratory problems.
Over time, the team found that the lungs of children living in smoggy areas grew more slowly than the lungs of kids who lived in areas with cleaner air.
This is important because during adolescence, lung function grows dramatically, reaching its peak in the early 20s. Children with decreased lung function growth may never achieve full lung growth, may be more prone to respiratory disease and more likely to have chronic respiratory problems as adults.
When researchers followed children who moved out of smoggy areas to cleaner communities, though, they found their lungs actually started growing more quickly. That was encouraging news to Edward L. Avol, associate professor of research in preventive medicine and a study investigator, who believes it renews the call for cleaner air.
“Air pollution can have long-term effects on lung health in children—it can affect lung growth rates,” Avol says, “but this shows reducing community air pollution can make a measurable difference.”
And more studies are in the works. Soon scientists may have more answers on whether antioxidant-rich foods and juices can help protect kids’ lungs, for example, or whether certain genes can predispose kids to lung damage from pollutants.
Even asthma—the most common chronic disease of childhood—has ties to pollution. Keck School researchers are examining children most at risk.
In a recent study, for example, Rob McConnell, M.D., associate professor of preventive medicine, and his colleagues looked at children who regularly exercise. They found that kids who play three or more team sports in high-ozone areas have a three-to-four-times higher risk of developing asthma than non-athletic kids.
Because exercise often involves rapid or prolonged deep breathing, people who exercise can be exposed to high doses of pollution. In addition, many sports are played outside, where ozone concentrations are higher.
McConnell recognizes the findings’ irony. “Exercise is really healthy for kids, for many reasons,” he says. Yet kids who exercise during hours of heavy ozone (usually the afternoon) or in heavily polluted areas might run a greater risk of asthma.
“If ozone is causing asthma, then the solution is to reduce the levels of ozone,” says McConnell, who hopes to expand and refine the study to confirm relationships between pollution and asthma.
Other researchers also are looking at the importance of allergens, such as dust mites and cockroaches, while others look at the effects of second-hand smoke exposure—even while a child is still in the womb.
Researchers advocate for public health through science. In San Diego, for example, they joined with a nonprofit group and a community clinic to aid residents of Barrio Logan, a low-income neighborhood with some of the largest sources of pollution—and the worst children’s asthma problems—in the county. They asked the state to install an air quality monitoring station, and got help from the U.S. Environmental Protection Agency.
Today, they work with community members to improve their neighborhoods —from teaching high school students about pollution to informing health clinic staff members about asthma.
Says McConnell: “The hope is that the work we do can protect and improve children’s health, now and later.”
Blowing smoke
Not only can air pollution come from cars, but also from a tightly rolled stick of tobacco.
A lifetime smoking habit usually begins at the dawn of kids’ teen years, so for public health advocates, it is important to understand why these teens light up their first smoke.
Reasons are complex, varying according to culture, region, gender, age and other factors. USC’s Transdisciplinary Tobacco Use Research Center, or TTURC, will make the causes a little clearer.
Scientists united under the banner of TTURC—a multimillion-dollar effort funded by the National Cancer Institute—to answer questions such as how adjusting to a new culture affects a teen’s openness to smoking.
Jennifer B. Unger, Ph.D., research assistant professor of preventive medicine and TTURC member, has studied nearly 6,000 California eighth-graders, asking about their smoking history and openness to trying tobacco. She also asked students whether their friends smoked and if smoking was common among other kids their age.
She found that white teen-agers are more likely to smoke due to peer pressure than are teen-agers from other ethnic groups.
Asian, Latin-American and African-American cultures tend to emphasize collective communities rather than individ- ualism, she says. Because teen-agers from collective backgrounds are less likely to rebel from the social rules of their parents and society, they may be less likely to model themselves after rebellious teen-agers who smoke. Among white students, though, rebellion may be more accepted.
With such information, public health specialists can design better anti-smoking or stop-smoking programs. “As the population becomes increasingly multicultural, it will become more important to develop smoking prevention programs that are relevant and effective for adolescents of diverse cultural backgrounds,” Unger says.
USC investigator Steve Sussman, Ph.D., professor of preventive medicine, and his colleagues already have created one such program, Project Toward No Tobacco Use (TNT).
Acclaimed by the Centers for Disease Control and Prevention as a “program that works,” Project TNT has been reproduced in school classrooms around the nation.
Focusing mostly on seventh-graders, the project teaches kids that using tobacco is addictive, has health consequences, and is not as common or acceptable as they might think. It also covers marketing and a variety of other smoking topics.
The results: students who participated in Project TNT were 26 percent less likely to start smoking than other kids. Weekly or more frequent cigarette smoking by Project TNT students was reduced by about 60 percent.
