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Lee H, Harrell MB, Rao DR. Psychosocial stressors of adolescents with E-cigarette, or vaping, product-use associated lung injury: A qualitative study. Addict Behav 2024; 158:108107. [PMID: 39067416 DOI: 10.1016/j.addbeh.2024.108107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/27/2024] [Accepted: 07/16/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND AND OBJECTIVES Adolescent electronic cigarette (EC) use has reached epidemic rates and has been linked to numerous mental health and psychosocial stressors (PS). There is limited qualitative data on PS for adolescents with e-cigarette, or vaping, product-use associated lung injury (EVALI), a severe complication of EC use. METHODS All patients hospitalized at Children's Medical Center in Dallas, Texas from 2018 to 2022 and met CDC case definitions for EVALI were included in the analysis. PS were extracted from the electronic health record and analyzed for recurring themes using the HEADSS assessment as a framework. Results were summarized using descriptive statistics, and representative quotations were selected to highlight each theme. RESULTS Forty-three adolescents (mean age 16.3 years; 62.8 % male; 39.5 % Non-Hispanic White, 60.5 % Hispanic) were included in the analysis, and 40 (93 %) reported PS. The most common themes were family (51 %; "restraining order issued against 28-year-old brother"), polysubstance use (77 %; "experimenting with…ecstasy, LSD, CCC, misusing Adderall"), and mental health (63 %; "has been suicidal since he was 'a toddler'"). Less commonly, patients reported PS related to peers (28 %; "spending the entire day at the cemetery where his best friend was buried"), school (49 %; "attending his second alternative school"), and the legal system (19 %; "placed in juvenile detention, released, and will be on probation"). CONCLUSIONS Adolescents with EVALI had PS that were chronic, severe, and involving multiple domains. These findings emphasize the importance of psychosocial screening in adolescents and coordinating interdisciplinary care with mental health and social services.
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Affiliation(s)
- Harin Lee
- Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Melissa B Harrell
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston, School of Public Health, 616 Guadalupe, Austin, TX 78701, USA
| | - Devika R Rao
- Division of Pulmonology and Sleep Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA; Children's Health Dallas, 1935 Medical District Drive, Dallas, TX 75235, USA.
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Alemu BT, Olayinka O, Beydoun HA. Prevalence and hospital resource usage associated with substance use disorder among hospitalized adolescents in the United States. J Addict Dis 2023; 41:233-241. [PMID: 36591945 DOI: 10.1080/10550887.2022.2100209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We sought to determine common characteristics of SUD-related hospitalizations and patterns of discharge diagnoses among adolescents in the United States. Using the 2016 KID, a cross-sectional study was conducted to identify discharge records associated with ICD-10-CM diagnostic codes for SUD. Adolescents between the ages of 13 and 19 were included. SUD and non-SUD groups were compared using the Student's t-test for continuous variables and the χ2 test for categorical variables. A total of 6.7 million hospital discharges were analyzed. A uniform and a standardized coding system were used to identify cases. Subgroup comparative analysis for length of stay, hospital charge, and common discharge diagnoses was performed. A weighted estimate of 94,732 adolescents associated with SUD was discharged from the U.S. hospitals during the study year. Teens with SUD accounted for 510,268 days of inpatient days in the U.S. community hospitals accounting for a total charge of $3,070,948,580. The average LOS for all SUD teens in the U.S. was 5.4 days with a mean charge per discharge of $32,754, indicating higher LOS but a significantly lower mean charge compared to non-SUD teens (4.1 days; $39,657). In 2016, more than 88% of SUD patients had ≥ 3 diagnoses compared to non-SUD patients (76%) (P < 0.0001 for all). The most frequently observed diagnosis associated with teens with SUD was psychoses, depressive neuroses, and alcohol use disorder. With one in ten teenagers found with an SUD, early substance initiation still appears to be an important public health issue. Unfortunately, the health and economic impact of substance use in adolescence on society are huge requiring effective strategies targeted to this population. The concerning data and literature identify a significant need to address prevention, treatment, and recovery services for adolescents throughout the United States.
