BACKGROUND
Mental health concerns increased during the coronavirus disease 2019 pandemic, but previous studies have not examined depression screening in pediatric primary care. We aimed to describe ...changes in screening, depressive symptoms, and suicide risk among adolescents during the coronavirus disease 2019 pandemic.
METHODS
In a repeat cross-sectional analysis of electronic health record data from a large pediatric primary care network, we compared the percentage of primary care visits where adolescents aged 12 to 21 were screened for depression, screened positive for depressive symptoms, or screened positive for suicide risk between June and December 2019 (prepandemic) and June and December 2020 (pandemic). Changes were examined overall, by month, and by sex, race and ethnicity, insurance type, and income. Modified Poisson regression was used to calculate prevalence ratios (PRs) for the prepandemic to pandemic changes.
RESULTS
Depression screening at primary care visits declined from 77.6% to 75.8% during the pandemic period (PR: 0.98, 95% confidence interval CI: 0.90–1.06). The percentage of adolescents screening positive for depressive symptoms increased from 5.0% to 6.2% (PR: 1.24, 95% CI: 1.15–1.34), with greater increases among female, non-Hispanic Black, and non-Hispanic white adolescents. Positive suicide risk screens increased from 6.1% to 7.1% (PR: 1.16, 95% CI: 1.08–1.26), with a 34% relative increase in reporting recent suicidal thoughts among female adolescents (PR: 1.34, 95% CI: 1.18–1.52).
CONCLUSIONS
Results suggest that depression and suicide concerns have increased during the pandemic, especially among female adolescents. Results underscore the importance of consistent depression and suicidality screening.
Jenssen and Fiks discuss the study by DeSilva et al which address the critical issue for the pediatric community of declining vaccination rates during the COVID-19 pandemic. The team used data from ...the Vaccine Safety Datalink, a collaborative effort between the US Center for Disease Control and Prevention's Immunization Safety Office and S integrated health care organizations across 6 US states. The data presented by the study team describe a situation that is both reassuring and concerning regarding the impact of the COVID-19 pandemic on childhood vaccinations. Vaccine administration rates in health care systems, after an initial decline, have essentially returned to prepandemic levels.
E-cigarettes have emerged and soared in popularity in the past ten years, making them the most common tobacco product used among youth in the United States (US). In this review, we discuss what the ...Surgeon General has called a public health "epidemic"-the precipitous increase in youth use of e-cigarettes and the health consequences of this behavior. Further, we review tobacco control policy efforts (e.g., Tobacco 21, banning flavors, advertising restrictions, and clean indoor air laws)-efforts proven to be critical in reducing cigarette smoking and smoking-related disease and death among US children and adults-including their potential and challenges regarding managing and mitigating the emergence of e-cigarettes. Finally, we close with a discussion of the efforts of transnational tobacco companies to rebrand themselves using e-cigarettes and other new products.
On January 20, 2020, authorities reported the first US case of coronavirus disease 2019 (COVID-19) in Snohomish County, Washington. By March 11, the World Health Organization declared a global ...pandemic, and on March 13, the US declared a national emergency. On March 18, the American Academy of Pediatrics issued guidance1 suggesting that pediatricians limit preventive care visits to younger children requiring immunization, separate the well-visit and sick-visit spaces and times, and increase telehealth capacity. Following Medicare's lead, many Medicaid programs and other payers expanded coverage and relaxed stipulations about telehealth use. In-person visit volumes in pediatric primary care practices plummeted, and many practices initiated or dramatically expanded video visits to reach patients and attempt to maintain financial viability. Within weeks, primary care practices and the families they serve had widely adopted virtual primary care.
Objective
Adolescent e‐cigarette use has risen to epidemic levels in the US, revealing a new phenomenon of e‐cigarette vaping‐associated lung injury (EVALI). It is important to better characterize ...EVALI in critically ill adolescents as this is a vulnerable and rapidly growing demographic.
Methods
This was a retrospective case series of patients ≤21 years old with confirmed or probable EVALI (as defined by the Centers for Disease Control) that resulted in admission to the pediatric intensive care unit (PICU) of a large tertiary academic children's hospital between August 2019 and January 2020.
Results
There were six eligible patients, with a median age of 17 years. All patients reported tetrahydrocannabinol as well as nicotine e‐cigarette use. Half of the patients had a preexisting diagnosis of asthma and four patients had mental health comorbidities. All patients presented with respiratory alkalosis and chest radiography showing diffuse bilateral infiltrates; two patients had pneumomediastinum, subcutaneous air and/or pneumothorax. The lowest documented ratio of oxygen saturation to inspired oxygen (SpO2:FiO2 or S/F ratio) ranged from 146 to 296. Two patients required an arterial line, with the lowest ratio of arterial oxygen to inspired oxygen (PaO2:FiO2 or P/F ratio) of 197 and 165. Two patients tested positive for rhinovirus and respiratory cultures were negative for all patients. Four patients underwent chest computed tomography imaging, which showed diffuse ground‐glass opacities. Every patient required noninvasive positive pressure ventilation, with one progressing to invasive ventilation. All patients received broad‐spectrum intravenous antibiotics and steroids, though there was considerable variability in dose, frequency, and duration of steroids. The hospital length of stay ranged from 5 to 16 days (median 8.3 days) with PICU length of stay ranging from 4 to 10 days (median 5.5 days). Four patients had pulmonary function testing before discharge, two of which showed decreased diffusing capacity of the lung for carbon monoxide. There were no patient deaths.
Conclusions
This single‐center case series describes the presentation, course, and treatment of EVALI in a pediatric intensive care unit setting. Our results show nuanced differences in the presentation and management of the critically ill adolescent, and raise many questions about the long term implications on lung health, morbidity, and mortality. Importantly, these cases illustrate the critical care consequences of a public health phenomenon and should spur further research and policy to address the negative health effects of vaping.
