27 results on '"Kennedy, Sara M."'
Search Results
2. Pharmacotherapy for Alcohol Use Disorder: A Systematic Review and Meta-Analysis.
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McPheeters, Melissa, O'Connor, Elizabeth A., Riley, Sean, Kennedy, Sara M., Voisin, Christiane, Kuznacic, Kaitlin, Coffey, Cory P., Edlund, Mark D., Bobashev, Georgiy, and Jonas, Daniel E.
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ALCOHOLISM ,TRAFFIC accidents ,ALCOHOL drinking ,DRUG therapy ,CINAHL database - Abstract
Key Points: Question: Which pharmacotherapies are associated with improved outcomes for people with alcohol use disorder? Findings: In this systematic review and meta-analysis that included 118 clinical trials and 20 976 participants, 50 mg/d of oral naltrexone and acamprosate were each associated with significantly improved alcohol consumption-related outcomes compared with placebo. Meaning: These findings support oral naltrexone at 50 mg/d and acamprosate as first-line therapies for alcohol use disorder. Importance: Alcohol use disorder affects more than 28.3 million people in the United States and is associated with increased rates of morbidity and mortality. Objective: To compare efficacy and comparative efficacy of therapies for alcohol use disorder. Data Sources: PubMed, the Cochrane Library, the Cochrane Central Trials Registry, PsycINFO, CINAHL, and EMBASE were searched from November 2012 to September 9, 2022 Literature was subsequently systematically monitored to identify relevant articles up to August 14, 2023, and the PubMed search was updated on August 14, 2023. Study Selection: For efficacy outcomes, randomized clinical trials of at least 12 weeks' duration were included. For adverse effects, randomized clinical trials and prospective cohort studies that compared drug therapies and reported health outcomes or harms were included. Data Extraction and Synthesis: Two reviewers evaluated each study, assessed risk of bias, and graded strength of evidence. Meta-analyses used random-effects models. Numbers needed to treat were calculated for medications with at least moderate strength of evidence for benefit. Main Outcomes and Measures: The primary outcome was alcohol consumption. Secondary outcomes were motor vehicle crashes, injuries, quality of life, function, mortality, and harms. Results: Data from 118 clinical trials and 20 976 participants were included. The numbers needed to treat to prevent 1 person from returning to any drinking were 11 (95% CI, 1-32) for acamprosate and 18 (95% CI, 4-32) for oral naltrexone at a dose of 50 mg/d. Compared with placebo, oral naltrexone (50 mg/d) was associated with lower rates of return to heavy drinking, with a number needed to treat of 11 (95% CI, 5-41). Injectable naltrexone was associated with fewer drinking days over the 30-day treatment period (weighted mean difference, −4.99 days; 95% CI, −9.49 to −0.49 days) Adverse effects included higher gastrointestinal distress for acamprosate (diarrhea: risk ratio, 1.58; 95% CI, 1.27-1.97) and naltrexone (nausea: risk ratio, 1.73; 95% CI, 1.51-1.98; vomiting: risk ratio, 1.53; 95% CI, 1.23-1.91) compared with placebo. Conclusions and Relevance: In conjunction with psychosocial interventions, these findings support the use of oral naltrexone at 50 mg/d and acamprosate as first-line pharmacotherapies for alcohol use disorder. This systematic review and meta-analysis evaluates efficacy and comparative efficacy of 9 therapies for alcohol use disorder (AUD). [ABSTRACT FROM AUTHOR]
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- 2023
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3. Not Just Cigarettes : A More Comprehensive Look at Marijuana and Tobacco Use Among African American and White Youth and Young Adults
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Kennedy, Sara M., Caraballo, Ralph S., Rolle, Italia V., and Rock, Valerie J.
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- 2016
4. National Surveys and Tobacco Use Among African Americans : A Review of Critical Factors
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Rolle, Italia V., Beasley, Derrick D., Kennedy, Sara M., Rock, Valerie J., and Neff, Linda
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- 2016
5. Tobacco and Marijuana Initiation Among African American and White Young Adults
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Kennedy, Sara M., Patel, Roshni P., Cheh, Paul, Hsia, Jason, and Rolle, Italia V.