“It’s good to know that Project TNT is at least a part of the equation to prevent tobacco use among teens,” Sussman says. “Certainly, more research, education and legislative action are needed to prevent and stop tobacco use among children—and adults.”
Fitness, not fat
Today, a four-year-old wheels his tricycle with abandon; but by age 10, he too often has traded the cycle for a seat in front of the TV.
Combine inactivity with a growing taste for fast food, and kids’ waistlines are expanding at a rapid clip. The Surgeon General reports that in 1999, 13 percent of children ages 6 to 11 and 14 percent of adolescents ages 12 to 19 were overweight. The number of overweight teens has tripled since 1980, with a disproportionate number of Latino, African-American and Native American teens affected.
High cholesterol and high blood pressure—risk factors for heart disease—occur more often in overweight children than in others. There is an 80 percent chance that big teens will become big adults, and obesity brings with it a 50 to 100 percent increased risk of early death.
Girls are especially at risk: Among children ages 12 to 21, girls are twice as likely to be inactive as boys.
So says Donna Sprüijt-Metz, Ph.D., assistant professor of research in preventive medicine, who focuses on exercise behavior. Sprüijt-Metz recently began a project called “Get Moving” to find out why so many girls stop exercising. By examining attitudes among young women, she hopes to uncover information that will help her design effective programs to encourage physical activity.
Sprüijt-Metz believes that girls tend to act on their feelings about exercise instead of their knowledge about it. For example, a girl may know that exercise is good for her; but if she feels fat and clumsy when she exercises, she will choose not to exercise. Changing these feelings may be key.
“Exercise, with dietary changes, is the way to combat obesity,” she says. “Girls who exercise are less likely to get breast cancer, and they are at lower risk for osteoporosis. They are also less likely to smoke.”
Obesity is the key interest of Michael Goran, Ph.D., professor of preventive medicine. Goran seeks to understand why obesity is so dangerous.
Obesity is closely linked to type 2 diabetes, Goran notes. Type 2 diabetes—once thought only to hit adults—is increasing in adolescents. Latino and African-American teens are especially at risk.
That is why Goran, who already has been investigating African-American kids’ vulnerability to diabetes, now is looking at what happens to Latino children as they mature.
With the help of a $3.5 million grant from the National Institute of Diabetes and Digestive and Kidney Diseases, Goran is monitoring dozens of East Los Angeles children over time to understand the metabolic events that set type 2 diabetes into motion.
He and his colleagues are looking at fitness, physical activity level and body fat in kids to discern the role of each in diabetes. They also are looking at the distribution of body fat in children.
“There is a theory that a buildup of fat around the organs is more detrimental than fat on legs or arms,” he explains. “We’d like to look at that, and see if it’s true in children.”
While Goran studies the effects of fat on kids in East Los Angeles, pediatric diabetes specialists a few miles away at Childrens Hospital Los Angeles (CHLA) focus on teaching kids about healthy eating and exercise habits—so they can keep from gaining too many pounds.
The Kids ‘N Fitness program was created by Francine Kaufman, M.D., Keck School professor of pediatrics and chief of endocrinology and metabolism at CHLA, along with Mary Halvorson, M.N.S., R.N., C.D.E., Marsha MacKenzie, R.D., C.D.E., and the other diabetes specialists at the Comprehensive Childhood Diabetes Center. The nutrition and activity program has garnered attention because it succeeds in battling the bulge in children.
In a pilot study, 83 overweight children, ages 8 to 16, completed the eight-week program. By program’s end, they were gaining about a half pound each month, down from an average gain of more than two-and-a-half pounds each month. The average normal weight gain for children in this age range is one pound each month.
The goal is not to make children stop gaining weight—which is a normal part of growing up and developing—but to maintain a healthy growth rate, explains MacKenzie, director of the Endocrine and Obesity Nutrition Program at CHLA.
Program leaders work with kids in 90-minute sessions, focusing on eating and exercise behavior. They also go on supermarket shopping scavenger hunts and analyze food labels to look for fat content.
Kids have fun exercising through games and sports for 30 minutes, as well—without feeling embarrassed about being overweight—and parents get involved, too, so they can reinforce learning at home.
Researchers found that children ate more fruits and vegetables and exercised more after they completed the program.
“If we can address this issue of childhood obesity by giving children the information they need to make better choices, we can go a long way toward reducing the risk of developing type 2 diabetes—as well as cardiovascular disease and osteoporosis, which have their antecedents in childhood,” Kaufman says.
Goran says kids need to hear these healthy messages.
“The best way to get healthy adults is to have them start out as healthy children,” Goran says. “If kids get messages about healthy eating and exercise, they’re a lot more likely to keep these habits later in life.”
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