Secondhand smoke exposure, illness severity, and resource utilization in pediatric emergency department patients with respiratory illnesses

OBJECTIVE

Hospital-based data reveal that children who have secondhand smoke exposure (SHSe) experience severe respiratory illnesses and greater resource utilization. Our objective was to assess the relationship between SHSe and illness severity/resource utilization among children presenting to the pediatric emergency department (PED) with three common respiratory conditions-asthma, bronchiolitis, and pneumonia.

METHODS

A retrospective review of a yearlong consecutive sample of PED patients with SHSe status documentation and asthma, bronchiolitis, or pneumonia diagnoses was performed. PED illness severity/resource utilization variables included triage categorization, initial oxygen saturation, evaluation/testing (influenza A & B, respiratory syncytial virus, chest X-ray), procedures/interventions performed (supplemental oxygen, suctioning, intubation), medications administered, and disposition. Logistic and linear regression models were conducted to determine differences in each diagnosis group while controlling for sociodemographics, medical history, seasonality, and insurance type.

RESULTS

There were 3,229 children with documentation of SHSe status and an asthma (41%), bronchiolitis (36%), or pneumonia (23%) diagnosis. Across diagnosis groups, approximately 1/4 had positive documentation of SHSe. Asthmatic children with SHSe were more likely to receive corticosteroids (odds ratio (OR) = 1.71, 95% confidence interval (CI) = 1.19, 2.44) and/or magnesium sulfate (OR = 1.66, 95% CI = 1.14, 2.40). Children with SHSe and bronchiolitis were more likely to receive racemic epinephrine (OR = 2.48, 95% CI = 1.21, 5.08), have a chest X-ray (OR = 1.36, 95% CI = 1.00, 1.85), and/or be admitted (OR = 1.46, 95% CI = 1.09, 1.95). No differences in illness severity/resource utilization were identified for children with pneumonia.

CONCLUSIONS

SHS-exposed children with asthma or bronchiolitis have greater illness severity/resource utilization. Our findings highlight the importance of SHSe assessment, cessation, and research efforts in the PED setting.

Secondhand Smoke Exposure and Pediatric Healthcare Visits and Hospitalizations

INTRODUCTION

This study assessed the relationship between secondhand smoke exposure (SHSe) as measured by serum cotinine and healthcare utilization among children.

METHODS

In 2016, the 2009-2012 National Health and Nutrition Examination Survey data were analyzed including 4,985 children aged 3-19 years. Associations between SHSe and having a routine place for healthcare, type of place, and hospital utilization were examined using logistic regression models. Poisson regression analyses assessed the relationship between SHSe and number of hospital admissions. Relationships between SHSe and acute care visits and hospital utilization were examined among asthmatic children.

RESULTS

SHSe level did not differ by having a routine place for healthcare, although children with high SHSe indicative of active smoking (cotinine ≥3 ng/mL) were 3.49 times (95% CI=1.77, 6.89) more likely to use an emergency department. Children with high SHSe were 2.85 times (95% CI=1.87, 4.34) more likely to have had an overnight hospital stay. Children with high SHSe had 2.05 times (95% CI=1.46, 2.87) the risk of having a higher number of hospital admissions for overnight stays versus children with no SHSe (cotinine <0.05 ng/mL). Among asthmatic children, those with high SHSe and low SHSe (cotinine 0.05-2.99 ng/mL) were more likely to have an acute care visit, overnight hospital stay, and higher number of hospital admissions than asthmatic children with no SHSe.

CONCLUSIONS

High SHSe is associated with increased healthcare utilization. The emergency department and inpatient settings are important venues in which to routinely offer cessation and SHSe reduction interventions.