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Affiliation(s)
- Brook T Alemu
- Health Sciences Program, School of Health Sciences, Western Carolina University, Cullowhee, North Carolina, USA
| | - Olaniyi Olayinka
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Hind A Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Department of Defense, Virginia, USA
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Alemu BT, Young B, Beydoun HA, Olayinka O. Substance Use Disorder among Hospitalized Adolescents in North Carolina. South Med J 2022; 115:616-621. [PMID: 35922048 DOI: 10.14423/smj.0000000000001426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Individuals who began using alcohol or other drugs before the age of 15 are 7 times more likely to develop a substance use disorder (SUD) in adulthood. This study sought to determine the common characteristics of SUD-related hospitalizations and patterns of discharge diagnoses among adolescents in North Carolina. METHODS Using the 2014 State Inpatient Database (SID), discharge records associated with the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes for SUD were identified. Adolescents between the ages of 13 and 19 years were included. SUD and non-SUD groups were compared using the Student t test for continuous variables and the χ2 test for categorical variables. A total of 1.1 million hospital discharges were analyzed. A uniform and standardized coding system called Clinical Classifications Software was used to identify cases. The Clinical Classifications Software collapses the ICD-9-CM codes into 679 clinically meaningful categories. A cluster of 3900 ICD-9-CM procedure codes also was used to identify clinically relevant groups of procedures performed during hospitalization. RESULTS An estimated 3276 adolescents associated with SUD were discharged from North Carolina hospitals during the study year. Discharged patients with a SUD spent a total of 21,242 inpatient days, at a cost of $62 million. Among the adolescents with a SUD, 53% were boys, 62% were White, 24% were Black, 8% were Hispanic (8%), and 6% were of other races. Compared with patients without a SUD, those with a SUD had longer mean hospital stays (6.5 days vs 4.7 days; P < 0.0001) and lower mean hospital charge per hospitalization ($18,932 vs 24,532; P < 0.0001). Adolescents with a SUD also were diagnosed primarily as having mood disorders (44.78%), followed by schizophrenia and other psychological disorders, upon discharge. Approximately 37% of the SUD-related discharges occurred in areas, denoted in this study using ZIP code designations, with mean household annual incomes <$38,999. A large proportion of the SUD-related hospitalizations (44%) were billed to Medicaid. Frequently observed diagnoses associated with adolescents with a SUD were mood disorders (45%), schizophrenia (7%), and poisoning by other medications and drugs (4%). In 16% of hospitalized adolescents with a SUD, there were at least 2 procedures performed. There was a statistically significant mean hospital charge difference of $5600 between SUD and non-SUD teens. CONCLUSIONS The literature reflects the connection between adolescent use and the propensity for diagnosis with a SUD in adulthood; it is evident that this is a growing public health crisis. This study identified patterns of adolescent substance use that, based on the current literature, are indicative of problematic futures for these individuals. The concerning data and literature identify a significant need to address prevention, treatment, and recovery services for adolescents, not only in North Carolina but throughout the United States. The need for focused interventions, access to care, and funding of substance-specific adolescent education and services is greatly needed to change the trajectory of these adolescents' lives.
