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Extracts from the Journals relating to Children, Youth and Families - in the fields of health, substance abuse, education, psychology, science ...

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22 JUNE

Good relationships with siblings may buffer the effects of family conflict

Children who are exposed to hostile, escalating conflicts between parents are at increased risk for developing mental health problems. However, many children from homes marked by conflict don't experience significant psychological problems. A new longitudinal study sought to determine why some children are protected from the negative consequences of witnessing repeated hostility between their parents. It found that having a good relationship with a sibling may help buffer the distress of ongoing family conflict.

The study was done by researchers at the University of Rochester, the University of Nebraska-Lincoln, and the University of Notre Dame. It appears in Child Development, a journal of the Society for Research in Child Development.

"Most children not only grow up with a sibling but spend more time interacting with siblings than with any other family member," according to Patrick T. Davies, professor of psychology at the University of Rochester, who led the study. "We showed that having a good relationship with a brother or sister reduced heightened vulnerability for youth exposed to conflicts between their parents by decreasing their tendencies to experience distress in response to later disagreements between their parents." The study defined a good relationship as one in which there were high levels of warmth and problem-solving and low levels of conflict and detachment.

The researchers looked at 236 families, including children with at least one sibling who wasn't a twin, their mothers, and their fathers. The families, most of which were White and middle class, were assessed when the children were 12, 13, and 14 years old.

Conflict between parents was gauged by observing arguments between mothers and fathers, who were asked in the lab to discuss topics of disagreement. The quality of sibling relationships was measured by mothers' verbal responses to interview questions about siblings' closeness and conflict, which the authors acknowledge may limit accuracy. Adolescents reported on their distressed responses to family conflicts. And adolescents, mothers, and teachers completed questionnaires to assess the youth's psychological problems (e.g., aggression, depression, anxiety, hyperactivity).

Adolescents who witnessed conflict between their parents had greater distressed responses to conflicts a year later, and greater distressed responses, in turn, predicted mental health problems in the teens in the subsequent year, the study found. However, teens who had good bonds with their siblings were protected from experiencing these distressed responses when they witnessed their parents' conflict, and ultimately were protected from subsequent mental health problems. These protective effects were similar for siblings of different ages and combinations of genders.

"Relationships with siblings protected teens whether we defined a good bond as one that included warmth and problem-solving skills or one that had low levels of destructive conflict or disengagement," explains Meredith Martin, assistant professor of psychology at the University of Nebraska-Lincoln, who coauthored the study. "Strengthening sibling relationships may not only directly foster children's psychological adjustment, but also offer new approaches to counteracting the risks associated with experiencing hostility and unresolved conflicts between parents."

The study's authors caution that because the families were mostly White and middle class, the findings should not be generalized to families of other races and socioeconomic statuses.

Source: Society for Research in Child Development

19 June 2018 

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20 JUNE

Boredom is fantastic for children's play, say parenting experts

A bit of boredom is not a bad thing – in fact it can actually do children some good, say experts at the Australian Government-funded parenting website raisingchildren.net.au

“When children are required to find something to do, they’re forced to use their problem-solving skills, creative thinking and imagination to play,” says Associate Professor Julie Green, a raisingchildren.net.au director and Acting CEO of the Parenting Research Centre.

The benefits of boredom are outlined in a new raisingchildren.net.au video series launched for parents containing tips and information on children and play.

“It can really be worth parents holding their nerve when the kids complain about being bored. It shows children it isn’t the end of the world to be a bit bored and to work through it.”Associate Professor Green says. “It’s important for parents to play with their children but they don’t have to entertain them all the time.”

With school holidays fast approaching that may be music to parents’ ears.

Boredom can also allow children to:

“When children are bored it creates a feeling of being able to rely on themselves to be resilient; the ability to get through something that might be a little bit tough and a little bit stressful,” says Cat Sewell, play specialist.

To embed the videos on your website visit -https://www.youtube.com/playlist?list=PL7C3A480FCFEB2A23

By Natalie Perrin

19 June 2018

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18 JUNE

AUSTRALIA

First transgender youth-specific healthcare guidelines unveiled

Today the first guidelines specific to the health-care needs of transgender and gender diverse children and adolescents have been released in the Medical Journal of Australia.