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- 2016
6. Cigarette Smoking Among Inmates by Race/Ethnicity : Impact of Excluding African American Young Adult Men From National Prevalence Estimates
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Kennedy, Sara M., Sharapova, Saida R., Beasley, Derrick D., and Hsia, Jason
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- 2016
7. Interventions to prevent iatrogenic anemia: a Laboratory Medicine Best Practices systematic review
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Whitehead, Nedra S., Williams, Laurina O., Meleth, Sreelatha, Kennedy, Sara M., Ubaka-Blackmoore, Nneka, Geaghan, Sharon M., Nichols, James H., Carroll, Patrick, McEvoy, Michael T., Gayken, Julie, Ernst, Dennis J., Litwin, Christine, Epner, Paul, Taylor, Jennifer, and Graber, Mark L.
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- 2019
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8. Cigarette, Cigar, and Marijuana Use Among High School Students — United States, 1997–2013
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Rolle, Italia V., Kennedy, Sara M., Agaku, Israel, Jones, Sherry Everett, Bunnell, Rebecca, Caraballo, Ralph, Xu, Xin, Schauer, Gillian, and McAfee, Tim
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- 2015
9. Smoke-Free Policies in U.S. Prisons and Jails : A Review of the Literature
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Kennedy, Sara M., Davis, Shane P., and Thorne, Stacy L.
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- 2015
10. Clinical interventions to reduce secondhand smoke exposure among pregnant women: a systematic review
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Tong, Van T, Dietz, Patricia M, Rolle, Italia V, Kennedy, Sara M, Thomas, William, and England, Lucinda J
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- 2015
11. Tobacco Use Among Middle and High School Students — United States, 2013
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Arrazola, René A., Neff, Linda J., Kennedy, Sara M., Holder-Hayes, Enver, and Jones, Christopher D.
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- 2014
12. Screening for Depression and Suicide Risk in Children and Adolescents: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.
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Viswanathan, Meera, Wallace, Ina F., Cook Middleton, Jennifer, Kennedy, Sara M., McKeeman, Joni, Hudson, Kesha, Rains, Caroline, Vander Schaaf, Emily B., and Kahwati, Leila
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DIAGNOSIS of mental depression ,RESEARCH ,SUICIDE prevention ,RESEARCH methodology ,SYSTEMATIC reviews ,MEDICAL screening ,EVALUATION research ,PREVENTIVE health services ,COMPARATIVE studies ,MENTAL depression ,POLICY sciences - Abstract
Importance: Depression, suicidal ideation, and self-harm behaviors in youth are associated with functional impairment and suicide.Objective: To review the evidence on screening for depression or suicide risk in children and adolescents to inform the US Preventive Services Task Force (USPSTF).Data Sources: PubMed, Cochrane Library, PsycINFO, CINAHL, and trial registries through July 19, 2021; references, experts, and surveillance through June 1, 2022.Study Selection: English-language, randomized clinical trials (RCTs) of screening for depression or suicide risk; diagnostic test accuracy studies; RCTs of psychotherapy and first-line pharmacotherapy; RCTs, observational studies, and systematic reviews reporting harms.Data Extraction and Synthesis: Two reviewers assessed titles/abstracts, full-text articles, and study quality and extracted data; when at least 3 similar studies were available, meta-analyses were conducted.Main Outcomes and Measures: Test accuracy, symptoms, response, remission, loss of diagnosis, mortality, functioning, suicide-related events, and adverse events.Results: Twenty-one studies (N = 5433) were included for depression and 19 studies (N = 6290) for suicide risk. For depression, no studies reported on the direct effects of screening on health outcomes, and 7 studies (n = 3281) reported sensitivity of screening instruments ranging from 0.59 to 0.94 and specificity from 0.38 to 0.96. Depression treatment with psychotherapy was associated with improved symptoms (Beck Depression Inventory pooled standardized mean difference, -0.58 [95% CI, -0.83 to -0.34]; n = 471; 4 studies; and Hamilton Depression Scale pooled mean difference, -2.25 [95% CI, -4.09 to -0.41]; n = 262; 3 studies) clinical response (3 studies with statistically significant results using varying thresholds), and loss of diagnosis (relative risk, 1.73 [95% CI, 1.00 to 3.00; n = 395; 4 studies). Pharmacotherapy was associated with improvement on symptoms (Children's Depression Rating Scale-Revised mean difference, -3.76 [95% CI, -5.95 to -1.57; n = 793; 3 studies), remission (relative risk, 1.20 [95% CI, 1.00 to 1.45]; n = 793; 3 studies) and functioning (Children's