The adolescent and substance use, an approach to office management

Variations in pre-operative management of adolescents undergoing elective surgery

OBJECTIVE

To understand whether preoperative care of adolescent patients differs according to two different pediatric subspecialties with respect to patient pregnancy status, drug use, and patient assent. To understand how preoperative care of adolescent patients varies with length of practice and practice setting.

METHODS

A cross-sectional study surveyed 51 American Society of Pediatric Otolaryngology (ASPO) members and 108 American Pediatric Surgical Association (APSA) members. Outcomes included how often ('always', 'sometimes', 'never') participants ask adolescents (ages 12-18 years) about substance use, pregnancy, and assent for surgery. Differences according to physicians' practice duration and setting were also examined. Fisher's exact tests and Cochran-Armitage tests were applied for statistical analysis.

RESULTS

Although ASPO and APSA members did not differ significantly in how often they ask adolescent patients about pregnancy, ASPO members were more likely to 'always' cancel elective surgery in a pregnant patient (p<0.007). ASPO members were also more likely to 'always' ask about substance use, although this difference was not significant (p<0.06). APSA members were more likely to proceed with surgery despite an adolescent's refusal (p<0.007). Physicians in both specialties with <5 years in practice were most likely to 'always' ask about pregnancy, and physicians with fewer adolescent patients in their practice were more likely to 'always' ask about substance use. Physicians in differing practice settings varied in their responses about proceeding with elective surgery in a pregnant patient (p<0.03).

CONCLUSION

ASPO and APSA members differ in their preoperative management of adolescent patients. Newer physicians and those with fewer adolescent patients also differ from physicians with more extensive experience with adolescents.

Longitudinal predictors of changes to illicit drug use among young Australian women

AIM

Much information regarding predictors of illicit drug initiation and cessation is drawn from cross-sectional data. This paper aims to determine the longitudinal changes in factors associated with initiation and cessation of illicit drugs by young Australian women over a 3-year period.

PARTICIPANTS

The sample was the cohort of young women moving from their mid- to late 20s, completing the Australian Longitudinal Study on Women's Health (ALSWH) survey in 2000 and 2003, who were either 'new' users or 'quitters' at the 2003 survey.

MEASUREMENTS

Crude and multivariate associations between changes in predictor variables and the probability of illicit drug initiation or cessation were evaluated. Variables significant in univariate analyses were used to create multivariable logistic regression models which predicted initiation and cessation of illicit drugs.

FINDINGS

All categories of smokers, except ex-smokers and those who adopted and quit smoking between surveys, were less likely to cease the use of illicit drugs. Women who became pregnant were more likely to cease illicit drug use. Women who continued to drink at levels described as long-/short-term risk and women who suffered continuing emotional abuse were less likely to cease use of illicit drugs.

CONCLUSIONS

Longitudinal studies that examine factors associated with illicit drug initiation are best conducted in a cohort aged in their late teens to early 20s. Following the current cohort into their late 30s may further explain predictors of illicit drug cessation.