Gender identity is a person’s innermost sense of who they are – male, female, a blend of both or neither. Most children grow up thinking of themselves as a girl or a boy and don’t question their gender. But some children and teenagers identify as a gender that’s different to the sex they were assigned at birth. This is often referred to as being gender diverse, or transgender.

Being transgender or gender diverse is now largely viewed as part of the natural spectrum of human diversity. For some people, this is just part of who they are, and it’s not a cause of concern. Others experience gender dysphoria – the distress related to the mismatch between one’s sex and gender. It’s the reason many seek help from health-care professionals.

Why the guidelines were needed

Our clinic is the largest paediatric gender service in Australia. In the last five years referrals to our service have increased tenfold. Rising referral rates have also been reported in many other countries across the Western world.

Although older international treatment guidelines exist, these are no longer fully reflective of current practices. They also focus on adults and not exclusively children and adolescents.

This is important because children and adolescents are continually developing in a social, emotional and physical sense. They also exist within the context of a family and school. So taking a developmental perspective is central to providing good care.

The new guidelines were developed in consultation with not only clinicians who work in the area of child and adolescent transgender health across Australia, but also members of the transgender community, their families, and relevant support organisations. And they draw on findings and recommendations from previous studies.

What they outline

Although more research is needed, we know supportive, gender affirming care during childhood and adolescence contributes to improved mental health and well-being.

As gender diversity is an unfamiliar area for many people, the guidelines include a list of commonly used terms. Language is rapidly evolving and people may use words in different ways. An important part of providing affirming and respectful care is to understand and use inclusive language. For example, when we see young people, we often ask what name and pronouns they would like used to build rapport and affirm their gender identity.

The guidelines also outline general principles for the care of transgender and gender diverse children and adolescents:

The guidelines emphasise that providing gender-related health care to a young person requires many different approaches. This may include psychological support, social transition, voice and communication training, fertility counselling, hormonal intervention and surgery.

Many professionals may be involved, and the guidelines separately outline roles for mental health clinicians, paediatricians, endocrinologists, fertility specialists, nurses, speech therapists, GPs, bioethicists and lawyers.

But not all of these will be applicable to a given individual. It’s important to remember many transgender and gender diverse young people will choose not to access gender-related health care at all.

As a relatively new endeavour, gender-related health care for children and adolescents is surrounded by myths and misinformation. Accessing reliable, up-to-date information can be challenging for clinicians, patients and families.

We hope our guidelines ease this challenge and help young people access supportive, gender affirming care that helps them to lead happy and authentic lives.

By Carmen Pace, Ken Pang and Michelle Tollit

18 June 2018

Carmen Pace is Clinical Psychologist and Research Fellow at the Murdoch Childrens Research Institute; Ken Pang is Clinician Scientist Fellow and Paediatrician at the Murdoch Childrens Research Institute, and Michelle Tollit is Research Officer at the Murdoch Childrens Research Institute.  

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13 JUNE

When a history of depression helps treat young people

When Mike Shooter was in medical school, he suffered the first of what he calls "thunderous depressions." More followed. Shooter's efforts to come to grips with these experiences has made him acutely aware of what young people with mental-health problems endure and forged his career as a pre-eminent child psychiatrist in England.

Recently he published Growing Pains, which is based on 40 years of working with young people. The book explains why it's imperative to differentiate between depression and the ordinary but often intense difficulties some children face. He recently spoke with The Washington Post on these issues.

Q: Do you think young people are more vulnerable to mental illness now?

A: Research suggests that the United Kingdom is the least happy place for a child to be brought up in the Western world; America cannot be far behind. Some of this could be attributed to the grinding effect of poverty. But not all: The frenetic competition, in school, in the scramble for jobs, in peer-group relationships, means many children fall off the bottom of the ladder of competition and feel as if they've failed. Or are so unsure of their own worth that they sit up all night searching for "likes" on social media in lieu of proper friendships.

