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CORK Bibliography: Preadolescent Substance Use

66 citations. 2010 to present

Prepared: June 2012

Amirav I; Luder A; Viner Y; Finkel M. Decriminalization of cannabis: Potential risks for children? Acta Paediatrica 100(4): 618-619, 2011. (9 refs.)

The legalization of cannabis for medicinal purposes is becoming increasingly widespread worldwide. The anticipated growing ease of access to cannabis may create an increased risk for passive and/or active ingestion by children. We report a case of a 1.5-year-old infant who presented with unexplained coma that was later proved to be associated with the ingestion of cannabis. This case highlights the importance of considering cannabis ingestion in the differential diagnosis of infantile and toddler coma and the need for public education regarding the risks of childhood exposure in the light of the legalization of cannabis for medical purposes and its greater availability.

Andrews JA; Gordon JS; Hampson SE; Christiansen SM; Gunn B; Slovic P et al. Short-term efficacy of Click City (R): Tobacco: changing etiological mechanisms related to the onset of tobacco use. Prevention Science 12(1): 89-102, 2011. (51 refs.)

This paper described the short-term results from an ongoing randomized controlled efficacy study of Click City (R): Tobacco, a tobacco prevention program designed for 5th graders, with a booster in sixth grade. Click City (R): Tobacco is an innovative school-based prevention program delivered via an intranet, a series of linked computers with a single server. The components of the program target theoretically based and empirically supported etiological mechanisms predictive of future willingness and intentions to use tobacco and initiation of tobacco use. Each component was designed to change one or more etiological mechanisms and was empirically evaluated in the laboratory prior to inclusion in the program. Short-term results from 47 elementary schools (24 schools who used Click City (R): Tobacco, and 23 who continued with their usual curriculum) showed change in intentions and willingness to use tobacco from baseline to 1-week following the completion of the 5th grade sessions. The results demonstrate the short-term efficacy of this program and suggest that experimentally evaluating components prior to including them in the program contributed to the efficacy of the program. The program was most efficacious for students who were most at risk.

Apostolou A; Garcia-Esquinas E; Fadrowski JJ; McLain P; Weaver VM; Navas-Acien A. Secondhand tobacco smoke: A source of lead exposure in US children and adolescents. American Journal of Public Health 102(4): 714-722, 2012. (53 refs.)

Objectives. We evaluated the relationship between secondhand tobacco smoke (SHS) exposure and blood lead levels in US children and adolescents. Methods. We analyzed data from 6830 participants aged 3-19 years in the National Health and Nutrition Examination Survey (1999-2004) who were not active smokers and for whom SHS exposure information and blood lead measurements were available. Results. After multivariable adjustment, participants in the highest quartile of serum cotinine (>= 0.44 mu g/L) had 28% (95% confidence interval=21%, 36%) higher blood lead levels than had those in the lowest quartile (<0.03 mu g/L). Similarly, blood lead levels were 14% and 24% higher in children who lived with 1 or with 2 or more smokers, respectively, than they were in children living with no smokers. Among participants for whom lead dust information was available, the associations between SHS and blood lead levels were similar before and after adjustment for lead dust concentrations. Conclusions. SHS may contribute to increased blood lead levels in US children. Lead dust does not appear to mediate this association, suggesting inhalation as a major pathway of exposure. Eliminating SHS exposure could reduce lead exposure in children.

Appleton S. Frequency and outcomes of accidental ingestion of tobacco products in young children. (review). Regulatory Toxicology and Pharmacology 61(2): 210-214, 2011. (44 refs.)

This review assesses published literature related to frequency and outcomes associated with accidental ingestion of tobacco and pharmaceutical nicotine products among young children. Twenty-seven years of annual reports by American Association of Poison Control Centers (AAPCC) were analyzed for occurrence and outcomes associated with accidental ingestion events involving tobacco and pharmaceutical nicotine products among young children. Over a 27-year period, and of >50 million contacts for all categories combined, 217,340 contacts involving ingestion of tobacco products were reported. Approximately 89% involved children <6 years old. One fatality was reported, however the co-ingestion of both cigarettes and diazepam complicates an assessment of a contributory role of tobacco. The rate of major, non-fatal, outcomes was <0.1%. Data from AAPCC reports and other sources indicate the frequency of accidental poisoning events is relatively low for tobacco products compared with other products such as drugs, dietary supplements, cleaning products, and personal care products. These findings, along with those for pharmaceutical nicotine products, are consistent with published case reports and reviews, indicating that the frequency and severity of outcomes associated with accidental ingestion of tobacco products by young children appear to be relatively low. However, adults should keep tobacco products out of the reach of children.

Azzi-Lessing L. Home visitation programs: Critical issues and future directions. (review). Early Childhood Research Quarterly 26(4): 387-398, 2011. (122 refs.)

As support for intervening early in the lives of vulnerable children has risen in the United States in recent years, so has interest in home-visitation programs. Home visitation is increasingly recognized for its potential to foster early child development and competent parenting, as well as to reduce risk for child abuse and neglect and other poor outcomes for vulnerable families. This paper provides a discussion of several aspects of home-visitation programs that warrant further development and evaluation, including the powerful role of context in determining program outcomes, as well as the impact of other factors, including service dosage, levels of family engagement, and characteristics of home visitors. The importance of more accurately understanding and measuring risk and engaging family members beyond the mother-child dyad is also discussed. Recommendations are made for making improvements in all of these areas, in order to strengthen home-visitation programs and produce better outcomes for the children and families they serve. Aspects of Nurse Family Partnership and Early Head Start, two widely replicated and rigorously evaluated programs, are highlighted to demonstrate how the issues discussed here are likely to affect service delivery and program outcomes. The multiple challenges inherent in replicating and evaluating home-visitation programs that are truly responsive to the needs of a wide array of families with young children are examined. This discussion concludes with a call to expand and improve methods for evaluating these programs, and to view home visitation as a component of a comprehensive system of child and family supports, rather than as a stand-alone model of intervention.

Bauer CR; Lambert BL; Bann CM; Lester BM; Shankaran S; Bada HS et al. Long-term impact of maternal substance use during pregnancy and extrauterine environmental adversity: Stress hormone levels of preadolescent children. Pediatric Research 70(2): 213-219, 2011. (33 refs.)

Prenatal cocaine exposure (PCE) is associated with blunted stress responsivity within the extrauterine environment. This study investigated the association between PCE and diurnal salivary cortisol levels in preadolescent children characterized by high biological and/or social risk (n = 725). Saliva samples were collected at their home. Analyses revealed no group differences in basal evening or morning cortisol levels; however, children with higher degrees of PCE exhibited blunted overnight increases in cortisol, controlling for additional risk factors. Race and caregiver depression were also associated with diurnal cortisol patterns. Although repeated PCE may contribute to alterations in the normal or expected stress response later in life, sociodemographic and environmental factors are likewise important in understanding hormone physiology, especially as more time elapses from the PCE. Anticipating the potential long-term medical, developmental, or behavioral effects of an altered ability to mount a normal protective cortisol stress response is essential in optimizing the outcomes of children with PCE.

Bellot B; Michel F; Thomachot L; Chaumoitre K; Battaglia F; Lagier P. Acute leukoencephalopathy after buprenorphine intoxication in a 2-year-old child. European Journal of Paediatric Neurology 15(4): 368-371, 2011. (7 refs.)

Leukoencephalopathies have been reported after heroin inhalation or ingestion, and buprenorphine injection, but the physiopathology remains unclear. We report here the first case of leukoencephalopathy caused by buprenorphine ingestion in a 2-year-old child who was admitted for coma and fever. Due to technical problems, the toxicology screen was delayed, and infectious disease was first suspected. A brain MRI found bilateral and symmetric white matter damages in the cerebral hemispheres and the cerebellum. Rapid recovery and positive toxicology screen for buprenorphine on day 4 confirmed the diagnosis of acute intoxication.

Benko CR; Farias AC; Farias LG; Pereira EF; Louzada FM; Cordeiro ML. Potential link between caffeine consumption and pediatric depression: A case-control study. BMC Pediatrics 11: AR 73, 2011. (38 refs.)

Background: Early-onset depressive disorders can have severe consequences both from developmental and functional aspects. The etiology of depressive disorders is complex and multi-factorial, with an intricate interaction among environmental factors and genetic predisposition. While data from studies on adults suggest that caffeine is fairly safe, effects of caffeine in children, who are in period of rapid brain development, are currently unknown. Furthermore, systematic research addressing the relationship between depressive symptoms in children and caffeine consumption is lacking. The present study examined the effects of caffeine consumption on depressed mood in children with depression and non-depressed participants. Methods: Children and adolescents (n = 51) already enrolled in an ongoing longitudinal study, aged 9-12 years, were assessed for depressive symptoms with the Children Depressive Inventory (CDI). Psychopathological symptoms were assessed with the Child Behavioral Checklist (CBCL) and eating habits were assessed with the Nutrition-Behavior Inventory (NBI) [1]. The children were compared to control children without psychopathology attending public schools in a Southern Brazilian city. Results: Participants with CDI scores = 15 (mean = 19; S. D. = 4) also had high NBI scores (mean = 52; S. D. = 19, p < 0.001) suggestive of a relationship between depressive symptoms and environmental factors, in this case nutrition/behavior. Additional linear regression adjusted statistical analysis, considering the factors of consumption of sweets and caffeine individually, showed that caffeine, but not sweets, was associated with depressive symptoms. Conclusions: These findings indicate that depressed children consume more caffeinated drinks than non-depressed children. Nonetheless while a strong association between depressive symptoms and caffeine consumption among children was found, further research should investigate whether or not this association is due to a cause and effect relationship.

Beyerlein A; Ruckinger S; Toschke AM; Rosario AS; von Kries R. Is low birth weight in the causal pathway of the association between maternal smoking in pregnancy and higher BMI in the offspring? European Journal of Epidemiology 26(5): 413-420, 2011. (57 refs.)

