Systematic Review of Mentoring to Prevent or Reduce Tobacco Use by Adolescents

BackgroundSurveys conducted 1998 to 2008 (530,849 13- to 15-year-olds, 100 countries) by the World Health Organization and the Centers for Disease Control and Prevention found increased tobacco use.ObjectivesTo conduct a systematic review of mentoring to prevent/reduce youth smoking.Data SourcesEight electronic peer-reviewed databases and gray literature searched through January 2013.Study Eligibility Criteria, Participants, and InterventionsStudies were included if they were randomized controlled trials, included children or adolescents, employed mentoring (consistent companionship, support, guidance to develop youth competence and character), and reported tobacco use.Study Appraisal/Synthesis MethodsTwo reviewers independently assessed abstracts and full-text studies. Disagreements were resolved through consensus.ResultsFour randomized controlled trials were identified. Two studies focused exclusively on tobacco outcomes; the other 2 reported on both drug and tobacco use reductions. Only 1 study reported that mentoring (by peers) reduced adolescent smoking. Heterogeneity of both participants and outcome measures did not permit meta-analysis.Conclusions and Implications of Key FindingsThere is limited literature on this topic. Further research achieving sample sizes required by power computations, minimizing attrition, and ascertaining mentoring content and achievements from mentor and mentee perspectives is needed.     

Rurality and gender. Effects on early adolescent alcohol use.

Previous studies of adolescent alcohol use have focused almost exclusively on urban and suburban youth, although alcohol is the most important drug of abuse among rural adolescents. Young adolescents, aged 11 to 14 years (N = 1601), from urban, suburban, and two different rural areas (delta and highland), were surveyed about health-compromising behaviors, such as alcohol use. Significant differences in the number of adolescents using alcohol and the patterns of alcohol use were noted across areas by gender. Youths from the delta area, especially girls, reported drinking less frequently and in less abusive patterns than did adolescents from other areas, while youths from the highland area reported rates and patterns of drinking similar to those of urban adolescents. The reasons for intrarural variation in adolescent drinking are unknown.     

Factors distinguishing youth who report self-injurious behavior: a population-based sample

ObjectiveTo identify factors distinguishing adolescents across 3 groups: no self-harm, nonsuicidal self-injury (NSSI) only, and NSSI and suicide attempt (NSSI + SA).MethodsData were from the 2007 Minnesota Student Survey. The sample included 61,330 students in grades 9 and 12. Logistic regression analysis determined factors that best distinguished adolescents who reported NSSI from those who reported no self-harm, and adolescents who reported NSSI + SA. Final models were developed over 3 stages of analysis that tested the importance of variables within risk factor, protective factor, and co-occurring health-risk behavior domains.ResultsFor male and female subjects, factors that consistently distinguished youth who reported NSSI from those who reported no self-harm included depressive symptoms, hopelessness, physical abuse, less parent connectedness, running away from home, and maladaptive dieting behavior. Factors that distinguished the NSSI + SA group from the NSSI only group for both sexes were a mental health problem, depressive symptoms, hopelessness, physical abuse, and running away from home. Other factors, such as sexual abuse, were significant in models for males or females only. Hopelessness constituted the leading factor to increase the likelihood that youth who self-injured also attempted suicide.ConclusionsYouth engaging in NSSI experience diverse psychosocial stressors and significant distress. Clinicians and school personnel are well-positioned to offer support to these youth. Furthermore, they can help address NSSI among youth by identifying those who self-injure early, assessing for hopelessness and suicidality, facilitating connections to prosocial adults, addressing maladaptive dieting behavior, and supporting runaway youth.     

Review of the efficacy and safety of antidepressants in youth depression

BACKGROUND: Depression in children and adolescents is a cause of substantial morbidity and mortality in this population. It is a common disorder that affects 2% of children and up to 6% of adolescents. Although antidepressants are used frequently for the treatment of this disorder, there has been recent controversy about the efficacy and safety of these medications in this population. This review examined the available evidence from clinical trials of antidepressants in adolescents and children with depression. METHODS: Clinical trial data reviewed were obtained from published reports, including peer review journals and meeting abstracts, as well as unpublished data in the public domain. Clinical trials in this review included large RCTs of antidepressants in youth under the age of 19 with depression. Studies were identified in 2 stages: 1) all RCTs included in the 2004 FDA safety report were reviewed; and 2) to ensure that no additional studies not reported to the FDA were missed, MEDLINE and PSYCH Info were searched from inception until December 2004. A total of 8 published studies and 9 unpublished studies were identified and reviewed. RESULTS: Efficacy and safety results from each study are reviewed in detail. There are significant differences in remission and response rates between different antidepressants but also between placebo groups across studies. Adverse events are common in clinical trials involving children and adolescents with depression. Due to lack of access to full data sets, effect sizes could not be calculated. CONCLUSIONS: With the variability in trial methodology and the variation in the drug/placebo response rates within a single trial, clinicians need to be judicious in their interpretation of research data on pediatric antidepressant trials. Significant methodological issues may also have affected the efficacy and safety results from these clinical trials.     

阿立哌唑治疗儿童抽动障碍疗效和安全性的Meta 分析

目的 运用Meta 分析方法评价阿立哌唑治疗儿童抽动障碍(TD)的临床疗效和安全性。方法 检索2000 年1 月到2014 年8 月国内外主要数据库,收集有关阿立哌唑治疗儿童TD 的临床对照试验,将符合纳入标准的文献进行Meta 分析。结果 6 个随机对照研究(共551 个病例)纳入分析,显示在随访终点时阿立哌唑与各个传统治疗TD 的药物的疗效比较差异无统计学意义,而不同治疗时间疗效的亚组分析显示:2周、4 周和8 周时与传统治疗TD 的药物比较,差异亦无统计学意义。与氟哌啶醇比较,二者疗效无差别,但阿立哌唑的锥体外系反应较少(P结论 与传统的药物相比,阿立哌唑在改善儿童TD 主要症状方面同样疗效显著,但尚不能认为阿立哌唑更具安全性。     

An Integrative Review of Adolescent Smoking Cessation Using the Transtheoretical Model of Change

IntroductionThe purpose of this literature review is to report the effectiveness of trials using the Transtheoretical Model of Change for achieving smoking cessation among adolescents.MethodAn integrative literature review was performed. Two reviewers searched the Internet for randomized, controlled trials or observational studies of adolescent smoking cessation trials reported between 1999 and June 2009 that used the Transtheoretical Model of Change.ResultsSix randomized controlled trials remained after all inclusion and exclusion criteria were met. Each study was reviewed qualitatively and odds ratio and quit rates were calculated. Four studies demonstrated an odds ratio of greater than 1.0, and in four studies significantly better quit rates were found in the intervention arm versus the control arm at the endpoint evaluation.DiscussionEvidence exists for the effectiveness of stage-based interventions in promoting smoking cessation in adolescents.     

The role of economic and cultural status as risk indicators for alcohol and marijuana use among adolescents

INTRODUCTION:

A number of reports suggest that Aboriginal cultural status is a major risk indicator for drug and alcohol use. The primary purpose of the present paper was to determine whether Aboriginal cultural status is independently associated with risk behaviours, such as marijuana use and alcohol abuse, among youth after multivariate adjustment for other factors, such as socioeconomic status.

METHODS:

Every student between grades 5 and 8 in Saskatoon, Saskatchewan, was asked to complete a questionnaire in February 2007. Logistic regression was used to determine the independent risk indicators associated with alcohol abuse and marijuana use.

RESULTS:

Four thousand ninety-three youth participated in the school health survey. At the cross-tabulation level, cultural status and neighbourhood income were both strongly associated with alcohol and marijuana use. After multivariate adjustment, the association between Aboriginal cultural status and alcohol abuse was not statistically significant (crude OR=3.52 to adjusted OR=0.80). For marijuana use, the association was significantly reduced (crude OR=9.91 to adjusted OR=2.79). After controlling for all other variables, results showed that low-income youth were 103% more likely to get drunk at least once and were 163% more likely to have tried marijuana at least once.

CONCLUSION:

To be more successful, future policies directed toward reducing risk behaviours among youth should consider neighbourhood income characteristics.     