But it's not all bad news. There is currently much research into resilience: what enables some children to cope while others do not. I know from experience that there is one thing that can make all the difference: a relationship with an adult close enough to them, that supports them, listens to their distress and treats them as worthwhile. That person could be a relative, a family friend, a teacher or, dare I say it, a child psychiatrist.

Q: What's the difference between depression and sadness?

A: Depression is a formal psychiatric diagnosis with recognizable symptoms, well-researched treatments and a predictable outcome. Sadness is a normal reaction to sad circumstances, or a free-floating mood typical of adolescents.

The danger is that the sort of distress I describe, if it ever reaches the clinic, will either be squashed into a psychiatric category that it does not warrant or will be dismissed as a problem for which the psychiatrist has no answer. The children in Growing Pains have been unable to get help because they haven't met the formal criteria, reinforcing their sense of failure. These children need help, whatever we call them – sad or depressed.

Q: Is there a danger in labelling a disorder?

A: Labelling can be very dangerous. At best, it can fossilize a child's image and the way they are seen and handled by those around them. At worst, it can wreck their lives.

Q: How best, then, to support a vulnerable child?

A: Most helpful is a relationship that can hold the child in trust while we work together on trying to change things.

The trust must be earned. Some children feel safer talking in the privacy of a clinic. Some are so young and so frightened that they are beyond words and need special techniques to uncover the cause of their distress. Many will need to be seen on their own patch – at home, school, wherever they feel most comfortable. It may require negotiation with adults to secure the necessary space, and unless the child needs immediate rescue from harm, it will take time.

Q: Do we overmedicate?

A: I try not to blame people: the children and young people who have so often been blamed for their own distress and have felt so guilty that they have blamed themselves; parents and carers who are unable to understand what children are going through and are often just as needy of help; fellow professionals, who are desperate to help but are clinically trained and emotionally more comfortable with traditional ways of doing things.

So, yes, we are in danger of overdiagnosing distressed children and reaching too quickly for a prescription more appropriate for adult illness. But I understand why. Showing how a young person might fulfill – or not – a set of criteria and dishing out a course of pills is very obviously "doing" something, and the pressure to do something is huge.

By Anthea Rowan

12 June 2018 

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11 June

UK

The children who hear 'terrifying' voices

One in 12 children is thought to persistently hear voices that are not there. Sometimes they tell them they are worthless. Now new research suggests the reaction of adults can affect the voices they hear in future.

"It's like being in a crowded room. All you can hear is all these multiple different voices having a go at you," Laura Moulding tells the BBC's Victoria Derbyshire programme. The 21-year-old hears voices around her almost constantly, and has done since childhood. "The voices are a combination of male and female voices, adults and children. One of them sounds like a Doctor Who monster. They just tell me I'm useless pretty much all the time."

Laura's experiences began when she was around three years old.

She was sitting on the stairs at her grandparents' home and heard a lion and bear from a children's television programme saying, "I'm coming to get you, I'm coming to get you", over and over again. It was a terrifying experience, she says. But when she first approached her parents, they assumed she was talking about imaginary friends. She does not blame them for this, but did not try and talk to an adult about her voices for several more years.

It is estimated that one in 12 children has persistent auditory hallucinations.

Researchers at Manchester Metropolitan University and the University of Manchester - in the first UK study into children who have such hallucinations and their parents - have found that the way in which people react to the child's experiences can influence what the voices are like in the future.

At 15, Laura found the hallucinations were becoming too much for her to deal with on her own. Her mother took her to see a GP to seek treatment.

"I was self-harming and it was horrible moment for me," she says. "I was struggling because the voices were so loud, so intimidating, so abusive, that it was something I couldn't cope with."

'Hearing mum's voice'

The research undertaken suggests that although many young people hearing voices will have a negative experience like Laura, others find the voices reassuring or even fun.

The researchers asked young people and their carers to fill out detailed questionnaires about their experiences.

"Tia" is 13. She does not want us to use her real name. Her experiences with voices were quite different to Laura's. She was seven when she first noticed she could hear things no-one else could. "I used to hear my mum's voice quite a lot," she says.

She would also hear men shouting from a distance, and once heard electricity pylons singing. The voices would often make Tia laugh, but sometimes this led to her getting in trouble at school. "One of my voices was just messing around with me, making me giggle too much," she says, leading her to swear at them to keep quiet.

