Policy Statement-Alcohol Use by Youth and Adolescents: A Pediatric Concern
Pediatrics (Impact Factor: 5.47). 05/2010; 125(5):1078-1087. DOI: 10.1542/peds.2010-0438
Alcohol use continues to be a major problem from preadolescence through young adulthood in the United States. Results of recent neuroscience research have substantiated the deleterious effects of alcohol on adolescent brain development and added even more evidence to support the call to prevent and reduce underaged drinking. Pediatricians should be knowledgeable about substance abuse to be able to recognize risk factors for alcohol and other substance abuse among youth, screen for use, provide appropriate brief interventions, and refer to treatment. The integration of alcohol use prevention programs in the community and our educational system from elementary school through college should be promoted by pediatricians and the health care community. Promotion of media responsibility to connect alcohol consumption with realistic consequences should be supported by pediatricians. Additional research into the prevention, screening and identification, brief intervention, and management and treatment of alcohol and other substance use by adolescents continues to be needed to improve evidence-based practices. Pediatrics 2010; 125: 1078-1087
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ABSTRACT: To determine whether a brief individual motivational interview (IMI) plus a family motivational interview (Family Check-Up [FCU]) would reduce alcohol use in adolescents treated in an emergency department after an alcohol-related event more effectively than would an IMI only. Two-group randomized design with 3 follow-up time points. An urban regional level I trauma center. Adolescents aged 13 to 17 years (N = 125) with a positive blood alcohol concentration as tested using blood, breath, or saliva. Either IMI or IMI plus FCU. Drinking frequency (days per month), quantity (drinks per occasion), and frequency of high-volume drinking (≥5 drinks per occasion). Both conditions resulted in a reduction in all drinking outcomes at all follow-up points (P < .001 for all), with the strongest effects at 3 and 6 months. Adding the FCU to the IMI resulted in a somewhat better outcome than did the IMI only on high-volume drinking days at 3-month follow-up (14.6% vs 32.1%, P = .048; odds ratio, 2.76; 95% confidence interval, 0.99-7.75). Motivational interventions have a positive effect on drinking outcomes in the short term after an alcohol-related emergency department visit. Adding the FCU to an IMI resulted in somewhat better effects on high-volume drinking at short-term follow-up than did an IMI only. The cost of extra sessions necessary to complete the FCU should be weighed against the potential benefit of reducing high-volume drinking when considering adding the FCU to an IMI for this population.
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ABSTRACT: To examine the association between use of alcohol and cigarettes among adolescents and their early socioeconomic background. Members of a longitudinal birth cohort (Avon Longitudinal Study of Parents and Children [ALSPAC], United Kingdom) were invited to attend a personal interview. A total of 5837 children aged 13 years were asked about previous consumption of alcohol and tobacco. Information on parental socioeconomic position, collected from questionnaires from the mother, included both social class and education of the expectant mother and her partner and average household disposable income in early preschool childhood. The impact of missing data was assessed by multiple imputation. Consuming a drink of alcohol in the previous 6 months was linearly associated with higher income levels even when adjusting for other socioeconomic indicators. In contrast, both the risk of binge drinking and recent drinking was lower for children whose mothers had a higher educational level. Smoking tobacco was associated with lower socioeconomic position irrespective of the indicator used. Analyses after imputation of missing data confirmed these associations. Alcohol drinking was more common in young people from higher-income households but less common with higher levels of maternal education. A consistent inverse socioeconomic gradient with tobacco smoking was apparent. These results may reflect how different aspects of socioeconomic position can influence health behavior in opposing directions. Higher income may increase the availability of alcohol in the family, whereas mothers with higher educational attainment might encourage more healthy behaviors in their children, including reduced alcohol use.
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ABSTRACT: Alcohol and other drug (AOD) misuse by youth is a significant public health concern. Unanticipated treatment for AOD-related morbidities is often sought in hospital emergency departments (EDs). Screening instruments that rapidly identify patients who require further diagnostic evaluation and/or brief intervention are critically important. To summarize evidence on screening instruments that can assist emergency care clinicians in identifying AOD misuse in pediatric patients. Fourteen electronic databases (including Medline, Embase, and PsycINFO) and reference screening were used. Psychometric and prospective diagnostic studies were selected if the instrument focused on detecting AOD misuse in patients aged 21 years or younger in the ED. Two reviewers independently assessed quality and extracted data. Validity and reliability data were collected for psychometric studies. Instrument performance was assessed by using sensitivity, specificity, and positive (LR(+)) and negative (LR(-)) likelihood ratios. Meta-analysis was not possible because of clinical and measurement heterogeneity. Of the 1545 references initially identified, 6 studies met inclusion criteria; these studies evaluated 11 instruments for universal or targeted screening of alcohol misuse. Instruments based on diagnostic criteria for AOD disorders were effective in detecting alcohol abuse and dependence (sensitivity: 0.88; specificity: 0.90; LR(+): 8.80) and cannabis use disorder (sensitivity: 0.96; specificity: 0.86; LR(+): 6.83). On the basis of the current evidence, we recommend that emergency care clinicians use a 2-question instrument for detecting youth alcohol misuse and a 1-question instrument for detecting cannabis misuse. Additional research is required to definitively answer whether these tools should be used as targeted or universal screening approaches in the ED.
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