rss

Recent eLetters

Displaying 11-20 letters out of 373 published

  1. Urgent need to conduct similar studies in developing countries

    Dear Editor,

    I have enjoyed reading the article which has well highlighted the fact that tobacco consumption and secondhand smoke (SHS) exposure in vehicles is indeed a serious health issue because of the high concentrations especially in confined environments.

    The results have global repercussions yet in the discussions the authors largely ignore low income and more crowded societies like India, Nigeria, Brazil and Kenya and only focus on high income settings like Spain, Italy and New Zealand. It would create better balance and become more comprehensive if similar studies were conducted as a matter of urgency in the developing world.

    The impressive results indicating high prevalence of SHS exposure to young children justify the need for more public education and the need for legislation to help introduce regulations to reduce exposure.

    Thank You

    Conflict of Interest:

    None declared

    Read all letters published for this article

    Submit response
  2. Re: Household sanitation and personal hygiene practices are associated with child stunting in rural India: a cross-sectional analysis of surveys

    The association of child stunting and water, sanitation and hygiene is an eye opening study. Concentration has been on what the child is missing from their diet, without really auditing how their surrounding would affect the ultimate absorption of these nutrients in their bodies. The study identifies diarrhoea and other water borne, water washed and other contact diseases as affecting the alimentary canal of the children and even their appetites. Thus a child who is constantly affected by these diseases has a higher chance of stunting due to malnutrition which the parent may not notice and would simply attribute the child's wasting to the effects of the illness. The association of stunting and water and sanitation and hygiene would definitely explain the many deaths and ill health among the vulnerable communities.

    The study highlights many pertinent issues surrounding water and sanitation in India which also affect Sub Saharan African households. It would be interesting to see if a similar study among sub-Saharan African households would reveal the same outcomes. The study revealed a relationship between stunting of the children and the level of formal education of their care givers in regards to WASH. I would like to know if the following considerations were made; 1. Were the care givers exposed to informal education systems on WASH and stunting through media campaigns? 2. Were the caregivers exposed to informal education systems using the informal health workers in their homes? 3. Were the caregivers exposed to informal education systems at the health facilities when they go to seek medical attention for the conditions related to WASH.?

    Finally the overall presentation of the paper was very concise. The key points were articulated clearly. The organization of the paper was good. I was able to follow the train of thought of the authors and enjoyed reading the paper. It had new knowledge on the relationship between childhood stunting and water sanitation and the personal hygiene of the caregivers. It opens up other follow up researches that may be of interest to many. The reference to previous studies gave a strong background to their case findings and therefore was very compelling.

    Conflict of Interest:

    None declared

    Read all letters published for this article

    Submit response
  3. Safe-sex belief and sexual risk behaviors among adolescents from three developing countries: a cross-sectional study