Many children first start hearing voices after they have suffered some kind of trauma.

Tia's mother Alice – not her real name – has a chronic illness, and thinks the stress of her becoming sick affected Tia. "[Tia's] been through so much, and this is how she is expressing it. That's what upset me most I think," Alice says.

Alice worked out that Tia was hearing voices after seeing her react to them. She decided not to take her to a doctor and instead spoke with the support group the Hearing Voice Network.

Dr Sarah Parry from Manchester Metropolitan University says her team's research has implications for how young people who hear voices should be treated. "The children see the voices as part of themselves, so telling them the voices are a problem can add to a child's stress, which in turn can make the voices become more unpleasant."

At the moment in the UK, children and young people who ask for help for hearing voices can be referred down a number of different treatment pathways. There are also a number of peer-support groups run by charities.

Dr Parry is seeking funding to set up a group specifically for young people who hear voices.

For Tia, one day the voices just went away on their own. "I was like, 'Wait, there's nothing actually in my head – no-one speaking to me. I can just hear what I'm thinking. I don't miss them."

Laura says she is now able to manage the voices with medication, or uses music to drown them out. "I feel a lot stronger, a lot better in myself, even though the voices are still there," she says. "They're not in control of me. I'm in control of them."

By James Melley

8 June 2018 

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8 JUNE

AUSTRALIA

New study reveals gap in mental health services for at-risk kids

In a paper published in The Lancet Public Health this month, a University of South Australia (UniSA) research team has estimated a concerning gap in the workforce required to deliver tertiary-level community health care to infants, children, adolescents and their families across South Australia.

The world-first, needs-based study, funded by the NHMRC and SA Health and led by UniSA expert in the social determinants of health, Professor Leonie Segal, identified seven per cent of children (to age 18) in South Australia are suffering very high to extreme levels of distress.

Professor Segal says the distress is typically due to adverse family environments and community stressors such as severe financial distress, parental separation, parental mental illness, bullying, family and community violence.

"That equates to more than 27,000 kids in SA suffering extreme or high levels of psychological distress and at considerable risk of long term mental health problems," she says. "The consequences of poor mental health for the individuals and society are dire – school failure, family separation, depression, self-harming, alcohol abuse, suicide, welfare dependency, child protection involvement, teen pregnancy, involvement in crime – a cycle of damage and powerlessness.

"As South Australia allocates similar resources as other states to this problem, the study points to a nationwide gap in treatment resources to meet the needs of infants, children and adolescents who are distressed and facing serious current and future adversity.

"In South Australia we would have to boost the clinical budget to $100 million, just to ensure the most vulnerable and distressed children were receiving the best level of care," Prof Segal says, compared to a current spend of $24 million on community-based CAMHS teams. We would need to grow our trained workforce by almost 950 community and mental health professionals to support the high unmet need that is having such devastating consequences for children and the wider community."

The research relied on data from the Longitudinal Study of Australian Children and the Young Minds Matter mental health surveys and focus groups of people working with troubled children – mental health workers, social workers, counsellors, teachers from the government, NGO sectors.

Prof Segal says the research underlines an urgent need for a new approach and stronger investment in the mental health of young people.

"We need to support the up-skilling and advanced training of mental health practitioners and of workers in the broader community services sector (such as Centrelink staff, housing, justice) so they can work more compassionately with the extremely troubled and traumatised infants, children and adolescents and their families who come to them for assistance," she says.

"Poor mental health has its genesis in trauma, in the complex layering of adversity. What will be central to success, is understanding that mental health issues can't be considered in isolation. We need a connected response that includes a vibrant central agency staffed by a highly skilled inter-disciplinary workforce of psychologists, social workers, OTs, psychiatrists, paediatricians, youth workers, speech pathologists, able to offer outreach therapeutic services into community agencies working with vulnerable families—into early childhood centres, schools, child protection, justice services, intensive family-support services.

"As a society and a community if we don't spend the dollars to help infants, children adolescents and their families in distress, the same money and more will be spent on the devastating consequences, as early issues become more intractable."

