Lorena Siqueira

Adolescents Becoming Smokers: The Roles of Stress and Coping Methods

PURPOSE To examine the relationship of stress and coping methods to smoking status (never-smoker, experimenter, and current smoker) among an inner-city, clinic-based, adolescent population, as well as to examine the prevalence of smoking and related behaviors in this population using a cross-sectional survey. METHODS A self-administered questionnaire that included the Perceived Stress Scale (PSS), negative life events (LES), and a coping measures scale was used with 954 clinic patients aged 12-21 years. Demographic characteristics were compared using analysis of variance and Chi-square test. The Kruskal-Wallis analysis of variance was used to compare the values of each scale among smoking-status groups. Logistic regression analysis was used to determine the relationship of smoking status to PSS, LES, and coping methods. RESULTS The overall prevalence of smoking in this population was 26%. The age of onset was 13.3 years for current smokers vs. 15.5 for experimenters (p<.01). Perceived stress and negative life events, adjusting for demographic variables, were highest among current smokers, less so in experimenters, and lowest in the never-smokers (p <.001). Stepwise logistic regression analysis showed that negative life events, perceived stress, greater use of the negative coping methods of anger and helplessness, and less use of the positive coping methods of parental support and cognitive coping were significantly and independently related to smoking status. CONCLUSIONS One in four inner-city youth report smoking. Higher levels of stress and greater use of negative coping methods were found in current smokers than in experimenters and never-smokers.

Testing for drugs of abuse in children and adolescents

Drug testing is often used as part of an assessment for substance use in children and adolescents. However, the indications for drug testing and guidance on how to use this procedure effectively are not clear. The complexity and invasiveness of the procedure and limitations to the information derived from drug testing all affect its utility. The objective of this clinical report is to provide guidance to pediatricians and other clinicians on the efficacy and efficient use of drug testing on the basis of a review of the nascent scientific literature, policy guidelines, and published clinical recommendations.

The Relationship of Stress and Coping Methods to Adolescent Marijuana Use.

As the use of marijuana among adolescents remains high, more effective interventions are needed. We conducted this cross‐sectional survey at an outpatient, university‐based, adolescent clinic to determine the prevalence of marijuana use in an inner‐city adolescent population and to examine the relationship of stress and coping methods to marijuana user status (never user, experimenter, and frequent user). The subjects were 918 adolescents aged 12–21 years. Lifetime use in this population was 59% (n = 611) with 18.4% (n = 191) reporting frequent weekly use. Almost all (97%) marijuana users acknowledged marijuana use by friends. Stepwise logistic regression analysis showed that negative life events, greater use of the negative coping method of anger and less frequent use of the positive coping method of parental support were significantly and independently related to marijuana user status. In the presence of high peer use, exploring parent‐child relationships and use of anger coping and intervening accordingly may decrease marijuana use.

Medication-assisted treatment of adolescents with opioid use disorders

Opioid use disorder is a leading cause of morbidity and mortality among US youth. Effective treatments, both medications and substance use disorder counseling, are available but underused, and access to developmentally appropriate treatment is severely restricted for adolescents and young adults. Resources to disseminate available therapies and to develop new treatments specifically for this age group are needed to save and improve lives of youth with opioid addiction.

Glucose Metabolism in Overweight Hispanic Adolescents With and Without Polycystic Ovary Syndrome

OBJECTIVES: About one third of overweight women with polycystic ovary syndrome (PCOS) have either impaired glucose tolerance (IGT) or type 2 diabetes mellitus (DM) by the age of 30. We sought to determine if overweight Hispanic adolescents with PCOS are more likely to be insulin resistant and glucose intolerant than those without PCOS. METHODS: A retrospective chart review of 101 subjects with PCOS and 40 without PCOS was conducted. Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), Quantitative Insulin Sensitivity Check Index (QUICKI), and fasting glucose/insulin ratio (FGIR) values were calculated by using fasting glucose and insulin levels. Insulin resistance (IR) was defined as a fasting insulin level of >15 μU/mL, a 2-hour insulin level of >75 μU/mL, a HOMA-IR value of >3.16, a QUICKI value of <0.357, and/or a FGIR value of <7. RESULTS: Of the 101 overweight subjects with PCOS (BMI: 33.2 ± 5.9 kg/m2), 4 had IGT and 2 had DM versus none of the 40 subjects without PCOS (BMI: 32.4 ± 5.3 kg/m2). IR was more frequent in the overweight PCOS than in the overweight non-PCOS group (QUICKI: 68.4% vs 14.3%, P = .014) and FGIR (47.4% vs 0%, P = .024). Of the 6 subjects with glucose intolerance, only the QUICKI value was abnormal in all. CONCLUSIONS: This retrospective study demonstrated that overweight Hispanic adolescents with PCOS had more IR, IGT and DM than their non-PCOS counterparts. As the QUICKI Index was abnormal in all subjects with IGT and DM, we suggest its use as the first step in deciding which overweight Hispanic adolescents with PCOS should be further tested with an OGTT.

Chlamydia trachomatis detection in adolescents: A comparison of direct specimen and tissue culture methods

We compared tissue cell culture isolation with the Microtrak fluorescent monoclonal antibody direct specimen test for detection of endocervical Chlamydia trachomatis in an inner-city population of sexually active Black and Hispanic adolescent girls. Of the 95 patients screened, C. trachomatis was identified in 26.3%. The sensitivity of the direct specimen test was 91.7%, and its specificity was 98.6%. The positive predictive value was 95.6%, and the negative predictive value was 97.2%. No significant difference was found between Blacks (28.6%) and Hispanics (24.1%) in the incidence of endocervical C. trachomatis, nor was the use of an oral contraceptive significantly associated with the diagnosis of C. trachomatis (p greater than 0.10). Neisseria gonorrhoeae was isolated in 8.4% of the patients. The direct specimen test appears to be an accurate and convenient method of screening sexually active adolescent girls for genital C. trachomatis. Further study is needed to determine if an oral contraceptive increases the risk of Chlamydia infection in adolescents.

Nicotine and Tobacco as Substances of Abuse in Children and Adolescents

Nicotine is the primary pharmacologic component of tobacco, and users of tobacco products seek out its effects. The highly addictive nature of nicotine is responsible for its widespread use and difficulty with quitting. This technical report focuses on nicotine and discusses the stages of use in progression to dependence on nicotine-containing products; the physiologic characteristics, neurobiology, metabolism, pharmacogenetics, and health effects of nicotine; and acute nicotine toxicity. Finally, some newer approaches to cessation are noted.

Incubating syphilis in an adolescent female rape victim.

The risk of infection after rape is believed to be low. The use of presumptive treatment is, therefore, controversial. Some experts recommend treatment of all patients, and others suggest treatment if the doctor suspects infection, if the patient requests it, if follow-up examination of the victim cannot be ensured, or if the assailant has a known infection. No regimen will cover all possible pathogens. The Centers for Disease Controls empiric regimen for victims of sexual assault is effective against gonorrhea, chlamydia, and, most likely, syphilis. We present a case of incubating syphilis following rape, that did not respond to ceftriaxone.