A number of cross-sectional and prospective studies suggested a priming effect of maternal smoking in pregnancy on offspring's obesity. It has been hypothesized that this association might be explained by low birth weight and subsequent catch-up growth in the causal pathway. We therefore examined the role of birth weight in children exposed versus not exposed to cigarette smoking in utero on later body mass index (BMI). Using data of 12,383 children and adolescents (3-17 years of age) recorded in a German population-based survey (KiGGS), we assessed mean body mass index standard deviation scores (BMI-SDS) in different birth weight SDS categories, stratified for children with smoking and non-smoking mothers. We calculated spline regression models with BMI-SDS as outcome variable, cubic splines of birth weight SDS, and potential confounding factors. Children whose mothers had been smoking during pregnancy had lower birth weight SDS and higher BMI-SDS at interview compared to children of non-smoking mothers. However, we observed a linear association between birth weight SDS and BMI-SDS in crude analyses for both groups. Similarly, almost linear effects were observed in adjusted spline regression analyses, except for children with very low birth weight. The respective 95% confidence bands did not preclude a linear effect for the whole birth weight SDS distribution. Our findings suggest that low birth weight is unlikely to be the main cause for the association between intrauterine nicotine exposure and higher BMI in later life. Alternative mechanisms, such as alterations in the noradrenergic system or increased food efficiency, have to be considered.

Bond GR; Woodward RW; Ho M. The growing impact of pediatric pharmaceutical poisoning. Journal of Pediatrics 160(2): 265-U312, 2012. (24 refs.)

Objective To understand which medications, under which circumstances, are responsible for the noted increase in pediatric medication poisonings, resource use, and morbidity. Study design: Patient records from 2001-2008 were obtained from the National Poison Data System of the American Association of Poison Control Centers for children aged <= 5 years evaluated in a health care facility following exposure to a potentially toxic dose of a pharmaceutical agent. Pharmaceutical agents were classified as over-the-counter or prescription and by functional category. Exposures were classified as child self-ingested the medication or as therapeutic error. For the 8-year period, emergency visits, admissions, significant injuries, and trends in these events were calculated for each substance category. Results: We evaluated 453 559 children for ingestion of a single pharmaceutical product. Child self-exposure was responsible for 95% of visits. Child self-exposure to prescription products dominated the health care impact with 248 023 of the visits (55%), 41 847 admissions (76%), and 18 191 significant injuries (71%). The greatest resource use and morbidity followed self-ingestion of prescription products, particularly opioids, sedative-hypnotics, and cardiovascular agents. Conclusions: Prevention efforts have proved to be inadequate in the face of rising availability of prescription medications, particularly more dangerous medications.

Bruner K; Chand D; Patel H; Stolfi A; Omoloja A. Chronic kidney disease, pediatric nephrologists, and tobacco counseling: perceptions and practice patterns. A Study from the Midwest Pediatric Nephrology Consortium. Journal of Pediatrics 159(1): 155-U188, 2011. (12 refs.)

We sought to identify practice patterns of pediatric nephrologists for tobacco counseling, because of a high incidence of secondhand smoke exposure and tobacco use in adolescents with chronic kidney disease. Counseling was minimal for several reasons, thus increasing the risk for heart disease inherent in children with chronic kidney disease.

Chan WC; Leatherdale ST; Burkhalter R; Ahmed R. Bidi and hookah use among Canadian youth: A examination of data from the 2006 Canadian Youth Smoking Survey. Journal of Adolescent Health 49(1): 102-104, 2011. (10 refs.)

Purpose: To examine the prevalence and associated factors of bidi and hookah use among Canadian youth. Methods: Data from 41,886 grade 7 to 12 youth were used to examine factors associated with bidi and hookah use. Results: Youth who are current or former cigarette smokers, have tried marijuana or alcohol, were more likely to use bidi or hookah. Conclusions: Results suggest bidi and hookah use may be an emerging issue in tobacco control among youth. Findings also support an integrated approach where future prevention efforts should address multiple risk behaviors.

Chang HY; Wu WC; Wu CC; Cheng JY; Hurng BS; Yen LL. The incidence of experimental smoking in school children: An 8-year follow-up of the child and adolescent behaviors in long-term evolution (CABLE) study. BMC Public Health (e844), 2011. (35 refs.)

Background: Studies have established that most regular adult smokers become addicted in their adolescent years. We investigated the incidence of and risk factors associated with initial experimental smoking among a group of school children who were followed for 8 years. Methods: We used cohort data collected as part of the Child and Adolescent Behaviors in Long-term Evolution (CABLE) study, which selected nine elementary schools each from an urban area (Taipei City) and a rural area (Hsingchu county) in northern Taiwan. From 2002 to 2008, children were asked annually whether they had smoked in the previous year. An accelerated lifetime model with Weibull distribution was used to examine the factors associated with experimental smoking. Results: In 2001, 2686 4(th)-graders participated in the study. For each year from 2002 to 2008, their incidences of trial smoking were 3.1%, 4.0%, 2.8%, 6.0%, 5.3%, 5.0% and 6.0%, respectively. There was an increase from 7(th) to 8(th) grade (6.0%). Children who were males, lived in rural areas, came from single-parent families, had parents who smoked, and had peers who smoked were more likely to try smoking earlier. The influence of parents and peers on experimental smoking demonstrated gradient effects. Conclusions: This study used a cohort to examine incidence and multiple influences, including individual factors, familial factors, and community factors, on experimental smoking in adolescents. The findings fit the social ecological model, highlighting the influences of family and friends. School and community attachment were associated with experimental smoking in teenagers.

Chen KH; Chen CY; Liu CY; Lin YC; Chen WJ; Lin KM. Multilevel influences of school and family on alcohol-purchasing behaviors in school-aged children. Drug and Alcohol Dependence 114(2-3): 127- 133, 2011. (52 refs.)

Background: Little has been known about children's illegal alcohol purchasing behaviors and associated contextual factors influencing commercial accessibility to alcohol. The aims are to determine multilevel effects of school-and family-characteristics on children's alcohol purchase and to probe possible drinking experience-related heterogeneity in such links. Methods: A representative sample of 2630 4th- and 6th-graders in an urban region of Taiwan in 2007 was drawn via multistage probability sampling. Information about family background and individual drinking experiences was collected via paper-and-pencil self-administered questionnaires; school neighborhood characteristics were assessed via commercial datasets of geographic information system. Results: Roughly one in nine 10-12-year-old children ever purchased alcoholic beverages by 6th grade. Children who did not participate in after-school programs or had observed parental drinking had 2-3-fold increased risk to buy alcoholic beverages alone. Living with one or none of parents was associated with alcohol purchase in children who never drank alcohol (Odds Ratio [OR] = 3.51; 95% Confidence Interval [CI] = 2.14, 5.76). School contextual characteristics have salient effects on minors' alcohol accessibility from commercial sources (e.g., the density of nearby educational institutions, OR = 0.33-0.53), and certain school neighborhood effects were notably different by children's drinking experience (e.g., the density of public transportation). Conclusions: The present study suggests the significant effects of family socioeconomics, family drinking, and school neighboring environment on children's independent alcohol purchase, which may operate differentially by one's drinking experience. Our findings may provide implications that family and school neighborhood contexts should be considered in the devising and delivery of underage drinking prevention programs.

Chen XG; Stanton B; Hopper J; Khankari N. Sources, locations, and predictors of environmental tobacco smoke exposure among young children from inner-city families. Journal of Pediatric Health Care 25(6): 365-372, 2011. (36 refs.)

Introduction: The purpose of this study was to determine the levels, sources, and locations of and influential factors for exposure to environmental tobacco smoke (ETS) among pediatric patients from inner-city families. Method: Descriptive and associative analysis of ETS exposure in children 6 to 10 years of age was performed with survey data collected at Children's Hospital of Michigan through mothers' report and children's urine cotinine. Results: The sample included 397 participants, 82.4% of whom were African American. Urine cotinine levels were correlated with reported ETS exposure and 71% of children with urine cotinine levels > 10 ng/mL. The mean duration of ETS exposure was 14.3 minutes (SD = 11.0) in the past week and 58.9 minutes (SD = 50.8) in the past month. Smoking parents (similar to 30%), grandparents (similar to 30%), and non-family members (similar to 28%) were the major ETS sources, and relatives' homes (similar to 40%), the children's own homes (similar to 24%), automobiles (similar to 15%), and friends' homes (similar to 11%) were the main ETS locations. Child ETS exposure was inversely correlated with having a non-single mother, maternal education, income, use of prenatal preventive care, and satisfactory parenting. Discussion: ETS exposure in inner-city children was prevalent. Findings of this study may aid pediatric practitioners and public health workers in providing targeted interventions.

Chowdhury F; Chisti MJ; Hossain MI; Malek MA; Salam MA; Faruque AG. Association between paternal smoking and nutritional status of under-five children attending Diarrhoeal Hospital, Dhaka, Bangladesh. Acta Paediatrica 100(3): 390-395, 2011. (20 refs.)

Aim: The study aimed at determining whether there is an association between paternal smoking and nutritional status of children aged 0-59 months. Furthermore, the study looked at the presence of any nutritional differentials within different socio-economic groups. Methods: Secondary analysis of data on children aged 0-59 months enrolled in the Hospital Surveillance System of International Centre for Diarrhoeal Disease Research, Dhaka Hospital, Bangladesh, during 1996-2006. Results: Among 13,555 under-five children, fathers of 49% were smokers. In multivariate logistic regression models adjusting for potential confounders, fathers' smoking was significantly associated with increased risk of moderate underweight (OR 1.16, 95% CI 1.08-1.25), severe underweight (OR 1.15, 95% CI 1.06-1.26), moderate stunting (OR 1.15, 95% CI 1.06-1.23) and severe stunting (OR 1.13, 95% CI 1.03-1.25). In middle and lower socio-economic strata, risk of moderate and severe child malnutrition was found to be significantly increased in the group where the father was a smoker. Conclusion: Results indicate that there is an association between fathers' smoking and malnutrition of under-five children particularly in lower socio-economic group. A possible mechanism - if this association is causal - may be through a negative effect on family economy.

Collins D; Abadi MH; Johnson K; Shamblen S; Thompson K. Non-medical use of prescription drugs among youth in an Appalachian population: Prevalence, predictors, and implications for prevention. Journal of Drug Education 41(3): 309-326, 2011. (47 refs.)

This article examines prevalence of non-medical use of prescription drugs (NMUPD) in a sample of elementary and high school students in an Appalachian Tennessee county. We found that lifetime prevalence of NMUPD (35%) was higher than prevalence of cigarette use (28%) and marijuana use (17%), but lower than lifetime prevalence of alcohol use (46%). We examined characteristics, as well as risk and protective factors in several domains, as predictors of NMUPD. For comparison, we also examined these characteristics and factors as predictors of alcohol, cigarette, and marijuana use. Using survey data from a sample of late elementary school and high school students (grades 5, 7, 9, and 11), logistic regression analyses showed that the risk factors of friends' non-medical use and perceived availability, and the protective factors of perceived risk, parents' disapproval, school commitment, and community norms against youth NMUPD were significant predictors of lifetime prevalence of NMUPD. Implications for prevention are discussed.