The analysis excluded private psychology and psychiatry as these services are not team-based and therefore suited to a less complex population. Family support programs working with vulnerable families were also excluded, as these agencies rarely offer a team-based therapeutic mental health service. Similary, Headspace was not included in the analysis.

South Australia's Chief Psychiatrist, Dr. John Brayley, says what the research has highlighted are significant gaps that need to be addressed for the benefit of children now and in the future. He says child and adolescent mental health will be a specific area of focus in the State's new Mental Health Services Plan, to be developed this year.

National Mental Health Commissioner Professor Helen Milroy says the research finally provides an evidence base for what we have known for a long time.

"There is a desperate need not only for prevention and early intervention in childhood but for a sophisticated, highly skilled and appropriately resourced mental health system for children and adolescents," Prof Milroy says. "We will never address the increasing burden of mental health problems into the future unless we pay attention to what is happening to our children."

Director of the Centre for Community Child Health at the Royal Children's Hospital in Melbourne and Professor at the Murdoch Children's Research Institute, Frank Oberklaid, says child mental health has long been marginalised in policy and funding discussions.

"Addressing child mental health issues is both worthy in its own right, as well as a preventive strategy that can reduce the incidence of mental health problems in later years, and the personal, social and economic burden associated with the long-term negative consequences of mental health problems," Prof Oberklaid says.

6 June 2018

Source: University of South Australia 

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6 JUNE

New Zealand: 1 in 5 teens affected by negative experience online

Nearly 1 in 5 NZ teens unable to take part in daily activities due to negative experience online

New research by online safety organisation Netsafe and the Ministry of Women highlights rates of harmful online communications received by young New Zealanders in the last 12 months.

The study reveals that Kiwi teenagers are twice as likely as adults to be negatively affected by harmful communications online. The research also showed that younger teenagers (aged 14 and 15) are at greater risk of harm.

Netsafe’s CEO Martin Cocker said he was concerned when he heard the rates of harm were high. “There can be a perception that because teenagers have grown up with technology they know better than adults how to manage things that happen online. What this research shows is that many young people are facing big challenges online and they need our support with managing them.”

The research highlighted that girls were at a higher risk of being harmed by online communications than boys were. It also found that teenagers aged 14 or 15 were more likely to say that an unwanted communication online had made it difficult for them to take part in their usual daily activities – this included being unable to go to school or study, not being able to participate online as usual or being unable to eat or sleep properly.

“This research shows that for girls, social media was the most common place for a harmful online communication to occur, while for boys it was on online games. We encourage parents to use this information to start a conversation with their kids about what they’ve experienced online and if they know what to do if they need help.”

The majority of unwanted digital communications were sent by a friend, with just over a quarter of teens saying the online communication was linked to something that was also taking place offline.

Teenagers with disabilities were more negatively impacted by harmful experiences online than teenagers without impairments. The study also highlighted that teenagers’ experience of harm online differed by ethnicity, with Maori and Pacific teenagers reporting they were more likely to have received an unwanted digital communication in the last 12 months.

“Preventing online harm is critical to the wellbeing of our young people,” says Cocker. “They need effective tools to be able to manage their online experiences and these tools need to reflect the unique experiences and challenges of different teen groups. This research highlights that effective actions to prevent and reduce digital harm must consider and respond to differences in the ways girls and boys interact online, and we must work to understand how ‘help’ differs for Maori and Pacific youth and for our young people living with disabilities”.

The research has been undertaken in partnership with the Ministry of Women, as part of a joint project aimed at better understanding the online behaviour of young New Zealanders.

5 June 2018

The full report is available at https://www.netsafe.org.nz/youth-population-survey-2018

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4 JUNE

AUSTRALIA

Children with severe trauma can be fostered, and recover with the right treatment and care

Being a foster carer for children who have experienced early life trauma – such as emotional and physical violence – can be challenging, complex and confusing. For children, experiencing severe early trauma can manifest in difficult behaviours, resulting in unsuccessful foster care placements.

We were commissioned to evaluate the effectiveness of a Victorian, home-based therapeutic program that only accepts children who aren’t suitable for traditional foster care because their needs are deemed too complex. These children are either already in residential care – a system of care that involves rostered staff as carers, and group living – or are eligible for it.