糖皮质激素预防过敏性紫癜患儿肾损害随机对照试验的Meta分析

目的 评价糖皮质激素对过敏性紫癜（HSP）患儿肾损害的预防作用。方法 检索Cochrane图书馆、Medline、EMBASE、中国期刊全文数据库、万方数据库、中文科技期刊全文数据库等,收集有关糖皮质激素预防HSP患儿肾损害的RCT或类随机对照试验（quasi-RCT）文献,检索文献起止时间均为1990年1月至2012年6月。由2名作者进行资料提取和文献质量评价。应用RevMan 4.3软件进行Meta分析,根据异质性结果选择相应的效应模型分析;无法进行Meta分析时采用描述性分析。结果 5篇RCT和1篇quasi-RCT进入Meta分析。4篇文献描述了具体随机化方法,采用了充分的分配隐藏和盲法,纳入6篇文献均报道了失访和退出情况;4篇为低度偏倚风险,2篇为高度偏倚风险。Meta分析结果显示,诊断HSP后6个月以内肾损害的发生率,糖皮质激素预防组为22.2%(42/189),对照组为26.3%(50/190),合并RR=0.67（95%CI: 0.17～2.62）,差异无统计学意义,P=0.57;诊断HSP后6个月以上肾损害发生率,糖皮质激素预防组为109%(41/373),对照组为12.6%(46/364),合并RR=0.85（95%CI: 0.44～1.64）,差异无统计学意义,P=0.65。剔除2篇高度偏倚风险文献行敏感性分析,结果无改变。结论 本Meta分析结果尚不支持早期糖皮质激素治疗能预防HSP患儿肾脏损害。建议临床医生根据患儿具体临床表现和实验室检查,慎重应用糖皮质激素或辅以抗凝、抗过敏等对症治疗。     

The impact of peer social networks on adolescent alcohol use initiation

ObjectiveEarly adolescent alcohol use is a major public health problem. Drinking before the 14th birthday is associated with a fourfold increase in risk of alcohol dependence in adulthood. The objective of this study is to evaluate the association between adolescent social network characteristics and alcohol initiation prospectively over time.MethodsThe study analyzes data from the National Longitudinal Study of Adolescent Health, a nationally representative survey of 7th- through 11th-grade students enrolled between 1995 and 1996. Generalized estimating equations are used to model the risk of alcohol use initiation at 1-year follow-up among nondrinkers at wave 1 of the study.ResultsBoth an adolescent’s friends’ alcohol use and the adolescent’s social network characteristics displayed an independent main effect on alcohol initiation. In comparison with abstainers, alcohol initiators had more popular friends as measured by more peer nominations as friends (indegree) and having more friends up to 3 steps removed (3-step reach), and more friends who drank. An adolescent’s risk of alcohol use onset increased 13% (95% CI, 4%–22%) for every additional friend with high indegree, 3% (95% CI, 0.3%–6%) for every additional 10 friends within 3-step reach, and 34% (95% CI, 14%–58%) for each additional friend who drank alcohol, and after controlling for confounders.ConclusionThe findings suggest that, in addition to well-established demographic risk factors, adolescents are at heightened risk of alcohol use onset because of their position in the social network in relationship to their friends and the friends of their friends.     

Cigarette, alcohol, and other drug use by school-age pregnant adolescents: prevalence, detection, and associated risk factors.

Use of cigarettes, alcohol, and other drugs among pregnant adolescents is just beginning to be documented. This study sought to determine the prevalence and associated risk factors of cigarette, alcohol, and other drug use among school-age adolescents attending a comprehensive teenage pregnancy program. All enrollees completed a self-administered questionnaire and provided a breath sample for carbon monoxide analysis. Urine was obtained for quantitative determination of drug metabolites at the initial and one third-trimester visit. A chart review determined medical provider recognition of cigarette, alcohol, and other drug use. Results were analyzed for 93% of 229 eligible patients. Seventeen percent were positive for alcohol or other drug use by questionnaire self-report, provider report, or initial urine screen. Eleven percent were positive by urine screen alone at either the initial or third-trimester visit. Medical providers were successful in identifying nearly all of the cigarette smokers, but fewer than half of the alcohol drinkers and few of the other drug users. Forward stepwise multiple regression determined the most efficient model for predicting alcohol and other drug use. A report of having been high at school and personal or friends' use of cigarettes were the most significant risk factors. Results indicate a high prevalence of alcohol and other drug use and suggest a need for changes in current practice related to the detection and management of such drug use in pregnant adolescents.     

Identification of Suicide Risk Among Rural Youth: Implications for the Use of HEADSS

IntroductionNurse practitioners have the power to assess psychosocial risk and detect and prevent suicide, a problem plaguing rural areas of the United States. Suicide risk assessment can be completed using the Home, Education, Activities, Drug use and abuse, Sexual behavior, and Suicidality and depression (HEADSS) interview instrument. The purpose of this study was to determine if HEADSS is appropriate for guiding suicide risk assessment of rural adolescents.MethodHigh school students in Southwestern Pennsylvania completed qualitative questions from the Child Behavior Checklist and Coping Response Inventory as part of the Intervention to Promote Mental Health in Rural Youth. Qualitative content analysis was performed.ResultsProminent themes identified by participants included academic performance, relationships, dislikes about school, friends, death, mental health, and the future. Several minor themes concerned safety. Most known risk factors for suicide were concerns of participants.DiscussionThe expansion of HEADSS to include death and safety should be considered. The modified version—HEADDSSS—can be used to guide suicide risk assessment of youth in rural Pennsylvania, ensuring both thoroughness of assessment and safety.     