Day C; Kowalenko S; Ellis M; Dawe S; Harnett P; Scott S. The Helping Families Programme: A new parenting intervention for children with severe and persistent conduct problems. Child and Adolescent Mental Health 16(3): 167-171, 2011. (18 refs.)

Background: Severe and persistent conduct problems in children during the primary school years are associated with school exclusion, increased risk of delinquency and early substance abuse. Method: Literature reviews and consultation with experts in the field were used to better understand the factors that contribute to severe and persistent conduct problems and to identify the principles and potential methods to be included in a new intervention. Results: Grounded in an ecological perspective, an innovative, multimodal intervention, the Helping Families Programme, has been developed. It uses a modular approach to systematically address parent behaviour, cognition and emotion across five key risk factor domains: parental mood and dysregulation; parent-child, family and school relationships; substance misuse; social support and networks; and managing life events and crises. Conclusion: Initial piloting of the Programme has offered early support for the potential value of the underlying principles and methods of the Programme.

de Leeuw RNH; Verhagen M; de Wit C; Scholte RHJ; Engels RCME. 'One cigarette for you and one for me': Children of smoking and non-smoking parents during pretend play. Tobacco Control 20(5): 344-348, 2011. (29 refs.)

Objective: To investigate whether perceived parental smoking is related to pretend smoking in young children and whether children influence each other in pretend smoking. Methods: Children who reported to have at least one smoking parent were coupled with children who had non-smoking parents. Both children were then asked to pretend that they were adults having a barbeque party. During their role playing, the children were observed in order to assess their pretend smoking behaviours and to examine whether children of smoking parents were more likely to initiate pretend smoking. Children were tested at their schools; the sample consisted of 206 children between 4 and 7 years of age (mean age = 5.14, SD = 0.87), of which 54.4% were girls. The main outcome was whether a child pretended to be smoking and whether the child initiated or followed the other child in this behaviour. Results: During their play, 63.6% (n = 131) of the children pretended to smoke. Children of smoking parents were more likely to initiate pretend smoking than to follow. Conclusions: Through their own smoking, parents appear to be able to influence the way in which their children interact with peers regarding pretend smoking. More specifically, children of smoking parents might instigate smoking among their peers.

de Moor JS; Puleo E; Ford JS; Greenberg M; Hodgson DC; Tyc VL et al. Disseminating a smoking cessation intervention to childhood and young adult cancer survivors: Baseline characteristics and study design of the partnership for health-2 study. BMC Cancer 11(e-article 165), 2011. (40 refs.)

Background: Partnership for Health-2 (PFH-2) is a web-based version of Partnership for Health, an evidence-based smoking cessation intervention for childhood cancer survivors. This paper describes the PFH-2 intervention and baseline data collection. Methods: 374 childhood and young adult cancer survivors were recruited from five cancer centers and participated in the baseline assessment. At baseline, participants completed measures of their smoking behavior, self-efficacy and stage of change for quitting smoking as well as psychological and environmental factors that could impact their smoking behavior. Results: At baseline, 93% of survivors smoked in the past seven days; however, 89% smoked a pack or less during this period. Forty-seven percent were nicotine dependent, and 55% had made at least one quit attempt in the previous year. Twenty-two percent of survivors were in contemplation for quitting smoking; of those 45% were somewhat or very confident that they could quit within six months. Sixty-three percent were in preparation for quitting smoking; however, they had relatively low levels of confidence that they could quit smoking in the next month. In multivariate analyses, stage of change, self-efficacy, social support for smoking cessation, smoking policy at work and home, fear of cancer recurrence, perceived vulnerability, depression, BMI, and contact with the healthcare system were associated with survivors' smoking behavior. Discussions/Conclusions: A large proportion of the sample was nicotine dependent, yet motivated to quit. Individual- interpersonal- and environmental-level factors were associated with survivors' smoking behavior. Smoking is particularly dangerous for childhood and young adult cancer survivors. This population may benefit from a smoking cessation intervention designed to build self-efficacy and address other known predictors of smoking behavior.

Dong GH; Wang D; Yang ZH; Zhang PF; Ren WH; Zhao YD et al. Gender-specific differences in effects of prenatal and postnatal environmental tobacco smoke exposure on respiratory symptoms in 23,474 children with and without allergic predisposition: Results from 25 districts of northeast China. International Journal of Environmental Health Research 21(3): 173- 188, 2011. (30 refs.)

To assess the interaction of environmental tobacco smoke (ETS) exposure and allergic predisposition regarding respiratory health among Chinese children, a sample of 23,474 children (6-13 years old) was studied from 25 districts in Liaoning province, China. The results showed that children without allergic predisposition were more susceptible to ETS than children with allergic predisposition. Among children without allergic predisposition, ETS exposure was associated with more respiratory symptoms and diseases in boys than in girls; In utero ETS exposure was associated with history of asthma (OR, 1.86; 95% CI, 1.44-2.40) and current asthma (OR, 2.25; 95% CI, 1.48-3.44) only among boys without allergic predisposition. Among children with allergic predisposition, more associations between ETS exposure and respiratory symptoms and diseases were detected in girls. In conclusion, ETS exposure was more evident in boys without family atopy history and more associations were detected in girls with family atopy history.

Dove MS; Dockery DW; Connolly GN. Smoke-free air laws and asthma prevalence, symptoms, and severity among nonsmoking youth. Pediatrics 127(1): 102-109, 2011. (42 refs.)

OBJECTIVE: We investigated the association between smoke-free laws and asthma prevalence, symptoms, and severity among nonsmoking youth (aged 3-15 years). METHODS: We examined data from the 1999 - 2006 National Health and Nutrition Examination Survey, a cross-sectional survey designed to monitor the health and nutritional status of the US population. Survey locations were dichotomized as having or not having at least 1 smoke-free workplace, restaurant, or bar law at the county or state level that covered the entire county population. Asthma prevalence was assessed as self-reported current asthma and as ever having asthma with current symptoms. Asthmatic symptoms included persistent wheeze, chronic night cough, and wheeze-medication use. We also examined asthma severity (asthma attack or emergency-department visit for asthma) and persistent ear infection. RESULTS: Smoke-free laws were not associated with current asthma but were significantly associated with lower odds of asthmatic symptoms (odds ratio [OR]: 0.67 [95% confidence interval (CI): 0.48-0.93]) among nonsmoking youth. The association between smoke-free laws and ever having asthma with current symptoms approached significance (OR: 0.74 [95% CI: 0.53-1.03]). Smoke-free laws were associated with lower odds of asthma attacks (OR: 0.66 [95% CI: 0.28-1.56]) and emergency-department visits for asthma (OR: 0.55 [95% CI: 0.27-1.13]), although these results were not statistically significant. CONCLUSIONS: Our results suggest that smoke-free laws reduce asthmatic symptoms, including persistent wheeze, chronic night cough, and wheeze-medication use in nonsmoking youth.

Drescher AA; Goodwin JL; Silva GE; Quan SF. Caffeine and screen time in adolescence: Associations with short sleep and obesity. Journal of Clinical Sleep Medicine 7(4): 337-342, 2011. (31 refs.)

Objective: To investigate the associations between sleep duration and obesity incidence and risk factors among preadolescents and adolescents. Design: Cross-sectional study of a community based cohort Setting: The Tucson Children's Assessment of Sleep Apnea follow-up study (TuCASA) cohort. Participants: 319 Caucasian and Hispanics between 10-17 years. Main Outcome: Parent-reported sleep duration and BMI z-score. Outcome Measures: Surveys of electronic screen time, dietary and caffeine intake, exercise and sleep habits by parents, and anthropometric measures. Results: Parent-reported total sleep time (TST) was inversely associated with BMI z-score, but not significantly correlated with any of the examined nutritional variables or exercise components. Hispanic ethnicity was associated with significantly lower parent-reported TST and higher BMI z-score. Parent-reported TST was inversely related to electronic screen time and caffeine use, but these findings were differentially related to age. Caffeine consumption was associated with decreasing parent-reported TST primarily in older adolescents. Electronic screen time was associated with lower parent-reported TST in younger adolescents. Conclusions: Hispanic ethnicity and parental reports of TST were found to be the most closely associated with BMI z-score. Decreased TST and increased caffeine intake and screen time may result in higher obesity risk in the adolescent population.

Dubowitz H; Kim J; Black MM; Weisbart C; Semiatin J; Magder LS. Identifying children at high risk for a child maltreatment report. Child Abuse & Neglect 35(2): 96-104, 2011. (46 refs.)

Objective: To help professionals identify factors that place families at risk for future child maltreatment, to facilitate necessary services and to potentially help prevent abuse and neglect. Method: The data are from a prospective, longitudinal study of 332 low-income families recruited from urban pediatric primary care clinics, followed for over 10 years, until the children were approximately 12 years old. Children with prior child protective services involvement (CPS) were excluded. The initial assessment included sociodemographic, child, parent and family level variables. Child maltreatment was assessed via CPS reports. Risk ratios (RRs) and their 95% confidence intervals (CIs) were estimated using Cox regression models. Results: Of the 224 children without a prior CPS report and with complete data who were followed for an average of 10 years, 97 (43%) later had a CPS report. In a multivariate survival analysis, 5 risk factors predicted CPS reports: child's low performance on a standardized developmental assessment (RR = 1.23, 95% CI = 1.01-1.49, p = .04), maternal education <= high school (RR = 1.55, CI = 1.01-2.38, p = .04), maternal drug use (RR = 1.71, Cl = 1.01-2.90, p < .05), maternal depressive symptoms (RR per one standard deviation higher score = 1.28, CI = 1.09-1.51, p < .01), and more children in the family (RR per additional child = 1.26, Cl = 1.07-1.47, p < .01). Conclusions: Five risk factors were associated with an increased risk for later maltreatment. Child health care and other professionals can identify these risk factors and facilitate necessary services to strengthen families, support parents and potentially help prevent child maltreatment.

Duijts L. Fetal and infant origins of asthma. (review). European Journal of Epidemiology 27(1): 5-14, 2012. (170 refs.)

