Vaping: Impact of Improving Screening Questioning in Adolescent Population: A Quality Improvement Initiative.

The use of Electronic Nicotine Delivery Systems (ENDS) increased dramatically over the past decade, making them the most common tobacco product used among youth. While physicians often screen for the use of tobacco, very few screen for vaping product usage. This quality improvement project aimed to increase the screening rate of ENDS use among adolescents to 85% to match the Healthy People 2020 screening target of 83.3% for smoking. METHOD: We collected data from weekly chart reviews of all adolescent visits with a primary care provider by using keywords such as "vapor," "e-cigs," and "vaping" to document screening for ENDS use. The project consisted of 4 PDSA cycles: (1) education of the Adolescent Clinic staff about screening; (2) the addition of the specific question for e-cigarette use in the facility's Electronic Health Record; (3) house staff lecture about the importance of screening; and (4) reinforcement about screening to adolescent physicians. RESULTS: The percentage of screening for traditional tobacco use was consistently higher than ENDS use in all months. ENDS use assessment increased since the first intervention, going from 0% at baseline to 90% at the end. The addition of a specific question for ENDS use in EPIC was the most significant intervention and increased the screening percentage to 78%. CONCLUSIONS: To adequately assess for the use of ENDS, the nonspecific question, "do you smoke?" is not sufficient. A direct approach is necessary. A specific question in the EHR is the most significant way to increase screening for ENDS use.

Prevalence and risk factors of polycystic ovarian syndrome among an ethnically diverse overweight/obese adolescent population.

BACKGROUND: More remains to be known about polycystic ovary syndrome (PCOS) among overweight/obese adolescents across different ethnicities especially in regards to mental illness as an associated comorbidity. OBJECTIVE: To determine the prevalence of PCOS among overweight and obese adolescents and to evaluate known risk factors for PCOS in a diverse population. METHODS: Charts of patients at an Adolescent Clinic between April 1, 2016 and July 30, 2018 were filtered using: obese, overweight and body mass index (BMI) >85%. Charts were reviewed to identify the presence of PCOS using National Institutes of Health (NIH) criteria, race/ethnicity and known risk factors for PCOS [lipid, BMI, glycated hemoglobin (HA1c), blood pressure (BP)] and mental health conditions associated with PCOS (anxiety/depression and self-harm/suicidal ideation). RESULTS: Patients with PCOS were more likely to have elevated lipids (19.6% vs. 9.9%, p = 0.05), be obese (67.4% vs. 50.9%, p = 0.03), and have acanthosis nigricans (68.9% vs. 28.2%, p =< 0.001). PCOS was more common among non-Hispanic patients (77.9%) vs. Hispanic patients (57.8%). There was no difference in the prevalence of depression/anxiety (37% vs. 33%, respectively, p = 0.590) or self - harm/suicidal ideation (17% vs. 17%, p = 0.96) in patients with and without PCOS. In a logistic regression model, after adjusting for all demographics and clinical features, ethnicity, acanthosis nigricans and BMI were significant risk factors for PCOS. CONCLUSION: Patients with PCOS are more likely to be obese, hyperlipidemic, have acanthosis nigricans and be of non-Hispanic ethnicity. However, there was no difference in the prevalence of depression/anxiety and self-harm/suicidal ideation among adolescents with or without PCOS.

Immunizations in adolescents--an update.

The past decade has brought a series of new vaccines targeted specifically to adolescents. Recommended vaccinations for adolescents now offer protection against human papillomavirus, Neisseria meningitidis, pertussis, and influenza. As the vaccine schedule is ever changing, it is critical that health care providers be up to date and implement current recommendations. In this article, we discuss the major vaccines targeted at adolescents, issues unique to vaccinating adolescents, and strategies for increasing vaccine coverage rates. Forming partnerships with other health professionals, school-based clinics, and most importantly adolescents and their families is a fundamental element of any successful adolescent vaccination effort.

An exploration of the ethical, legal and developmental issues in the care of an adolescent patient.

Providers of health care to adolescent patients face numerous challenges. In addition to increased risk for many health problems, adolescent patients may bring complex ethical, legal and developmental questions to bear as they seek medical services. This article describes the case of one such adolescent patient and discusses some of the attendant issues faced by her physician. For example, providing reproductive health care to teenage patients without the knowledge of parents or guardians requires familiarity on the part of providers with relevant state and federal law. Additionally, providers must be aware of financial barriers and they need to acquaint themselves with available services such as New York State's Family Planning Benefit Program. Attention to their patients' stages of cognitive and emotional development should inform providers' advice to adolescents, and an understanding of the importance that supportive adult relationships play during adolescence is essential to fostering healthy development. Open communication between adolescent patients and their parents or guardians should be encouraged, while maintaining the primary obligation of providing confidential care.