    Title: Views on Condom effectiveness among adolescents in three Latin American countries. This research made great contribution as a stepping stone in comparing safe sex and sexual risk behaviors in Latin American countries and by extension Spain, however similar studies conducted in Kenya, Uganda and South Africa revealed different levels on infection. Whereas the three countries had prevalence of HIV for the general population below 1%, conversely, the three sub-Saharan countries had HIV prevalence ranging from 5.6% (MOH Kenya, 2014) ,7% in Uganda and an all time worrying 12.2% South Africa respectfully. It is for this reason therefore, I could have suggested having countries with similar or close prevalence rates ranked together for a better comparison based on population dynamics and regional diversity. On safe sex belief, the research revealed that one out of seven adolescent believed that condoms are 100% effective in the three Latin America countries. As much as the results were appealing, a supplement article on Epidemiology of HIV and AIDS Among Adolescents: Current Status, Inequities, and Data Gaps indicated that knowledge in belief of condom effectiveness and use among the adolescents in developing countries remained low : HIV, AIDS, adolescents, prevention, care, treatment (J Acquir et.al ,2014;66:S144-S153). Based on the above results, comparing Kenya, Uganda and South Africa on the same parameters would less likely yield the same results. This is because there are different factors associated to condom use ranging from religious to cultural beliefs about safe sex. The paper also sought to find out whether the adolescents had had sex. Adolescents who believed that condoms were 100% effective were 82% likely to have had sex and used condoms. This was very good results if the paper would have been able to truly prove of scientifically that they used condoms. However, it is of crucial importance to note that early sexual debut among adolescents begins before 15 years of age. There are several researches showing significant variations of early sexual debut based on different regions of the world. The paper ought to have put in consideration the element of costs. Condoms access was not discussed in the paper. In Kenya for example, Condoms are sold or placed in specific dispensing points. Adolescents living in rural areas will either shy off or feel ashamed to pick condoms where their relatives dine and wine. Various reports indicate that where condoms are not available adolescents either improvise small micron polythene papers for condoms or practice unprotected sex. Adolescents also have tendency of using condoms at initial contacts and discard their use later. These has shown considerable rise in sexually transmitted infections as echoed by supplementary report on Epidemiology of HIV and AIDS among adolescents (J Acquir et.al, 2014; 66:S144-S153). Condoms use cannot guarantee protection of infections i.e. Herpes simplex and Human papilloma. This gives me a valid reason to say that it is not safe for adolescents in sub-Saharan Africa with little access to approve of its use. In as much as I respect the research findings, Wood, in his work on social cultural effects of HIV in South Africa wrote "Local understanding of the gendered effects of sexual intercourse and lack of it on men causes retention of semen which in turn is thought by many young South African men to cause an array of undesirable effects, including 'madness'.(Wood,2002)".Based on the above, adolescents growing up in this kind of settings will less likely use condoms because condoms may be considered like a barrier causing madness. The adolescents do not live in isolation, they operate and interaction in a society guided by cultural norms, I therefore, highly doubt them going against the dictates of cultural perception on condom use. When in doubt on condom information, adolescents would frequently ask these questions to peers who may not have befitting correct answers. His second finding was equally not possible to measure but has detrimental effects on adolescents. He further wrote "Women are said to have sexual appetites which are, again, thought to need regulating as well as satisfying too frequent sex and too many partners for women are considered to jeopardize vaginal tightness, which is desirable because it is associated with 'heat', which is central to male sexual pleasure (Wood, 2002)." Going by these findings revealing that condoms are100% effective and ready to be used by the adolescents in Sub Saharan Africa leaves me with many unanswered questions to our next generation. In spite of this inspiring work, the study in future may consider making comparison of researches done in Latin America and sub-Saharan Africa to inform on condom use as key prevention intervention among the adolescents. By: Benjamin Macharia

    Conflict of Interest:

    None declared

    Read all letters published for this article

    Submit response
  4. The Lisbon Cohort of Men Who Have Sex With Men

    The Lisbon Cohort of men who have sex with men (MSM) identified gays, bisexuals and MSM aged between 20-29 years as key populations most affected by HIV/AIDS1 and key contributors to the epidemic in Portugal. The study identified the need to establish instruments for monitoring HIV and syphilis incidence, determinants of infection and risk-taking behaviors in MSM. A community-based walk-in centre was used to recruit MSM as participants of a cohort study despite the obvious limitation of recruiting only men that walked into the centre. Chinese and European studies recommended the Internet as an effective avenue for recruiting study subjects, and other authors have used formal health or academic institutions to recruit participants2. The article highlighted several cultural, anthropological and sociological challenges in the conduct of community-based studies with MSM. The use of community-based or Internet strategies for recruiting participants from vulnerable populations such as MSM may be difficult in low-income countries; this is related to the reality that MSM is still not accepted in these countries. Conducting such a study in low-income settings may yield evidence which may not be generalized across populations. However, the Lisbon cohort provides a good foundation for researchers that would like to conduct research around MSM in similar settings.

    Conflict of Interest:

    None declared

    Read all letters published for this article

    Submit response
  5. The relationship between smoking status and health-related quality of life among smokers who participated in a 1-year smoking cessation programme in Taiwan: a cohort study using the EQ-5D Pei-Ching Chen, 1, 2 Raymond Nien-Chen Kuo, 3 Chih-Kuan Lai,4 Shih-

    Dear Editor, This article is an important study addressing priority areas of disease burden particularly in high income settings. The study is well designed with a large sample size. Unfortunately, the limitations mentioned by the authors seems rather severe, hindering the validity of conclusions both due to lack of funds to cover up the study period as intended and loss of follow up on some of the participants. The tool used also according to Mathias et al., 2012, gives inadequate information on health-related quality of life (HRQoL) which differs across the populations. In all, it is an important study that is worth exploring in other places particularly in the low and middle income countries on the road towards cancer prevention.

    References Matthias Vogl, Christina M Wenig, Reiner Leidl and Subhash Pokhrel . (2012) Smoking and health-related quality of life in English general population: implications for economic evaluations.