Global Assessment Scale pooled mean difference, 2.60 (95% CI, 0.78 to 4.42; n = 793; 3 studies). Other outcomes were not statistically significantly different. Differences in suicide-related outcomes and adverse events for pharmacotherapy when compared with placebo were not statistically significant. For suicide risk, no studies reported on the direct benefits of screening on health outcomes, and 2 RCTs (n = 2675) reported no harms of screening. One study (n = 581) reported on sensitivity of screening, ranging from 0.87 to 0.91; specificity was 0.60. Sixteen RCTs (n = 3034) reported on suicide risk interventions. Interventions were associated with lower scores for the Beck Hopelessness Scale (pooled mean difference, -2.35 [95% CI, -4.06 to -0.65]; n = 644; 4 RCTs). Findings for other suicide-related outcomes were mixed or not statistically significantly different.Conclusion and Relevance: Indirect evidence suggested that some screening instruments were reasonably accurate for detecting depression. Psychotherapy and pharmacotherapy were associated with some benefits and no statistically significant harms for depression, but the evidence was limited for suicide risk screening instruments and interventions. [ABSTRACT FROM AUTHOR]- Published
- 2022
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13. Screening for Anxiety in Children and Adolescents: Evidence Report and Systematic Review for the US Preventive Services Task Force.
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Viswanathan, Meera, Wallace, Ina F., Cook Middleton, Jennifer, Kennedy, Sara M., McKeeman, Joni, Hudson, Kesha, Rains, Caroline, Vander Schaaf, Emily B., and Kahwati, Leila
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ANXIETY disorders treatment ,RESEARCH ,RESEARCH methodology ,SYSTEMATIC reviews ,MEDICAL screening ,EVALUATION research ,COMPARATIVE studies ,ANXIETY ,POLICY sciences ,ANXIETY disorders ,SERTRALINE - Abstract
Importance: Anxiety in children and adolescents is associated with impaired functioning, educational underachievement, and future mental health conditions.Objective: To review the evidence on screening for anxiety in children and adolescents to inform the US Preventive Services Task Force.Data Sources: PubMed, Cochrane Library, PsycINFO, CINAHL, and trial registries through July 19, 2021; references, experts, and surveillance through June 1, 2022.Study Selection: English-language, randomized clinical trials (RCTs) of screening; diagnostic test accuracy studies; RCTs of cognitive behavioral therapy (CBT) or US Food and Drug Administration-approved pharmacotherapy; RCTs, observational studies, and systematic reviews reporting harms.Data Extraction and Synthesis: Two reviewers assessed titles/abstracts, full-text articles, and study quality and extracted data; when at least 3 similar studies were available, meta-analyses were conducted.Main Outcomes and Measures: Test accuracy, symptoms, response, remission, loss of diagnosis, all-cause mortality, functioning, suicide-related symptoms or events, adverse events.Results: Thirty-nine studies (N = 6065) were included. No study reported on the direct benefits or harms of screening on health outcomes. Ten studies (n = 3260) reported the sensitivity of screening instruments, ranging from 0.34 to 1.00, with specificity ranging from 0.47 to 0.99. Twenty-nine RCTs (n = 2805) reported on treatment: 22 on CBT, 6 on pharmacotherapy, and 1 on CBT, sertraline, and CBT plus sertraline. CBT was associated with gains on several pooled measures of symptom improvement (magnitude of change varied by outcome measure), response (pooled relative risk [RR], 1.89 [95% CI, 1.17 to 3.05]; n = 606; 6 studies), remission (RR, 2.68 [95% CI, 1.48 to 4.88]; n = 321; 4 studies), and loss of diagnosis (RR range, 3.02-3.09) when compared with usual care or wait-list controls. The evidence on functioning for CBT was mixed. Pharmacotherapy, when compared with placebo, was associated with gains on 2 pooled measures of symptom improvement-mean difference (Pediatric Anxiety Rating Scale mean difference, -4.0 [95% CI, -5.5 to -2.5]; n = 726; 5 studies; and Clinical Global Impression-Severity scale mean difference, -0.84 [95% CI, -1.13 to -0.55]; n = 550; 4 studies) and response (RR, 2.11 [95% CI, 1.58 to 2.98]; n = 370; 5 studies)-but was mixed on measures of functioning. Eleven RCTs (n = 1293) reported harms of anxiety treatments. Suicide-related harms were rare, and the differences were not statistically significantly different.Conclusions and Relevance: Indirect evidence suggested that some screening instruments were reasonably accurate. CBT and pharmacotherapy were associated with benefits; no statistically significant association with harms was reported. [ABSTRACT FROM AUTHOR]- Published
- 2022
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14. Evaluating Intensity, Complexity, and Potential for Causal Inference in Social Needs Interventions: A Review of a Scoping Review.
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Viswanathan, Meera, Kennedy, Sara M., Sathe, Nila, Eder, Michelle L., Ng, Valerie, Kugley, Shannon, Lewis, Megan A., and Gottlieb, Laura M.
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- 2024
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15. Screening for Hypertension in Children and Adolescents: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.
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Gartlehner, Gerald, Vander Schaaf, Emily B., Orr, Colin, Kennedy, Sara M., Clark, Rachel, and Viswanathan, Meera
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CARDIOVASCULAR disease prevention ,HYPERTENSION ,ANTIHYPERTENSIVE agents ,SYSTEMATIC reviews ,MEDICAL screening ,MEDICAL protocols ,PREVENTIVE health services ,EXERCISE ,COMBINED modality therapy ,BLOOD pressure measurement - Abstract
Importance: Childhood hypertension can result in adverse outcomes during adulthood; identifying and treating primary and secondary childhood hypertension may reduce such risks.Objective: To update the evidence on screening and treatment of hypertension in childhood and adolescence for the US Preventive Services Task Force.Data Sources: PubMed, Cochrane Library, International Pharmaceutical Abstracts, EMBASE, and trial registries through September 3, 2019; bibliographies from retrieved articles, experts, and surveillance of the literature through October 6, 2020.Study Selection: Fair- or good-quality English-language studies evaluating diagnostic accuracy of blood pressure screening; cohort studies assessing the association of hypertension in childhood and adolescence with blood pressure or other intermediate outcomes in adulthood; randomized clinical trials (RCTs) or meta-analyses of pharmacological and lifestyle interventions.Data Extraction and Synthesis: Two reviewers independently assessed titles/abstracts and full-text articles, extracted data, and assessed study quality; the evidence was synthesized qualitatively.Main Outcomes and Measures: Sensitivity, specificity, and measures of association between childhood and adulthood blood pressure; reduction of childhood blood pressure; adverse effects of treatments.Results: Forty-two studies from 43 publications were included (N>12 400). No studies evaluated the benefits or harms of screening and the effect of treating childhood hypertension on outcomes in adulthood. One study reported a sensitivity of 0.82 and a specificity of 0.70 for 2 office-based blood pressure measurements. Twenty observational studies suggested a significant association between childhood hypertension and abnormal blood pressure in adulthood (odds ratios, 1.1-4.5; risk ratios, 1.45-3.60; hazard ratios, 2.8-3.2). Thirteen placebo-controlled RCTs and 1 meta-analysis assessed reductions in systolic (SBP) and diastolic blood pressure from pharmacological treatments. Pooled reductions of SBP were -4.38 mm Hg (95% CI, -7.27 to -2.16) for angiotensin-converting enzyme inhibitors and -3.07 mm Hg (95% CI, -4.99 to -1.44) for angiotensin receptor blockers. Candesartan reduced SBP by -6.56 mm Hg (P < .001; n = 240). β-Blockers, calcium channel blockers, and mineralocorticoid receptor antagonists did not achieve significant reductions over 2 to 4 weeks. SBP was significantly reduced by exercise over 8 months (-4.9 mm Hg, P ≤ .05; n = 69), by dietary approaches to stop hypertension over 3 months (-2.2 mm Hg, P < .01; n = 57), and by a combination of drug treatment and lifestyle interventions over 6 months (-7.6 mm Hg; P < .001; n = 95). Low-salt diet did not achieve reductions of blood pressure.Conclusions and Relevance: Observational studies indicate an association between hypertension in childhood and hypertension in adulthood. However, the evidence is inconclusive whether the diagnostic accuracy of blood pressure measurements is adequate for screening asymptomatic children and adolescents in primary care. [ABSTRACT FROM AUTHOR]- Published
- 2020
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16. Modes of ever marijuana use among adult tobacco users and non-tobacco users— Styles 2014.
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Singh, Tushar, Kennedy, Sara M., Sharapova, Saida S., Schauer, Gillian L., and V. Rolle, Italia
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SMOKING ,CANNABIS (Genus) ,CONFIDENCE intervals ,PROBABILITY theory ,RESEARCH funding ,TOBACCO ,SECONDARY analysis ,SOCIOECONOMIC factors ,EQUIPMENT & supplies ,ELECTRONIC cigarettes ,DATA analysis software ,DESCRIPTIVE statistics ,ODDS ratio - Abstract
Background: Tobacco and marijuana use are related behaviors; therefore, it is important to identify how users consume marijuana, and how it varies with tobacco use status. We estimated the modes of ever marijuana use among current, former, and never adult tobacco users. Methods: Weighted data were analyzed for 4181 adults from 2014Styles, an online consumer panel survey of US adults, to estimate proportions for modes of ever marijuana use. Differences in modes of ever marijuana use between categories of tobacco use status were assessed (p-value <0.05). Results: More than half of current (56.6%) and former tobacco users (50.9%) had ever used marijuana, whereas only 13.0% of never tobacco users had ever used marijuana. Among ever marijuana users, joint use was the most common mode of use among current (86.4%), former (92.5%), and never (79.8%) tobacco users. Similarly, other modes of marijuana use were significantly higher in current and former tobacco users compared to never tobacco users. Conclusions: Prevalence of all modes of ever marijuana use was higher in current and former tobacco users. These findings underscore the importance of considering the relationship between marijuana and tobacco use when developing programs and policies aimed at preventing and reducing marijuana use. [ABSTRACT FROM AUTHOR]
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- 2016
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17. Racial Health Equity and Social Needs Interventions: A Review of a Scoping Review.
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Cené, Crystal W., Viswanathan, Meera, Fichtenberg, Caroline M., Sathe, Nila A., Kennedy, Sara M., Gottlieb, Laura M., Cartier, Yuri, and Peek, Monica E.
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- 2023
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18. Clinical interventions to reduce secondhand smoke exposure among pregnant women: a systematic review.
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Van T. Tong, Dietz, Patricia M., Rolle, Italia V., Kennedy, Sara M., Thomas, William, and England, Lucinda J.
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PASSIVE smoking ,CINAHL database ,CONFIDENCE intervals ,COUNSELING ,INFORMATION storage & retrieval systems ,MEDICAL databases ,PSYCHOLOGY information storage & retrieval systems ,MEDLINE ,HEALTH outcome assessment ,PATIENT education ,PRENATAL care ,RESEARCH funding ,SYSTEMATIC reviews ,RESEARCH bias ,DESCRIPTIVE statistics ,ODDS ratio ,PREGNANCY ,PREVENTION - Abstract
Objective To conduct a systematic review of clinical interventions to reduce secondhand smoke (SHS) exposure among non-smoking pregnant women. Data sources We searched 16 databases for publications from 1990 to January 2013, with no language restrictions. Study selection Papers were included if they met the following criteria: (1) the study population included non-smoking pregnant women exposed to SHS, (2) the clinical interventions were intended to reduce SHS exposure at home, (3) the study included a control group and (4) outcomes included either reduced SHS exposure of non-smoking pregnant women at home or quit rates among smoking partners during the pregnancy of the woman. Data extraction Two coders independently reviewed each abstract or full text to identify eligible papers. Two abstractors independently coded papers based on US Preventive Services Task Force criteria for study quality (good, fair, poor), and studies without biochemically-verified outcome measures were considered poor quality. Data synthesis From 4670 papers, we identified five studies that met our inclusion criteria: four focused on reducing SHS exposure among non-smoking pregnant women, and one focused on providing cessation support for smoking partners of pregnant women. All were randomised controlled trials, and all reported positive findings. Three studies were judged poor quality because outcome measures were not biochemically-verified, and two were considered fair quality. Conclusions Clinical interventions delivered in prenatal care settings appear to reduce SHS exposure, but study weaknesses limit our ability to draw firm conclusions. More rigorous studies, using biochemical validation, are needed to identify strategies for reducing SHS exposure in pregnant women. [ABSTRACT FROM AUTHOR]
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- 2015
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19. Tobacco Use among Middle & High School Students.
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Arrazola, René A., Neff, Linda J., Kennedy, