After setting out a conceptual framework that focuses on how personal and social resources aid adolescents in managing acute and chronic stressors, I describe methods by which to assess adolescents' family environments and specific life stressors and social resources, and the approach and avoidance coping responses adolescents use to manage life stressors. I then review some research that employs these concepts and methods to focus on the families and life contexts, and coping skills, of youth with chronic medical disorders, including juvenile rheumatic disease (JRD). I close by drawing implications for assessment and intervention and describing some fruitful areas for future research, such as examining the reciprocal linkages between parental and youth behavior, how adolescents' personal characteristics shape their life context, and how life crises and transitions enhance adolescents' development and maturation.

Objective:To examine whether televised food commercials influence preschool children's food preferences.

Design: In this randomized, controlled trial, preschool children viewed a videotape of a popular children's cartoon either with or without embedded commercials. Children were then asked to identify their preferences from pairs of similar products, one of which was advertised in the videotape with embedded commercials. Preschoolers' parents were interviewed to determine children's demographic characteristics and media use patterns.

Subjects: Forty-six 2- to 6-year-olds from a Head Start program in northern California.

Statistical Analyses: For demographic and media use characteristics, univariate data were examined and Student t and chi 2 tests were used to test for differences between the control and treatment groups. We calculated the Cochran Q statistic to assess whether the proportion of those choosing advertised food items was significantly higher in the treatment group than in the control group.

Results: Children exposed to the videotape with embedded commercials were significantly more likely to choose the advertised items than children who saw the same videotape without commercials (Qdiff = 8.13, df = 1, P .01).

Conclusions/Applications: Even brief exposures to televised food commercials can influence preschool children's food preferences. Nutritionists and health educators should advise parents to limit their preschooler's exposure to television advertisements. Furthermore, advocates should raise the public policy issue of advertising and young children, especially given the recent epidemic of childhood obesity and the ever-changing media environment.

Context: Helicobacter pylori commonly infects humans; however, its mode of transmission remains unknown.

Objective: To determine how humans-the primary host for H pylori-shed the organism into the environment.

Design: Controlled clinical experimental study conducted from February through December 1998.

Setting: Clinical research unit of a hospital in northern California.

Patients: Sixteen asymptomatic H pylori-infected and 10 uninfected adults.

Intervention: A cathartic (sodium phosphate) and an emetic (ipecac) were given to all infected subjects and an emetic was given to 1 uninfected subject.

Main Outcome Measure: Confirmed H pylori isolates cultured from stool, air, or saliva before and after catharsis and emesis and from vomitus during emesis. Isolates were fingerprinted using repetitive extragenic palindromic (REP) polymerase chain reaction and species identity was confirmed by sequencing the 16s ribosomal RNA gene.

Results: All vomitus samples from infected subjects grew H pylori, often in high quantities. Air sampled during vomiting grew H pylori from 6 (37.5%) of the 16 subjects. Saliva before and after emesis grew low quantities of H pylori in 3 (18.8%) and 9 (56.3%) subjects, respectively. No normal stools and only 22 (21.8%) of 101 induced stools grew the organism, although 7 (50.0%) of 14 subjects had at least 1 positive culture (2 stool culture samples were contaminated by fungus and were not included). Fingerprints of isolates within subjects were identical to one another but differed among subjects. No samples from uninfected subjects yielded H pylori.

Conclusions: Helicobacter pylori can be cultivated uniformly from vomitus and, occasionally, from saliva and cathartic stools. The organism is potentially transmissible during episodes of gastrointestinal tract illness, particularly with vomiting.

The full effects of decisions made today about many environmental policies -including climate change and nuclear waste- will not be felt for many years. For issues with long-term ramifications, analysts often employ discount rates to compare present and future costs and benefits. This is reasonable, and discounting has become a procedure that raises few objections. But are the methods appropriate for measuring costs and benefits for decisions that will have impacts 20 to 30 years from now the right ones to employ for a future that lies 200 to 300 years in the future?

Rather than simply disassemble current methodologies, the contributors examine innovations that will make discounting a more compelling tool for policy choices that influence the distant future. They discuss the combination of a high shout-term with a low long-term diescount rate, explore discounting according to more than one set of anticipated preferences for the future, and outline alternatives involving simultaneous consideration of valuation, discounting and political acceptability.

The effort to discover and develop new pharmaceuticals is a risky and costly enterprise. For diseases that affect few patients, the barriers to development maybe especially great, since the drugs' small markets may make it difficult for firms to recoup their initial research and development investments. The Federal Government has sought to reduce these barriers through incentives first adopted in the Orphan Drug Act of 1983 (Public Law 97-414). The transfer of technology from Federal laboratories such as the National Institutes of Health to the pharmaceutical industry can also reduce the cost and risk of drug development for firms. Although such incentives may result in important new therapies, their price to patients and insurers may still be high.

As part of our assessment, Government Policies and Pharmaceutical Research and

Development, requested by the House Committee on Energy and Commerce and its

Subcommittee on Health and the Environment and the Subcommittee on Antitrust,

Monopolies, and Business Rights of the Senate Committee on the Judiciary, OTA

commissioned researchers at Stanford University to examine the development and provision of alglucerase, an important new treatment for Gaucher disease. Gaucher disease is a rare inherited disorder in which the body lacks an enzyme necessary to break down fats. This background paper describes the development of alglucerase, illustrates the role that both the Federal Government and private sector can have in making new therapies available for orphan diseases, and lays out some of the tradeoffs that can exist between developing new medical technologies and controlling health care costs.

Most pesticide illnesses go untreated. Many are nor serious enough to require medical attention, others are not treated because agricultural workers lack access to health care. Additional analysis of physical report of occupational injuries and illnesses in California agriculture continues to rise. Only a fraction of these reports involve pesticides. Surveys of field workers indicate that there are many more pesticide illnesses than are reported by physicians. Most survey methods can report symptoms, but cannot confirm the incidence of illness. Some studies have found seasonal depression in the blood cholinesterase of field workers, but the physiological significance of such depression is uncertain.

Clinical tests and specific antidotes are needed to treat illnesses induced by pesticides other than cholinesterase inhibitors. The clinical significance of pesticide residues in human fluids and tissue has yet to be defined. Research is needed to standardize cholinesterase testing, and to find the means to assay the enzyme independent of its activity, so that baseline tests will not be needed. Research is needed on the neurotoxic effects of organophosphate insecticides, including the use of psychological tests and evaluation with EMG and EEG.

Field workers reentry standards are based on studies of foliar induced, and extrapolation forma few evaluation of human health effects. Research is needed to see if current standards are adequate, and to evaluate the risk assessment models used in setting reentry intervals. More research is needed to develop methods and equipment which better protect the pesticide applicator.

There are few studies which suggests that pesticides cause adverse long-term health effects in human populations, including cancer and birth defects. Such research is fraught with methodological difficulties. Research is needed to evaluate the new California program which is attempting to close the date gap of tests involving experimental animals.

Cholesterol Education Program: Hearing Before the Subcommittee on Health and the Environment of the Committee on Energy and Commerce, House of Representatives, One Hundred First Congress, First Session