CDC Report on Barriers to Children Walking to School

Walking as transportation is part of an active lifestyle that can decrease the risk of heart disease, diabetes, hypertension, and colon cancer. However, the number of children walking to or from school has decreased from previous years. In 1969, almost one half of all children and 87 percent of those living within one mile walked or biked to school. Currently, less than 15 percent of children are using active modes of transportation. The Centers for Disease Control and Prevention (CDC) has released a report on the barriers to children walking to and from school in the United States in 2004. The report appears in the September 30, 2005, issue of Morbidity and Mortality Weekly Report, and additional information is available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5438a2.htm.

Researchers examined data from surveys that parents completed to describe the barriers preventing their children five to 18 years of age from walking to or from school. Distance from the home to school (61.5 percent) was the most commonly reported barrier, followed by traffic-related danger (30.4 percent). Fifteen percent of parents cited “other” as a barrier, 11.7 percent reported crime as a barrier, and 6.0 percent reported school policy as a barrier. Only 15.9 percent (95% confidence interval, 14.1 to 18.0 percent) of parents selected the response, “It is not difficult for my child to walk to school.” The CDC believes that comprehensive initiatives that include behavioral, environmental, and policy strategies are needed to address these barriers to increase the percentage of children who walk to school.

Preventing CVD in Patients with Type 1 Diabetes

The National Heart, Lung, and Blood Institute (NHLBI) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) have released a report that identifies ways to improve prevention and treatment of cardiovascular disease (CVD) in persons with type 1 diabetes. According to the report, CVD is the main cause of morbidity and mortality in patients with type 1 and type 2 diabetes, but most investigations of diabetes and macrovascular CVD have addressed type 2 disease only. The NHLBI/NIDDK report appears in the June 28, 2005, issue of Circulation.

The authors suggest there are at least four potentially effective interventions to prevent coronary artery disease in persons with type 1 diabetes: control of hyperglycemia, control of hypertension, control of dyslipidemia, and control of insulin resistance. With the use of insulin analogues and pumps, A1C levels can be lowered safely below 7 percent in many adults with type 1 diabetes. Blood pressure should be lowered to a target of less than 130/80 mm Hg to improve kidney function and slow the progression of microalbuminuria (a risk factor for coronary artery disease). Tight control should be maintained over low-density lipoprotein (LDL) cholesterol levels, with a target level of less than 100 mg per dL (2.60 mmol per L), and an optional goal of less than 70 mg per dL (1.80 mmol per L) for persons with diabetes and CVD. Pharmacotherapy is recommended for patients with diabetes whose LDL cholesterol level is 100 mg per dL or higher. Insulin resistance can be reduced with optimal insulin therapy, increased physical activity, weight control, and (rarely) insulin-sensitizing medications.

The NHLBI/NIDDK report also notes that physicians are increasingly prescribing aspirin, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and statins to younger patients and those at high risk of developing CVD. Risk factor patterns need to be investigated further, the report states, and strategies should be considered for primary, secondary, and tertiary prevention of coronary artery disease in patients with type 1 diabetes.

CDC Releases Data on ADHD Diagnosis and Treatment in Children

The Centers for Disease Control and Prevention (CDC) has released a report analyzing the rate of diagnosis and treatment of attention-deficit/hyperactivity disorder (ADHD) among children and adolescents. The report, “Prevalence of Diagnosis and Medication Treatment for Attention-Deficit/Hyperactivity Disorder—United States, 2003,” appeared in the September 2, 2005, issue of Morbidity and Mortality Weekly Report and is available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5434a2.htm.

The CDC analyzed data from the 2003 National Survey of Children’s Health, which included persons 17 years or younger. According to the report, approximately 4.4 million children four to 17 years of age had been diagnosed with ADHD in 2003; 2.5 million of these children received medication to treat the disorder. The prevalence of ADHD diagnosis was higher in boys than in girls, and the rate of medication use was highest in patients nine to 12 years of age, regardless of sex.

Estimating the number of American children with ADHD is a significant factor in evaluating the overall burden of the disease, according to the report.