Ashley L. Merianos

Preliminary evidence that high levels of nicotine on children’s hands may contribute to overall tobacco smoke exposure

Background Dust and surfaces are important sources of lead and pesticide exposure in young children. The purpose of this pilot study was to investigate if third-hand smoke (THS) pollutants accumulate on the hands of children who live in environments where tobacco is used and if hand nicotine levels are associated with second-hand smoke (SHS), as measured by salivary cotinine. Methods Participants were parents and children (n=25; age mean (SD)=5.4 (5.3) years) presenting to the emergency department with a potentially SHS-related illness. A convenience sample of participants were recruited at baseline from an ongoing two-group, randomised controlled trial of a SHS reduction and tobacco cessation intervention. Parents were current smokers; thus, all children were at risk of SHS and THS exposure to varying extents. Primary outcome measures, which were assessed in child participants only, were hand nicotine and salivary cotinine. Parents reported sociodemographics and smoking patterns; children’s medical records were abstracted for chief complaint, medical history and discharge diagnosis. Results All children had detectable hand nicotine (range=18.3–690.9 ng/wipe). All but one had detectable cotinine (range=1.2–28.8 ng/mL). Multiple linear regression results showed a significant positive association between hand nicotine and cotinine (p=0.009; semipartial r2=0.24), independent of child age. Discussion The higher-than-expected nicotine levels and significant association with cotinine indicate that THS may play a role in the overall exposure of young children to tobacco smoke toxicants and that hand wipes could be a useful marker of overall tobacco smoke pollution and a proxy for exposure. Trial registration number ClinicalTrials.gov Identifier: NCT02531594

Authoritarian parenting and youth depression: Results from a national study

ABSTRACT Depression is a prevalent illness affecting youth across the nation. The study purpose was to examine depression and authoritarian parenting among youth from 12 to 17 years of age. A secondary data analysis of the National Survey on Drug Use and Health was performed in the present study. All participants in the present study were youth (N = 17,399) nationwide. The results revealed that 80.6% of youth participants reported having five or more depressive symptoms. Parenting styles based on depression significantly differed among males, females, 12–13-year-olds, 14–15-year-olds, and 16–17-year-olds. Specifically, those who reported experiencing authoritarian parenting practices were more likely to report depressive symptoms compared to their counterparts who experienced authoritative parenting practices. Emphasizing the role of the parents and teaching positive parenting practices and authoritative parenting styles may increase success of prevention programs.

School bullying and student trauma: Fear and avoidance associated with victimization.

ABSTRACT Bullying is a significant problem in U.S. schools. The purpose of the present study is to examine the impact student bullying has on avoidance behaviors and fear at school among youth nationwide. Data from the School Crime and Safety Survey was analyzed. Participants included 5,784 U.S. students in grades 5 through 12. Almost one-third of students reported being bullied in the past year. Females, junior high school students, and public school students were significantly more likely to report being bullied than their counterparts. Students who were bullied were significantly more likely than students who had not been bullied to report fear and avoidance. Prevention and intervention programs are needed to reduce bullying and negative consequences associated with the behavior.

School Violent Victimization and Recent Alcohol Use and Episodic Heavy Drinking among Youth.

School violent victimization is a serious public health problem among youth. The current study investigated the association between youth alcohol use and school violent victimization among middle school and high school students (N = 54,361). The PRIDE national survey for Grades 6–12 was administered to youth in their classrooms. Results indicated that 38.3% of students were involved in school violent victimization. School violent victimization differed significantly based on sex, race, and grade level. Logistic regression analyses indicated that school violent victimization was directly related to elevated alcohol use in the past 12 months and episodic heavy drinking among youth. Findings from this study may be beneficial to school nurses in creating bullying and substance abuse prevention programs for students. Recommendations for future research are included.

Secondhand Smoke Exposure, Illness Severity and Resource Utilization in Pediatric Emergency Department Patients with Respiratory Illnesses.

ABSTRACT Objective: Hospital-based data reveal that children who have secondhand smoke exposure (SHSe) experience severe respiratory illnesses and greater resource utilization. Our objective was to assess the relationship between SHSe and illness severity/resource utilization among children presenting to the pediatric emergency department (PED) with three common respiratory conditions—asthma, bronchiolitis, and pneumonia. Methods: A retrospective review of a yearlong consecutive sample of PED patients with SHSe status documentation and asthma, bronchiolitis, or pneumonia diagnoses was performed. PED illness severity/resource utilization variables included triage categorization, initial oxygen saturation, evaluation/testing (influenza A & B, respiratory syncytial virus, chest X-ray), procedures/interventions performed (supplemental oxygen, suctioning, intubation), medications administered, and disposition. Logistic and linear regression models were conducted to determine differences in each diagnosis group while controlling for sociodemographics, medical history, seasonality, and insurance type. Results: There were 3,229 children with documentation of SHSe status and an asthma (41%), bronchiolitis (36%), or pneumonia (23%) diagnosis. Across diagnosis groups, approximately 1/4 had positive documentation of SHSe. Asthmatic children with SHSe were more likely to receive corticosteroids (odds ratio (OR) = 1.71, 95% confidence interval (CI) = 1.19, 2.44) and/or magnesium sulfate (OR = 1.66, 95% CI = 1.14, 2.40). Children with SHSe and bronchiolitis were more likely to receive racemic epinephrine (OR = 2.48, 95% CI = 1.21, 5.08), have a chest X-ray (OR = 1.36, 95% CI = 1.00, 1.85), and/or be admitted (OR = 1.46, 95% CI = 1.09, 1.95). No differences in illness severity/resource utilization were identified for children with pneumonia. Conclusions: SHS-exposed children with asthma or bronchiolitis have greater illness severity/resource utilization. Our findings highlight the importance of SHSe assessment, cessation, and research efforts in the PED setting.

