Cynthia K. Suerken

Age, Race, and Ethnicity in the Use of Complementary and Alternative Medicine for Health Self-Management Evidence from the 2002 National Health Interview Survey

Objectives: Determine if complementary and alternative medicine (CAM) use for treating existing conditions and for health maintenance differs by age and ethnicity. Methods: Data from the 2002 National Health Interview Survey were used to operationalize distinct types of CAM in terms of (a) no use, (b) use for treatment only, (c) use for prevention only, and (d) use for both treatment and prevention. Differences in CAM use by age and ethnicity were examined using SUDAAN to adjust for design effects. Results: Associations of age with CAM use are curvilinear but differed by ethnicity. Some types of CAM are used primarily for treatment; others are used for health maintenance. Discussion: CAM use is one component of adults’ overall approach to health self-management. Patterns of CAM use by age and ethnicity likely reflect differences in CAM availability and prevailing public health policies when adults began making their own health-related decisions.

The Burden of Influenza in Young Children, 2004–2009

OBJECTIVE: To characterize the health care burden of influenza from 2004 through 2009, years when influenza vaccine recommendations were expanded to all children aged ≥6 months. METHODS: Population-based surveillance for laboratory-confirmed influenza was performed among children aged <5 years presenting with fever and/or acute respiratory illness to inpatient and outpatient settings during 5 influenza seasons in 3 US counties. Enrolled children had nasal/throat swabs tested for influenza by reverse transcriptase-polymerase chain reaction and their medical records reviewed. Rates of influenza hospitalizations per 1000 population and proportions of outpatients (emergency department and clinic) with influenza were computed. RESULTS: The study population comprised 2970, 2698, and 2920 children from inpatient, emergency department, and clinic settings, respectively. The single-season influenza hospitalization rates were 0.4 to 1.0 per 1000 children aged <5 years and highest for infants <6 months. The proportion of outpatient children with influenza ranged from 10% to 25% annually. Among children hospitalized with influenza, 58% had physician-ordered influenza testing, 35% had discharge diagnoses of influenza, and 2% received antiviral medication. Among outpatients with influenza, 7% were tested for influenza, 7% were diagnosed with influenza, and <1% had antiviral treatment. Throughout the 5 study seasons, <45% of influenza-negative children ≥6 months were fully vaccinated against influenza. CONCLUSIONS: Despite expanded vaccination recommendations, many children are insufficiently vaccinated, and substantial influenza burden remains. Antiviral use was low. Future studies need to evaluate trends in use of vaccine and antiviral agents and their impact on disease burden and identify strategies to prevent influenza in young infants.

Age, ethnicity, and use of complementary and alternative medicine in health self-management

Drawing on models of health self-management, we develop hypotheses that age and ethnicity will modify associations among indicators of poor health and use of complementary and alternative medicine. These hypotheses are evaluated using the 2002 National Health Interview Survey with the Alternative Health Supplement. Results produced partial support for hypotheses that the effects of ailments on use of complementary and alternative medicine differ by age. Results suggest that ailments such as bodily pain, chronic conditions, and functional impairment are associated with use of complementary and alternative medicine among midlife and younger adults, but these associations are generally attenuated among older adults. Hypothesized ethnic differences received weak support. These findings suggest that different interpretations of ailments and appropriate responses may explain why complementary and alternative medicine is used by fewer older adults. The results also highlight the significance of social and cultural factors in understanding patterns of complementary and alternative medicine use in the adult population.

Psychiatric disorders in rapid-onset dystonia-parkinsonism.

