Archives of pediatrics & adolescent medicine最新文献

OBJECTIVES To determine the prevalence of medical and nonmedical use of prescription opioids among high school seniors in the United States and to assess substance use behaviors based on medical and nonmedical use of prescription opioids. DESIGN Nationally representative samples of high school seniors (modal age 18 years) were surveyed during the spring of their senior year via self-administered questionnaires. SETTING Data were collected in public and private high schools. PARTICIPANTS The sample consisted of 7374 students from 3 independent cohorts (2007, 2008, and 2009). OUTCOME MEASURES Self-reports of medical and nonmedical use of prescription opioids and other substance use. RESULTS An estimated 17.6% of high school seniors reported lifetime medical use of prescription opioids, while 12.9% reported nonmedical use of prescription opioids. Sex differences in the medical and nonmedical use were minimal, while racial/ethnic differences were extensive. More than 37% of nonmedical users reported intranasal administration of prescription opioids. An estimated 80% of nonmedical users with an earlier history of medical use had obtained prescription opioids from a prescription they had previously. The odds of substance use behaviors were greater among individuals who reported any history of nonmedical use of prescription opioids relative to those who reported medical use only. CONCLUSIONS Nearly 1 in every 4 high school seniors in the United States has ever had some exposure to prescription opioids either medically or nonmedically. The quantity of prescription opioids and number of refills prescribed to adolescents should be carefully considered and closely monitored to reduce subsequent nonmedical use of leftover medication.

Objective: To determine whether children treated in emergency departments (EDs) with evidence-based standardized protocols (EBSPs) containing evidence-based content and format had lower risk of hospital admission or ED return visit and greater follow-up than children treated in EDs with no standardized protocols in Ontario, Canada.

Design: Retrospective population-based cohort study of children with asthma. We used multivariable logistic regression to estimate risk of outcomes.

Setting: All EDs in Ontario (N = 146) treating childhood asthma from April 2006 to March 2009.

Participants: Thirty-one thousand one hundred thirty-eight children (aged 2 to 17 years) with asthma. MAIN EXPOSURE Type of standardized protocol (EBSPs, other standardized protocols, or none).

Main outcome measures: Hospital admission, high-acuity 7-day return visit to the ED, and 7-day outpatient follow-up visit. RESULTS The final cohort made 46 510 ED visits in 146 EDs. From the index ED visit, 4211 (9.1%) were admitted to the hospital. Of those discharged, 1778 (4.2%) and 7350 (17.4%) had ED return visits and outpatient follow-up visits, respectively. The EBSPs were not associated with hospitalizations, return visits, or follow-up (adjusted odds ratio, 1.17 [95% CI, 0.91-1.49]; adjusted odds ratio, 1.10 [95% CI, 0.86-1.41]; and adjusted odds ratio, 1.08 [95% CI, 0.87-1.35], respectively).

Conclusions: The EBSPs were not associated with improvements in rates of hospital admissions, return visits to the ED, or follow-up. Our findings suggest the need to address gaps linking improved processes of asthma care with outcomes.

Objective: To examine the prevalence of sexting behaviors as well as their relation to dating, sex, and risky sexual behaviors using a large school-based sample of adolescents.

Design: Data are from time 2 of a 3-year longitudinal study. Participants self-reported their history of dating, sexual behaviors, and sexting (sent, asked, been asked, and/or bothered by being asked to send nude photographs of themselves).

Setting: Seven public high schools in southeast Texas.

Participants: A total of 948 public high school students (55.9% female) participated. The sample consisted of African American (26.6%), white (30.3%), Hispanic (31.7%), Asian (3.4%), and mixed/other (8.0%) teens.

Main outcome measure: Having ever engaged in sexting behaviors.

Results: Twenty-eight percent of the sample reported having sent a naked picture of themselves through text or e-mail (sext), and 31% reported having asked someone for a sext. More than half (57%) had been asked to send a sext, with most being bothered by having been asked. Adolescents who engaged in sexting behaviors were more likely to have begun dating and to have had sex than those who did not sext (all P < .001). For girls, sexting was also associated with risky sexual behaviors.

Conclusions: The results suggest that teen sexting is prevalent and potentially indicative of teens' sexual behaviors. Teen-focused health care providers should consider screening for sexting behaviors to provide age-specific education about the potential consequences of sexting and as a mechanism for discussing sexual behaviors.