    Conflict of Interest:

    None declared

    Read all letters published for this article

    Submit response
  6. Who is in control? Clinicians' view on their role in self-management approaches: a qualitative metasynthesis

    I enjoyed reading this article on clinician's View on their role in self management approaches. Nowadays a large number of people are living with chronic illnesses. Often, one living with chronic illness needs to be assisted with some skills to take care themselves better, applying the approach of self management. The findings of this study showed that clinicians may find it difficult to shift some tasks to or share control in health care with the patient or family care givers. However there is need for change in position moved from the more traditional approach of provider dominated care to a partnership as innovative approach to patient centered care. The method used to gather the data for this article were clearly explained. Metasynthesis as the methodology to synthesize data from several studies. Complete articles included in the study, on experiences, or views on clinicians' roles on self management approach were recaptured. The approach of synthesizing findings coming from different opinions can be complex, in generating harmonized results. Synthesis could be used as the primary study while qualitative design can used as secondary to explore how they applied the self management approach. Self management approach have many advantages in improving patients' wellbeing in the community, in coping with chronic illness. In low income settings where there is lack of health professionals, primary care teams may have difficulty finding time to provide patient education sessions and to monitor health indicators to ensure safety even when patients and their caretakers have been trained. Thus the needed change cannot be effected by the clinicians alone. It also needs community education, where education depends on the curiosity, educational background and socio economic status of those to included in a programme of education about self management .

    Conflict of Interest:

    None declared

    Read all letters published for this article

    Submit response
  7. The Lsibon Cohort of Men Who Have Sex With Men

    The Lisbon Cohort of men who have sex with men (MSM) identified gays, bisexuals and MSM aged between 20-29 years as key populations most affected by HIV/AIDS1 and key contributors to the epidemic in Portugal. The study identified the need to establish instruments for monitoring HIV and syphilis incidence, determinants of infection and risk-taking behaviors in MSM. A community-based walk-in centre was used to recruit MSM as participants of a cohort study despite the obvious limitation of recruiting only men that walked into the centre. Chinese and European studies recommended the Internet as an effective avenue for recruiting study subjects, and other authors have used formal health or academic institutions to recruit participants2. The article highlighted several cultural, anthropological and sociological challenges in the conduct of community-based studies with MSM. The use of community-based or Internet strategies for recruiting participants from vulnerable populations such as MSM may be difficult in low-income countries; this is related to the reality that MSM is still not accepted in these countries. Conducting such a study in low-income settings may yield evidence which may not be generalized across populations. However, the Lisbon cohort provides a good foundation for researchers that would like to conduct research around MSM in similar settings.

    Conflict of Interest:

    None declared

    Read all letters published for this article

    Submit response
  8. A Critical Appraisal of Esposito et al.'s Nomogram for Predicting HbA1c Response to DPP-4 Inhibitors

    Re: A nomogram to estimate the HbA1c response to different DPP-4 inhibitors in type 2 diabetes: a systematic review and meta-analysis of 98 trials with 24 163 patients. Esposito, et al. 5:2 e005892 doi:10.1136/bmjopen-2014-005892

    We read with interest the recent article by Esposito et al. describing their development of a nomogram to predict HbA1c response to different dipeptidyl peptidase (DPP)-4 inhibitors in the treatment of type 2 diabetes (1). We believe that several important factors need to be considered when interpreting the results of this study.

    Firstly, the nomogram was derived from a meta-regression model relating treatment effect to several covariates, including baseline HbA1c level, type of DPP-4 inhibitor and baseline fasting plasma glucose. Other covariates were tested but found to not have additional effects - although background medication was included only as a binary variable, and therefore the treatment effect of different types of medication may not have been captured. Importantly, however, the authors did not further test additional covariates likely to affect treatment response - notably, length of prior drug washout, diabetes duration and race/ethnicity. Regarding the latter, for example, there is evidence that the efficacy of DPP-4 inhibitors is greater in Asians than in Caucasians (2)(3).

    One particularly notable limitation of the model is the use of absolute HbA1c changes rather than the placebo-corrected values that are conventionally used in meta-analyses. The authors acknowledge this limitation without fully justifying it. Unfortunately, the use of absolute HbA1c changes without any adjustments can lead to inaccurate estimates of the treatment effects of individual DPP-4 inhibitors. For example, absolute changes in HbA1c in two of the studies included, both conducted in Asian patients, were -0.24% and -1.05%, suggesting the drug in the latter study (vildagliptin) to be more effective than that in the former (linagliptin). However, the placebo-corrected changes were -0.87% with linagliptin and -0.51% with vildagliptin (4)(5).