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Affiliation(s)
- Brook T Alemu
- From the Health Sciences Program School of Health Sciences, and the Department of Social Work, College of Health and Human Sciences, Western Carolina University, Cullowhee, North Carolina, the Department of Research Programs, Fort Belvoir Community Hospital, Department of Defense, Fort Belvoir, Virginia, and the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Beth Young
- From the Health Sciences Program School of Health Sciences, and the Department of Social Work, College of Health and Human Sciences, Western Carolina University, Cullowhee, North Carolina, the Department of Research Programs, Fort Belvoir Community Hospital, Department of Defense, Fort Belvoir, Virginia, and the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Hind A Beydoun
- From the Health Sciences Program School of Health Sciences, and the Department of Social Work, College of Health and Human Sciences, Western Carolina University, Cullowhee, North Carolina, the Department of Research Programs, Fort Belvoir Community Hospital, Department of Defense, Fort Belvoir, Virginia, and the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Olaniyi Olayinka
- From the Health Sciences Program School of Health Sciences, and the Department of Social Work, College of Health and Human Sciences, Western Carolina University, Cullowhee, North Carolina, the Department of Research Programs, Fort Belvoir Community Hospital, Department of Defense, Fort Belvoir, Virginia, and the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
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Smith JR, Hazen EP, Kaminski TA, Wilens TE. Literature review: Substance use screening and co-morbidity in medically hospitalized youth. Gen Hosp Psychiatry 2020; 67:115-126. [PMID: 33129136 DOI: 10.1016/j.genhosppsych.2020.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/30/2020] [Accepted: 10/03/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Pediatric and young adult patients frequently present to medical inpatient (MIP) units for treatment of substance use disorder (SUD). Given the risk of lifelong dependence and related complications in early life substance use (SU), a review of the literature is warranted. METHODS We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic review of literature published through April, 62,020, which examined incidence, screening, and complications of pediatric and young adult SU in the MIP setting. RESULTS 8843 articles were screened, and 28 articles were included for final qualitative synthesis. The overall prevalence of SU-related discharge diagnoses ranged from 1.3% to 5% for patients aged 0 to 26 years. When compared to adult patients, nearly double the rate of co-morbid psychopathology was observed. Three studies utilized systematic screening tools, with the remainder relying on biologic screens and admission or discharge diagnoses. CONCLUSIONS The results of our review indicate that current screening practices for SU in the MIP clinical setting are subpar and likely result in an underestimation of incidence and morbidity due to limited use of systematic screening tools. Despite this, incidence of SU hospitalizations and related medical and psychiatric complications continue to rise.
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Affiliation(s)
- Joshua R Smith
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, United States..
| | - Eric P Hazen
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, United States..
| | - Tamar A Kaminski
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, United States..
| | - Timothy E Wilens
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, United States..
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Ramsewak S, Putteeraj M, Somanah J. Exploring substance use disorders and relapse in Mauritian male addicts. Heliyon 2020; 6:e04731. [PMID: 32904255 PMCID: PMC7452487 DOI: 10.1016/j.heliyon.2020.e04731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/03/2020] [Accepted: 08/12/2020] [Indexed: 11/23/2022] Open
Abstract
Background Substance Use Disorder (SUD) places a heavy burden on societal and health systems given its association with high mortality and morbidity rates worldwide, including Mauritius. Illicit substances act as a positive reinforcement and stimulate addiction through its pleasure-seeking attributes. Aim This study focused on identifying the risk factors leading to SUD among Mauritian male addicts as well as examining the potency of those factors in SUD development. The study also aimed at determining the prevalence of relapse and its causation. Research setting A cross-sectional study was conducted over a period of six months using a sample of 180 male addicts registered in a public hospital. A questionnaire investigating dimensions such as risk factors, self-esteem and peer pressure was administered. Findings A high percentage of relapse was noted amongst users within the first year of abstinence. Majority of respondents originated from nuclear or single parents’ family and were deprived of adequate social supports given their marital status. 57.5% of participants had a positive family history of SUD. Cannabis was the most commonly abused substance and 76.2% of the addicts were introduced to drugs through curiosity. Transposing the results against the Gateway Drug Theory showed a constant progression from soft to hard drugs for male addicts, a trend which was consistent with literature. Lastly, a theoretical model was developed based on the strong statistical association found between impulsivity and reduced thought processes prior to relapse; data revealing increased impulsivity which is a common trait in antisocial personality disorder and borderline personality disorder as being largely responsible for relapse. Conclusion The study was successful in bringing out the most common risk factors of SUDs which are linked to low socioeconomic status. The inability of addicts to progress with their rehabilitation given the alarming 92% of relapse was related to social pressure as prime deterrent to successful remission. Programmes involving relapse prevention must implemented in the first year of abstinence to facilitate rehabilitation.
