Research of Note for October 2004

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Girls and Aches, Pains and Fatigue

Headache, Stomachache, Backache, and Morning Fatigue Among Adolescent Girls in the United States
Reem Ghandour, M.P.A.; Mary Overpeck, Dr.P.H.; and Zhihuan Huang, M.B., Ph.D., M.P.H.; et al
Archives of Pediatrics and Adolescent Medicine, Vol. 158, August 2004, pages 797-803
Available free from Ghandour at the Office of Women’s Health, U.S. Health Resources and Services Administration, 5600 Fishers Lane, Room 10C-09, Rockville, MD 20857 or

Who hasn’t heard teenage girls complain that they don’t feel well enough to do something because they have aches or pains or are too tired? A new study shows that these symptoms are common; they can be symptoms of heavy alcohol use, smoking or overuse of caffeine; and they are less likely if the teens have support from adults.

The 8,370 6th- to 10th-grade girls in the study were part of the Health Behavior of School Age Children study, conducted by the federal government. The girls were representative of the country as a whole and were studied in their classrooms. They estimated how frequently they experienced each of four health problems: stomachaches, headaches, backaches and fatigue.
The results may surprise those who think girls generally use these aches and pains as excuses. One-third of the girls reported they have headaches once a week, one-third reported morning fatigue more than once a week, and one-fifth reported stomachaches more than once a week. Most surprising, almost one-quarter experienced backaches more than once a week. There was only one racial or ethnic difference: African-American girls were the most likely to report stomachaches more than once a week.

Symptoms tended to increase with age, with older teens more likely to be tired and to have headaches or stomachaches. Headaches and stomachaches were less likely among girls who reported they had more support from their parents, and stomachaches and backaches were less likely among girls who reported support from teachers.

Symptoms were more likely among girls who had been bullied or who drank alcohol, smoked or consumed a lot of caffeine. Physical activity and peer support did not significantly influence these health problems.

It is unfortunate that the girls were not asked about the support of other adults in their lives, such as coaches and other youth workers. The surprisingly high impact of teachers compared with peers or parents probably reflects the many hours spent in school and the stress that schoolwork can cause. The fact that supportive teachers reduce stomachaches is probably not surprising to anyone, although the link to back pain certainly surprised me. While the aches and pains are certainly related to stress and other psychological factors, drug use can also cause physical problems, such as headaches from caffeine withdrawal or binge drinking.

It’s important to realize that whatever the cause, the physical symptoms are often real and can make kids’ lives more difficult. The results offer a reminder of the power of supportive adults in kids’ lives.

Violent Video Games and Kids

The effects of violent video game habits on adolescent hostility, aggressive behaviors and school performance
Douglas Gentile, Paul Lynch, Jennifer Ruh Linder and David Walsh
Journal of Adolescence, Vol. 27, February 2004, pages 5-22
Available free from Gentile at W112 Lagomarcino Hall, Iowa State University, Ames, Iowa 50011, or

The average American child between the ages of 2 and 17 plays video games for seven hours a week, so there is plenty of opportunity for those games to influence the kids. Unfortunately, researchers estimate that about half the games include serious violent content. This study of 8th- and 9th-graders shows a strong link between violent video games and fighting, hostility and school performance.

This isn’t the first study to find a link between violent video games and aggression, but it is different from others because it measures how games affect a teen’s hostile feelings as well as his or her interactions with kids and adults. The impact on hostile feelings was measured with a modified version of the Cook & Medley Hostility Scale. Long-term impact on interpersonal interactions was measured by using questions about fighting in the past year and arguing with teachers in the past year. The study also assessed whether time spent playing video games is related to grades received in school.

The results are based on a survey of 607 youths interviewed during classtime during one month in 2000. Video games were defined as including games on computers, video game consoles (such as Nintendo), hand-held game devices (such as Game Boy) and video arcade machines.

Students were asked to name their three favorite video games, say how often they played them, rate how violent the games were on a seven-point scale, and rate the amount of violence they liked in video games.

The youths reported paying these games an average of nine hours per week (13 hours for boys and five hours for girls). This was less time than they spent watching TV and listening to music, but more time than they spent reading for pleasure.

When asked how much violence they liked on a 10-point scale, the average was 6.7 for boys and 3.8 for girls, which averaged to 5.4. Only 1 percent of the boys and 16 percent of the girls said they preferred to have no violence in video games.

Exposure to violent video games and amount of video game playing were both associated with teens’ hostility, frequency of arguing with teachers, and whether they had been involved in a physical fight during the past year.

Especially interesting is the finding that exposure to video violence and to hostility each independently predicted whether teens got into fights. Only 28 percent of the very hostile students with low exposure to violent video games had had a physical fight in the past year. That compares with 38 percent of those with the lowest hostility and greatest exposure to violent video games, and 63 percent of the most hostile students who played the most violent video games. Violent video games independently predicted getting into fights even when sex, hostility, amount of play and parental restrictions on video games were statistically controlled. That means that the games themselves have an impact on children’s fighting.

In contrast, exposure to violent videos did not statistically predict whether teens argued with teachers when hostility, sex and amount of video game play were controlled.

A greater amount of video game playing predicted lower grades, even when hostility, violent video game playing, and sex were all controlled. This indicates that the amount of time spent playing video games reduces time spent on reading, studying and other activities, regardless of whether the games are violent and whether the child is hostile.

For the many youth workers who have the opportunity to encourage or restrict teens’ playing of video games, the findings have a clear message: Less violence in games will result in better interactions with peers and teachers, and less time spent playing games is better for school achievement.

Teens with the Blues

Prevalence of and Risk Factors for Depressive Symptoms Among Young Adolescents
Gitanjali Saluja, Ph.D; Ronaldo Iachan, Ph.D; Peter Scheidt, M.D., M.P.H.; et al
Archives of Pediatrics and Adolescent Medicine, Vol. 158, August 2004, pages 760-765
Available free from Saluja at National Institutes of Health, Room 7B03 MSC 7510, 6100 Executive Blvd., Bethesda, MD 20892-7510, or

Everyone knows that young adolescents can be moody, but a new study indicates that a substantial number have the same symptoms that therapists use to diagnose depression.

Based on a study of almost 10,000 youths in grades 6, 8 and 10, the study found that 25 percent of the girls and 10 percent of the boys reported at least five symptoms of depression. To be classified as depressed in this study, the youths had to say they were depressed for at least two weeks during the past year, and that while they were depressed they had at least five of the following eight symptoms: feeling irritable and grouchy most of the time, not being interested in doing much of anything, being unable to sleep or sleeping all the time, gaining or losing weight because of feeling depressed, being unable to concentrate as well as usual, feeling like a really rotten person, thinking about hurting himself or herself, and thinking about death a lot.

The chances of having at least five of these symptoms increased as the youths got older, doubling (from 7 to 14 percent) for boys between 6th and 10th grade and almost tripling for girls (from 13 to 34 percent). American Indians/Alaskan Natives and Hispanics were the most likely to be depressed, followed by whites. African-Americans were the least depressed, followed by Asian Americans.

Bullies and their victims were both more likely to be depressed. Among girls who were bullied more than twice in the preceding year, 37 percent reported symptoms of depression, as did 18 percent of the boys who were bullied. The chances of being depressed were even higher for girls who bullied others more than twice in the preceding year: a whopping 46 percent of girls, but only 15 percent of boys who bullied others.

Boys and girls who used drugs (including alcohol and tobacco) were at least twice as likely to be depressed. The study can’t tell us which came first, the symptoms of depression or the drug use, but most experts would consider this drug use typical of “self-medicating,” in which an individual uses drugs to try to cope with feeling bad.

The researchers also looked at weekly symptoms such as headaches, stomachaches, backaches, nervousness and dizziness. Each symptom was at least twice as common among depressed students.

Although it is old news that adolescents can be depressed, these numbers are higher than expected, and the researchers were especially surprised by the numbers among pre-teens and young teens. The relationship between race, bullying and substance abuse, and common health symptoms is also information that can be used by youth workers to help identify students who may be depressed and may need help.

There are important caveats, most notably that a finding of depression was based on questions used to diagnose adults, not adolescents. It may be that some symptoms, such as being irritable or having trouble sleeping, are so pervasive among adolescents that they should not necessarily be considered symptoms of depression. On the other hand, it is possible that what adults think of as bad habits or bad attitudes among adolescents should instead be considered potential signs of depression, and treated as such.

Diana Zuckerman, Ph.D., is president of the National Research Center for Women & Families. Contact: Information about many Research Watch columns is available at