    Additionally, the meta-regression model included baseline HbA1c as a covariate. However, most, if not all, of the included studies reported HbA1c changes from baseline derived from ANCOVA models that already contained baseline HbA1c as a covariate.

    As acknowledged by the authors, by far the strongest predictive factor for HbA1c response was baseline HbA1c, with different DPP-4 inhibitors explaining only a small amount of variance between studies. However, there was a significant residual variance in the meta-regression model that could not be explained, and may reflect the potential confounding factors discussed above.

    In light of these limitations, the authors' statement that "[T]he nomogram is not intended to give a comparison of different DPP-4 inhibitors, given the lack of head-to-head RCTs comparing their efficacy in HbA1c reduction from baseline" seems incongruent with their concluding sentence that "[T]he nomogram we developed may help clinicians in predicting the HbA1c response to individual DPP-4 inhibitor [sic] in clinical practice."

    We also note that studies in patients with renal impairment were excluded from the model. Given the high prevalence of chronic kidney disease among patients with T2DM, estimated to be ~40% (6), this exclusion could affect the external validity of the nomogram.

    On the basis of these considerations, we conclude that Esposito et al.'s nomogram - although an interesting and novel approach to predicting HbA1c response to DPP-4 inhibitors - is likely to be confounded, and may not provide an accurate estimate of the true treatment effects of individual medications. Consequently, the nomogram should not be used to compare clinical efficacy or real-world effectiveness between DPP-4 inhibitors, as the authors themselves note.

    1. Esposito K, Chiodini P, Maiorino MI, et al. A nomogram to estimate the HbA1c response to different DPP-4 inhibitors in type 2 diabetes: a systematic review and meta-analysis of 98 trials with 24 163 patients. BMJ Open 2015; 5: e005892. doi:10.1136/bmjopen-2014-005892.

    2. Kim YG, Hahn S, Oh TJ, Kwak SH, Park KS, Cho YM. Differences in the glucose-lowering efficacy of dipeptidyl peptidase-4 inhibitors between Asians and non-Asians: a systematic review and meta-analysis. Diabetologia 2013; 56: 696-708.

    3. Cai X, Han X, Luo Y, Ji L. Efficacy of dipeptidyl-peptidase-4 inhibitors and impact on beta-cell function in Asian and Caucasian type 2 diabetes mellitus patients: A meta-analysis. J Diabetes 2015; 7: 347-59.

    4. Pan C, Xing X, Han P, et al. Efficacy and tolerability of vildagliptin as add-on therapy to metformin in Chinese patients with type 2 diabetes mellitus. Diabetes Obes Metab 2012; 14: 737-744.

    5. Kawamori R, Inagaki N, Araki E, et al. Linagliptin monotherapy provides superior glycaemic control versus placebo or voglibose with comparable safety in Japanese patients with type 2 diabetes: a randomized, placebo and active comparator-controlled, double-blind study. Diabetes Obes Metab 2012; 14: 348-357.

    6. Koro CE, Lee BH, Bowlin SJ. Antidiabetic medication use and prevalence of chronic kidney disease among patients with type 2 diabetes mellitus in the United States. Clin Ther 2009; 31: 2608-2617.

    Acknowledgements: Editorial assistance, supported financially by Boehringer Ingelheim, was provided by Giles Brooke, PhD CMPP, of Envision Scientific Solutions during the preparation of this letter.

    Conflict of Interest:

    All authors are employees of Boehringer Ingelheim Pharma GmbH & Co. KG (Ingelheim, Germany), the manufacturer of a DPP-4 inhibitor (linagliptin).

    Read all letters published for this article

    Submit response
  9. Radical austerity and unemployment are associated with increased suicide mortality in Greece.