Facebook as a Recruitment Tool for Adolescent Health Research: A Systematic Review

BackgroundResearchers are increasingly using social media to recruit participants to surveys and clinical studies. However, the evidence of the efficacy and validity of adolescent recruitment through Facebook is yet to be established.ObjectiveTo conduct a systematic review of the literature on the use of Facebook to recruit adolescents for health research.Data SourcesNine electronic databases and reference lists were searched for articles published between 2004 and 2013.Study Eligibility CriteriaStudies were included in the review if: 1) participants were aged ≥10 to ≤18 years, 2) studies addressed a physical or mental health issue, 3) Facebook was identified as a recruitment tool, 4) recruitment details using Facebook were outlined in the methods section and considered in the discussion, or information was obtained by contacting the authors, 5) results revealed how many participants were recruited using Facebook, and 6) studies addressed how adolescent consent and/or parental consent was obtained.Study Appraisals and Synthesis MethodsTitles, abstracts, and keywords were scanned and duplicates removed by 2 reviewers. Full text was evaluated for inclusion criteria, and 2 reviewers independently extracted data.ResultsThe search resulted in 587 publications, of which 25 full-text papers were analyzed. Six studies met all the criteria for inclusion in the review. Three recruitment methods using Facebook was identified: 1) paid Facebook advertising, 2) use of the Facebook search tool, and 3) creation and use of a Facebook Page.ConclusionsEligible studies described the use of paid Facebook advertising and Facebook as a search tool as methods to successfully recruit adolescent participants. Online and verbal consent was obtained from participants recruited from Facebook.     

Efficacy and safety of paediatric medicinal cannabis use: A scoping review

IntroductionThe use of medicinal cannabis in the paediatric age group is increasing despite the lack of evidence for its efficacy or safety.ObjectiveTo map the available evidence on the efficacy and safety of medicinal cannabis in children and adolescents.MethodsWe conducted a scoping review and searched six electronic databases and grey literature. A study was eligible for inclusion when it investigated the efficacy or safety of medicinal cannabis for any condition, more than half of the participants were 0 to 18 years old, and had any study design except single case reports.ResultsWe included 36 studies in our final analysis, 32 of which investigated the efficacy or safety of cannabis in treatment-resistant epilepsy. The remaining 4 studies examined patients with cancer, dysautonomia, Epidermolysis Bullosa, and motor disorders.ConclusionsThere is a lack of evidence on the efficacy and safety of medicinal cannabis in most paediatric conditions.     

The effect of adding metformin to insulin therapy for type 1 diabetes mellitus children: A systematic review and meta‐analysis

We aimed to assess the effectiveness of adding metformin to insulin in type 1 diabetes mellitus (T1DM) children for improving metabolic outcomes. We performed a systematic review and meta‐analysis of randomized controlled trials (RCTs) conducted on children age 6 to 19 years who are diagnosed with T1DM, and examined the effect of adding Metformin to standard insulin therapy. We performed literature searches on Ovid Midline, Ovid Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) from the date of inception of the database to February 15, 2016. Two reviewers screened titles and abstracts independently, assessed full text eligibility, and extracted information from eligible trials. The primary outcome is glycated hemoglobin (HbA1c), and the secondary outcomes are health‐related quality of life, body mass index (BMI), lipid profile, total insulin daily dose, hypoglycaemia, and diabetes ketoacidosis. We screened 736 studies, and included 6 RCTs with 325 patients. All RCTs were of low risk of bias, and included adolescents (mean age 15 years). The meta‐analysis showed that the addition of Metformin resulted in decreased total insulin daily dose (TIDD) (unit/kg/d) (mean difference [MD] = ?0.15, 95%CI, ?0.24, ?0.06), and reduced BMI kg/m² (MD ?1.46, 95%CI ?2.54, 0.38), and BMI z‐score (MD= ? 0.11, 95%CI ?0.21, ?0.01), and similar HbA1c (%) (MD= ? 0.05, 95%CI, ?0.19, 0.29). The overall evidence quality was high to moderate. Current evidence does not support use of Metformin in T1DM adolescents to improve HbA1c. However, Metformin may provide modest reduction in TIDD and BMI.     

