November 4, 2011
NIH Podcast Episode #0146
Balintfy: Welcome to episode 146 of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health – the nation's medical research agency. I'm your host Joe Balintfy. Coming up in this episode, a double feature on teen driving: research confirms risky driving is a cause for the high crash rates of newly licensed teen drivers; we’ll learn about a detailed study, and get tips to prevent accidents; also, November is National Diabetes Month, we’ll hear about prevention and the importance of eye exams. But first, this news update. Here’s Craig Fritz.
Fritz: A landmark NIH study in mice could help explain how tobacco products could act as gateway drugs, increasing a person's future likelihood of abusing cocaine and perhaps other drugs as well. The study is the first to show that nicotine might prime the brain to enhance the behavioral effects of cocaine. In the study exposure to nicotine led to an increased response to cocaine. This priming effect depended on a previously unrecognized effect of nicotine on genes, in which nicotine changes the structure of the tightly packaged DNA molecule, reprograms the patterns of specific genes, and ultimately alters the behavioral response to cocaine. The gateway drug model is based upon evidence that most illicit drug users report use of tobacco products or alcohol prior to illicit drug use. Before now, studies have not been able to show a biological mechanism by which nicotine exposure could increase vulnerability to illicit drug use.
For this NIH news update – I’m Craig Fritz
Balintfy: News updates are compiled from information at www.nih.gov/news. Coming up: details for diabetics and tips for everyone to better understand the disease, including the risk of vision loss. And a study on teen drivers using the latest technology. That’s next on NIH Research Radio
(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)
NIH research shows risk factors for teen drivers' high crash rates
Balintfy: A major study has identified risky driving as an underlying factor for the high crash rates of newly licensed teen drivers. Researchers using sensitive data recording devices – including video cameras and global positional systems — have found that newly licensed teenagers are more likely than older drivers to engage in risky driving behavior.
Simons-Morton: This actually confirms findings from other studies that are self-report or observational but this is the first objective assessment of teenage risky driving.
Balintfy: Dr. Bruce Simons-Morton, an NIH scientist and prevention researcher, explains a recent study is unique because of its use of technology.
Simons-Morton: The instrumentation included cameras, so we would know what’s happening inside and outside of the vehicle. GPS, so we know where they are going and we could assess speed. And accelerometers which allowed us to measure gravitational force events which is changes is acceleration such as rapid starts, hard stops, sharp turns and swerves.
Balintfy: The study shows that although crashes and near crashes decline over the first 18 months of having a license teenage drivers maintain a risky style of driving. This driving behavior increases the likelihood of a crash.
Simons-Morton: Teens engaged in risky driving sort of a style; they actually got better at driving in this risky manner because their crash rates declined but they maintained on average a very high level of risky driving. It’s not clear if this behavior is due to intent, that is they may have driven this way because it’s sort of fun or because they are simply clueless about the risks of such driving.
Balintfy: According to the CDC, motor vehicle crashes are the leading cause of death for U.S. teens, accounting for more than one in three deaths in this age group. Dr. Simons-Morton says this study has implications for prevention.
Simons-Morton: Sadly it points out the teenage driving dilemma which is that newly licensed drivers of all ages who are particularly teenagers are at high risk for crashes early on because they're inexperienced. It takes a lot of practice to become better. But all drivers eventually become relatively good. The dilemma is that teens only learn by driving but the more they drive, the greater their risk.
Balintfy: But Dr. Simons-Morton notes there are ways to reduce the risk of crashes.
Simons-Morton: The solution to the dilemma from a policy and prevention point of view is to limit the conditions under which newly licensed teenagers are allowed to drive either through graduated driver licensing which is not in place in every state in the nation but which varies from state to state in terms of its strictness and by parents who can set limits on certain conditions such as the number of passengers, the use of electronic devices, late night driving, high speed roads; this may not limit their risky driving but it limits the conditions that are most right for serious crashes.
Balintfy: The study results have been published in the American Journal of Public Health. For more information on this study, visit www.nichd.nih.gov. Stay tuned for more from Dr. Simons-Morton, later in the program: he’ll explain what the cameras in the cars saw, plus give tips to help reduce accidents.
National Diabetes Month: Make a Plan to Prevent Diabetes and Its Complications
Balintfy: November is National Diabetes Month—a time for people, groups, and communities across the country to shine a spotlight on diabetes. Dr. Griffin Rodgers is an NIH institute director and leader of the National Diabetes Education Program, or NDEP, a joint program of the NIH and CDC. The NDEP’s theme is “Make a Plan to Prevent Diabetes and Its Complications.” Why make a plan? Dr. Rodgers says it’s to make lifestyle changes.
Rodgers: Making lifestyle changes – and sticking with them – is a very hard thing to do. When you are trying to make lifestyle changes, it’s common to feel overwhelmed, sad, or angry – especially if you are living with a lifelong disease such as diabetes. Even if you know what to do to improve your health, figuring out how to do it and fitting it into your daily routine can be a big challenge.
Balintfy: Why is it especially important for people living with diabetes to make a plan?
Rodgers: Diabetes is a self-managed disease. People with diabetes can’t take a vacation from diabetes – they need to make decisions to manage their diabetes 24 hours a day, 7 days a week. To manage diabetes, people with diabetes have to think about: making healthy food choices, staying at a healthy weight, being active, working to keep blood glucose (or blood sugar), cholesterol, and blood pressure levels under control, and taking medicine the way the doctor tells you.
Balintfy: What can someone who wants to improve their health do to make these changes a little easier?
Rodgers: It’s easier to make changes if you set a goal and make a plan to help you get to that goal. Start by setting one goal to work on first. Decide on a goal that is important to you, and is something that you are willing and able to do. For example, if you want to be more active and you have not been very active in the past, start slowly—maybe by walking 10 or 15 minutes a day. Then you can try adding a few minutes each day until you get to 30 minutes of physical activity most days of the week.
Make sure your goal is realistic. For example, if you know that you work late, it might not be a realistic goal to say that you’re going to go for a walk or run after work. Instead, you might try getting out for a walk or run in the morning, or using some time during your lunch break to fit this in your schedule.
Once you have set your goal, think about the steps you will need to take to help you reach your goal. Pick one step to try this week. And once you make that first step, take another step the next week, and then another until you have reached your goal.
To help you get started in making a plan for you, visit www.YourDiabetesInfo.org/MakeAPlan.
Balintfy: Dr. Rodgers, what are some things that a person can do to overcome the challenges in making – and sustaining – lifestyle changes?
Rodgers: There are many things that can help people handle the challenges of making lifestyle changes. It’s important to realize that you are not alone. Join a support group where you can learn from others who are also working to prevent or manage diabetes. Find support from family and friends. Find someone who is a good listener to talk about your feelings. Set aside time for yourself even when you are busy. If it helps you remember to take the time, don’t be afraid to mark down time for yourself in your calendar. Look for ways to find balance in your life. Juggling many roles and responsibilities – like managing diabetes, taking care of mom, working, helping friends – can leave little time for you. And learn skills to cope with difficult emotions. Talk to your health care team about getting a referral to a counselor, psychologist, or psychiatrist to help you learn these skills.
Balintfy: Why is it important for us to highlight diabetes, not just during National Diabetes Month, but year round?
Rodgers: It’s important to point out that this is a very common problem. Nationally, nearly 26 million Americans, or 8.3 percent of the U.S. population, are currently living with diabetes. Nationally, more than one-fourth or 7 million, of those with diabetes do not know they have it. And then on a national level, approximately 79 million adults have pre-diabetes. This is a condition that increases the risk of developing type 2 diabetes, heart disease & stroke.
Balintfy: So what would you emphasize for people during National Diabetes Month?
Rodgers: One point I just like to emphasize is again to get more information about this, visit our website, www.YourDiabetesInfo.org.
Balintfy: Thank you very much Dr. Griffin Rodgers.
Encouraging annual dilated eye exams for people with diabetes
Balintfy: Complications of diabetes include heart disease and stroke, as well as damage to the kidney, feet and eyes – basically anywhere in the body where there are very small blood vessels. For example the retina inside the eye is especially susceptible to diabetic eye disease. So up next we’re talking with Dr. Suber Huang; he’s chair of the National Eye Health Education Program’s Diabetic Eye Disease Subcommittee for the National Eye Institute here at NIH; he’s also professor and Vice-Chairman of the Department of Ophthalmology at Case Western Reserve University. Dr. Huang, what exactly is diabetic eye disease?
Huang: Diabetic eye disease refers to a group of diseases that are caused by the disease called diabetes or sometimes diabetes mellitus. Diabetes can cause blindness and is in fact the number one cause of blindness in the United States. It damages the retina which is the light sensing tissue inside the back of the eye.
The diabetic retinopathy is the most common complication affecting the eye.
Diabetic retinopathy often affects parts of the retina that do not interfere with vision and detecting that may be difficult in its early stages.
Balintfy: Does it have any warning signs or symptoms?
Huang: Often diabetes does not. Often diabetes can begin to cause damage to the retina without causing visual loss. It's important to notice these problems before vision is lost, and to do that you need to see your eye care professional.
Balintfy: How often should people with diabetes have an eye exam?
Huang: You should have a comprehensive dilated eye exam at least once a year. It's important to detect disease in its early stages. If you have disease, you may need more frequent examinations; and if you have disease, things can be done.
Balintfy: Why is early detection so important, Dr Huang?
Huang: Early detection is important for early treatment. Treatment options are available and often most beneficial when the disease is detected early. It's good to catch things early. Vision often lost can't be restored. So when detecting disease before vision lost is key in preserving sight.
Balintfy: What can people with diabetes do to protect their vision?
Huang: In addition to having dilated eye exams every year, people should take their medicines, reach and maintain a healthy weight, add physical activity to their daily routine, control their blood sugar, blood pressure and cholesterol, and they need to quit the smoking habit.
Balintfy: Where can people get more information about diabetic eye disease?
