The consequences of chronic cannabis smoking in vulnerable adolescents.

Cannabis, like the mythic shape-shifter, presents in various guises, morphing with the perspective and context of the observer. Arguments about cannabis are confused by a myriad of debates-medical, social, ethical and political-as if a single conceptual umbrella can capture the variety and granularity of marijuana-related issues. This paper responds to marijuana use as it is commonly practised by youth in Australia. It has little to say about synthetic cannabinoids, specific medicinal cannabinoids, or medicinal properties of marijuana. We address those adolescents genetically and environmentally vulnerable to mental illness, with specific emphasis on indigenous and neurodevelopmentally impaired young people who show patterns of usage and response very different to adults and more resilient members of the population. Specifically, the practice of mixing tobacco with marijuana by aboriginal youth, and the resultant coalition of dependencies, will likely presage a rise in pulmonary and central nervous system pathology over the coming decades. Aboriginal youth begin using earlier, persist longer, and take greater quantities of cannabis than non-indigenous youth. This paper recommends practical interventions to reduce the multiple health consequences of chronic cannabis use in young people, especially indigenous young people.

Addressing adolescent substance use in a paediatric health-care setting.

AIM: The aim of this study is to review the operation of a specialist adolescent drug and alcohol consultation liaison service in a tertiary paediatric hospital. METHOD: A retrospective review of patient records was conducted to identify patient characteristics and assess service utilisation. RESULTS: Two hundred adolescents were referred over 4 years. Most presented during mid-adolescence (14-16 years). Alcohol, cannabis and nicotine were the most frequently reported substances, and almost half of referrals involved polysubstance use. Mental health diagnoses and behavioural problems were commonly reported. Almost two-thirds (63.5%) attended an appointment for drug and alcohol assessment and intervention (n = 92) or were referred to appropriate services (n = 35). Adolescents more likely to engage and attend an appointment with the specialist adolescent addiction medicine service included those with amphetamine use, polysubstance use, chronic illness, any mental health diagnosis and mood disorder. Indigenous Australians and those with a history of aggression were more difficult to engage. CONCLUSIONS: Adolescents present to paediatric health settings with drug- and alcohol-related issues, including associated harms. These comprise, but are not limited to, physical and sexual assault, family conflict, mood and behavioural concerns (including psychosis), and forensic issues. Early intervention aims to reduce long-term risks such as dependence in adulthood. Specialist adolescent drug and alcohol services may assist in identifying and engaging these high-risk and often complex young people in developmentally appropriate treatment.

Alcohol, drugs and Australian young people.

Experimentation with alcohol and other drugs is often seen as a normal part of adolescent development. The harm associated with substance misuse in young people include injury, violent behaviour, sexual risk taking, drink-driving, overdose, toxicity and death (1-4). Australian young people are drinking alcohol and using illicit substances at an earlier age than previous cohorts (5). hey are more likely to binge drink, have poly-substance use and are at risk of co-morbid mental health problems (1-3). The reasons young people use drugs are complex and varied. An effective response to illicit drug use by young people has to be holistic, as complex and varied as the needs it addresses. It must seek to prevent minimize and manage harm caused by drug use and must be provided to and involve young people in the context of their family, peer group, school and community. Reaching out to young people with drug and alcohol problems is everyone's responsibility. Australia has developed specific prevention and early intervention programs for young people at risk of substance abuse however, further research and development is still needed for effective prevention, early intervention and treatment programs.

Refugee youth--immunisation status and GP attendance.

BACKGROUND: We describe reported immunisation status and primary health care utilisation in refugee and migrant young people in western Sydney, New South Wales. METHOD: Students attending an Intensive English Centre (IEC) high school in western Sydney were surveyed for self reported general health, immunisation status of hepatitis B and measles, mumps and rubella and attendance at general practice following arrival in Australia. RESULTS: Of 165 respondents, 68 (41%) had a named general practitioner and 66 (40%) reported seeing a doctor in Australia. Students who had not seen a doctor in Australia were significantly more likely to request immunisation. DISCUSSION: Refugee and migrant young people are likely to have a poor utilisation of primary health care relative to their needs. Most who had seen a GP in Australia required catch up immunisation. Stronger links and increased GP education about the requirements of these young people are needed to improve immunisation status and GP utilisation in this high risk group.