Previous studies have suggested that asthma, like other common diseases, has at least part of its origin early in life. Low birth weight has been shown to be associated with increased risks of asthma, chronic obstructive airway disease, and impaired lung function in adults, and increased risks of respiratory symptoms in early childhood. The developmental plasticity hypothesis suggests that the associations between low birth weight and diseases in later life are explained by adaptation mechanisms in fetal life and infancy in response to various adverse exposures. Various pathways leading from adverse fetal and infant exposures to growth adaptations and respiratory health outcomes have been studied, including fetal and early infant growth patterns, maternal smoking and diet, children's diet, respiratory tract infections and acetaminophen use, and genetic susceptibility. Still, the specific adverse exposures in fetal and early postnatal life leading to respiratory disease in adult life are not yet fully understood. Current studies suggest that both environmental and genetic factors in various periods of life, and their epigenetic mechanisms may underlie the complex associations of low birth weight with respiratory disease in later life. New well-designed epidemiological studies are needed to identify the specific underlying mechanisms. This review is focused on specific adverse fetal and infant growth patterns and exposures, genetic susceptibility, possible respiratory adaptations and perspectives for new studies.

Durmus B; Ay L; Hokken-Koelega ACS; Raat H; Hofman A; Steegers EAP et al. Maternal smoking during pregnancy and subcutaneous fat mass in early childhood. The Generation R Study. European Journal of Epidemiology 26(4): 295- 304, 2011. (46 refs.)

Maternal smoking during pregnancy increases the risk of obesity in the offspring. Not much is known about the associations with other measures of body composition. We assessed the associations of maternal smoking during pregnancy with the development of subcutaneous fat mass measured as peripheral and central skinfold thickness measurements in early childhood, in a population-based prospective cohort study from early fetal life onward in the city of Rotterdam, The Netherlands. The study was performed in 907 mothers and their children at the ages of 1.5, 6 and 24 months. As compared to non-smoking mothers, mothers who continued smoking during pregnancy were more likely to have a younger age and a lower educational level. Their children had a lower birth weight, higher risk of small size for gestational age and were breastfed for a shorter duration (P-values < 0.01). We did not observe differences in peripheral, central and total subcutaneous fat mass between the offspring of non-smoking mothers, mothers who smoked in first trimester only and mothers who continued smoking during pregnancy (P > 0.05). Also, the reported number of cigarettes smoked by mothers in both first and third trimester of pregnancy were not associated with peripheral, central and total subcutaneous fat mass in the offspring at the ages of 1.5, 6 and 24 months. Our findings suggest that fetal exposure to cigarette smoke during pregnancy does not influence subcutaneous fat mass in early childhood. Follow-up studies are needed in children at older ages and to identify associations of maternal smoking during pregnancy with other measures of body composition.

Elkoussi A; Bakheet S. Volatile substance misuse among street children in upper Egypt. Substance Use & Misuse 46(Supplement 1): 35-39, 2011. (19 refs.)

This work assessed the extent, patterns, attitudes, motivations, and impacts of volatile substance misuse (VSM) among street children in Upper Egypt. In 2009, a 36-item questionnaire was administered to a randomly selected sample of 120 street children aged 10-18 years. Nearly 91%% (n = 109) reported misusing products containing volatile substances because they are inexpensive, legal, and easy to acquire. Familial neglect and lack of supervision were the main social motivations reported by street youth for misusing volatile substances. One-third (34.2%%, n = 41) reported inhaling "Kolla," a commercial glue; this study identifies its physicochemical, neuropharmacological, and toxicological properties. The study's limitations are noted.

Fite PJ; Stoppelbein L; Greening L; Preddy TM. Associations between relational aggression, depression, and suicidal ideation in a child psychiatric inpatient sample. Child Psychiatry & Human Development 42(6): 666-678, 2011. (55 refs.)

The current study examined relations between relational aggression, depressive symptoms, and suicidal ideation in a child clinical population. Participants included 276 children (M (age) = 9.55 years; 69% Male) who were admitted to a child psychiatric inpatient facility. Findings suggested that relational aggression was associated with depressive symptoms, which in turn was associated with suicidal ideation. The test of indirect effects suggested that depressive symptoms fully accounted for the link between relational aggression and suicidal ideation. Moreover, these relations were found when also controlling for the variance associated with overt aggression, history of abuse, and social problems. Current findings appear to suggest that relational aggression is linked to depressive symptoms, which is linked to suicidal ideation within a clinical population, and as such there may be clinical utility in assessing relational aggression.

Foltran F; Gregori D; Franchin L; Verduci E; Giovannini M. Effect of alcohol consumption in prenatal life, childhood, and adolescence on child development. (review). Nutrition Reviews 69(11): 642-659, 2011. (256 refs.)

The effects of alcohol consumption in adults are well described in the literature, while knowledge about the effects of alcohol consumption in children is more limited and less systematic. The present review shows how alcohol consumption may negatively influence the neurobiological and neurobehavioral development of humans. Three different periods of life have been considered: the prenatal term, childhood, and adolescence. For each period, evidence of the short-term and long-term effects of alcohol consumption, including neurodevelopmental effects and associations with subsequent alcohol abuse or dependence, is presented.

Haltigan JD; Lambert BL; Seifer R; Ekas NV; Bauer CR; Messinger DS. Security of attachment and quality of mother-toddler social interaction in a high-risk sample. Infant Behavior & Development 35(1): 83-93, 2012. (70 refs.)

The quality of children's social interactions and their attachment security with a primary caregiver are two widely studied indices of socioemotional functioning in early childhood. Although both Bowlby and Ainsworth suggested that the parent-child interactions underlying the development of attachment security could be distinguished from other aspects of parent-child interaction (e.g., play), relatively little empirical research has examined this proposition. The aim of the current study was to explore this issue by examining concurrent relations between toddler's attachment security in the Strange Situation Procedure and quality of mother-child social interaction in a high-risk sample of toddlers characterized by prenatal cocaine exposure and low levels of maternal education. Analyses of variance suggested limited relations between attachment security and quality of social interaction. Further research examining the interrelations among various components of the parent-child relationship is needed.

Hanioka T; Ojima M; Tanaka K; Yamamoto M. Does secondhand smoke affect the development of dental caries in children? A systematic review. (review). International Journal of Environmental Research and Public Health 8(5): 1503- 1519, 2011. (49 refs.)

This review evaluated evidence of the relationship between secondhand smoke (SHS) and dental caries in children in epidemiological studies. Relevant literature was searched and screened, and the methodological quality was assessed. The search yielded 42 citations. High-quality studies including one cohort format and 14 case-control format studies were selected. Early childhood caries was examined in 11 studies. The independent association of SHS was significant in 10 studies, and the strength was mostly weak to moderate. One study did not select SHS as a significant variable. Three studies reported decreases in the risk of previous exposure, and the association was not significant. Dose-response relationships were evident in five studies. Permanent teeth were examined in seven studies. Five studies reported significant associations, which were mostly weak. The risk of previous exposure remained similar to that of current exposure, and a dose-response relationship was not evident in one study. The overall evidence for the causal association in early childhood caries is possible regarding epidemiological studies, and the evidence of permanent teeth and the effect of maternal smoking during pregnancy were insufficient. The results warrant further studies of deciduous teeth using a cohort format and basic studies regarding the underlying mechanism.

Hawkins SS; Berkman L. Increased tobacco exposure in older children and its effect on asthma and ear infections. Journal of Adolescent Health 48(6): 647- 650, 2011. (10 refs.)

Purpose: To examine selected social determinants of children's exposure to household tobacco use and smoking inside the home and to assess the effect of second-hand smoke exposure on asthma and ear infections across children's age groups. Methods: A total of 90,961 parents of children aged 0-17 years from the 2007 National Survey of Children's Health were included in the study. Results: In all, 26.2% of parents reported that anyone in the household used tobacco products. Parents of children aged 6-11 and 12-17 years were 1.97 (adjusted OR; 95% CI, 1.65-2.36) and 2.93 (2.46-3.49) times more likely, respectively, to report that someone smoked inside the house than parents of younger children. Second-hand smoke exposure varied by children's race/ethnicity, and children from more disadvantaged circumstances were more likely to be exposed. For all children, they were more likely to ever have asthma if someone in their household used tobacco. Although young children's likelihood of recurrent ear infections did not increase with household tobacco use, children aged 12-17 were 1.67 (1.02-2.72) times more likely to have recurrent ear infections if someone smoked inside their home. Conclusion: Family members are increasingly likely to smoke indoors as children age, which may increase adolescents' vulnerability to ear infections. Parents and health professionals should monitor second-hand smoke exposure at home and encourage a smoke-free environment.

Heard TR; Daly JB; Bowman JA; Freund MAG; Wiggers JH. A cross-sectional survey of the prevalence of environmental tobacco smoke preventive care provision by child health services in Australia. BMC Public Health 11(e-article 324), 2011. (40 refs.)

Background: Despite the need for a reduction in levels of childhood exposure to environmental tobacco smoke (ETS) being a recognised public health goal, the delivery of ETS preventive care in child health service settings remains a largely unstudied area. The purpose of this study was to determine the prevalence of ETS preventive care in child health services; differences in the provision of care by type of service; the prevalence of strategies to support such care; and the association between care support strategies and care provision. Method: One-hundred and fifty-one (83%) child health service managers within New South Wales, Australia completed a questionnaire in 2002 regarding the: assessment of parental smoking and child ETS exposure; the provision of parental smoking cessation and ETS-exposure reduction advice; and strategies used to support the provision of such care. Child health services were categorised based on their size and case-mix, and a chi-square analysis was performed to compare the prevalence of ETS risk assessment and ETS prevention advice between service types. Logistic regression analysis was used to examine associations between the existence of care support strategies and the provision of ETS risk assessment and ETS exposure prevention advice. Results: A significant proportion of services reported that they did not assess parental smoking status (26%), and reported that they did not assess the ETS exposure (78%) of any child. Forty four percent of services reported that they did not provide smoking cessation advice and 20% reported they did not provide ETS exposure prevention advice. Community based child and family health services reported a greater prevalence of ETS preventive care compared to other hospital based units. Less than half of the services reported having strategies to support the provision of ETS preventive care. The existence of such support strategies was associated with greater odds of care provision. Conclusions: The existence of major gaps in recommended ETS preventive care provision suggests a need for additional initiatives to increase such care delivery. The low prevalence of strategies that support such care delivery suggests a potential avenue to achieve this outcome.

Huang HL; Yen YY; Lin PL; Chiu CH; Hsu CC; Chen T et al. Household secondhand smoke exposure of elementary schoolchildren in Southern Taiwan and factors associated with their confidence in avoiding exposure: A cross-sectional study. BMC Public Health 12: e-article 40, 2012. (22 refs.)

Background: Exposure to household Secondhand Smoke (SHS) poses a major health threat to children after an indoor smoking ban was imposed in Taiwan. This study aimed to assess the household SHS exposure in elementary school children in southern Taiwan and the factors associated with their avoidance of SHS exposure before and after the implementation of Taiwan's new Tobacco Hazards Prevention Act in 2009. Methods: In this cross-sectional school-based study, data on household SHS exposure, avoidance of SHS and related variables was obtained from the 2008 and 2009 Control of School-aged Children Smoking Study Survey. A random sample of 52 elementary schools was included. A total of 4450 3-6 graders (aged 8-13) completed the questionnaire. Regression models analyzed factors of children's self-confidence to avoid household SHS exposure. Results: Over 50% of children were found to have lived with a family member who smoked in front of them after the new law enacted, and 35% of them were exposed to household SHS more than 4 days a week. Having a positive attitude toward smoking (beta = -0.05 to -0.06) and high household SHS exposure (beta = -0.34 to -0.47) were significantly associated with a lower avoidance of SHS exposure. Comparing to girls, boys had lower scores in their knowledge of tobacco hazards; and this factor was significantly related to their SHS avoidance (beta = 0.13-0.14). Conclusions: The intervention program should enhance school children do actively avoid exposure to SHS in home settings, and more importantly, provide tobacco hazard knowledge to male students to avoid exposure to household SHS for themselves. The results also provide further evidence that Tobacco Hazards Prevention Act should perhaps be extended to the family environment in order to protect children from the hazards of household SHS exposure.

Hussong AM; Jones DJ; Stein GL; Baucom DH; Boeding S. An internalizing pathway to alcohol use and disorder. Psychology of Addictive Behaviors 25(3): 390-404, 2011. (117 refs.)

Research emanating from the field of developmental science indicates that initial risk factors for alcohol use and disorder can be evident in early childhood. One dominant developmental pathway connecting these initial risk factors with subsequent alcohol involvement focuses on the central role of disinhibited or externalizing behaviors. In the current paper, we delineate a second pathway that focuses on internalizing symptomatology. Several studies indicate that internalizing symptoms in early and middle childhood predict alcohol involvement in adolescence and young adulthood. We use a developmental psychopathology framework to describe a risk model that traces the potential developmental markers of this internalizing pathway and to consider the relation between the internalizing pathway and the more widely researched externalizing pathway. We outline the markers of risk in this pathway and conclude with a discussion of the implications of this model for prevention efforts and future research. In this manner, we strive for a translational goal, linking our existing understanding of internalizing processes and alcohol use and disorder with our efforts to develop effective prevention programs.

Johnson KW; Grube JW; Ogilvie KA; Collins D; Courser M; Dirks LG. A community prevention model to prevent children from inhaling and ingesting harmful legal products. Evaluation and Program Planning 35(1): 113-123, 2012. (93 refs.)

Children's misuse of harmful legal products (HLPs), including inhaling or ingesting everyday household products, prescription drugs, and over-the-counter drugs, constitutes a serious health problem for American society. This article presents a community prevention model (CPM) focusing on this problem among pre and early adolescents. The model, consisting of a community mobilization strategy and environmental strategies targeting homes, schools, and retail outlets, is designed to increase community readiness and reduce the availability of HLPs, which is hypothesized to reduce HLPs use among children. The CPM is being tested in Alaskan rural communities as part of an in-progress eight-year National Institute on Drug Abuse randomized-controlled trial. This paper presents the CPM conceptual framework, describes the model, and highlights community participation, challenges, and lessons learned from implementation of the model over a 21-month period.

Kelly B; Baur LA; Bauman AE; King L. Tobacco and alcohol sponsorship of sporting events provide insights about how food and beverage sponsorship may affect children's health. Health Promotion Journal of Australia 22(2): 91-96, 2011. (48 refs.)

Issue addressed: Determining children's exposure to food and beverage company sponsorship, and the effect of this exposure, is important in establishing the extent to which there may be health and societal consequences. This paper aimed to provide preliminary evidence on the scope and potential effects on children of unhealthy food and beverage sponsorship. Methods: A review of published literature and media and marketing reports was conducted to determine the types of food and beverage sponsorship campaigns that children are exposed to, and the effect of corporate sponsorship (including tobacco and alcohol) on children and adolescents. Results: A large range of food and beverage sponsorship activities, in Australia and internationally, were identified for both school and sport settings. In particular, food and beverage companies have attempted to develop a marketing presence at all levels of professional and community sport. No information was identified measuring the effect of food and beverage company sponsorship on children and adolescents. However, empirical evidence from consumer studies relating to tobacco and alcohol sponsorship has repeatedly demonstrated that sponsorship has an impact on children's product recall and product-related attitudes and behavioural intentions. Conclusions: While there is no available research on the direct effect of food and beverage sponsorship, the demonstrated effects of tobacco and alcohol sponsorship on children's product awareness, preferences and consumption are likely to be applicable to food companies.

King BA; Dube SR; Tynan MA. Secondhand smoke exposure in cars among middle and high school students -- United States, 2000-2009. Pediatrics 129(3): 446-452, 2012. (43 refs.)

Objective: Exposure to secondhand smoke (SHS) from cigarettes poses a significant health risk to nonsmokers. Among youth, the home is the primary source of SHS. However, little is known about youth exposure to SHS in other nonpublic areas, particularly motor vehicles. Methods: Data were obtained from the 2000, 2002, 2004, 2006, and 2009 waves of the National Youth Tobacco Survey, a nationally representative survey of US students in grades 6 to 12. Trends in SHS exposure in a car were assessed across survey years by school level, gender, and race/ethnicity by using binary logistic regression. Results: From 2000 to 2009, the prevalence of SHS exposure in cars declined significantly among both nonsmokers (39.0%-22.8%; trend P < .001) and smokers (82.3%-75.3%; trend P < .001). Among nonsmokers, this decline occurred across all school level, gender, and race/ethnicity subgroups. Conclusions: SHS exposure in cars decreased significantly among US middle and high school students from 2000 to 2009. Nevertheless, in 2009, over one-fifth of nonsmoking students were exposed to SHS in cars. Jurisdictions should expand comprehensive smoke-free policies that prohibit smoking in worksites and public places to also prohibit smoking in motor vehicles occupied by youth.

Lessov-Schlaggar CN; Wahlgren DR; Liles S; Jones JA; Ji M; Hughes SC et al. Sensitivity to secondhand smoke exposure predicts smoking susceptibility in 8-13-year-old never smokers. Journal of Adolescent Health 48(3): 234-240, 2011. (41 refs.)

Purpose: To investigate the sensitivity to secondhand smoke exposure (SHSe) in preteens aged 8-13 years who have never smoked, and to determine whether it predicts smoking susceptibility. Methods: We assessed the sensitivity to SHSe using reactions commonly used for the assessment of sensitivity to the first-smoked cigarette (e. g., feeling dizzy), and investigated the factor structure of these reactions for the purpose of data reduction. We examined the association of each reaction measure and summary score with demographic characteristics and smoking susceptibility, using logistic regression and ordinal logistic regression. Results: One factor was identified that captured the physical and/or unpleasant reactions. Older preteens and preteens with more highly educated parents reported fewer reactions to SHSe. More African American preteens reported feeling relaxed or calm compared with all other racial/ethnic groups. Experiencing physical and/or unpleasant reactions to SHSe predicted lower risk for smoking susceptibility. Conclusions: This was the first study to extend analytical methodology for sensitivity to active smoking to sensitivity to SHSe in youth who had never smoked. Results suggest a desensitization process with age and lower sensitivity to some reactions in preteens from more highly educated households. Preteens who have more aversive experiences with SHSe tend to be less susceptible to smoking than those who experience fewer aversive reactions. Assessment of sensitivity to SHSe is a novel approach to the study of cigarette use etiology and may contribute to better prediction of smoking initiation.

Levy DE; Winickoff JP; Rigotti NA. School absenteeism among children living with smokers. Pediatrics 128(4): 650-656, 2011. (36 refs.)

OBJECTIVE: Involuntary tobacco smoke exposure causes substantial morbidity in children. We hypothesized that children exposed to tobacco smoke in the home would have increased school absenteeism with associated costs due to lost caregiver wages/time. METHODS: We analyzed data on health and absenteeism among schoolchildren aged 6 to 11 years identified in the 2005 National Health Interview Survey (NHIS). We used multivariate models to assess the relationships between adult-reported household smoking and child health and school absenteeism. Analyses were adjusted for children's and parents' demographic and socioeconomic characteristics. The value of lost caregiver time was estimated by using self-reported employment and earnings data in the NHIS and publicly available time-use data. RESULTS: Children living with 1 or >= 2 adults who smoked in the home had 1.06 (95% confidence interval [CI]: 0.54-1.55) and 1.54 (95% CI: 0.95-2.12) more days absent from school per year, respectively, than children living with 0 smokers in the home. Living with >= 2 adults who smoked in the home was associated with increased reports of having >= 3 ear infections in the previous 12 months (adjusted odds ratio [aOR]: 2.65 [95% CI: 1.36-5.16]) and having a chest cold in the 2 weeks before interview (aOR: 1.77 [95% CI: 1.03-3.03]) but not with having vomiting/diarrhea in the previous 2 weeks (aOR: 0.93 [95% CI: 0.45-1.89]). Caregivers' time tending children absent from school was valued at $227 million per year. CONCLUSIONS: Tobacco smoke exposure has significant consequences for children and families above and beyond child morbidity, including academic disadvantage and financial burden.

Lin DH; Li XM; Fan XH; Fang XY. Child sexual abuse and its relationship with health risk behaviors among rural children and adolescents in Hunan, China. Child Abuse & Neglect 35(9): 680-687, 2011. (40 refs.)

Objective: The current study was designed to explore the prevalence of child sexual abuse (CSA) and its association with health risk behaviors (i.e., smoking, alcohol use, binge drinking, suicidal ideation, and suicide attempt) among rural children and adolescents in China. Methods: A sample of 683 rural children and adolescents (8 to 18 years of age) completed an anonymous questionnaire which assessed experiences of CSA and 5 health risk behaviors. Data on several potential confounding factors were also collected. Results: A total of 123(18%) respondents reported experiencing at least 1 kind of CSA before 16 years of age, with more boys reporting CSA than girls (21.5% vs. 14.2%). In addition, attending non-boarding schools, lower levels of self-esteem, and higher levels of perceived peer pressure for engagement in health risk behaviors were associated with higher rates of CSA. Multivariate logistic regression analyses revealed that CSA experience was significantly associated with cigarette smoking (aOR = 2.14), binge drinking (aOR = 2.68), suicidal ideation (aOR = 1.69), and suicide attempt (aOR = 2.69) after controlling for several demographic and psychological factors. Conclusion: More attention should be paid to the issues of CSA among rural children and adolescents in China. Effective CSA prevention intervention needs to address the vulnerabilities of the population, increase children's and parents' awareness of CSA and ability of self-protection.

Logan JE; Crosby AE; Hamburger ME. Suicidal ideation, friendships with delinquents, social and parental connectedness, and differential associations by sex findings among high-risk pre/early adolescent population. Crisis 32(6): 299-309, 2011. (32 refs.)

Background: The association between suicidal ideation, friendships with delinquents, and social/parental connectedness among pre/early adolescents who reside in high-risk communities is poorly understood. Aims: This study examined among high-risk youths: (1) the association between suicidal ideation and having delinquent friends, school connectedness, social support, and different parenting styles (i.e., caring only, supervision only, caring with supervision); and, (2) the differential associations by sex. Methods: The associations were assessed among 2, 598 pre/early adolescents using logistic regression. The analyses were adjusted for demographic, mental distress, illicit substance use, and peer/date violence victimization factors. The interaction terms determined differences by sex. Results: After adjusting for demographic factors and mental distress, suicidal ideation was positively associated with having delinquent friends; however, after factoring in illicit substance use and violence victimization, this association was negative for males. After adjusting for all factors, suicidal ideation was negatively associated with school connectedness and all parenting styles; however, the association between suicidal ideation and having parental caring with supervision was stronger for females. Conclusions: The results suggest the potential benefits of increasing school connectedness and improving parent-child interactions, particularly among females, and the potential benefits of violence and substance-abuse prevention strategies for youths, particularly males, connected with delinquent peers.

Loukova A; Stankova E. Factors influencing acute alcohol poisoning in adolescents in Bulgaria. Przeglad Lekarski 68(8): 410-412, 2011

The aim of the current study is to analyze the social dimensions of acute alcohol poisoning in children. We have studied the patients at the age up to 18 years with acute alcohol poisoning hospitalized in the Children Toxicology Department of Emergency Hospital Pirogov, Sofia, Bulgaria, from January 1, 2007 to June 31,2008. All of them were at teen years--between 12 and 17 years old. Data on children were retrived from hospital medical records. We have used the inquiry method - specially created for the purpose of the survey questionnaire comprising 39 questions (location and the reason for drinking, type of alcoholic beverage, age at first drink, combination alcohol - illicit drug, type of family, education and employment of parents, frequency of alcohol consumption by parents, consecutiveness of the children in family, presence of siblings, presence of children in a single room, interests etc.). We have studied 137 Adolescents with acute alcohol poisoning. 77 are boys and 60 girls. The results demonstrate tendency of increase of the poisonings in weekends and in late afternoon and evening. No repeated hospitalization for acute alcohol poisoning in the study group for that period has been registered. The most frequent alcoholic beverage leading to intoxication was vodka (63.1 %). 64 % of the children come from complete families. Both parents have secondary education in 79.7 % and in 53.3 % both parents are employed. 60 % were the first born child in the family. The most frequent reason for alcohol consumption was meeting with friends. The research concerns one important medico-social problem--alcohol consumption among children. The increasing alcohol consumption leads to increasing number of acute alcohol poisonings and associated problems. The proposed preventive program may play in important role in decreasing the consequences of alcohol consumption among young people. It should be further developed and popularized among physicians.

2011, Partswowy Zaklad Wydawnictur Lekarskich

Marsiglia FF; Yabiku ST; Kulis S; Nieri T; Parsai M; Becerra D. The influence of linguistic acculturation and gender on the initiation of substance use among Mexican heritage preadolescents in the borderlands. Journal of Early Adolescence 31(2): 271-299, 2011. (93 refs.)

This article examined the impact of linguistic acculturation and gender on the substance use initiation of a sample of 1,473 Mexican heritage preadolescents attending 30 public schools in Phoenix, Arizona. It was hypothesized that linguistic acculturation operates differently as a risk or protective factor for young children than for older youth. The study used discrete-time event history methods to model the rate at which nonusing children initiate substance use. Alcohol, cigarettes, marijuana, and inhalants were studied separately while inhalant use was examined more closely. Results suggested that while linguistic acculturation is a risk factor for Mexican heritage preadolescents, this association depended on the type of substance. For inhalants, higher linguistic acculturation with friends was inversely associated with drug initiation both for boys and girls. Implications for preventive science and future intervention research are discussed.

Mc Donnell C. Opioid medication errors in pediatric practice: Four years' experience of voluntary safety reporting. Pain Research & Management 16(2): 93-98, 2011. (26 refs.)

BACKGROUND: Opioids are the most common source of drug error that leads to harm in pediatric hospitals. OBJECTIVE: To undertake a comprehensive review of experience with voluntary safety reports describing pediatric opioid medication errors at The Hospital for Sick Children (Toronto, Ontario), and to characterize the specific opioids involved, severity and type of error described, hospital location and time of day that the error occurred. METHODS: All medication-related safety reports submitted to an anonymous, voluntary electronic safety reporting database in a university-affiliated pediatric hospital during the first four years of its use were examined. A database of opioid error reports was created for further analysis. RESULTS: A total of 5935 medication-related safety reports were collected, 507 of which described opioids. Morphine was the most frequently reported opioid, administration was the most frequently reported stage of the medication process (192 errors) and surgical wards were the location from which opioid error was most frequently reported (128 reports). Twenty-two reports described patient harm requiring urgent treatment and intervention. Errors with codeine or hydromorphone resulted in the most significant harm reported. A total of 162 reports described problems with inappropriate opioid disposal, missing opioids, or incorrect opioid counts and checks. CONCLUSIONS: Future opportunities for improvement in opioid safety should focus on morphine, opioid administration errors in general, the safe disposal of opioids in the hospital environment and the identification of pain as an adverse event.

Milligan K; Niccols A; Sword W; Thabane L; Henderson J; Smith A. Length of stay and treatment completion for mothers with substance abuse issues in integrated treatment programmes. Drugs: Education, Prevention and Policy 18(3): 219-227, 2011. (33 refs.)

Aim: To examine the effects of integrated treatment programmes (those with addiction services and pregnancy-, parenting- or child-related services) on length of stay and treatment completion. Methods: We systematically reviewed studies published between 1990 and 2008 comparing integrated programmes with non-integrated programmes on length of stay (number of studies [K] = 3, number of participants [n] = 1910) and treatment completion (K = 6, n = 2556). We performed meta-analyses using standardized mean differences (d) of effect size estimates. Findings: There was a significant advantage of integrated treatment programmes over non-integrated treatment in the number of days women spent in treatment (d = 0.35, p < 0.0001) but not treatment completion (d = 0.38, p = 0.09). Conclusions: This meta-analysis is the first systematic quantitative review of studies evaluating the impact of integrated programmes. Findings suggest that integrated programmes may be associated with a small advantage over non-integrated programmes in length of stay. This review highlights the need for further research with improved methodology, quality, and reporting to improve our understanding of how best to engage, retain and support mothers with substance abuse issues in treatment.

Muenster E; Zier U; Letzel S; Ochsmann E; Weirich HH; Toschke AM. Low social support and further risk factors for nicotine abuse in childhood and adolescence in Germany. Social Work in Health Care 50(3): 230-241, 2011. (46 refs.)

The health hazards of tobacco consumption are well known; numerous prevention programs exist, but knowledge of risk factors for starting to smoke is scarce. This study addressed the question if school-related factors influence smoking behavior in 7-17-year-old pupils. A cross-sectional study including 2459 pupils of schools in Rhineland-Palatinate, Germany, was conducted. Roughly every twentieth child (n = 135, 4.5%) had smoked at least once. In the multivariate model the probability of smoking was associated with older age, being male, not being content, and having inadequate family support, as well as with feeling unfairly treated at school. These findings suggest the imposition of gender- and age-adequate prevention with a focus on social support from school and parents to decrease the number of juvenile smokers.

Mzayek F; Khader Y; Eissenberg T; Al Ali R; Ward KD; Maziak W. Patterns of water-pipe and cigarette smoking initiation in schoolchildren: Irbid longitudinal smoking study. Nicotine & Tobacco Research 14(4): 448-454, 2012. (25 refs.)

Tobacco use remains a major public health problem worldwide. Water-pipe smoking is spreading rapidly and threatening to undermine the successes achieved in tobacco control. A school-based longitudinal study in the city of Irbid, Jordan, was performed from 2008 to 2010. All seventh-grade students in 19 randomly selected schools, out of a total of 60 schools in the city, were enrolled at baseline and surveyed annually. Of the 1781 students enrolled at baseline 1,701 (95.5%) were still in the study at the end of the second year of follow-up (869 boys, median age at baseline 13 years). Ever and current water-pipe smoking were higher than those of cigarette smoking at baseline (ever smoking: 25.9% vs. 17.6% and current smoking: 13.3% vs. 5.3% for water-pipe and cigarette smoking, respectively; p < .01 for both) but cigarette smoking caught up by the second year of follow-up (ever smoking: 46.4% vs. 44.7%; p = .32 and current smoking: 18.9% vs. 14.9%; p < .01). Water pipe-only smokers at baseline were twice as likely to become current cigarette smokers after 2 years compared with never smokers (relative risk (RR) = 2.1; 95% CI = 1.2, 3.4). A similar pattern was observed for cigarette-only smokers at baseline (RR = 2.0; 95% CI = 0.9, 4.8). Prevalence of water-pipe and cigarette smoking increased dramatically over the 2-year follow-up period with similar patterns in boys and girls, although girls had lower prevalence in all categories. Water-pipe smoking at baseline predicted the progress to cigarette smoking in the future and vice versa.

O'Cleirigh C; Safren SA; Mayer KH. The pervasive effects of childhood sexual abuse: Challenges for improving HIV prevention and treatment interventions. (commentary). Journal of Acquired Immune Deficiency Syndromes 59(4): 331-334, 2012. (40 refs.)

Two of the articles in the current issue correctly focus attention on the formative influences of childhood trauma generally and CSA specifically on HIV prevention and treatment outcomes. This new information provides important new insights that inform the existing research base supporting evidence that posttraumatic stress reactions to early trauma provides a conceptual model for understanding the multiple pathways that early life events result in sequelae potentiating the global AIDS epidemic. We conclude that integrated HIV prevention interventions must address sexual risk and other health outcomes within the posttraumatic stress context. A common sequelae of childhood sexual abuse is alcohol and drug problems.

Peck JD; Peck BM; Skaggs VJ; Fukushima M; Kaplan HB. Socio-environmental factors associated with pubertal development in female adolescents: The role of prepubertal tobacco and alcohol use. Journal of Adolescent Health 48(3): 241-246, 2011. (40 refs.)