Huang: People can visit the NEI Diabetic Eye Disease website at www.nei.nih.gov/diabetes to find more information. They also find information about finding financial assistance for eye care, tips for finding eye care professional, and order educational materials about diabetic eye disease.
Balintfy: Thank you Dr. Suber Huang.
Huang: Thanks for having me.
Balintfy: Coming up, more about teen driving, including specific tips to help prevent accidents. That’s next on NIH Research Radio.
(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)
NIH research shows risk factors for teen drivers' high crash rates
Balintfy: We’re talking more with Dr. Bruce Simons-Morton, an NIH scientist and prevention researcher. He is the lead author on that paper in the American Journal of Public Health about risky teen drivers. So can you explain more about how you measured risky driving.
Simons-Morton: Yeah. Our measure of risky driving is an objective measure of changes in acceleration or elevated G-Force events and there are five kinds of these. You can have an elevated G-Force event by stopping very suddenly and teens commonly have these hard stops because they slam on the breaks at the last minute. Cornering sharply increases the G-Force event, the G-Force on the vehicle. Even starting very fast can do this and then often there’s an over correction factor when you turn sharply, you adjust that’s called yaw. Anyway, we put these together and then evaluate them overtime and that’s our measure of risky driving.
Now there have been lots of other measures that are subjective. This is an objective measure because we know exactly what G-Force was exerted and we can measure commonly across all of the drivers and overtime. Other researchers without the advantages of this technology have measured risky driving by asking teens, “Do they engage in these risky behaviors -- similar kind of behaviors?” So here we have an objective measure.
Balintfy: What technology were you using to measure this – did you use cameras?
Simons-Morton: We did, this technology is amazing. These are little tiny cameras installed in the vehicle that one looks forward so that you know what is going on outside the vehicle and another looks rearward. And then there is a camera that’s always on the rearview mirror that looks at the driver’s face. So we know where the driver is looking and we know when they are engaging in some secondary task. And then periodically, we have a camera that is overhead and it’s a very broad view and it just takes a still of the occupants of the vehicle. And we do that because we don’t have consent necessarily form all of the passengers. So we just take a still view and it’s blurred so you can’t really make out who but you can invariably determine whether it’s a male or female and whether it’s an adult or a young person.
So we have information on who’s driving the vehicle and all of the other information about occupants.
Balintfy: Could you see these “secondary tasks” – what may have been contributing to risky driving?
Simons-Morton: Yes, we could see that and we are about to submit a paper that reports very high secondary task engagement among teens and the most common of these are dialing, talking and texting on a cell phone. And these are associated highly with crash, near crash events.
Another secondary task or related secondary task that we’ve observed that is how they associated with crash, near crash, is reaching for other objects. It’s one of the biggest risks and because what we know from an earlier study is that the most important cause of a crash is when the driver’s eye is off the road, eyes are off the road. So any task that encourages the driver to look away from the road for any length of time increases risk and the longer that glance the greater the risk because when something happens when you’re not looking, you’ve lost all that time to respond.
Balintfy: Dr. Simons-Morton, did you see any differences between boys and girls in your study?
Simons-Morton: Curiously, we did not find differences between boys and girls in either crash rates or in risky driving rates. Now there was a lot of variability and it’s a relatively small sample so there may be some differences. What the epidemiologic data show is that males and females have very similar non-fatal crash rates, the teenagers but males have much higher fatal crash rates than females. Suggesting that there is you know, the adolescent risk taking that is higher among males probably operates here.
Balintfy: If I were a parent of a teenager, whose about to get their license or who has a new driver’s license, what advice would you give based on the results of this study?
Simons-Morton: I guess the important thing to know if you’re a parent is that teenagers, when they first get licensed are very likely to crash. The rates are very high, at whatever age they get licensed but the younger they get licensed, the higher the risk and the slower the decline in that risk. So point one would be to delay licensure as long as possible. Everyone who is raised, a teenager knows that when they’re 17 they’re more mature when they’re 16. So the longer you can delay licensure, the better -- both because they’re going to be a little more mature and second of all because they’ve not been exposed during that period.
And then the second thing that parents can do and unfortunately most parents don’t do this very much is to set limits on their newly licensed teens. They need to drive in order to develop confidence but the likelihood of a crash and the severity of a crash is linked to certain driving conditions as well.
So if you limit those conditions which include late night driving, multiple teenage passengers, high speed roads, unfamiliar terrain and secondary task engagement. You can reduce crash rates. And we know from at least one previous study that teens whose parents do set these kind of limits report that they engage in less risky driving.
Balintfy: Thank you very much Dr. Bruce Simons-Morton. For more information on this study, again visit the website, www.nichd.nih.gov.
Balintfy: And that’s it for this episode of NIH Research Radio. Please join us again on Friday, November 18 when our next edition will be available. If you have any questions or comments about this program, or have story suggestions for a future episode, please let me know. Best to reach me by my email—my address is firstname.lastname@example.org. I'm your host, Joe Balintfy. Thanks for listening.
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