Etiology of alcohol use among Hispanic adolescents: sex-specific effects of social influences to drink and problem behaviors.

BACKGROUND: Hispanic adolescents seem to be at greater risk for alcohol use; a greater understanding of the factors that predict alcohol use among Hispanic youth is needed. Social influences to drink and other problem behaviors often predict adolescent alcohol use. However, most past research has concentrated on samples of predominantly white adolescents residing in suburban areas. OBJECTIVES: To determine which demographic factors, social influences, and problem behaviors are associated with alcohol use among Hispanic adolescents and to eludicate the difference in the origins of alcohol use depending on sex. DESIGN: Cross-sectional study. SETTING: Middle schools in New York City. PARTICIPANTS: This study focuses on 1410 adolescents in grade 7 from inner-city schools who identified themselves as Hispanic at the baseline assessment of an investigation of alcohol and other drug use. MAIN OUTCOME MEASURES: Alcohol initiation, alcohol consumption, and future drinking. RESULTS: The findings showed that social influences to drink and reported problem behaviors were associated with alcohol use across and within sex groups. In particular, friends' drinking was related to alcohol initiation, consumption, and plans to drink in the future across sexes and within both sex groups. Other predictors (mother's drinking, siblings' drinking, ease of obtaining alcohol, deviance, cigarette smoking, and marijuana use) exhibited sex-specific effects. CONCLUSION: These findings lend support to teaching social resistance skills to improve Hispanic adolescents' ability to resist social influences to drink and use other drugs.     

Alcohol use disorder in adolescents

Alcohol use and abuse by children and adolescents remains a critical problem for modern developed countries. Although tolerance and public policy for alcohol use varies among Western countries, the use of alcohol and other harmful substances is common among adolescents. The use of alcohol can lead to a variety of negative consequences for youth. The risk for alcohol use and abuse, the acquisition of use behaviors, and development into alcohol use disorders and interventions for such problems should be considered in a comprehensive manner that considers neurobiology, development, and the adolescent's environmental ecology. Although the nature and extent of the alcohol problems between countries may vary, approaches to assessment and treatment from the United States may be useful to clinicians in other countries. This paper presents essential background information for the clinician in order to understand the presentation, risk, prevention and treatment of adolescents with alcohol use problems.     

Clinical review of mania, hostility and suicide-related events in children and adolescents treated with antidepressants

BACKGROUND

Recent controversy surrounding the use of non-tricyclic antidepressants and the emergence of suicide-related events, hostility/behavioural activation and mania in youth with depression warrants an exploration of the results from randomized controlled trials (RCTs) and published case reports for the emergence of these adverse events.

OBJECTIVE

To provide a clinical review of the available evidence from RCTs and case reports regarding the safety of nontricyclic anti-depressants in youth with depression.

METHODS

Seven RCTs of antidepressant use in youth with depression, four case reports of suicide-related adverse events, three case reports of hostility/behavioural activation, and 12 case reports of precipitation of mania were reviewed.

RESULTS

The majority of patients with suicide-related adverse events from both RCTs and published case reports were suicidal before the start of antidepressant treatment. Hostility/behavioural activation generally developed within days to weeks after the start of antidepressant treatment; in the majority of cases, symptoms resolved within four weeks of dosage lowering or discontinuation of the medication alone. Rates for precipitation of mania from RCTs ranged from 0% to 6%. In approximately 60% of published case reports, manic symptoms resolved with the discontinuation or lowering of the dosage of medication alone.

CONCLUSIONS

Several trends were observed in the association between adverse events and the use of nontricyclic antidepressants in youth. When prescribing antidepressants to youth, clinicians should closely monitor patients and fully inform them and their families of the risks and benefits of treatment with antidepressants.     

Adolescents and HIV infection: A clinician's perspective

Increasing concern in the United States has centered on HIV infection in adolescents. While less than 0.4% of all reported cases of AIDS are reported in adolescents 13–19 years of age, it is speculated that upwards of 20% of all AIDS cases have acquired their infection as teenagers. Most cases are now reported to occur among minority youth and most are now related to sexual or drug use behavior. The natural history of HIV infection in adolescents has yet to be defined. Many adolescents have progressed to clinically significant low CD4+ cells by the time their infection is discovered. While traditional risk factors are also risk factors for adolescents, number of sexual partners and non-injection drug use appear to be related to an increased risk of HIV infection in this age group. Prevention efforts must target both techniques as well as one-on-one counselling. Health care providers have a unique role to play in both patient and community education.