Electronic cigarettes (e-cigarettes) are the most commonly used tobacco product among youth. The 2016 US Surgeon General's Report on e-cigarette use among youth and young adults concluded that ...e-cigarettes are unsafe for children and adolescents. Furthermore, strong and consistent evidence finds that children and adolescents who use e-cigarettes are significantly more likely to go on to use traditional cigarettes-a product that kills half its long-term users. E-cigarette manufacturers target children with enticing candy and fruit flavors and use marketing strategies that have been previously successful with traditional cigarettes to attract youth to these products. Numerous toxicants and carcinogens have been found in e-cigarette solutions. Nonusers are involuntarily exposed to the emissions of these devices with secondhand and thirdhand aerosol. To prevent children, adolescents, and young adults from transitioning from e-cigarettes to traditional cigarettes and minimize the potential public health harm from e-cigarette use, there is a critical need for e-cigarette regulation, legislative action, and counterpromotion to protect youth.
Background
As primary care moves toward a system of population health management, providers will need to engage patients outside traditional office-based interactions.
Objective
We assessed patient ...attitudes regarding technology use to communicate with their primary care team or to engage with other patients outside typical office settings.
Design/Participants/Main Measures
We conducted a national survey using GfK KnowledgePanel
®
to examine attitudes on the use of digital technology (email, text messaging, and social media such as Facebook and Twitter) to communicate with primary care teams about health behavior goals and test results. We also assessed attitudes toward the use of digital technologies to engage with other patients in activities such as peer coaching.
Key Results
Of the 5119 panel members invited to participate, 3336 completed the survey (response rate, 65.2 %). Among respondents, more than half (58 %) reported using Facebook, and nearly two-thirds (64.1 %) used text messaging. Overall, few participants were willing to communicate about health goals via social media (3.1 %) or text messaging (13.3 %), compared to email (48.8 %) or phone (75.5 %) (results were similar for communication about test results). Among those that used text messaging, race/ethnicity was the only factor independently associated with greater support for text messaging African American (OR 1.44; 95 % CI, 1.01–2.06) and Hispanic (OR 1.8; 95 % CI, 1.25–2.59) in multivariate models. Participants interested in engaging in peer coaching through Facebook (11.7 %) were more likely to be younger (
p
< 0.0001), female (p < 0.001), and a racial/ethnic minority (African American, non-Hispanic or Hispanic,
p
< 0.0004).
Conclusions
Despite regular use of new digital technology such as text messaging and social media, few participants supported using these tools for communicating with their physicians’ practice. Participants were most supportive of using email for communication. Contrary to previous studies, among users of technology, low socioeconomic status and racial/ethnic minorities were equally or more likely to support use.
Early detection of health vulnerabilities in adolescents is integral to promoting healthy behaviors into adulthood. Our objective was to quantify the prevalence of health vulnerabilities among ...adolescents and examine differences by age and neighborhood opportunity.
In a cross-sectional analysis of electronic health record data for adolescents aged 13 to 18 years with preventive visits in a large pediatric primary care network between September 2021 and September 2022, we examined 5 health vulnerabilities: Tobacco use, substance use, firearm access, condomless intercourse, and depressive symptoms. Health vulnerabilities were assessed via self-reported adolescent health questionnaire and the validated Patient Health Questionnaire-Modified. Prevalence of health vulnerabilities were calculated alone and in combination, and compared by age and by quintile of neighborhood Child Opportunity Index (COI) score. Multivariable logistic regression estimated associations of neighborhood COI with reporting ≥2 health vulnerabilities.
Among 40 197 adolescents (57.7% aged 13-15 years, 66.3% living in "high"/"very high" COI neighborhoods), 29.7% reported at least 1 health vulnerability and 7.9% reported ≥2 vulnerabilities. Cumulative health vulnerabilities were more prevalent among older adolescents and adolescents from lower opportunity neighborhoods. In adjusted models, lower COI was associated with 65% higher odds of having ≥2 vulnerabilities (odds ratio 1.65, 95% confidence interval 1.43-1.91) compared with adolescents from the highest COI quintile.
Understanding the relationship between health vulnerabilities and neighborhood opportunities among adolescents may allow pediatric primary care providers and health systems to offer more tailored community support services and transdiagnostic specialized care navigation to address the health needs of teens with multiple vulnerabilities.
Fourteen percent of US adults use tobacco products. Because many of those who use tobacco are parents and/or caregivers, children are disproportionately exposed to tobacco smoke. People who use ...tobacco products often become addicted to nicotine, resulting in tobacco dependence, a chronic, relapsing disease. Tobacco use and exposure are more likely to occur in vulnerable and marginalized groups, including those living in poverty. Although some view tobacco use as a personal choice, evidence suggests that structural forces play an important role in tobacco uptake, subsequent nicotine addiction, and perpetuation of use. Viewing tobacco use and tobacco dependence through a structural competency lens promotes recognition of the larger systemic forces perpetuating tobacco use, including deliberate targeting of groups by the tobacco industry, lack of enforcement of age-for-sale laws, inferior access to health insurance and health care, poor access to cessation resources, and economic stress. Each of these forces perpetuates tobacco initiation and use; in turn, tobacco use perpetuates the user's adverse health and economic conditions. Pediatricians are urged to view family tobacco use as a social determinant of health. In addition to screening adolescents for tobacco use and providing resources and treatment of tobacco dependence, pediatricians are encouraged to systematically screen children for secondhand smoke exposure and support family members who smoke with tobacco cessation. Additionally, pediatricians can address the structural issues perpetuating tobacco use by becoming involved in policy and advocacy initiatives.
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