Objective: Rapid-onset dystonia-parkinsonism (RDP) is caused by a variety of missense mutations in the ATP1A3 gene. Psychiatric comorbidity has been reported, although systematic examination of psychiatric disease in individuals with RDP is lacking. This study examines psychiatric morbidity for 23 patients with RDP in 10 families with family member control subjects and in 3 unrelated patients with RDP, totaling 56 individuals. Methods: Twenty-nine ATP1A3 mutation–positive individuals were examined; 26 exhibited motor symptoms (motor manifesting carrier [MMC]) and 3 did not (nonmotor manifesting carriers [NMC]). Twenty-seven ATP1A3 mutation-negative participants (noncarriers [NC]) were included. Rates of psychiatric illness for patients with RDP and related asymptomatic gene mutation carriers were compared with those for related nonmutation carriers. Outcome measures included the Unified Parkinsons Disease Rating Scale, Burke-Fahn-Marsden Dystonia Rating Scale, Instrumental Activities of Daily Living, Composite International Diagnostic Interview, Structured Clinical Interview for DSM-IV, Hamilton Depression Scale, Hamilton Anxiety Scale, and Yale-Brown Obsessive-Compulsive Scale. Results: NMC participants did not report any history of psychiatric disorder. Findings in MMC and NC groups included anxiety (MMC 48, NC 41%), mood (MMC 50%, NC 22%), psychotic (MMC 19%, NC 0%), and substance abuse/dependence (MMC 38%, NC 27%). Conclusions: ATP1A3 mutations cause a wide spectrum of motor and nonmotor features. Psychotic symptoms tended to emerge before or concurrent with motor symptom onset, suggesting that this could be another expression of the ATP1A3 gene mutation.

Prayer for Health Among U.S. Adults: The 2002 National Health Interview Survey

Data for the United States is limited on prayer for health, including associations with other complementary and alternative medicine (CAM) modalities. The 2002 National Health Interview Survey and Alternative Health Supplement data were examined for associations between prayer for health and demographic, health, and CAM use characteristics. Forty-five percent of adults reported some form of prayer for health. Use of prayer for health was associated with increasing age, ethnic minority status, lower socioeconomic status, southern/midwestern U.S. region, poorer health, and use of most forms of CAM. These data provide information about prayer for health in the United States. Further research could examine associations between prayer for health and healthrelated decisions, behaviors, and outcomes.

Marijuana use trajectories and academic outcomes among college students.

BACKGROUND Marijuana is the most commonly used illicit drug by college students. Prior studies have established an association between marijuana use and poor academic performance in college, but research on the frequency of marijuana use over the entire college career is limited. The study objective was to examine the association of marijuana use trajectories on academic outcomes, including senior year enrollment, plans to graduate on time, and GPA. METHODS Data were collected from a cohort of 3146 students from 11 colleges in North Carolina and Virginia at six time points across the college career. Group-based trajectory models were used to characterize longitudinal marijuana use patterns during college. Associations between marijuana trajectory groups and academic outcomes were modeled using random-effects linear and logistic regressions. RESULTS Five marijuana trajectory groups were identified: non-users (69.0%), infrequent users (16.6%), decreasing users (4.7%), increasing users (5.8%), and frequent users (3.9%). Decreasing users and frequent users were more likely to drop out of college and plan to delay graduation when compared to non-users. All marijuana user groups reported lower GPAs, on average, than non-users. CONCLUSION These results identify marijuana use patterns that put students at risk for poor academic performance in college. Students who use marijuana frequently at the beginning of the college career are especially at risk for lower academic achievement than non-users, suggesting that early intervention is critical.

Cognitive impairment in rapid-onset dystonia-parkinsonism

Rapid‐onset dystonia‐parkinsonism (RDP) is caused by mutations in the ATP1A3 gene. This observational study sought to determine if cognitive performance is decreased in patients with RDP compared with mutation‐negative controls. We studied 22 familial RDP patients, 3 non‐motor‐manifesting mutation‐positive family members, 29 mutation‐negative family member controls in 9 families, and 4 unrelated RDP patients, totaling 58 individuals. We administered a movement disorder assessment, including the Burke‐Fahn‐Marsden Dystonia Rating Scale (BFMDRS) and the Unified Parkinsons Disease Rating Scale (UPDRS) and a cognitive battery of memory and learning, psychomotor speed, attention, and executive function. The cognitive battery was designed to evaluate a wide range of functions; recognition memory instruments were selected to be relatively pure measures of delayed memory, devoid of significant motor or vocal production limitations. Comparisons of standardized cognitive scores were assessed both with and without controlling for psychomotor speed and similarly for severity of depressive symptoms. A majority of RDP patients had onset of motor symptoms by age 25 and had initial symptom presentation in the upper body (face, mouth, or arm). Among patients, the BFMDRS (mean ± SD, 52.1 ± 29.5) and UPDRS motor subscore (29.8 ± 12.7) confirmed dystonia‐parkinsonism. The affected RDP patients performed more poorly, on average, than mutation‐negative controls for all memory and learning, psychomotor speed, attention, and executive function scores (all P ≤ 0.01). These differences persisted after controlling for psychomotor speed and severity of depressive symptoms. Impaired cognitive function may be a manifestation of ATP1A3 mutation and RDP.