In residential care, a child may be exposed to other young people with high-risk behaviours and can be disconnected from family, culture, school and community supports. This delays their recovery and puts them at risk of further trauma.

The Treatment and Care for Kids (TrACK) program was developed as an alternative to residential care for children with complex needs. Some children in the program have experienced severe trauma including witnessing murder by their parents and being subjected to chronic sexual assault (with some being involved in paedophile rings organised by their parents).

Among the 48 children who have been fostered through the program, 19 had come from residential care where they had multiple placements. Fifteen of these children had lived in more than six placements before TrACK and seven had experienced more than ten placements. One child had experienced 18 and another 30 placements within five-and-a-half years.

A review of their case files identified a shift from placement instability to long-term placement stability after joining TrACK. The program showed encouraging results in other domains too, including education, forming peer relationships and emotional regulation.

These results show complex trauma can be healed.

Children in care and TrACK

In Australia, one in every 32 children has received child protection services. By the time they are in residential care, they have often experienced physical, sexual and emotional violence in early childhood, as well as severe neglect from their caregivers.

After ageing out of care at 18 years, many of these young people are over-represented in the criminal justice system. They experience homelessness, unemployment, mental illness and poor social relationships at greater rates than the rest of the population.

Due to the complexity of their trauma, every child in TrACK has a therapeutic plan tailored to their needs and a team of specialists who support them and their family. For children who are placed in care, complex trauma has mostly been acquired through repeated traumatic experiences in the context of a relationship that’s meant to be secure and trustworthy.

TrACK’s approach to treating complex trauma is informed by the science of neurobiology, which suggests trauma develops in a relationship and can also be healed in a relationship. This is also referred to as the neurobiology of love, where love isn’t just a simple emotion but a deep sense of care, concern and connectedness to the child.

We are all wired for connection. However, most children in care have been denied this opportunity. The neurobiology of love, in this case, is about accepting their complexities and vulnerabilities, providing comfort and constantly nurturing the relationship between the carer and the traumatised child.

The success of a placement is mainly based on the carer’s capacity to respond to the complexity of the child. TrACK carers are trained in several key areas. This involves knowing ways to counter some of the negative self-perceptions the child may have; having appropriate expectations of the child and showing them love and acceptance even if their behaviour isn’t changing; avoiding escalation; and noticing and responding to the child’s emotional needs.

TrACK only recruits carers who are prepared to commit to the long-term care of children with significant adversity. In return, they are offered “round the clock” support. This includes specialist training on parenting children with complex needs and individualised coaching.

What we found

Our key finding was a considerable reduction in the number of placements children experienced after joining TrACK. It fell from a median of 6.1 to 1.9 (remember seven children had over ten placements before joining the program).

We also found all children in TrACK at the time of the evaluation were attending school full-time. A 2012 Victorian report showed 49% of children in residential care, and 88% in other home-based care programs, were going to school every day.

All children in TrACK experienced enhanced emotional stability and capacity to regulate their own emotions. Although this was hard to measure, carers reported their children were less volatile than when they first arrived in their care.

Stability of relationship with carers was another key outcome. All the children in a TrACK placement at the time of the evaluation were able to develop trusting relationships with their carers. This result is encouraging because many of these children had previously been identified as being too complex, volatile and aggressive for a home-based care placement.

One young person in TrACK, Daren, said:

I definitely think I am part of the family, from the first time I walked in, they were welcoming […] had a joke which was amusing and funny […] and not leaving me out of anything pretty much […] they let me know everything that involves me and [even] when it does not involve me, [they tell me] what they are doing in their lives […] there are no secrets.

Daren now continues to live with his foster parents despite his foster care arrangement ending at the age of 18.

One of the carers said his strategy for reassuring his foster sons that he will never leave them is by speaking to them in future tense.

I talked to [our foster son] when he was 14 about how I’m going to teach him how to drive [when he is older] and he knows he is welcome to stay here for the rest of his life.

Our interviews with young people and reports from their carers showed recovery started when the young people felt the foster family would never abandon them, reject them, retraumatise them, hurt them or withdraw their affection, regardless of how slow or complex their healing journey was.