Do paediatricians provide brief intervention for adolescents who smoke?

AIMS: This study aimed to describe the self-reported practice of paediatricians in brief interventions for adolescents who smoke. We also aimed to compare practice with confidence, skills and knowledge of brief intervention and nicotine replacement therapy after a targeted training programme. METHODS: Medical staff at The Children's Hospital at Westmead completed a questionnaire of clinical practice and confidence in brief intervention for smoking cessation. Data were analysed comparing self-reported practice with confidence, skill and knowledge of brief interventions, based on Fiore's 5A's approach (Ask about smoking at every opportunity, Assess willingness to quit, Advise patients to quit smoking, Assist quit attempts and Arrange follow up). RESULTS: Fifty-seven clinicians completed questionnaires, 55 (96%) recognised the importance of asking adolescents about smoking. Thirty-one (54%) identified adolescent smokers all or most of the time, increasing to 50 (88%) if their presenting condition was associated with smoking. Twenty-five (44%) clinicians assessed the stage of change, 33 (58%) advised the adolescent to quit smoking, nine (16%) assisted quit attempts and 10 (17.5%) arranged follow up. Clinicians more confident in brief intervention skills, motivational interviewing and relapse prevention were more likely to use the 5A's (P<0.05). Training increased clinician's confidence in brief intervention skills and knowledge of nicotine replacement therapy (P<0.01); however, there was no statistically significant change in clinical practice 1 month post training. CONCLUSION: Training paediatricians in brief intervention skills, motivational interviewing and relapse prevention can increase the use of 5A's brief intervention in clinical practice, potentially increasing quit attempts in adolescents who smoke.

Immunisation of refugee and migrant young people: can schools do the job?

OBJECTIVES: To assess immunisation needs, primary health care (PHC) use and trial a school-based immunisation service for refugee and migrant young people attending an Intensive English Centre (IEC) high school in Western Sydney. METHODS: We surveyed students attending an IEC in Western Sydney, assessing self-reported immunisation status and use of PHC services via questionnaires translated in six languages. Those students who were not immunised for hepatitis B and measles-mumps-rubella (MMR) were provided the first and second dose of a three-dose hepatitis B immunisation schedule and a single dose of MMR vaccine. We compared the immunisation requirements for MMR and hepatitis B with utilisation of PHC. RESULTS: One-hundred and sixty-five students (85%) returned the questionnaire. Forty-nine students (30%) reported previous immunisation with MMR and 29 (18%) with hepatitis B. As part of the school immunisation program, 142 (74%) received MMR vaccine, 151 (78%) received the first dose of hepatitis B vaccine, 144 (95%) received the second dose of hepatitis B, and 34 (23%) received the third hepatitis B dose elsewhere. Sixty-six students (40%) reported seeing a doctor in the past year. Students who had not seen a doctor in the previous year were significantly more likely to request immunisation (p < 0.01). CONCLUSIONS AND IMPLICATIONS: Refugee and migrant young people attending an IEC in Western Sydney report low immunisation rates. Our study highlights the urgent need for education and health to work together to provide specialised immunisation services for refugee and migrant young people.

Influenza A associated morbidity and mortality in a Paediatric Intensive Care Unit.

This paper reports the clinical features and outcome of all children with a laboratory proven diagnosis of influenza A virus infection admitted to a major Paediatric Intensive Care Unit (PICU) in 2003. Eight of the 22 patients with influenza A virus infection (A/Fujian/411/2002-like type) presented with encephalopathy and three of the 22 patients died. This can be compared with 44 admissions and seven (16%) deaths of patients with influenza virus admitted in the same PICU in the preceding 15 years. In the present cohort, four (18%) of the 22 patients, including one child who died, should have received influenza vaccine according to the current Australian immunisation recommendations. We have no documented evidence that any of the 22 children received influenza vaccination. During the 2003 influenza season there was an increased number of children admitted to our PICU with influenza A infection and an increased number of deaths compared with previous years. Influenza infection causes significant morbidity and mortality in young children, most of whom are not currently recommended for annual influenza vaccination.