    Radical austerity and unemployment are associated with increased suicide mortality in Greece. George Rachiotis1, David Stuckler2,3 Martin McKee34, Christos Hadjichristodoulou1. 1.Department of Hygiene and Epidemiology, Medical Faculty, School of Health Science, University of Thessaly, Larissa, Greece 2.Department of Sociology, University of Oxford, Oxford, UK 3.European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK 4.European Observatory on Health Systems and Policies, London, UK We would like to thank researchers and readers of the journal for their interest in our paper [1]. Dr Fountoulakis, in his reply, [2] accused us of selectivity of citation, insisting that the increase in suicides after 2010 has been already reported by him and co-workers [3-6]. Remarkably, three out of 4 references that Dr Fountoulakis mentioned are totally irrelevant to analysis of suicides in Greece after 2010 [3-5]. Surprisingly, in a short communication about suicidality in Greece in the period 2000-2010, the authors stated that:'' The results of the current study suggest no increase in suicidality in Greece during the recent economic crisis...'' [4]. In one of the references mentioned by Dr Fountoulakis [6] there is a statement that the absolute number of suicides in Greece increased in 2011, but data for 2012 were not reported. We did not mention this letter to the editor -which refers to only one year- given that the description of a trend was impossible. Regarding age and gender specific rates, we feel that the use of numerous age groups in the analysis of suicides creates the problems associated with of small numbers of observations. On the contrary our analysis (with 3 large age groups) provides the reader with a clearer picture of the impact of unemployment on suicides, especially among males of working ages. At this point we note that there was a significant correlation between unemployment rates and suicide mortality among males of working age. On the contrary this was not the case for females, despite the observed increase in suicide rates among them. Dr Fountoulakis denied that male suicide rates are common, but the data suggest a 34% increase in male suicide rate in 2011-2012. The increase among females of working age during the same period was lower (25.5%) although considerable. The previous data confirmed a key role for male gender in increased suicide rates in Greece and are consistent with previous published information [7]. Dr Fountoulakis missed the point regarding the significance of 2010 in relation to the radical austerity policies. The fact that, as Dr Fountoulakis stated, the correlation of male suicide rates with unemployment changed, within two years, from 2011 to 2012, from -0.09 to 0.54 is indicative of the strong and independent impact of radical austerity on male suicide rates in Greece. Unfortunately, this documented impact has been consistently ignored by Dr Fountoulakis. Further, we note that Dr Fountoulakis ignored the results by many independent research teams from Greece and abroad regarding a positive correlation between unemployment and suicide rates in Greece [8-10]. In addition he failed to mention that an increase in suicide rates was associated with austerity policies in Greece [11]. Regarding the temporal association between unemployment and suicide rates in Greece, the facts are quite clear. The general trend indicates-at least after 2009 and among males- that unemployment increased and the suicide rates increased afterwards. Dr Fountoulakis failed to explain the nature of the program imposed to Greece by the Troika from 2010. This program refers to a ''shock therapy'' very similar to that implemented in Russian Federation during the 90's. The Greek economy shrank by 25% between 2008-2012 and the unemployment rate doubled from 12.7% in 2010 to 24% in 2012. These figures indicate an unprecedented, at least since World War II, radical experiment in socio-economic destruction and welfare-state retrenchment in Europe. We have pointed out the harmful consequences of continuing delays in publishing mortality data [1]. These delays mean that it will not be possible to bring the story of economic crisis and suicides completely up to date. Indeed, in our analysis we had available data only for the first two years (2011 and 2012) of the implementation of radical austerity in Greece. Nevertheless, these data provide preliminary evidence that radical austerity is associated with increased suicides in Greece, although there are several possible mechanisms by which austerity may act. It is a positive sign that the President of European Commission Jean Claude Juncker recently recognized the ongoing humanitarian crisis in Greece [12]. However, there is an urgent need to undertake a comprehensive health impact assessment of the radical austerity imposed by the Troika, in line with the obligation placed on the European institutions by the European Treaties [13]. References: 1. Rachiotis G, Stuckler D, McKee M, et al. What has happened to suicides during the Greek economic crisis? Findings from an ecological study of suicides and their determinants (2003-2012). BMJ open 2015;5(3):e007295 doi: 10.1136/bmjopen-2014-007295[published Online First: Epub Date]|. 2. Fountoulakis KN. Reply to Rachiotis et al: Increased unemployment might not be the cause of the world wide rise in suicide rates. BMJ Open, April 23, 2015; e-letter 3. Fountoulakis KN, Koupidis SA, Siamouli M, et al. Suicide, recession, and unemployment. Lancet 2013;381(9868):721-2 doi: 10.1016/S0140-6736(13)60573-5[published Online First: Epub Date]|. 4. Fountoulakis KN, Savopoulos C, Siamouli M, et al. Trends in suicidality amid the economic crisis in Greece. European archives of psychiatry and clinical neuroscience 2013;263(5):441-4 doi: 10.1007/s00406 -012-0385-9[published Online First: Epub Date]|. 5. Fountoulakis KN, Siamouli M, Grammatikopoulos IA, et al. Economic crisis-related increased suicidality in Greece and Italy: a premature overinterpretation. Journal of epidemiology and community health 2013;67(4):379-80 doi: 10.1136/jech-2012-201902[published Online First: Epub Date]|. 6. Fountoulakis KN, Koupidis SA, Grammatikopoulos IA, et al. First reliable data suggest a possible increase in suicides in Greece. Bmj 2013;347:f4900 doi: 10.1136/bmj.f4900[published Online First: Epub Date]|. 7. Kentikelenis A, Karanikolos M, Reeves A et al. Greece's health crisis: from austerity to denialism. Lancet 2014;383:748-53. 8. Kontaxakis V, Papaslanis T, Havaki-Kontaxaki B et al. Suicide in Greece: 2001-2011. Psychiatrike. 2013;2:170-4. 9. Madianos MG, Alexiou T, Patelakis A et al. Suicide, unemployment and other socioeconomicfactors: evidence from the economic crisis in Greece. Eur J Psychiat 2014;28:39-49. 10. Antonakakis N, Collins A. The impact of fiscal austerity on suicide: on the empirics of a modern Greek tragedy. Soc Sci Med. 2014;112:39-50. doi: 10.1016/j.socscimed.2014.04.019. Epub 2014 Apr 19. 11. Branas CC, Kastanaki AE, Michalodimitrakis M et al. The impact of economic austerity and prosperity events on suicide in Greece: a 30-year interrupted time-series analysis. BMJ Open. 2015;5:e005619. doi: 10.1136/bmjopen-2014-005619. 12. EU's Junker pledges 2bn euros for Greek ''humanitarian crisis''. BBC News. 20 March 2015. 13. McKee M, Karanikolos M, Belcher P et al. Austerity: a failed experiment on the people of Europe. Clinical Medicine 2012;12:346-50.

    Conflict of Interest:

    None declared

    Read all letters published for this article

    Submit response
  10. Reply to : BMJ Open 2015 5:e007179; doi:10.1136/bmjopen-2014-007179

    Thank you for a well presented article. We would like to highlight a few aspects that we found in the literature related to the subject and subsequently would like to convey our opinions. Alcoholism and other addictions have genetic and environmental causes. Both have serious consequences for children who live in homes where parents are involved. Children of addicted parents are the highest risk group of children to become alcohol and drug abusers due to both genetic and family environment factors1. Biological children of alcohol dependent parents who have been adopted continue to have an increased risk (2-9 fold) of developing alcoholism.2 Adolescent alcohol use, especially heavy use, is associated with many negative outcomes. It has been found that alcohol dependent adolescents have poorer neuropsychological performance and are more sensitive to learning and memory impairments produced by alcohol exposure. Adolescent alcohol use may interfere with the development of social, coping, and related skills needed for effective social functioning in late adolescence and early adulthood. Children who coped effectively with the trauma of growing up in families affected by alcoholism often relied on the support of a non-alcoholic parent, stepparent, grandparent, teachers and others.3 Our opinion apart from those presented in the referenced literature above would be that beyond the socio-cultural and genetic aspects covered in different articles , there is an element of parental responsibility and parental monitoring which needs to be taken into account when it comes to alcohol and substance misuse in the adolescent population . We also feel that there is an argument for parenting styles and parental monitoring as the manner in which boundaries are set and the individual young person's needs met, could be a crucial element in determining the young person's potential subsequent involvement and or reliance on drugs, alcohol and other mind altering substances. Family conflicts , domestic violence , social isolation ,financial problems are only a few other contributing factors which need to be accounted for when one considers the association between parental roles and adolescent drinking behaviour . References: 1. Kumpfer, K.L. (1999). Outcome measures of interventions in the study of children of substance-abusing parents. Paediatrics. Supplement. 103 (5): 1128-1144. 2. Schuckit, M.A., Goodwin, D.A., & Winokur, G. (1972). A study of alcoholism in half siblings. American Journal of Psychiatry, 128: 1132- 1136 3. Brown, S., & Tapert, S. (2004). Adolescence and the trajectory of alcohol use: Basic to clinical studies. Annals of the New York Academy of Sciences, 1021, 234-244.

    Conflict of Interest:

    None declared

    Read all letters published for this article

    Submit response

Don't forget to sign up for content alerts to receive selected information relevant to your specialty interests and be the first to know when the latest research is published.