Secondhand Smoke Exposure and Pediatric Healthcare Visits and Hospitalizations

INTRODUCTION This study assessed the relationship between secondhand smoke exposure (SHSe) as measured by serum cotinine and healthcare utilization among children. METHODS In 2016, the 2009-2012 National Health and Nutrition Examination Survey data were analyzed including 4,985 children aged 3-19 years. Associations between SHSe and having a routine place for healthcare, type of place, and hospital utilization were examined using logistic regression models. Poisson regression analyses assessed the relationship between SHSe and number of hospital admissions. Relationships between SHSe and acute care visits and hospital utilization were examined among asthmatic children. RESULTS SHSe level did not differ by having a routine place for healthcare, although children with high SHSe indicative of active smoking (cotinine ≥3 ng/mL) were 3.49 times (95% CI=1.77, 6.89) more likely to use an emergency department. Children with high SHSe were 2.85 times (95% CI=1.87, 4.34) more likely to have had an overnight hospital stay. Children with high SHSe had 2.05 times (95% CI=1.46, 2.87) the risk of having a higher number of hospital admissions for overnight stays versus children with no SHSe (cotinine <0.05 ng/mL). Among asthmatic children, those with high SHSe and low SHSe (cotinine 0.05-2.99 ng/mL) were more likely to have an acute care visit, overnight hospital stay, and higher number of hospital admissions than asthmatic children with no SHSe. CONCLUSIONS High SHSe is associated with increased healthcare utilization. The emergency department and inpatient settings are important venues in which to routinely offer cessation and SHSe reduction interventions.

Assessment of tobacco smoke exposure in the pediatric emergency department.

OBJECTIVE Tobacco smoke exposure causes significant childhood morbidity and is associated with a multitude of conditions. National organizations recommend tobacco smoke exposure screening at all pediatric clinical encounters. Data regarding tobacco smoke exposure screening in the pediatric emergency department is sparse, although children with tobacco smoke exposure-associated conditions commonly present to this setting. We aimed to determine the frequency and outcome of tobacco smoke exposure screening in the pediatric emergency department, and assess associated sociodemographic/clinical characteristics. METHODS This retrospective review included pediatric patients presenting to a large pediatric emergency department in Cincinnati, Ohio between 2012 and 2013. Variables extracted included: age, sex, race/ethnicity, insurance, childs tobacco smoke exposure status, triage acuity, diagnosis, and disposition. Regression analyses examined predictors of tobacco smoke exposure screening and tobacco smoke exposure status. RESULTS A total of 116,084 children were included in the analysis. Mean child age was 6.20years (SD±5.6); 52% were male. Nearly half of the children in the study did not undergo tobacco smoke screening; only 60% of children with tobacco smoke exposure-related illnesses were screened. Predictors of tobacco smoke exposure screening were: younger age, male, African American, non-commercial insurance, high acuity, tobacco smoke exposure-related diagnoses and non-intensive care admission. Of children screened for tobacco smoke exposure, 28% were positive. Children more likely to screen positive were non-Hispanic, had non-commercial insurance, and had tobacco smoke exposure-related diagnoses. NonAfrican American children triaged as low acuity were more likely to have tobacco smoke exposure, yet were less likely to be screened. CONCLUSION Despite national recommendations, current tobacco smoke exposure screening rates are low and fail to identify at-risk children. Pediatric emergency department visits for tobacco smoke exposure-associated conditions are common, thus further research is needed to develop and assess standardized tobacco smoke exposure screening tools/interventions in this setting.

Typical sources and locations where recent youth drinkers obtain and consume alcohol based on intensity of use

Abstract Background: The purpose of the present study was to examine whether typical sources and locations where youth recent drinkers, defined as youth who drank alcohol in the past month, obtain and consume alcohol differed significantly based on intensity of use. Intensity of use was based on binge drinking, which was defined as drinking five or more alcoholic beverages in a row on the same occasion. Methods: Youth recent drinkers from 12 to 17 years of age (N = 2321) who participated in the National Survey on Drug Use and Health were included. After running a series of logistic regression models, all statistically significant variables were retained and included in final multiple logistic regression analyses. Results: Predictors for sources of last alcoholic beverage drank based on intensity were race/ethnicity, age, number of days drank in the past 30 days and usual number of drinks per day in past 30 days. Predictors for locations where alcohol users drank their last alcoholic beverage based on intensity of use were race/ethnicity, number of days binge drank in the past 30 days, usual number of drinks per day in past 30 days and age first drank alcohol. Conclusion: Recommendations for future studies are included.

Coordination of Care Between Health and Education Systems for Patients With a Hematologic or Oncologic Diagnosis: A Time Study Analysis

Given the increasing emphasis on care coordination between healthcare and schools, hospital-school liaison services are increasing in demand. Limited research examines hospital-school liaison programs that focus on educational journeys of school-age patients with a chronic illness. Thus, this initiative aimed to determine the time needed to support the educational needs of these patients. Liaisons tracked time spent per patient, and per specific task category, to support school-age patients (N=419) using work-sampling and time-and-motion methods. Findings may be useful for hospital-based programs seeking to establish or increase staff dedicated to the coordination of care between school and healthcare systems.

College students' perceived confidence in mental health help-seeking

Limited research exists regarding peer-assisted help-seeking for mental health problems. This study assesses the relationship between stigma and an individuals willingness to help a friend with mental illness. Results indicated that students were somewhat confident they could help a friend experiencing a mental health disorder. Significant differences in confidence were found based on sex, grade, holding stigma-related attitudes and outcome expectations. Findings from this study may be used by mental health professionals working with college students.