Two reports from the National Center for Health Statistics update data
on the prevalence of obesity and overweight in the United States using measured
weights and heights obtained during the National Health and Nutrition Examination
Survey (NHANES) conducted in 1999 and 2000. Flegal and colleagues report that
the age-adjusted prevalence of obesity (body mass index [BMI] ≥30) among
US adults increased from 22.9% in 1988-1994 (NHANES III) to 30.5% in 1999-2000.
Ogden and colleagues report that the prevalence of overweight among US children
(≥95th percentile of sex-specific BMI for age) increased in 1999-2000 compared
with 1988-1994. Prevalence of overweight in 1999-2000 was 15.5% among 12-
through 19-year-olds, 15.3% among 6- through 11-year-olds, and 10.4% among
2- through 5-year-olds. In another article in this issue of THE JOURNAL, Freedman
and colleagues, using self-reported weights and heights obtained in the Behavioral
Risk Factor Surveillance System survey of US adults conducted between 1990
and 2000, found that the prevalence of class 3 obesity (BMI ≥40) increased
from 0.8% in 1990 to 2.2% in 2000.
With rapid increases in prescription drug spending, many employers and
health insurance providers are changing benefits packages to better control
costs. In this analysis of claims data from working-age adults with employer-provided
drug coverage with varying benefit designs, Joyce and colleagues found that
adding an additional level of co-payment, increasing existing co-payments,
and requiring mandatory generic substitution all significantly reduced health
insurance plan payments and overall drug spending. Increasing co-payments
in multitier plans increased the percentage of drug expenses paid out-of-pocket
by beneficiaries. In an editorial, Steinwachs notes that as co-payments became
larger, patients filled fewer prescriptions, an outcome that may have adverse
To assess brain volume abnormalities and longitudinal brain growth in
attention-deficit/hyperactivity disorder (ADHD), Castellanos and colleagues
conducted serial magnetic resonance imaging scans over 10 years in children
and adolescents with ADHD and in healthy controls. On initial scan, children
and adolescents with ADHD had significantly smaller brain volumes in all regions.
Longitudinal growth curves for almost all brain structures among children
and adolescents with ADHD were roughly parallel to those among controls, but
on a lower track.
To determine the accuracy of human papillomavirus (HPV) DNA testing
for detection of high-grade cervical lesions or cancer, Kulasingam and colleagues
screened women aged 18 to 50 years during an annual examination using a thin-layer
Papanicolaou (Pap) test and 2 different assays for HPV DNA testing: a polymerase
chain reaction–based assay and a liquid-based DNA-RNA hybridization
capture with signal amplification assay. Women with positive screening results
(presence of high-risk HPV types or Pap result of atypical squamous cells
of undetermined significance or higher) were referred for colposcopy and biopsy,
and a random sample of women with negative screening results were also referred
for colposcopy. Of 7 colposcopy triage strategies evaluated, those based on
a single HPV DNA test were more sensitive but less specific for detection
of cervical intraepithelial neoplasia grade 3 or higher than screening strategies
based on thin-layer Pap testing.
Direct-to-consumer advertisements that promote genetic testing and services
have begun to appear in a variety of print media. Gollust and coauthors examine
the potential benefits of direct-to-consumer health promotions and discuss
factors that limit the value and appropriateness of direct-to-consumer advertising
for genetic testing.
The National Cancer Institute is recruiting 50 000 current and
former smokers for a study of spiral computed tomographic scans for early
lung cancer detection. The scans have grown in public popularity despite the
absence of solid evidence that they prevent premature death from lung cancer.
Effective treatment of tobacco dependence includes clinical, health
system, and community-level interventions.
Original clinical research reports, translational research studies,
and systematic reviews on obesity are invited for a JAMA theme issue scheduled
for spring 2003.
Part 1 of a 2-part article describes a model for effective primary care of patients with chronic
illness and how components of the chronic care model have been implemented
in 4 health care organizations.
For your patients: Information about attention-deficit/hyperactivity
This Week in JAMA. JAMA. 2002;288(14):1689. doi:10.1001/jama.288.14.1689