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Affiliation(s)
- Shalina Ramsewak
- Psychiatry Department, Dr A.G. Jeetoo Hospital, Port-Louis, Mauritius
| | - Manish Putteeraj
- School of Health Sciences, La Tour Koeing, Point aux Sables, 11108, University of Technology, Mauritius
- Corresponding author.
| | - Jhoti Somanah
- School of Health Sciences, La Tour Koeing, Point aux Sables, 11108, University of Technology, Mauritius
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Becker JE, Smith JR, Hazen EP. Pediatric Consultation-Liaison Psychiatry: An Update and Review. PSYCHOSOMATICS 2020; 61:467-480. [PMID: 32482345 PMCID: PMC7194908 DOI: 10.1016/j.psym.2020.04.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 12/11/2022]
Abstract
Background In recent years, there has been an increasing burden of child and adolescent mental illness recognized in the United States, and the need for pediatric mental health care is growing. Pediatric consultation-liaison (C-L) psychiatrists are increasingly playing a role in the management of medical and psychiatric disease for pediatric patients. The field is a fast-moving one, with understanding of new neuropsychiatric disease entities; reformulation of prior disease entities; and new interdisciplinary treatments and models of care. Methods In this study, we aim to review recent advances in the field of pediatric C-L psychiatry, including new diagnostic entities, updated management of frequently encountered clinical presentations, and developments in systems of care. Conclusion The advances in pediatric C-L psychiatry are broad and serve to promote more streamlined, evidence-based care for the vulnerable population of psychiatrically ill pediatric medical patients. More work remains to determine the most effective interventions for the wide array of presentations seen by pediatric C-L psychiatrists.
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Affiliation(s)
- Jessica E Becker
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA.
| | - Joshua R Smith
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Eric P Hazen
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
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Nguyen TL, Boudemaghe T, Leguelinel-Blache G, Eiden C, Kinowski JM, Le Manach Y, Peyrière H, Landais P. Identifying Life-Threatening Admissions for Drug Dependence or Abuse (ILIADDA): Derivation and Validation of a Model. Sci Rep 2017; 7:44428. [PMID: 28290530 PMCID: PMC5349588 DOI: 10.1038/srep44428] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 02/07/2017] [Indexed: 12/23/2022] Open
Abstract
Given that drug abuse and dependence are common reasons for hospitalization, we aimed to derive and validate a model allowing early identification of life-threatening hospital admissions for drug dependence or abuse. Using the French National Hospital Discharge Data Base, we extracted 66,101 acute inpatient stays for substance abuse, dependence, mental disorders or poisoning associated with medicines or illicit drugs intake, recorded between January 1st, 2009 and December 31st, 2014. We split our study cohort at the center level to create a derivation cohort and a validation cohort. We developed a multivariate logistic model including patient's age, sex, entrance mode and diagnosis as predictors of a composite primary outcome of in-hospital death or ICU admission. A total of 2,747 (4.2%) patients died or were admitted to ICU. The risk of death or ICU admission was mainly associated with the consumption of opioids, followed by cocaine and other narcotics. Particularly, methadone poisoning was associated with a substantial risk (OR: 35.70, 95% CI [26.94-47.32], P < 0.001). In the validation cohort, our model achieved good predictive properties in terms of calibration and discrimination (c-statistic: 0.847). This allows an accurate identification of life-threatening admissions in drug users to support an early and appropriate management.
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Affiliation(s)
- Tri-Long Nguyen
- Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, UPRES EA2415, University of Montpellier, Montpellier, France.
- Laboratory of Clinical Pharmacy, Faculty of Pharmacy, University of Montpellier, Montpellier, France.
- Department of Pharmacy, Nîmes University Hospital, Nîmes, France.
| | - Thierry Boudemaghe
- Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, UPRES EA2415, University of Montpellier, Montpellier, France.
