John W. Kulig

Tobacco, Alcohol, and Other Drugs: The Role of the Pediatrician in Prevention, Identification, and Management of Substance Abuse

Substance abuse remains a major public health concern, and pediatricians are uniquely positioned to assist their patients and families with its prevention, detection, and treatment. The American Academy of Pediatrics has highlighted the importance of such issues in a variety of ways, including its guidelines for preventive services. The harmful consequences of tobacco, alcohol, and other drug use are a concern of medical professionals who care for infants, children, adolescents, and young adults. Thus, pediatricians should include discussion of substance abuse as a part of routine health care, starting with the prenatal visit, and as part of ongoing anticipatory guidance. Knowledge of the nature and extent of the consequences of tobacco, alcohol, and other drug use as well as the physical, psychological, and social consequences is essential for pediatricians. Pediatricians should incorporate substance-abuse prevention into daily practice, acquire the skills necessary to identify young people at risk of substance abuse, and provide or facilitate assessment, intervention, and treatment as necessary.

Computer-Facilitated Substance Use Screening and Brief Advice for Teens in Primary Care: An International Trial

OBJECTIVE: Primary care providers need effective strategies for substance use screening and brief counseling of adolescents. We examined the effects of a new computer-facilitated screening and provider brief advice (cSBA) system. METHODS: We used a quasi-experimental, asynchronous study design in which each site served as its own control. From 2005 to 2008, 12- to 18-year-olds arriving for routine care at 9 medical offices in New England (n = 2096, 58% females) and 10 in Prague, Czech Republic (n = 589, 47% females) were recruited. Patients completed measurements only during the initial treatment-as-usual study phase. We then conducted 1-hour provider training, and initiated the cSBA phase. Before seeing the provider, all cSBA participants completed a computerized screen, and then viewed screening results, scientific information, and true-life stories illustrating substance use harms. Providers received screening results and “talking points” designed to prompt 2 to 3 minutes of brief advice. We examined alcohol and cannabis use, initiation, and cessation rates over the past 90 days at 3-month follow-up, and over the past 12 months at 12-month follow-up. RESULTS: Compared with treatment as usual, cSBA patients reported less alcohol use at follow-up in New England (3-month rates 15.5% vs 22.9%, adjusted relative risk ratio [aRRR] = 0.54, 95% confidence interval 0.38–0.77; 12-month rates 29.3% vs 37.5%, aRRR = 0.73, 0.57–0.92), and less cannabis use in Prague (3-month rates 5.5% vs 9.8%, aRRR = 0.37, 0.17–0.77; 12-month rates 17.0% vs 28.7%, aRRR = 0.47, 0.32–0.71). CONCLUSIONS: Computer-facilitated screening and provider brief advice appears promising for reducing substance use among adolescent primary care patients.

Alcohol use and religiousness/spirituality among adolescents.

Background: Previous studies indicate that religiousness is associated with lower levels of substance use among adolescents, but less is known about the relationship between spirituality and substance use. The objective of this study was to determine the association between adolescents’ use of alcohol and specific aspects of religiousness and spirituality. Methods: Twelve- to 18-year-old patients coming for routine medical care at three primary care sites completed a modified Brief Multidimensional Measure of Religiousness/Spirituality; the Spiritual Connectedness Scale; and a past-90-days alcohol use Timeline Followback calendar. We used multiple logistic regression analysis to assess the association between each religiousness/spirituality measure and odds of any past-90-days alcohol use, controlling for age, gender, race/ethnicity, and clinic site. Timeline Followback data were dichotomized to indicate any past-90-days alcohol use and religiousness/spirituality scale scores were z-transformed for analysis. Results: Participants (n = 305) were 67% female, 74% Hispanic or black, and 45% from two-parent families. Mean ± SD age was 16.0 ± 1.8 years. Approximately 1/3 (34%) reported past-90-day alcohol use. After controlling for demographics and clinic site, Religiousness/Spirituality scales that were not significantly associated with alcohol use included: Commitment (OR = 0.81, 95% CI 0.36, 1.79), Organizational Religiousness (OR = 0.83, 95% CI 0.64, 1.07), Private Religious Practices (OR = 0.94, 95% CI 0.80, 1.10), and Religious and Spiritual Coping – Negative (OR = 1.07, 95% CI 0.91, 1.23). All of these are measures of religiousness, except for Religious and Spiritual Coping – Negative. Scales that were significantly and negatively associated with alcohol use included: Forgiveness (OR = 0.55, 95% CI 0.42–0.73), Religious and Spiritual Coping – Positive (OR = 0.67, 95% CI 0.51–0.84), Daily Spiritual Experiences (OR = 0.67, 95% CI 0.54–0.84), and Belief (OR = 0.76, 95% CI 0.68–0.83), which are all measures of spirituality. In a multivariable model that included all significant measures, however, only Forgiveness remained as a significant negative correlate of alcohol use (OR = 0.56, 95% CI 0.41, 0.74). Conclusions: Forgiveness is associated with a lowered risk of drinking during adolescence.

Prevalence of the Metabolic Syndrome in Children with Psoriatic Disease

Adults with psoriasis have a greater risk of developing metabolic syndrome (MetS) and cardiovascular disease (CVD), but few studies have investigated the prevalence of MetS and other risk factors for CVD in children with psoriasis. In an assessor‐blinded study, 20 children ages 9–17 years with a current or previously documented history of psoriasis involving 5% or more of their body surface area or psoriatic arthritis were compared with a cohort of age‐ and sex‐matched controls with benign nevi, warts, or acne. MetS, our primary endpoint, was defined by the presence of abnormal values in at least three of the following measures: triglycerides, high‐density lipoprotein cholesterol (HDL‐C), fasting blood glucose (FBG), waist circumference, and blood pressure. Secondary endpoints included high‐sensitivity C‐reactive protein (hs‐CRP), total cholesterol (TC), and low‐density lipoprotein cholesterol (LDL‐C). Thirty percent (6/20) of children with psoriasis met the criteria for MetS, compared with 5% (1/20) of the control group (p < 0.05). Subjects with psoriasis had higher mean FBG (91.1 mg/dL) than the control group (82.9 mg/dL) (p = 0.01). There were no statistically significant differences in the other four components of MetS, BMI, BMI percentile, hs‐CRP, TC, or LDL‐C. The results of this trial demonstrate that children with psoriasis have higher rates of MetS than age‐ and sex‐matched controls. It may therefore be important to evaluate children with psoriasis for components of MetS to prevent future CVD morbidity and mortality.

Testing for drugs of abuse in children and adolescents: Addendum - Testing in schools and at home

The American Academy of Pediatrics continues to believe that adolescents should not be drug tested without their knowledge and consent. Recent US Supreme Court decisions and market forces have resulted in recommendations for drug testing of adolescents at school and products for parents to use to test adolescents at home. The American Academy of Pediatrics has strong reservations about testing adolescents at school or at home and believes that more research is needed on both safety and efficacy before school-based testing programs are implemented. The American Academy of Pediatrics also believes that more adolescent-specific substance abuse treatment resources are needed to ensure that testing leads to early rehabilitation rather than to punitive measures only.

Temperament, anxiety, and attentional control

To regulate attention has been a significant component of individual differences in temperament, and other research supported a relation between measures of attentional control and anxiety, i.e., high scores on trait anxiety were correlated with inability to regulate attention in response to the environment, so enhanced attentional control may interact with dimensions of temperament to modify the effects of generalized anxiety. To test this hypothesis, 69 undergraduates completed the Revised Dimensions of Temperament Survey, the Burns Anxiety Scale, and the Derryberry and Reed measure of Attentional Control. Analysis suggested attentional control may be a significant factor in modifying reported anxiety. Further research is warranted, given the present small sample tested with numerous measures.

Diagnosis of anorexia nervosa in the adolescent male

Sporadic cases of anorexia nervosa in the male patient have been described. We present three cases of weight loss in adolescent males. The first is a typical case of primary anorexia nervosa. The second illustrates weight loss in the competitive adolescent athlete. The third was mistakenly thought to have primary anorexia nervosa. At autopsy, he had regional enteritis. These patients are compared to call attention to the differential diagnosis of anorexia nervosa in the adolescent male.

What's in a name? Our false uniqueness!

The current study investigated our perception of first names. In Study 1, participants estimated their own first name to be less frequent compared with estimates from yoked controls. The first name uniqueness effect was seen for both rare and common names, and male and female names. The uniqueness bias was not due to differential encoding of variegated and shortened names, such as different versions of the name Caitlyn. Study 2 established that rarer names are preferred, and, that when we contemplate a name change, we often consider rare names. Several theoretical explanations for a general name uniqueness effect are proposed.

Condoms: the basics and beyond.

Used properly and consistently condoms have a dual role in the prevention of STIs and unintended pregnancy. Condoms remain the only method of STI prevention and birth control available for use by the sexually active male. They are relatively inexpensive available without a prescription easy to obtain easy to carry and disposable after single use. Condoms also may prolong erection and male sexual response and reduce anxiety about STIs and pregnancy in both partners. Condoms require an erection to be applied must be applied before genital contact may reduce sensation significantly and may interfere with spontaneity when sexual activity is interrupted to put on the condom. Condoms are free of side effects except for individuals with latex allergy. Of U.S. adults 5–7% report latex allergy and these rates may reach 8–17% among hospital employees. Polyurethane condoms provide a latex-free alternative. Some individuals of either gender also may be sensitive to a specific condom lubricant and partners may need to experiment with alternative brands. (excerpt)

Nominations committee report

How the Committee spent its time in 2017 Following the changes to the composition of the Board during 2016, including the appointment of the new Chairman and new Group Chief Financial Officer, the Committee’s activities in 2017 have focused on overseeing the induction of recently joined Board members and assessing changes to committee composition arising from the changes to the Board’s composition.