It’s critical that locally grown programs do not fall off the agenda as viable and cost-effective strategies for reform. Often, our systems are criticised for what they do not achieve for children; they also need to be acknowledged when they do something well.

The Coversation

31 May 3018

TrACK is funded by the Victorian Department of Health and Human Services and run by the Australian Childhood Foundation (ACF) and Anglicare-Victoria. 

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1 JUNE

Ban e-cig flavors and misleading adverts to protect youth, says global respiratory group

In a statement published in the European Respiratory Journal, a coalition of respiratory doctors and scientists from six continents have warned of the dangers posed to children and adolescents by electronic cigarettes.

They say there is mounting evidence that e-cigarettes damage health and are highly addictive, yet manufacturers are marketing them as "healthier" cigarettes and their popularity among young people is growing. As a result, they are calling for an immediate ban on flavourings and on marketing e-cigarettes as lower risk alternatives to children and adolescents.

The Forum of International Respiratory Societies is a collaborative of nine organisations from North and South America, Europe, Africa, Asia and Australia that was created to promote lung health worldwide.

The paper brings together a wide range of research findings on e-cigarettes. It highlights evidence that children and adolescents are highly susceptible to nicotine addiction, and that use of e-cigarettes has risen steeply in this age group to become the most commonly used tobacco-related product among adolescents in some countries.

The authors lay out a set of evidence-based recommendations for protecting youth from nicotine addiction and its harmful effects.

The paper was co-authored by Thomas Ferkol MD, Alexis Hartmann professor of paediatrics and professor of cell biology and physiology at Washington University in St. Louis, USA. He said: "Until recently, the risks of e-cigarettes and their rising popularity with children and adolescents were under-recognised or ignored. We wrote this statement to address growing public health concerns over e-cigarette use among youths.

"Product design, flavours, marketing, and perception of safety and acceptability have increased the appeal of e-cigarettes to young people. These products are 'normalising' smoking and leading to new generations addicted to nicotine."

The authors found growing evidence that e-cigarettes act as a "one-way bridge" to cigarette smoking in adolescents.

Professor Ferkol added: "Some people truly believe e-cigarettes could be used as a smoking cessation technique, but these products also are an entry to nicotine addiction and tobacco use in young people."

Charlotta Pisinger, clinical professor of tobacco control at Bispebjerg and Frederiksberg Hospital and University of Copenhagen, Denmark was also a co-author. She said: "Although exposure to potentially harmful ingredients from electronic cigarettes may be lower than traditional cigarettes, this does not mean that e-cigarettes are harmless.

"And when we're talking about children and adolescents who are trying e-cigarettes for the first time, we should not be comparing their use to traditional cigarettes. We should be comparing them to no tobacco use."

The paper puts forward a series of expert recommendations that the authors say will protect this vulnerable group. They state that e-cigarettes should be regulated in the same way as tobacco products and included in smoke-free policies. They say that there should be a ban on sales to youths worldwide, which must be enforced. Advertising e-cigarettes as lower-risk alternatives directed to youths and young adults should cease.

The paper also calls for a ban on flavoured products, because there is evidence that flavourings draw young people to e-cigarettes. There are currently more than 7,500 different flavoured e-cigarettes and refills available. Finally, the authors recommended further research on the health effects of e-cigarettes as well as surveillance of use across different countries.

Regulation of e-cigarettes varies widely around the world. For example, legislation on a minimum age for buying e-cigarettes is non-existent or not enforced in most countries.

Dr. Aneesa Vanker, a senior specialist in paediatric pulmonology, at the Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa, was also a co-author the paper. She added: "E-cigarettes are largely unregulated, particularly in low and middle-income countries. They are marketed as a smoking cessation tool and a safer alternative to tobacco cigarettes.

"However, there is growing evidence that nicotine has many acute and long-term adverse effects, including addiction. Young people are at particular risk for this.

"We want local, national, and regional decision-makers to recognise the growing public health threat that e-cigarettes pose to children and adolescents. Inhaling something other than air is never good for a child's lungs."

European Lung Foundation

30 May 2018 

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