- Department of Biostatistics, Epidemiology, Public Health and Medical Informatics, Nîmes University Hospital, Nîmes, France.
| | - Géraldine Leguelinel-Blache
- Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, UPRES EA2415, University of Montpellier, Montpellier, France.
- Department of Pharmacy, Nîmes University Hospital, Nîmes, France.
| | - Céline Eiden
- Department of Medical Pharmacology and Toxicology, Addictovigilance Centre, Montpellier University Hospital, Montpellier University Hospital, Montpellier, France.
| | - Jean-Marie Kinowski
- Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, UPRES EA2415, University of Montpellier, Montpellier, France.
- Department of Pharmacy, Nîmes University Hospital, Nîmes, France.
| | - Yannick Le Manach
- Departments of Anesthesia & Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
- The Perioperative Research Group, Population Health Research Institute, Hamilton, Ontario, Canada.
| | - Hélène Peyrière
- Laboratory of Clinical Pharmacy, Faculty of Pharmacy, University of Montpellier, Montpellier, France.
- Department of Medical Pharmacology and Toxicology, Addictovigilance Centre, Montpellier University Hospital, Montpellier University Hospital, Montpellier, France.
| | - Paul Landais
- Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, UPRES EA2415, University of Montpellier, Montpellier, France.
- Department of Biostatistics, Epidemiology, Public Health and Medical Informatics, Nîmes University Hospital, Nîmes, France.
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Watanabe-Galloway S, Valleley R, Rieke K, Corley B. Behavioral Health Problems Presented to Integrated Pediatric Behavioral Health Clinics: Differences in Urban and Rural Patients. Community Ment Health J 2017; 53:27-33. [PMID: 27250844 DOI: 10.1007/s10597-016-0024-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 05/27/2016] [Indexed: 11/26/2022]
Abstract
Behavioral health diagnoses and service use may differ based on rurality. The purpose of this study was to examine the patterns of mental disorder diagnoses of urban, rural, and remote pediatric populations. This retrospective study used electronic medical records from integrated behavioral health clinics in Nebraska from 2012 to 2013. Bivariate and multivariable models were used to examine the differences in diagnoses. Adolescents with attention deficit and related disorders were more likely to be male, younger, have public insurance and rural/remote residents. Adjustment disorders were associated with being female, older, and urban residents. Adolescents with anxiety disorder had a significant interaction between age and gender, with both genders being older, having private insurance, and urban residents. Adolescents with mood disorder were more likely to be female, older, and urban residents. Demographic and clinical differences among patients in urban and rural/remote settings have implications for care in rural settings.
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Affiliation(s)
- Shinobu Watanabe-Galloway
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center (UNMC), 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA.
| | - Rachel Valleley
- Department of Psychology, Munroe-Meyer Institute, University of Nebraska Medical Center, 985450 Nebraska Medical Center, Omaha, NE, 68198-5450, USA
| | - Katherine Rieke
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center (UNMC), 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA
| | - Brittany Corley
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center (UNMC), 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA
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Refining Measurement of Substance Use Disorders Among Women of Child-Bearing Age Using Hospital Records: The Development of the Explicit-Mention Substance Abuse Need for Treatment in Women (EMSANT-W) Algorithm. Matern Child Health J 2016; 19:2168-78. [PMID: 25680703 DOI: 10.1007/s10995-015-1730-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Substance use disorder (SUD) in women of reproductive age is associated with adverse health consequences for both women and their offspring. US states need a feasible population-based, case-identification tool to generate better approximations of SUD prevalence, treatment use, and treatment outcomes among women. This article presents the development of the Explicit Mention Substance Abuse Need for Treatment in Women (EMSANT-W), a gender-tailored tool based upon existing International Classification of Diseases, 9th Edition, Clinical Modification diagnostic code-based groupers that can be applied to hospital administrative data. Gender-tailoring entailed the addition of codes related to infants, pregnancy, and prescription drug abuse, as well as the creation of inclusion/exclusion rules based on other conditions present in the diagnostic record. Among 1,728,027 women and associated infants who accessed hospital care from January 1, 2002 to December 31, 2008 in Massachusetts, EMSANT-W identified 103,059 women with probable SUD. EMSANT-W identified 4,116 women who were not identified by the widely used Clinical Classifications Software for Mental Health and Substance Abuse (CCS-MHSA) and did not capture 853 women identified by CCS-MHSA. Content and approach innovations in EMSANT-W address potential limitations of the Clinical Classifications Software, and create a methodologically sound, gender-tailored and feasible population-based tool for identifying women of reproductive age in need of further evaluation for SUD treatment. Rapid changes in health care service infrastructure, delivery systems and policies require tools such as the EMSANT-W that provide more precise identification methods for sub-populations and can serve as the foundation for analyses of treatment use and outcomes.
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Onyeka IN, Beynon CM, Ronkainen K, Tiihonen J, Föhr J, Kuikanmäki O, Paasolainen M, Kauhanen J. Hospitalization in a Cohort Seeking Treatment for Illicit Drug Use in Finland. J Subst Abuse Treat 2015; 53:64-70. [DOI: 10.1016/j.jsat.2014.12.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 12/19/2014] [Accepted: 12/22/2014] [Indexed: 11/28/2022]
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Bernstein J, Derrington TM, Belanoff C, Cabral HJ, Babakhanlou-Chase H, Diop H, Evans SR, Jacobs H, Kotelchuck M. Treatment outcomes for substance use disorder among women of reproductive age in Massachusetts: a population-based approach. Drug Alcohol Depend 2015; 147:151-9. [PMID: 25496707 PMCID: PMC4297726 DOI: 10.1016/j.drugalcdep.2014.11.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 11/07/2014] [Accepted: 11/21/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Longitudinal patterns of treatment utilization and relapse among women of reproductive age with substance use disorder (SUD) are not well known. In this statewide report spanning seven years we describe SUD prevalence, SUD treatment utilization, and differences in subsequent emergency department (ED) use and post-treatment relapse rates by type of treatment: none, 'acute only' (detoxification/stabilization), or 'ongoing' services. METHODS We linked a statewide dataset of hospital discharge, observation stay and ED records with SUD treatment admission records from hospitals and freestanding facilities, and birth/fetal death certificates, in Massachusetts, 2002-2008. We aggregated episodes into individual woman records, identified evidence of SUD and treatment, and tested post-treatment outcomes. RESULTS Nearly 150,000 (8.5%) of 1.7 million Massachusetts women aged 15-49 were identified as SUD-positive. Nearly half of SUD-positive women (71,533 or 48.3%) had evidence of hospital or facility-based SUD treatment; among these, 12% received acute care/detoxification only while 88% obtained 'ongoing' treatment. Treatment varied by substance type; women with dual diagnosis and those with opiate use were least likely to receive 'ongoing' treatment. Treated women were older and less likely to have a psychiatric history or chronic illness. Women who received 'acute only' services were more likely to relapse (12.4% vs. 9.6%) and had a 10% higher rate of ED visits post-treatment than women receiving 'ongoing' treatment. CONCLUSIONS Many Massachusetts women of reproductive age need but do not receive adequate SUD treatment. 'Ongoing' services beyond detoxification/stabilization may reduce the likelihood of post-treatment relapse and/or reliance on the ED for subsequent medical care.
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Affiliation(s)
| | | | | | - Howard J. Cabral
- Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - Hafsatou Diop
- Bureau of Substance Abuse Services, Massachusetts Department of Public Health, Boston, MA, USA.
| | - Stephen R. Evans
- Boston University School of Public Health, Boston, Massachusetts, USA
| | - Hilary Jacobs
- Bureau of Substance Abuse Services, Massachusetts Department of Public Health, Boston, MA, USA.
| | - Milton Kotelchuck
- Center for Child and Adolescent Health Research and Policy, MassGeneral Hospital for Children, Boston, MA, USA.
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Langhan ML. Acute Alcohol Intoxication in Adolescents: Frequency of Respiratory Depression. J Emerg Med 2013; 44:1063-9. [DOI: 10.1016/j.jemermed.2012.11.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 06/27/2012] [Accepted: 11/02/2012] [Indexed: 11/28/2022]
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Bouthoorn SH, van Hoof JJ, van der Lely N. Adolescent alcohol intoxication in Dutch hospital centers of pediatrics: characteristics and gender differences. Eur J Pediatr 2011; 170:1023-30. [PMID: 21286749 DOI: 10.1007/s00431-011-1394-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 01/11/2011] [Indexed: 11/26/2022]
Abstract
Gender differences in alcohol intoxication among adolescents are still largely unknown, whereas these differences have been studied in adults. To investigate possible differences, this study analyzed pediatric admissions for alcohol intoxication to the majority of Dutch hospitals between 2007 and 2009. Another aim was to explore key characteristics (e.g. blood alcohol concentration, duration of reduced consciousness, and age) and trends of alcohol intoxication among adolescents in the period 2007-2009. We analyzed data from the Dutch Pediatric Surveillance system, which monitors alcohol intoxication among children in pediatric departments of Dutch hospitals. Patients aged 11-17 years with reduced consciousness due to alcohol intoxication were included. The number of adolescents admitted with alcohol intoxication increased sharply from 2007 to 2009. The average age of the patients treated for alcohol intoxication increased from 15.3 years in 2007 and 15.4 years in 2008 to 15.7 years in 2009. The duration of reduced consciousness due to alcohol intoxication also increased over the 3-year period: from 2.2 to 3.1 h. Gender differences were observed regarding alcohol intoxication characteristics. Most strikingly, intoxicated girls were younger (15.3 vs. 15.7 years), had a lower blood alcohol concentration (1.79 vs. 1.94 g/l) and were hospitalized for shorter times than boys. No association was found between alcohol intoxication and other, possibly illicit drug use. The drinks most consumed prior to hospital admission were spirits and beer. Alcohol intoxication among adolescents is an emerging problem. Differences in intoxication characteristics between boys and girls were observed. These findings are important for future prevention and intervention strategies. In the Netherlands, special policlinics for children with alcohol intoxication have already been established.
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Affiliation(s)
- Selma H Bouthoorn
- Department of Pediatrics, Reinier de Graaf Hospital, P.O. Box 5011, 2600, GA, Delft, The Netherlands.
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Hains DS, Reagan PB, Smoyer WE. Do declining private insurance coverage rates influence pediatric hospital charging practices? Clin Pediatr (Phila) 2011; 50:417-23. [PMID: 21357198 DOI: 10.1177/0009922810393498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To analyze trends in primary payer composition for pediatric hospitalizations and insurance coverage rates from 2000 to 2006 and possible effects on hospital charging practices. DESIGN We documented national trends in hospital charge-to-cost ratios and primary payer mixes for pediatric discharges from 2000 to 2006 using the Healthcare Cost and Utilization Project (HCUP) Kid's Inpatient Database (KID). We then performed regression analyses at the hospital level to analyze associations between pediatric insurance coverage rates and hospital charge-to-cost ratios. RESULTS We found pediatric inpatient charge-to-cost ratios increased dramatically during study period. Charge-to-cost ratios were higher for hospitals located in states with either higher uninsurance rates or a public-private coverage mix that was skewed towards public coverage. CONCLUSIONS This study provides evidence of both important changes in pediatric health insurance distribution in the United States and hospital charging practices.
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Affiliation(s)
- David S Hains
- The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
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Bouthoorn SH, van der Ploeg T, van Erkel NE, van der Lely N. Alcohol intoxication among Dutch adolescents: acute medical complications in the years 2000-2010. Clin Pediatr (Phila) 2011; 50:244-51. [PMID: 21138855 DOI: 10.1177/0009922810388509] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate acute medical complications of alcohol intoxication among adolescents presenting to Reinier de Graaf Hospital, a major nonacademic hospital in Delft, the Netherlands. METHODS The frequency of reduced consciousness, hypothermia, electrolyte disturbances, hypoglycemia, and acidosis along with alcohol intoxication was retrospectively studied in the medical records of patients aged 11 to 17 years admitted between January 1, 2000, and April 30, 2010. RESULTS Reduced consciousness (45%) and hypothermia (43.1%) were the most common clinical findings. More boys than girls experienced hypothermia (P = .028), probably because of the higher blood alcohol concentration level ( P = .026), which was associated with lower temperature (Pearson's r = -.37; P < .001). The most frequent electrolyte disturbance was hyperchloremia (31.1%), followed by low bicarbonate (22%), hypokalemia (11.9%), and hypernatremia (7.7%). Strikingly, none of the patients in this study suffered hypoglycemia. On the contrary, 13.6% of the patients were slightly hyperglycemic. Mild acidosis, both metabolic and respiratory, was observed among 28.8% of the patients, although the metabolic component predominated. CONCLUSIONS Acute medical complications because of alcohol intoxication appeared to be mild, and most remarkably none of the patients experienced hypoglycemia.
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Affiliation(s)
- Selma H Bouthoorn
- Department of Pediatrics, Reinier de Graaf Hospital, Delft, Netherlands.
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Hemispherectomy-associated complications from the Kids’ Inpatient Database. Epilepsy Res 2009; 87:47-53. [DOI: 10.1016/j.eplepsyres.2009.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2008] [Revised: 07/16/2009] [Accepted: 07/24/2009] [Indexed: 10/20/2022]
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Chisolm DJ, Mulatu MS, Brown JR. Racial/ethnic disparities in the patterns of co-occurring mental health problems in adolescents in substance abuse treatment. J Subst Abuse Treat 2009; 37:203-10. [DOI: 10.1016/j.jsat.2008.11.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Revised: 10/01/2008] [Accepted: 11/25/2008] [Indexed: 11/29/2022]
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Lallemont T, Mastroianni A, Wickizer TM. Decision-making authority and substance abuse treatment for adolescents: a survey of state laws. J Adolesc Health 2009; 44:323-34. [PMID: 19306790 DOI: 10.1016/j.jadohealth.2008.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2008] [Revised: 11/14/2008] [Accepted: 11/19/2008] [Indexed: 11/27/2022]
Abstract
PURPOSE State laws concerning decision-making authority for voluntary inpatient substance abuse (SA) treatment of minors may be a potential barrier to appropriate treatment. We sought to identify and classify relevant laws related to the provision of voluntary inpatient SA treatment to adolescents 12 to 17 years (minors) as an exploratory assessment to improve understanding of how these laws might affect treatment decisions. METHODS In summer 2006, we conducted a survey of statutes, regulations, and legal cases in the 50 states and the District of Columbia regarding the authority of parents (or guardians) and minors to make treatment decisions for voluntary inpatient SA treatment. RESULTS All 50 states have laws applicable to voluntary inpatient SA treatment for adolescents, and the laws vary significantly throughout the nation. If a minor and parent disagree about SA treatment, some states defer to the decision-making authority of the minor, whereas other states defer to the parent. Most significantly, the majority of states fail to specify whether the minor's or the parent's decision will control in the event of a conflict. CONCLUSIONS The lack of clarity in state laws regarding decision-making authority for voluntary inpatient SA treatment of minors may create a potential barrier to treatment for adolescents, especially those with more serious SA problems. This lack of clarity could lead to confusion among parents, adolescents, healthcare professionals, and treatment facilities, and ultimately could result in a failure to treat adolescents in need of medical attention. Policymakers should ensure that state laws clearly specify procedures to enable treatment if a conflict arises between adolescents and parents, including procedures to ensure that the due process rights of adolescents are protected.
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Affiliation(s)
- Tori Lallemont
- Department of Health Services, University of Washington, Seattle, WA 98195-7660, USA
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