Tag Archives: adolescents

Adolescent Misuse of Prescription Pain Medicine Starts Early

In stark contrast to most research that suggests senior year in high school or later is the peak time for misuse of prescription pain relievers, it is younger 16-year-olds who are the mostly likely to report their first use of these agents outside their intended prescription within the previous year, a new study finds.

Courtesy Wikimedia Creative Commons/Kandy Talbot

The time for physicians to identify risk and intervene is the young to middle teenage years, Elizabeth A. Meier, Ph.D., and her associates at Michigan State University in East Lansing reported.

“With peak risk at age 16 years and a notable acceleration in risk between ages 13 and 14 years, any strict focus on college students or 12th graders might be an example of too little too late in the clinical practice sector and in public health work,” they wrote in the Archives of Pediatrics & Adolescent Medicine, published online May 7, 2012.

“We suspect that many physicians, other prescribing clinicians, and public health professionals will share our surprise that for youth in the United States, the peak risk of starting extramedical use of prescription pain relievers occurs before the final year of high school [and] not during the post-secondary school years,” the authors wrote.

Another reason to screen your young adolescent patients is the risk of hazardous consequences associated with prescription pain misuse, which is greatest during early adolescence, Dr. Meier and her colleagues noted.

They assessed self-reported extramedical prescription pain reliever use among 119,877 U.S. teens and young adults (ages 12-21 years) using 2004-2008 data from the National Survey on Drug Use and Health (NSDUH).

They calculated the highest risk estimate, 2.8%, at 16 years of age. This is an increase from 0.5% at 12 years; 0.7% at 13 years; 1.6% at 14 years; and 2.2% at 15 years. After the peak in mid-adolescence, risk dropped steadily by 0.3% or 0.4% each year, down to 1.1% among 21-year-olds.

Reliance on self-reported misuse of prescription pain killers is a limitation of the study. A strong point of the research, however, was including adolescents and young adults regardless of whether they were still in school.

Earlier and stronger school-based prevention and outreach programs are warranted, according to the researchers. There also is a distinct role and reason for pediatricians, dentists, and other clinicians to work toward misuse prevention in their practices, they added: roughly 15% of the youths surveyed were not in school during the peak time of risk.

–Damian McNamara

@MedReporter on twitter

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Filed under Anesthesia and Analgesia, Drug And Device Safety, Epidemiology, Family Medicine, IMNG, Internal Medicine News, Pediatrics, Uncategorized

Inner-city Teens Get Asthma Messages by MP3

Ask a teenager what he or she did today, and you’ll probably get the universal adolescent answer: “Nothing.” Turns out that a whole lot of that “nothing” involves using electronic media. Some innovative pilot studies tapped into those habits to get inner-city teenagers to improve their use of asthma medications, Dr. Giselle Mosnaim reported at the annual meeting of the American Academy of Allergy, Asthma and Immunology (AAAAI).

Image of iPod Shuffle by flickr user aliciat80 (Creative Commons license).

She became frustrated when she kept seeing the same teens in the emergency department in acute asthma crisis over and over again. The messages to use their asthma medications were not getting through to them, so she looked for potentially better ways to reach them.

In a large survey study by the Kaiser Family Foundation, youths aged 8-18 years reported that their use of media (TV, music, computer, video games, print, or movies) in 2009 increased to 10 hours and 45 minutes per day, up from 8.5 hours in 2004 and 7.5 hours in 1999. How is that even possible? They’re multitasking 29% of that time, compared with 26% of media time spent multitasking in 2004 and 16% in 1999. Even accounting for multitasking, they were exposed to media 7 hours and 38 minutes per day in 2009.

In that same time span, cellphone ownership increased in this age group from 39% to 66%. The proportion that owned an iPod or other MP3 player increased from 18% to 76%.

Dr. Mosnaim (Photo by Sherry Boschert)

So Dr. Mosnaim designed a pilot study in which 27 inner-city teenagers with asthma received free cellphones and could choose music to listen to via the phones, but they had to  hear messages from celebrities urging them to take their asthma meds before they could access the music. That study bombed. (Not as in, “You’re the bomb!” but as in, “Fail!”)  Medication adherence did not improve, and the teens found a way around safeguards on the cellphones to run up hundreds of dollars in calls that they weren’t supposed to be making, said Dr. Mosnaim of Rush University Medical Center, Chicago. Plus, they didn’t think much of the celebrity messages.

So she tried again, this time using iPod Shuffles. Four teens in the second pilot study were allowed to download 10 profanity-free MP3 songs per week. They met weekly in coping/peer-support groups, where they recorded their own take-your-asthma-meds messages, and those were mixed in with the tracks on the iPod Shuffle. I don’t have permission to post audio of some of those messages here, but suffice it to say that their creativity outshines most rappers and DJs. The investigators attached a device to each teen’s inhaler to objectively measure medication adherence.

Hearing their own voice on the “asthma track” proved to be a hit. And it seemed to work. Medication adherence increased to 70% in 8 weeks, a “clinically significant treatment target,” Dr. Hosnaim said.

The idea is now graduating from pilot studies to a randomized, controlled trial with 90 participants. The control group will get the iPod Shuffles and follow the same protocol as the intervention group, but the voice on the asthma messages will be Dr. Mosnaim.

Not too long ago, I might have ended this blog post by saying, “Stay tuned.” That’s so last century. When the study’s results drop, you’ll get them here first. Are you subscribed?

— Sherry Boschert (@SherryBoschert on Twitter)

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Filed under Allergy and Immunology, Emergency Medicine, Family Medicine, IMNG, Internal Medicine, Pediatrics, Primary care

Talking To Teens, Even When They Ignore You

Teenage patient issues can be a dermatologist’s nightmare: unrealistic expectations, poor compliance, and little or no patience for anything less than instant gratification—yesterday.

courtesy of flickr user Glasgow Street Art (creative commons)

But few aspects of medicine are more satisfying than breaking through the barrier with a teen patient, according to Dr. Hilary Baldwin, vice chair and associate professor of dermatology at the State University of New York in Brooklyn, N.Y.

At this year’s Orlando Dermatology Aesthetic and Clinical Conference, Dr. Baldwin shared some anecdotes and tips for talking to teens.

–Keep at it. Just because a teen isn’t looking at you doesn’t mean they aren’t listening. Even if that 14-year-old boy seems more interested in the mechanism of his chair than in what you are saying, keep talking.

–Minimize distractions. That chair may be interesting, but it is no iPod. Dr. Baldwin said she insists that her teen patients refrain from wearing hats, sunglasses, or earphones, and desist from texting, chewing gum, or sprawling on the exam table.

–Talk to the teen, not to the parent. Give teens the option to have their parents in the exam room, but if a parent is present be sure to keep talking to the teen, said Dr. Baldwin. But friends definitely stay in the waiting room, and (ideally) so do siblings, she said.

–Give teens some control. Dr. Baldwin advised letting teens make decisions about factors such as the vehicle of a skin care product (cream or gel, etc.) to improve compliance. And make sure teens know that you aren’t forcing a treatment on them. Instead, try suggesting “I will be here to help when you are ready.”

–Other tips to boost teen compliance: Avoid morning use products if possible, and be liberal in giving sample-sized products so they can be carried in every backpack, purse, or coat pocket. Dr. Baldwin also recommends taping a tube of skin product to the  computer monitor at home to improve compliance.

–Heidi Splete (@hsplete on twitter)

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Filed under Dermatology, Family Medicine, IMNG, Internal Medicine, Pediatrics, The Mole

New Obesity Recommendations Face Uphill Battle

Courtesy of Flickr user ktheory

There is now enough evidence to recommend screening for overweight and obesity in children aged 6 years and older and enough evidence backing the efficacy of behavioral interventions of at least moderate intensity, according to the U.S. Preventive Services Task Force. (See story.)

Will this recommendation pack a big enough punch to kick-start a movement toward more screening and greater acceptance and awareness of the efficacy of behavioral interventions? It looks like it will be an uphill battle, if a new survey of members of the American Academy of Pediatrics gives a true indication.

The survey of 677 primary care clinicians in active practice revealed that only 52% assess BMI percentile for children older than 2 years and only 23% said they believe that there are good treatment strategies for overweight. Less than half said they are able to make referrals to interventional programs.

It also was notable that clinicians who are familiar with American Academy of Pediatrics guidelines on obesity screening and treatment were more likely to use BMI percentiles in their care and more likely to feel prepared to counsel patients.

Dr. Ned Calonge, the chair of the USPSTF, recognized that many clinicians won’t be able to offer referrals to weight management centers, but he said with greater recognition of the value of screening and the efficacy of treatment, greater availability of referral services and insurance coverage will hopefully follow. That will be key because 69% of providers in the survey said that insurance does not cover weight management programs, and only 15% reported that they can bill for overweight counseling and treatment separate from well-child visits.

Jeff Evans (@jeffaevans on Twitter)


Filed under Endocrinology, Diabetes, and Metabolism, Family Medicine, Pediatrics, Primary care, Uncategorized