Purpose: Alcohol administered to laboratory animals has been shown to suppress puberty-related hormones and delay puberty by interfering with ovarian development and function. The effects of early substance use on human pubertal development are relatively unexplored. Methods: This cross-sectional study of 3,106 female adolescents, aged 11-21 years, evaluated the association between prepubertal alcohol and tobacco use and the onset of puberty. Ages at initial breast development, body hair growth, and menarche were self-reported. Prepubertal alcohol and tobacco use were defined as the age at first use before the age of pubertal development and accompanied by regular use. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox proportional hazard models. Logistic regression was used to estimate the association between substance use and delayed puberty, defined as lack of breast development by the age of 13 years. Results: Unadjusted models indicated prepubertal tobacco use was associated with a longer time required for breast development (HR = 0.74; 95% CI, 0.65-0.85) and body hair growth (HR = 0.81; 95% CI, 0.71-0.93). Prepubertal alcohol use was associated with late breast development(HR = 0.71; 95% CI, 0.57-0.88). The direction of the observed associations remained consistent after adjusting for covariates, but the magnitude of effects were attenuated and the upper bound of the 95% CIs exceeded the null value. Girls who used alcohol before puberty had four times the odds of having delayed puberty (OR = 3.99; 95% CI, 1.94-8.21) as compared with nonusers. Conclusion: The results of this study suggest that the endocrine-disrupting effects of alcohol and tobacco use may alter the timing of pubertal development. These cross-sectional findings warrant further investigation.

Pedapati EV; Bateman ST. Toddlers requiring pediatric intensive care unit admission following at-home exposure to buprenorphine/naloxone. Pediatric Critical Care Medicine 12(2): E102-E107, 2011. (38 refs.)

Background: Sublingual buprenorphine is an alternative to methadone for office-based treatment of opioid dependence. Recent reports have examined a growing number of unintentional buprenorphine exposures in children resulting in significant toxicity, even after a single lick or taste of a sublingual tablet. Here, we report a series of unintentional buprenorphine exposures in toddlers over a 2.5-yr period that led to admission to the pediatric intensive care unit. Objectives: The goals of this study were to determine: 1) the prevalence of symptomatic buprenorphine exposure in children < 3 yrs of age; 2) the severity of toxicity associated with such exposures; and 3) effective clinical interventions. Methods and Main Results: A retrospective case review was performed on records from the pediatric intensive care unit at an academic medical center located in the northeastern United States. Unintentional buprenorphine/naloxone exposure (n = 9) accounted for the largest single fraction of toxic ingestions among patients younger than 3 yrs within the study period (9/33, 27%). All exposures occurred at the child's place of residence n = 9, 100%). Clinical signs of opioid toxicity were evident in all nine cases, with the most common symptom being drowsiness or lethargy (n = 9, 100%), followed by miosis (n = 6, 67%) and respiratory depression (n = 5, 56%). Six patients were effectively treated with naloxone (n = 6, 67%). Conclusions: The increased use and similarity to candy of the current formulation of buprenorphine pose a special risk to children, especially toddlers. Buprenorphine exposure in children < 3 yrs old can cause significant opioid toxidrome. Naloxone is an effective agent for reversal of symptoms; however, given buprenorphine's high affinity and long action, higher doses or continuous infusion may be required. Adults on buprenorphine should be educated on the risks posed to young children in their household and the appropriate storage of medication.

Ridenour TA; Caldwell LL; Coatsworth JD; Gold MA. Directionality between tolerance of deviance and deviant behavior is age-moderated in chronically stressed youth. Journal of Child & Adolescent Substance Abuse 20(2): 184-204, 2011. (73 refs.)

Problem behavior theory posits that tolerance of deviance is an antecedent to antisocial behavior and substance use. In contrast, cognitive dissonance theory implies that acceptability of a behavior may increase after experiencing the behavior. Using structural equation modeling, this investigation tested whether changes in tolerance of deviance precede changes in conduct disorder criteria or substance use or vice versa, or if they change concomitantly. Two-year longitudinal data from 246 8- to 16-year-olds suggested that tolerance of deviance increases after conduct disorder criteria or substance use in 8-to-10- and 11-to-12-year-olds. These results were consistent with cognitive dissonance theory. In 13-to-16-year-olds, no directionality was suggested, consistent with neither theory. These results were replicated in boys and girls and for different types of conduct disorder criteria aggression (covert behavior), deceitfulness and vandalism (overt behavior), and serious rule-breaking (authority conflict). The age-specific directionality between tolerance of deviance and conduct disorder criteria or substance use is consistent with unique etiologies between early onset versus adolescent-onset subtypes of behavior problems.

Rothwell H; Segrott J. Preventing alcohol misuse in young people aged 9-11 years through promoting family communication: an exploratory evaluation of the Kids, Adults Together (KAT) Programme. BMC Public Health 11: 810, 2011. (65 refs.)

Background: Alcohol misuse by young people is an important public health issue, and has led to the development of a range of prevention interventions. Evidence concerning the most effective approaches to intervention design and implementation is limited. Parental involvement in school-based interventions is important, but many programmes fail to recruit large numbers of parents. This paper reports findings from an exploratory evaluation of a new alcohol misuse prevention programme - Kids, Adults Together (KAT), which comprised a classroom component, engagement with parents through a fun evening for families with children aged 9-11 years, and a DVD. The evaluation aimed to establish the programme's theoretical basis, explore implementation processes and acceptability, and identify plausible precursors of the intended long-term outcomes. Methods: Documentary analysis and interviews with key personnel examined the programme's development. Classroom preparation and KAT family events in two schools were observed. Focus groups with children, and interviews with parents who attended KAT family events were held immediately after programme delivery, and again after three months. Interviews with head teachers and with teachers who delivered the classroom preparation were conducted. Follow-up interviews with programme personnel were undertaken. Questionnaires were sent to parents of all children involved in classroom preparation. Results: KAT achieved high levels of acceptability and involvement among both children and parents. Main perceived impacts of the programme were increased pro-social communication within families (including discussions about harmful parental alcohol consumption), heightened knowledge and awareness of the effects of alcohol consumption and key legal and health issues, and changes in parental drinking behaviours. Conclusions: KAT demonstrated promise as a prevention intervention, primarily through its impact on knowledge and communication processes within families, and its ability to engage with large numbers of parents. A key programme mechanism was the classroom preparation's facilitation of parental involvement in the family fun evening. The programme also incorporated features identified in the literature as likely to increase effectiveness, including a focus on harm reduction, interactive delivery, and targeting primary-school-age children. Further research is needed to test and develop programme theory through implementation in different school contexts, and to examine potential longer-term impacts, and the feasibility of large scale delivery.

Samet JM. Could secondhand smoke exposure harm the mental health of children? (editorial). Archives of Pediatrics & Adolescent Medicine 165(4): 370-372, 2011. (18 refs.)

Schneider MB; Benjamin HJ; Bhatia JJS; Abrams SA; De Ferranti SD; Schneider MB et al. Clinical report. Sports drinks and energy drinks for children and adolescents: Are they appropriate? Pediatrics 127(6): 1182-1189, 2011. (45 refs.)

Sports and energy drinks are being marketed to children and adolescents for a wide variety of inappropriate uses. Sports drinks and energy drinks are significantly different products, and the terms should not be used interchangeably. The primary objectives of this clinical report are to define the ingredients of sports and energy drinks, categorize the similarities and differences between the products, and discuss misuses and abuses. Secondary objectives are to encourage screening during annual physical examinations for sports and energy drink use, to understand the reasons why youth consumption is widespread, and to improve education aimed at decreasing or eliminating the inappropriate use of these beverages by children and adolescents. Rigorous review and analysis of the literature reveal that caffeine and other stimulant substances contained in energy drinks have no place in the diet of children and adolescents. Furthermore, frequent or excessive intake of caloric sports drinks can substantially increase the risk for overweight or obesity in children and adolescents. Discussion regarding the appropriate use of sports drinks in the youth athlete who participates regularly in endurance or high-intensity sports and vigorous physical activity is beyond the scope of this report.

Shi Y; Warner DO. Pediatric surgery and parental smoking behavior. Anesthesiology 115(1): 12-17, 2011. (24 refs.)

Background: Secondhand smoke exposure poses health risks to children, including increased risks for anesthesia. In adult smokers, surgery serves as a teachable moment to motivate quitting. For parents who smoke, having a child undergo surgery may also serve as a teachable moment for smoking behavioral change. This study determined if there is an association between children undergoing a surgical procedure and changes in their parents' smoking behavior. Methods: Secondary analyses were performed using logistic regression analysis of 2005 survey data from the National Health Interview Survey. Analyses included 9,289 parent respondents who provided information on both themselves and their children. Results: Of the sampled children, 1,112 (12.6%, 95% CI: 11.7, 13.4) lived in a home with at least one person who smoked inside in a usual week. In multivariate analysis of the relationship between parent and child surgical history in the past 12 months and smoking behavior, surgery in either the parent (odds ratio 2.19, 95% CI: 1.55, 3.08) or child (odds ratio 2.61, 95% CI: 1.56, 4.35) was associated with an increased likelihood of a quit attempt by the parent. However, these attempts were more likely to be successful if the parents (odds ratio 2.35, 95% CI: 1.35, 4.07), not their child (odds ratio 0.51, 95% CI: 0.20, 1.28), had surgery within the past 12 months. Conclusions: Parents who smoke were more likely to make a quit attempt within the past 12 months if their children had surgery within this time, but they were not more likely to succeed in maintaining abstinence and thus could benefit from assistance.

Siqveland T; Smith L; Moe V. The impact of optimality on maternal sensitivity in mothers with substance abuse and psychiatric problems and their infants at 3 months. Infant Behavior & Development 35(1): 60-70, 2012. (69 refs.)

The main aim of this study was to investigate the predictive validity of four different optimality indexes, as well as infant perinatal status, in relation to maternal sensitivity in interaction at 3 months. The four optimality indexes comprised items related to substance abuse, psychiatric condition, relational experience and socioeconomic status (SES). Maternal sensitivity in mother-infant interaction was assessed in two different groups of mothers. One group consisted of mothers with substance abuse and psychiatric problems who underwent treatment during pregnancy. The other group of mothers had neither substance abuse nor psychiatric problems. The expectant mothers were interviewed in the third trimester of pregnancy. Medical records and meconium were obtained from the infants at birth. Three months after birth, maternal sensitivity in mother-infant interaction was assessed. Altogether 79 mother-infant dyads participated in the study. The mothers' optimality associated with relational experiences, as well as the infants' perinatal status were found to predict maternal sensitivity in mother-infant interaction at 3 months. The SES index was also significantly related to maternal sensitivity. The relation between group and maternal sensitivity was mediated by the mothers' optimality associated with relational experiences. This study points to the importance of addressing the mothers' own relational experiences and their current representations of motherhood during treatment, in order to support and enhance maternal sensitivity.