Examining a Partial Biopsychosocial Model for Monthly Alcohol, Tobacco, and Marijuana Use Among Adolescents

Alcohol, tobacco, and marijuana are commonly used substances among adolescents. In the context of the Biopsychosocial Model (BPSM), this study investigated the relationships between psychological and normative factors associated with adolescent alcohol, tobacco, and marijuana use. Data were analyzed from 1053 middle and high school students. Structural equation modeling was used to examine the relationships between BPSM constructs. Results indicate that latent constructs of the BPSM are significant antecedent factors to alcohol, tobacco, and marijuana use; however, the relationships between study constructs were inconsistent with those theorized by BPSM. Findings support the importance of theory testing for complex models applied to new topics and new populations.

Impact of Perceived Risk and Friend Influence on Alcohol and Marijuana Use Among Students

We performed a secondary analysis of Adolescent Health Risk Behavior Survey data ( N = 937), examining associations between lifetime alcohol and marijuana use with intrapersonal (i.e., risk perceptions) and interpersonal (e.g., peer approval and behavior) factors. Multinomial and binary logistic regression analyses contend students reporting lifetime alcohol use-compared to students who had never used alcohol or marijuana-perceived lower alcohol risk ( p < .001), higher friend drinking approval ( p < .001), and greater friend drinking ( p = .003). Using both alcohol and marijuana in one's life was associated with being in public schools ( p = .010), higher grade levels ( p = .001), lower perceived alcohol ( p = .011) and marijuana use risk ( p = .003), higher friend approval of alcohol ( p < .001) and marijuana use ( p < .001), and believed more friends used alcohol ( p < .001). Compared to lifetime alcohol only, perceived friend academic performance decreased the risk of lifetime alcohol and marijuana use ( p = .043). Findings are beneficial to school nurses with students experiencing effects associated with substance use.

Adolescent flourishing in relation to having asthma: Results from a population-based cross-sectional study

OBJECTIVE

This study investigated parent report of adolescent behaviors and flourishing of adolescents with asthma from a nationwide sample.

METHODS

A secondary analysis of the 2011-2012 National Survey of Children's Health was conducted. There were 2,880 youth with asthma in our sample and 25,841 without asthma between 13 and 17 years of age. Analyses examined flourishing among adolescents with and without asthma and the impact of adolescent arguing, bullying, and mood difficulties on adolescent flourishing for adolescents with asthma, while controlling for sex, age, and race.

RESULTS

Findings indicated lower flourishing for youth with asthma compared to youth without asthma. Moreover, adolescents with asthma who experienced negative behaviors, such as arguing and bullying, and adolescents who were experiencing sad feelings had lower flourishing.

CONCLUSIONS

The results were consistent with literature, indicating that relatively poorer behavioral and emotional functioning is related to lower flourishing in adolescents with asthma. The results highlight the importance of screening for emotional functioning in adolescents and the need for further research to understand characteristics of adolescents related to their positive functioning.

Healthy families: study protocol for a randomized controlled trial of a screening, brief intervention, and referral to treatment intervention for caregivers to reduce secondhand smoke exposure among pediatric emergency patients

Background

Involuntary exposure to secondhand smoke (SHSe) is an important cause of morbidity in children who present to the pediatric emergency department (PED) and urgent care (UC). SHSe interventions delivered in the PED and UC would benefit both the smoker and child, but there have been no large trials testing the efficacy of such interventions. The Healthy Families program is the first randomized controlled trial to test whether a screening, brief intervention, and referral to treatment (SBIRT) intervention delivered in the PED and UC will be effective in decreasing SHSe in children and increasing cessation in smokers.

Methods/design

This trial uses a randomized, two-group design in which caregiver-smokers of children 0–17 years old are recruited from the PED and UC. Eligible caregiver-smokers are randomized to either the: 1) SBIRT Condition with face-to-face, tailored counseling that focuses on the child’s illness, the importance of reducing child SHSe, caregiver smoking cessation, and the option to receive nicotine replacement therapy; or 2) Healthy Habits Control Condition which includes face-to-face, tailored attention control “5–2–1-0” counseling that focuses on improving the child’s health. Dyadic assessments are conducted in-person at baseline, and via email, phone, or in-person at 6-weeks and 6-months. The primary outcomes are biochemically-verified, 7-day point prevalence and prolonged smoking abstinence. Secondary outcomes are cigarettes smoked per week, 24 h quit attempts, and biochemically validated child SHSe at each time point. The costs of this intervention will also be analyzed.

Discussion

This study will test an innovative, multilevel intervention designed to reduce child SHSe and increase smoking cessation in caregivers. If effective and routinely used, this SBIRT model could reach at least one million smokers a year in the U.S., resulting in significant reductions in caregivers’ tobacco use, SHSe-related pediatric illness, and healthcare costs in this population of children.

Trial registration

ClinicalTrials.gov Identifier: NCT02531594. Date of registration: August 4, 2015.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4278-8) contains supplementary material, which is available to authorized users.

Preliminary evidence that high levels of nicotine on children's hands may contribute to overall tobacco smoke exposure

BACKGROUND

Dust and surfaces are important sources of lead and pesticide exposure in young children. The purpose of this pilot study was to investigate if third-hand smoke (THS) pollutants accumulate on the hands of children who live in environments where tobacco is used and if hand nicotine levels are associated with second-hand smoke (SHS), as measured by salivary cotinine.

METHODS

Participants were parents and children (n=25; age mean (SD)=5.4 (5.3) years) presenting to the emergency department with a potentially SHS-related illness. A convenience sample of participants were recruited at baseline from an ongoing two-group, randomised controlled trial of a SHS reduction and tobacco cessation intervention. Parents were current smokers; thus, all children were at risk of SHS and THS exposure to varying extents. Primary outcome measures, which were assessed in child participants only, were hand nicotine and salivary cotinine. Parents reported sociodemographics and smoking patterns; children's medical records were abstracted for chief complaint, medical history and discharge diagnosis.

RESULTS

All children had detectable hand nicotine (range=18.3-690.9 ng/wipe). All but one had detectable cotinine (range=1.2-28.8 ng/mL). Multiple linear regression results showed a significant positive association between hand nicotine and cotinine (p=0.009; semipartial r²=0.24), independent of child age.

DISCUSSION

The higher-than-expected nicotine levels and significant association with cotinine indicate that THS may play a role in the overall exposure of young children to tobacco smoke toxicants and that hand wipes could be a useful marker of overall tobacco smoke pollution and a proxy for exposure.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Identifier: NCT02531594.

Examining the Impact of Alcohol and Other Drug Education Exposure on Student Alcohol Consumption

This investigation examined the association between alcohol and other drug (AOD) prevention/education programs and drinking behaviors among students aged 12 to 17 years. We conducted a secondary analysis of the 2013 National Survey on Drug Use and Health ( N = 17,736). AOD prevention/education was assessed in three school settings: special class, regular class, and outside regular class. Outcome variables included past year alcohol use and current heavy episodic drinking. Associations were assessed via one-way analyses of variance and multiple regression models. There was a significant effect of program exposure on alcohol use ( p<.001) and heavy episodic drinking ( p = .002). Regression results found AOD prevention/education exposure ( p = .004) was significant, indicating that exposure decreased past year use. No difference was found based on heavy episodic drinking. Increasing exposure to AOD prevention/education programs is warranted and encouraged.

Tobacco Smoke Exposure-Related Illnesses Among Pediatric Emergency Department Patients

INTRODUCTION

This study aimed to determine the relationship between patients presenting to the pediatric emergency department (PED) and potential tobacco smoke exposure (TSE)-related illnesses.

METHODS

A retrospective review of electronic medical records of pediatric emergency department patients (N = 116,084) was conducted. Sociodemographic characteristics, TSE-related illnesses, and TSE documentation were extracted. Logistic regression analyses were performed.

RESULTS

More than one fifth (21.7%) of patients had TSE-related illnesses. Patients who were younger, male, non-White, or Hispanic; had Medicaid/Medicare insurance, had low triage acuity; or were admitted to any non-intensive care unit or intensive care unit were significantly more likely to have TSE-related illnesses. Twenty-eight percent of patients with TSE documentation had positive TSE status. Although regression models for positive TSE indicated similar findings, no difference was found based on ethnicity.

DISCUSSION

Pediatric emergency departments, especially those that care for large numbers of children, should offer tobacco interventions that target at-risk populations and caregivers who are most likely not receiving interventions in other health care settings.

Tobacco Smoke Exposure and Health-Care Utilization Among Children in the United States

PURPOSE

The purpose of this study was to assess patterns of health-care utilization among children who potentially had tobacco smoke exposure (TSE) compared to those who were not exposed.

DESIGN

A secondary data analysis of the 2011 to 2012 National Survey on Children's Health was performed.

SETTING

Households nationwide were selected.

PARTICIPANTS

A total of 95 677 children aged 0 to 17 years.

MEASURES

Sociodemographic characteristics, TSE status, and health-care visits were measured.

ANALYSIS

Multivariable logistic regression models were performed.

RESULTS

A total of 24.1% of children lived with smokers. Approximately 5% had home TSE. Participants who lived with a smoker were significantly more likely to have had a medical care visit (odds ratio [OR] = 1.22, confidence interval [CI] = 1.21-1.22) and were more likely to seek sick care or health advice at an emergency department (OR = 1.23, CI = 1.23-1.24) but were less likely to have had a dental care visit (OR = 0.82, CI = 0.82-0.83) than those who did not live with a smoker. Similar findings were found among participants who had home TSE.

CONCLUSION

TSE is a risk factor for increased use of pediatric medical care. Based on the high number of children who potentially had TSE and received sick care or health advice at an emergency emergency department, this setting may be a venue to deliver health messages to caregivers.

The Impact of Protective Behavioral Strategy Use Frequency on Blood Alcohol Concentrations Among Student Drinkers Nationwide

PURPOSE

This study assessed whether college student (1) protective behavioral strategy (PBS) use differed between those who reached legal intoxication during their most recent drinking episode compared to those who did not reach the legal blood alcohol concentration (BAC) threshold, and (2) frequency of PBS use could explain the variance associated with BAC during the most recent drinking episode, above and beyond one's sex, age, and involvement in the Greek system.

DESIGN

Secondary data analysis of the American College of Health Association's National College Health Assessment.

SETTING

Forty-four distinct campuses were included.

PARTICIPANTS

A total of 21479 college students were included.

MEASURES

BAC and PBS were measured.

ANALYSIS

The data were analyzed by conducting both independent samples t-tests and a multiple regression model. Effect sizes are reported.

RESULTS

Participants who reached legal intoxication used PBS less frequently ( P < .001; d = 0.80). Frequency of PBS use had the strongest unique contribution to the regression model (β = -.315, P < .001), such that participants with higher BAC reported less frequent use of PBS.

CONCLUSION

Interventions should seek to develop strategies that encourage college student use of PBS prior to, and during, drinking episodes. More frequent use of PBS can reduce intoxication as well as occurrence of alcohol-associated consequences.

Effective Prevention Strategies for Increasing Health Services Utilization Among Hispanic Youth

The study purpose is to address the underutilization of mental health services among Hispanic youth. This article provides professionals with strategies to increase health services utilization by utilizing a framework of the levels of prevention model, with an emphasis on primary prevention. The following questions were explored: (1) What are primary prevention strategies that can assist school professionals? (2) What are secondary prevention strategies and tertiary prevention strategies school professionals can employ to increase the utilization of health services? Implementing primary, secondary, and tertiary prevention strategies may improve Hispanic youth's overall mental health, academic achievement, and quality of life.

Authoritarian parenting and youth depression: Results from a national study

Depression is a prevalent illness affecting youth across the nation. The study purpose was to examine depression and authoritarian parenting among youth from 12 to 17 years of age. A secondary data analysis of the National Survey on Drug Use and Health was performed in the present study. All participants in the present study were youth (N = 17,399) nationwide. The results revealed that 80.6% of youth participants reported having five or more depressive symptoms. Parenting styles based on depression significantly differed among males, females, 12-13-year-olds, 14-15-year-olds, and 16-17-year-olds. Specifically, those who reported experiencing authoritarian parenting practices were more likely to report depressive symptoms compared to their counterparts who experienced authoritative parenting practices. Emphasizing the role of the parents and teaching positive parenting practices and authoritative parenting styles may increase success of prevention programs.

Psychosocial Factors Associated with Alcohol Use Among Hispanic Youth

This study examined whether authoritarian parenting, school experiences, depression, legal involvement and social norms predicted recent alcohol use and binge drinking among a national sample of Hispanic youth. A secondary data analysis of the National Survey on Drug Use and Health was performed (N = 3457). Unadjusted odds ratios were computed via univariate logistic regression analyses and significant variables were retained and included in the multivariable logistic regression analyses. Results indicated that in the past 30 days, 13.8 % of Hispanic youth drank alcohol and 8.0 % binge drank. Hispanic youth at highest risk for alcohol use were 16-17 years of age, experienced authoritarian parenting, lacked positive school experiences, had legal problems, and felt that most students at their school drank alcohol. Results should be considered when developing and implementing alcohol prevention efforts for Hispanic youth. Multiple approaches integrating family, school, and peers are needed to reduce use.

Top 100 Cited Articles in Recent Tobacco Research

Background

The total citations that a peer-reviewed manuscript has is often used to measure the impact that a publication has in its respective field of study. Both the citation count and total number of publications are often used as measures of academic productivity and success. This issue has been previously investigated in the field of tobacco control research. Given the changing landscape in the field of tobacco research since 2004, we sought to re-examine this issue. The study purpose was to identify the 100 top-cited tobacco-related articles published since 2005, and to categorize and describe the fields of study represented in these articles.

Methods

We searched the Scopus library database to determine the citations of the top 100 tobacco-related articles. Information was gathered on: title, number of authors, publication year, journal name and impact factor, country of origin, article type and subject category. Articles were selected and analyzed by two independent investigators.

Results

We identified the 100 top-cited articles published in 58 journals, led by The New England Journal of Medicine (8) and Lancet (6), between 2005 and 2014. The United States was the most common country of origin for the highly-cited articles. The top article types were observation (27%), basic science (26%), and review articles (24%). The most common article subject area was medicine (74%). A statistically significant association was found between the journal impact factor and the number of top 100 cited articles (p = 0.03).

Conclusions

This review may be helpful to identify articles that may be contributing to the conduct of current and future tobacco research. The analysis can be used as a reference to review and evaluate the publications that are making a high impact in the field of tobacco research.

Assessing Drinking and Academic Performance Among a Nationally Representative Sample of College Students

This investigation assessed whether alcohol consumption was negatively related to grade point average (GPA) among a nationally representative sample of college students. Items from the American College Health Association’s National College Health Assessment ( N = 22,424) were investigated. One-way ANOVAs and logistic regression analyses were conducted. Results revealed that respondents with lower GPAs consumed a greater number of drinks compared with those with higher GPAs. Students with higher GPAs engaged in heavy episodic drinking less than students with lower GPAs. Number of drinks consumed was the strongest predictor of academic performance; the likelihood of being an A student decreased with each drink consumed. Similarly, binge drinking was the strongest predictor; the likelihood of being an A student decreased as binge drinking increased. The dynamic, interdependent relationship between alcohol and GPA documented herein confirms previous research, which delineates reduced academic performance as a function of alcohol consumption.

Depiction of Health Effects of Electronic Cigarettes on YouTube

BACKGROUND

This study was conducted to assess the quantity, quality, and reach of e-cigarette health effects YouTube videos, and to quantify the description of positive and negative e-cigarette health effects and promotional content in each video.

METHOD

Searches for videos were conducted in 2015 using the YouTube search engine, and the top 20 search results by relevance and view count were identified. Videos were classified by educational/medical news, advertising/marketing, and personal/testimonial categories. A coding sheet was used to assess the presence or absence of negative and positive health effects, and promotional content.

RESULTS

Of the 320 videos retrieved, only 55 unique videos were included. The majority of videos (46.9%) were educational/medical/news, 29.7% were personal/testimonial, and 23.4% were advertising/marketing. The three most common negative health effects included discussing nicotine, e-cigarettes not being FDA regulated, and known and unknown health consequences related to e-cigarette use. The top positive health effects discussed were how e-cigarettes can help individuals quit smoking, e-cigarettes are healthier than smoking, and e-cigarettes have no smoke or secondhand smoke exposure.

CONCLUSIONS

It is critical to monitor YouTube health effects content and develop appropriate messages to inform consumers about the risks associated with use while mitigating misleading information presented.

Assessment of tobacco smoke exposure in the pediatric emergency department

OBJECTIVE

Tobacco smoke exposure causes significant childhood morbidity and is associated with a multitude of conditions. National organizations recommend tobacco smoke exposure screening at all pediatric clinical encounters. Data regarding tobacco smoke exposure screening in the pediatric emergency department is sparse, although children with tobacco smoke exposure-associated conditions commonly present to this setting. We aimed to determine the frequency and outcome of tobacco smoke exposure screening in the pediatric emergency department, and assess associated sociodemographic/clinical characteristics.

METHODS

This retrospective review included pediatric patients presenting to a large pediatric emergency department in Cincinnati, Ohio between 2012 and 2013. Variables extracted included: age, sex, race/ethnicity, insurance, child's tobacco smoke exposure status, triage acuity, diagnosis, and disposition. Regression analyses examined predictors of tobacco smoke exposure screening and tobacco smoke exposure status.

RESULTS

A total of 116,084 children were included in the analysis. Mean child age was 6.20years (SD±5.6); 52% were male. Nearly half of the children in the study did not undergo tobacco smoke screening; only 60% of children with tobacco smoke exposure-related illnesses were screened. Predictors of tobacco smoke exposure screening were: younger age, male, African American, non-commercial insurance, high acuity, tobacco smoke exposure-related diagnoses and non-intensive care admission. Of children screened for tobacco smoke exposure, 28% were positive. Children more likely to screen positive were non-Hispanic, had non-commercial insurance, and had tobacco smoke exposure-related diagnoses. NonAfrican American children triaged as low acuity were more likely to have tobacco smoke exposure, yet were less likely to be screened.

CONCLUSION

Despite national recommendations, current tobacco smoke exposure screening rates are low and fail to identify at-risk children. Pediatric emergency department visits for tobacco smoke exposure-associated conditions are common, thus further research is needed to develop and assess standardized tobacco smoke exposure screening tools/interventions in this setting.

Recent alcohol use, episodic heavy drinking, and school violent victimization: Sex and grade level differences among Hispanic youth

Alcohol use and involvement in school violent victimization are two significant public health problems among Hispanic youth. The present study examined alcohol use by involvement in school violent victimization among seventh through twelfth grade Hispanic students in one metropolitan area. The Pride Student National Survey was administered to students in their school classrooms. Results indicated that Hispanic students who were involved in school violent victimization were at increased risk for recent alcohol use and frequent episodic heavy drinking compared to Hispanic students who were not involved. Logistic regression revealed Hispanic males, junior high school, and high school students were at increased odds for recent alcohol use based on involvement in school violent victimization. Regarding frequent episodic heavy drinking, Hispanic males, females, and high school students were at increased odds. These findings can aid professionals in developing effective prevention programs and efforts for this high-risk population. Recommendations for future studies are included.

Predictors of Recent Marijuana Use and Past Year Marijuana Use Among a National Sample of Hispanic Youth

BACKGROUND

Marijuana use rates remain higher among Hispanic youth compared to youth from other ethnic groups.

OBJECTIVES

The purpose of the study was to examine if sex, age, authoritarian parenting, perceived school experiences, lifetime depression, legal involvement, and perceived social norms of marijuana use predicted recent marijuana use and past year marijuana use among Hispanic youth.

METHODS

The participants of this study were a nationwide sample of Hispanic youth (n = 3,457) in the United States. A secondary data analysis of the 2012 National Survey on Drug Use and Health was performed. Unadjusted odds ratios were computed via univariate logistic regression analyses and all statistically significant variables were retained and included in the final multiple logistic regression analyses. Recent marijuana use was operationally defined as use within the past 30 days, and marijuana use in the past year was defined as use within the past year.

RESULTS

Results indicated that 7.5% of Hispanic youth used within the past month and 14.5% of Hispanic youth used within the past year. Results revealed that significant predictors for recent use were age, authoritarian parenting, perceived school experiences, legal involvement, and perceived social norms of youth marijuana use. Predictors for past year were age, perceived school experiences, legal involvement, and perceived social norms of youth marijuana use.

CONCLUSIONS/IMPORTANCE

Findings from this study can be used to address the public health problem of marijuana use among Hispanic youth that is ultimately contributing to health disparities among this ethnic group nationwide. Recommendations for future studies are included.

Coordination of care between health and education systems for patients with a hematologic or oncologic diagnosis: a time study analysis

Given the increasing emphasis on care coordination between healthcare and schools, hospital-school liaison services are increasing in demand. Limited research examines hospital-school liaison programs that focus on educational journeys of school-age patients with a chronic illness. Thus, this initiative aimed to determine the time needed to support the educational needs of these patients. Liaisons tracked time spent per patient, and per specific task category, to support school-age patients (N=419) using work-sampling and time-and-motion methods. Findings may be useful for hospital-based programs seeking to establish or increase staff dedicated to the coordination of care between school and healthcare systems.

Students' benefits and barriers to mental health help-seeking

Stigma is recognized as a potential barrier to seeking help for a mental health disorder. The present study assessed college students' perceived benefits and barriers to obtaining mental health treatment and stigma-related attitudes via a four-page survey. A total of 682 students at one Midwestern university participated in the study. Findings indicated that females perceived a greater number of benefits to having participated in mental health services and held significantly lower stigma-related attitudes than did males. Students who had ever received mental health services reported significantly more barriers to treatment than did students who had never received services. Health professionals should target students with educational programs about positive outcomes related to receiving mental health services and work with treatment centers to reduce barriers for receiving services.

Sex and grade level differences in lifetime nonmedical prescription drug use among youth

Nonmedical prescription drug (NMPD) use is a significant health issue among youth. The purpose of this study was to examine NMPD use among students in 7th through 12th grades. A total of 54,631 students participated in the study, which utilized the PRIDE Questionnaire. A total of 13.6 % of youth reported lifetime NMPD use. Hispanic youth were more likely than white or African American youth to report use of NMPDs. Engaging in high levels of pro-social behaviors and having high levels of parent and teacher/school protective factors decreased the odds of use among males, females, 7th and 8th grade students and 9th through 12th grade students. Conversely, engaging in risky behaviors and having friends who used other substances increased the odds for use. Study findings highlight the increasing problem of prescription drug use. Prevention professionals may benefit from findings that can be used to tailor educational initiatives to students.

School violent victimization and recent alcohol use and episodic heavy drinking among youth

School violent victimization is a serious public health problem among youth. The current study investigated the association between youth alcohol use and school violent victimization among middle school and high school students (N=54,361). The PRIDE national survey for Grades 6-12 was administered to youth in their classrooms. Results indicated that 38.3% of students were involved in school violent victimization. School violent victimization differed significantly based on sex, race, and grade level. Logistic regression analyses indicated that school violent victimization was directly related to elevated alcohol use in the past 12 months and episodic heavy drinking among youth. Findings from this study may be beneficial to school nurses in creating bullying and substance abuse prevention programs for students. Recommendations for future research are included.