K2 and Spice use among a cohort of college students in southeast region of the USA

Abstract Background: K2 and Spice consist of an herbal blend of plant matter and chemical synthetic cannabinoids. These substances emerged in the early 2000s as a popular alternative to marijuana among youth and young adults. Objectives: This study sought to identify rates and correlates of K2 and Spice at college entry and first use during college. Methods: In Fall 2010, 3146 students at 11 colleges in North Carolina and Virginia were recruited to participate in a longitudinal cohort survey. The cohort was invited to participate in a total of six surveys over their college career. Random-effects logistic regression models were used to identify factors associated with lifetime K2 and Spice use at college entry and first use during college, adjusting for clustering within schools and sample weights. Results: Weighted lifetime prevalence of K2 and Spice use at college entry was 7.6%. An additional 6.6% of students reported first use during college. By the cohort’s fourth year, 17.0% reported lifetime K2 and Spice use. While lifetime prevalence increased, past 6-month prevalence decreased substantially over time. K2 and Spice use at college entry was associated with sensation seeking; hookah, marijuana, and illicit drug use; and low religiosity. First use during college was associated with having a father with less than a four-year degree; alcohol and hookah use. Conclusion: Universities should ensure that prevention efforts address current substance use, including K2/Spice, and that treatment options are available for first year students who use substances.

Physical activity of preschool-aged Latino children in farmworker families.

OBJECTIVE To describe time spent in sedentary and moderate-to-vigorous physical activity (MVPA) by children in Latino farmworker families and delineate sources of variation in sedentary and MVPA. METHOD Data were from mother-child dyads (N = 248) in Latino farmworker households in North Carolina. Physical activity was assessed using accelerometers; mothers described their childrens characteristics and their physical and social environments. RESULTS Children spent 6.2 hours/day sedentary (Median=369 minutes), and 6.0 minutes/day in MVPA. Children in Head Start spent more time sedentary, whereas children living where dogs roam freely were less sedentary. Children whose mothers limited screen time spent 2 more minutes in MVPA. CONCLUSIONS Preschool-aged Latino children in farmworker families are sedentary, engaging in little MVPA.

Influenza Testing, Diagnosis, and Treatment in the Emergency Department in 2009–2010 and 2010–2011

OBJECTIVES The objective was to describe patterns of rapid influenza test ordering, diagnosis of influenza, and antiviral prescribing by the treating physician for children and adults presenting to emergency departments (EDs) with fever and acute respiratory symptoms in Winston-Salem, North Carolina, over two influenza seasons. METHODS The authors prospectively enrolled patients presenting to the ED with fever and acute respiratory symptoms for two influenza seasons: H1N1 pandemic of September 2009 through mid-May 2010 and November 2010 through April 2011. Enrolled patients had nose or and throat swabs obtained and tested for influenza by viral culture and polymerase chain reaction (PCR) testing. Demographic information and medical history were obtained by patient or guardian report. Testing, treatment, and discharge diagnosis from the ED visit, as well as medical history and insurance status, were ascertained from chart review. RESULTS Among 2,293 eligible patients approached, 1,657 (72%) were enrolled, of whom 38% were younger than 18 years, 47% were 18 to 49 years, and 15% were 50 years of age and older. Overall, 14% had culture- or PCR-confirmed influenza. The odds of 1) rapid influenza test ordering, 2) a physician diagnosis of influenza, and 3) prescribing antiviral treatment during the ED visit were fourfold higher among patients with than without culture- or PCR-confirmed influenza. The odds of rapid influenza test ordering were threefold lower in 2009/2010 than 2010/2011, whereas the odds of physician diagnosis of influenza and antiviral prescriptions were 2- and 3.5-fold higher, respectively. CONCLUSIONS In 2009/2010 compared to 2010/2011, the odds of rapid influenza test ordering were lower, whereas the odds of influenza-specific discharge diagnoses and antiviral prescriptions were higher among patients presenting to the ED with culture/PCR-confirmed influenza. These results demonstrated a gap between clinical practice and recommendations for the diagnosis and treatment of influenza from the Centers for Disease Control and Prevention (CDC).