Stosic L; Milutinovic S; Lazarevic K; Blagojevic L; Tadic L. Household environmental tobacco smoke and respiratory diseases among children in Nis (Serbia). Central European Journal of Public Health 20(1): 29-32, 2012. (23 refs.)

The authors investigated the relationship between household environmental tobacco smoke (ETS) exposure and prevalence of respiratory symptoms and diseases as well as absenteeism related to respiratory illness in schoolchildren. The study sample consisted of 1,074 children aged 7-11 years from three primary schools in Nit (Serbia). ETS exposure was associated with wheezing (OR-1.48; 1.09-2.01), bronchitis (OR-1.66; 1.23-2.23), headache (OR-1.45; 1.08-1.95), and fatigue (OR-1.38; 1.02-1.85) in exposed children. The other risk factors with possible influences weren't assessed. There was no statistically significant difference in the number of physicians' visits as well as in absenteeism from school due to illness in children exposed to ETS in comparison to non exposed children. The tobacco smoke effect on children is an essential and urgent problem with life lasting negative health effects which are preventable.

van Lier PAC; Huizink A; Vuijk P. The role of friends' disruptive behavior in the development of children's tobacco experimentation: results from a preventive intervention study. Journal of Abnormal Child Psychology 39(1): 45-57, 2011. (61 refs.)

Having friends who engage in disruptive behavior in childhood may be a risk factor for childhood tobacco experimentation. This study tested the role of friends' disruptive behavior as a mediator of the effects of a classroom based intervention on children's tobacco experimentation. 433 Children (52% males) were randomly assigned to the Good Behavior Game (GBG) intervention, a universal preventive intervention targeting disruptive behavior, and facilitating positive prosocial peer interactions. Friends' disruptive behavior was assessed from age 7-10 years. Participants' experimentation with tobacco was assessed annually from age 10-13. Reduced rates in tobacco experimentation and friends' disruptive behavior were found among GBG children, as compared to controls. Support for friends' disruptive behavior as a mediator in the link between intervention status and tobacco experimentation was found. These results remained after controlling for friends' and parental smoking status, and child ADHD symptoms. The results support the role of friends' disruptive behavior in preadolescents' tobacco experimentation.

Villatoro JA; Cruz SL; Ortiz A; Medina-Mora ME. Volatile substance misuse in Mexico: Correlates and trends. Substance Use & Misuse 46(Supplement 1): 40-45, 2011. (16 refs.)

This paper analyzes volatile substance misuse in Mexico since the 1980s. Data were collected from national household and school surveys, epidemiological surveillance systems, and studies among special populations. Volatile substance misuse begins at 12-14 years. Prevalence is approximately 1% in the general population, 7% among high school students, and higher for street children. Toluene is the main solvent used, but preferences vary within population groups. Volatile substance misuse has increased among youngsters that live in families and attend school. Marijuana and volatile substances are now the drugs of choice among Mexican female high school students. The study's limitations are noted.

Warzak WJ; Evans S; Floress MT; Gross AC; Stoolman S. Caffeine consumption in young children. Journal of Pediatrics 158(3): 508-509, 2011. (10 refs.)

Two hundred twenty-eight surveyed parents reported that their 5 to 7 year old children drank approximately 52 mg of caffeine daily and their 8 to 12 year old children drank 109 mg daily. Caffeine consumption and hours slept were significantly negatively correlated, but caffeine consumption and enuresis were not significantly correlated. Spanish-speaking parents reported fewer bedwetting events than their English-speaking peers.

Weiss JW; Mouttapa M; Cen S; Johnson CA; Unger J. Longitudinal effects of hostility, depression, and bullying on adolescent smoking initiation. Journal of Adolescent Health 48(6): 591- 596, 2011. (39 refs.)

Purpose: The present study examined the associations between smoking initiation and, hostility, depressive symptoms, and bullying (bullies and bully-victims) among a culturally diverse sample of 1,771 adolescents who reported never having smoked at baseline. Methods: Data were obtained from a longitudinal school-based experimental trial of smoking prevention programs in Southern California. Annual survey was performed for students of the sixth, seventh, and eighth grades. All students in the 24 participating schools were invited to participate in the study during the sixth grade. Results: The risk of smoking initiation was significantly higher among students who scored higher on hostility and depressive symptoms, and were bully-victims. Conclusion: The findings suggest that tobacco prevention programs should include strategies for managing hostile feelings and negative effect as part of the curriculum. In addition, it might be helpful to identify youth who score high on these psychosocial factors and teach them skills to handle interpersonal conflict and negative feelings to prevent their involvement in substance use.

Winickoff JP; Tanski SE; McMillen RC; Ross KM; Lipstein EA; Hipple BJ et al. Acceptability of testing children for tobacco-smoke exposure: A national parent survey. Pediatrics 127(4): 628-634, 2011. (30 refs.)

BACKGROUND: Tests are available to measure children's exposure to tobacco smoke. One potential barrier to testing children for tobacco-smoke exposure is the belief that parents who smoke would not want their child tested. No previous surveys have assessed whether testing children for exposure to tobacco smoke in the context of their child's primary care visit is acceptable to parents. OBJECTIVE: To assess whether testing children for tobacco-smoke exposure is acceptable to parents. DESIGN AND METHODS: We conducted a national random-digit-dial telephone survey of households from September to November 2006. The sample was weighted by race and gender, based on the 2005 US Census, to be representative of the US population. RESULTS: Of 2070 eligible respondents contacted, 1803 (87.1%) completed the surveys. Among 477 parents in the sample, 60.1% thought that children should be tested for tobacco-smoke exposure at their child's doctor visit. Among the parental smokers sampled, 62.0% thought that children should be tested for tobacco-smoke exposure at the child's doctor visit. In bivariate analysis, lower parental education level, allowing smoking in the home, nonwhite race, and female gender were each associated (P < .05) with wanting the child tested for tobacco-smoke exposure. CONCLUSIONS: The majority of nonsmoking and smoking parents want their children tested for tobacco-smoke exposure during the child's health care visit.

Wolfson M; Champion H; Rogers T; Neiberg RH; Barker DC; Talton JW et al. Evaluation of Free to Grow: Head Start partnerships to promote substance-free communities. Evaluation Review 35(2): 153- 188, 2011. (41 refs.)

Free to Grow: Head Start Partnerships to Promote Substance-free Communities (FTG) was a national initiative in which local Head Start (HS) agencies, in partnership with other community organizations, implemented a mix of evidence-based family-strengthening and community-strengthening strategies. The evaluation of FTG used a quasi-experimental design to compare 14 communities that participated in the FTG intervention with 14 matched comparison communities. Telephone surveys were conducted with two cohorts of the primary caregivers of children in HS at baseline and then annually for 2 years. The survey was also administered to repeated cross-sectional samples of primary caregivers of young children who were not enrolled in HS. No consistent evidence was found in changes in family functioning or neighborhood conditions when the 14 FTG sites were compared to 14 matched sites. However, caregivers of young children who were not in HS in three high-implementing FTG sites showed evidence of improvements in neighborhood organization, neighborhood norms against substance abuse, and child disciplinary practices. Results provide highly limited support for the concept that family and neighborhood conditions that are likely to affect child development and well-being can be changed through organized efforts implemented by local HS programs.

Wolk BJ; Ganetsky M; Babu KM. Toxicity of energy drinks. (review). Current Opinion in Pediatrics 24(2): 243-251, 2012. (86 refs.)

Purpose of review: 'Energy drinks', 'energy shots' and other energy products have exploded in popularity in the past several years; however, their use is not without risk. Caffeine is the main active ingredient in energy drinks, and excessive consumption may acutely cause caffeine intoxication, resulting in tachycardia, vomiting, cardiac arrhythmias, seizures, and death. The effects of chronic high-dose caffeine intake in children and adolescents are unknown. Caffeine may raise blood pressure, disrupt adolescent sleep patterns, exacerbate psychiatric disease, cause physiologic dependence, and increase the risk of subsequent addiction. Recent findings: Coingestion of caffeine and ethanol has been associated with increased risk-taking behaviors, harm to adolescent users, impaired driving, and increased use of other illicit substances. The toxicity of ingredients often present in energy drinks, such as taurine, niacin, and pyridoxine, is less well defined. Recent and significant literature describing adverse events associated with energy drink use are reviewed. Summary: Although prior studies have examined the effects of caffeine in adolescents, energy drinks should be considered a novel exposure. The high doses of caffeine, often in combination with ingredients with unknown safety profiles, mandates urgent research on the safety of energy drink use in children and adolescents. Regulation of pediatric energy drink use may be a necessary step once the health effects are further characterized.

Wu LT; Gersing K; Burchett B; Woody GE; Blazer DG. Substance use disorders and comorbid Axis I and II psychiatric disorders among young psychiatric patients: Findings from a large electronic health records database. Journal of Psychiatric Research 45(11): 1453-1462, 2011. (59 refs.)

This study examined the prevalence of substance use disorders (SUDS) among psychiatric patients aged 2-17 years in an electronic health records database (N = 11,457) and determined patterns of comorbid diagnoses among patients with a SUD to inform emerging comparative effectiveness research (CER) efforts. DSM-IV diagnoses of all inpatients and outpatients at a large university-based hospital and its associated psychiatric clinics were systematically captured between 2000 and 2010: SUD, anxiety (AD), mood (MD), conduct (CD), attention deficit/hyperactivity (ADHD), personality (PD), adjustment, eating, impulse-control, psychotic, learning, mental retardation, and relational disorders. The prevalence of SUD in the 2-12-year age group (n = 6210) was 1.6% and increased to 25% in the 13-17-year age group (n = 5247). Cannabis diagnosis was the most prevalent SUD, accounting for more than 80% of all SUD cases. Among patients with a SUD (n = 1423), children aged 2-12 years (95%) and females (75-100%) showed high rates of comorbidities; blacks were more likely than whites to be diagnosed with CD, impulse-control, and psychotic diagnoses, while whites had elevated odds of having AD, ADHD, MD, PD, relational, and eating diagnoses. Patients with a SUD used more inpatient treatment than patients without a SUD (43% vs. 21%); children, females, and blacks had elevated odds of inpatient psychiatric treatment. Collectively, results add clinical evidence on treatment needs and diagnostic patterns for understudied diagnoses.