Suicide and Suicide Risk in Adolescents.

Suicide is the second leading cause of death for 10- to 24-year-olds in the United States and is a global public health issue, with a recent declaration of a National State of Emergency in Children's Mental Health by the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, and Children's Hospital Association. This clinical report is an update to the previous American Academy of Pediatrics clinical report, "Suicide and Suicide Attempts in Adolescents." Because pediatricians and pediatric health care providers are at the front line of care for adolescents amid a child and adolescent mental health crisis, and because of the chronic and severe shortage of mental health specialists, it is important that pediatric health care providers become facile with recognizing risk factors associated with suicidality and at-risk populations, screening and further assessment of suicidality as indicated, and evidence-based interventions for patients with suicidal ideation and associated behaviors. Suicide risk can be mitigated by appropriate screening, bolstering of protective factors, indicated treatment, community resources, and referrals to mental health providers when available.

What Parents Are Missing: Parental Knowledge of Adult-Use Cannabis Legislation and Health Effects, and Communication with Adolescents.

Background: The cannabis regulation landscape is ever evolving, and it may be difficult for parents to stay up to date. This study aimed to assess parental knowledge of recent cannabis legislation and cannabis health effects, as well as communication around cannabis use. Materials and Methods: Data were collected through the 2020 Voices of Child Health in Chicago Parent Panel Survey. Parents were asked about the veracity of statements on cannabis legislation and health effects, and about communication with their children. Descriptive statistics were calculated to characterize response frequencies. Rao-Scott chi-square test explored differences in the proportion of parents who answered all questions correctly or got at least one question wrong. Results: 75% and 74% of parents answered at least one legislation or health items incorrectly, respectively. Most parents reported talking to their children about legislation (56%), not using cannabis (75%) and rules around drug use (90%). Conclusions: While parents reported communicating with their children about cannabis, the majority had gaps in their knowledge. The results of this study indicate a need for effective cannabis education interventions.

Urine Drug Testing in Adolescents: Common Questions and Uses.

Identifying adolescent substance use can be complicated, as symptoms can be nonspecific and testing can be difficult to obtain and interpret appropriately. Familiarity with consent and confidentiality issues surrounding urine drug testing is important when discussing testing with adolescents and families. Understanding the pros and cons of testing can help pediatricians decide when and how to obtain urine drug screening as well as inform result interpretation. Being aware of home drug testing concerns and having a basic knowledge of fentanyl test strips can assist pediatricians in guiding families and their adolescents. [Pediatr Ann. 2023;52(5):e166-e169.].

Adolescents' Awareness of E-Cigarette or Vaping Product Use-Associated Lung Injury (EVALI) and E-Cigarette Use Impact on Health.

PURPOSE: The purposes of this study were to: (1) examine adolescents' knowledge regarding e-cigarettes and e-cigarette or vaping product use-associated lung injury (EVALI), and (2) describe common misconceptions regarding e-cigarette use. METHODS: Adolescents aged 13 to 19 years were recruited in pediatric dental clinics and completed a survey questionnaire regarding their knowledge of e-cigarettes. RESULTS: A total of 66 adolescents participated. Forty-seven adolescents indicated knowledge of e-cigarettes. Forty adolescents recognized that most e-cigarettes contain nicotine, and 49 adolescents reported knowledge of EVALI cases. Adolescents had knowledge of possible lung damage from e-cigarette use. Adolescents also had misconceptions about e-cigarettes containing nicotine and them being less addictive than other tobacco products. CONCLUSIONS: Adolescents were aware of e-cigarette or vaping product use-associated lung injury cases, and the majority of them viewed e-cigarette use as harmful to their health. However, some adolescents had misconceptions regarding the safety of e-cigarette use. Oral health providers should recognize that they play an important role in identifying risky behaviors amongst adolescents, incorporate adolescent-specific risk assessments into their clinical practice, and be comfortable providing anticipatory guidance about e-cigarette and nicotine use.

E-cigarette disparities: Who are the targets?

The tobacco industry has a long history of promoting health disparities especially through targeted marketing campaigns. The disparities perpetuated by e-cigarettes are just becoming apparent. This article will focus on disparities in e-cigarette usage within the following categories of youth: racial or ethnic groups, sexual and gender minoritized individuals, adolescents with asthma, teens with disabilities, and those coping with mental health stresses. Millions of youth are still using e-cigarettes, and e-cigarette use is disproportionately impacting White youth, youth who identify at lesbian, gay and transgender, and youth with disabilities. In addition, this article highlights the timeline of key tobacco regulations and recommended actions to curb the e-cigarette epidemic.

Association between prescribed opioid use for acute pain in adolescents and the subsequent development of opioid misuse and substance use disorders: a systematic review protocol.

OBJECTIVE: This review aims to examine prescribed short-term opioid use in adolescents to treat acute pain. The review will analyze the influence of opioid use on future non-medical opioid use (misuse) or substance use disorders (addiction) in adolescents and young adults. INTRODUCTION: Prescription opioids are medically indicated for acute pain. Descriptive studies of administrative datasets and surveys implicate adolescent opioid exposure as a risk factor for subsequent opioid misuse and addiction. This review will provide a synthesis of the literature on the association between prescribed opioid exposure to treat acute pain in adolescents and the subsequent development of opioid misuse or substance use disorders in adolescents and young adults. INCLUSION CRITERIA: This review will consider quantitative studies on opioid misuse or substance use disorders in Canadian and US adolescents and young adults (12 to 25 years of age). Studies must include exposure during adolescence (12 to 17 years of age) to legitimately prescribed short-term opioid use to treat acute pain. Studies on chronic pain or exposure to opioids for longer duration (more than 30 doses or more than 7 days) will be excluded. METHODS: This review will follow the JBI methodology for systematic reviews of etiology and risk. Published and unpublished studies will be sourced from multiple databases and resources. Two independent reviewers will screen, appraise, and extract data from studies that meet the inclusion criteria. Data synthesis will be conducted and a Summary of Findings will be presented. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020179635.

Cannabinoids and the Adolescent Patient: A Pragmatic Guide for Pediatric Practitioners.

Primary care and emergency medicine practitioners frequently care for adolescents with acute or chronic effects of cannabinoids. Cannabinoid epidemiology and pharmacology are changing as new laws and regulations, new products, and new means of delivery are rapidly developed. A grasp of basic cannabinoid terminology, which is also constantly shifting, helps clinicians obtain histories and discuss diagnoses, treatments, and outcomes with their patients. The ability to identify and treat cannabinoid-associated illnesses such as cannabinoid hyperemesis syndrome, withdrawal syndrome, and acute intoxication with synthetic cannabinoids can reduce morbidity. Research on neurodevelopmental, cognitive, and psychological effects of adolescent cannabinoid use helps clinicians to have informed conversations with their patients, while providing anticipatory guidance. This article is designed with busy clinicians in mind and highlights the practical information necessary to provide care to their adolescent patients. [Pediatr Ann. 2021;50(2):e57-e64.

A chart review of substance use screening and related documentation among adolescents in outpatient pediatric clinics: implications for practice.

BACKGROUND: Despite recent reductions, youth substance use continues to be a concern in the United States. Structured primary care substance use screening among adolescents is recommended, but not widely implemented. The purpose of this study was to describe the distribution and characteristics of adolescent substance use screening in outpatient clinics in a large academic medical center and assess related factors (i.e., patient age, race/ethnicity, gender, and insurance type) to inform and improve the quality of substance use screening in practice. METHODS: We abstracted a random sample of 127 records of patients aged 12-17 and coded clinical notes (e.g., converted open-ended notes to discrete values) to describe screening cases and related characteristics (e.g., which substances screened, how screened). We then analyzed descriptive patterns within the data to calculate screening rates, characteristics of screening, and used multiple logistic regression to identify related factors. RESULTS: Among 127 records, rates of screening by providers were 72% (each) for common substances (alcohol, marijuana, tobacco). The primary method of screening was use of clinical mnemonic cues rather than standardized screening tools. A total of 6% of patients reported substance use during screening. Older age and racial/ethnic minority status were associated with provider screening in multiple logistic regression models. CONCLUSIONS: Despite recommendations, low rates of structured screening in primary care persist. Failure to use a standardized screening tool may contribute to low screening rates and biased screening. These findings may be used to inform implementation of standardized and structured screening in the clinical environment. CLINICAL TRIAL REGISTRATION: not applicable.

Cobalamin C deficiency in an adolescent with altered mental status and anorexia.

Although cobalamin (cbl) C deficiency is the most common inherited disorder of vitamin B12 metabolism, the late-onset form of the disease can be difficult to recognize because it has a broad phenotypic spectrum. In this report, we describe an adolescent female exposed to unknown illicit substances and sexual abuse who presented with psychosis, anorexia, seizures, and ataxia. The patient's diagnosis was delayed until a metabolic workup was initiated, revealing hyperhomocysteinemia, low normal plasma methionine, and methylmalonic aciduria. Ultimately, cblC deficiency was confirmed when molecular testing showed compound heterozygosity for mutations (c.271dupA and c.482G>A) in the MMACHC gene. This diagnosis led to appropriate treatment with hydroxocobalamin, betaine, and folate, which resulted in improvement of her clinical symptoms and laboratory values. This patient demonstrates a previously unrecognized presentation of late-onset cblC deficiency. Although neuropsychiatric symptoms are common in late-onset disease, seizures and cerebellar involvement are not. Furthermore, anorexia has not been previously described in these patients. This case emphasizes that inborn errors of metabolism should be part of the differential diagnosis for a teenager presenting with altered mental status, especially when the diagnosis is challenging or neurologic symptoms are unexplained. Correct diagnosis of this condition is important because treatment is available and can result in clinical improvement.(1.)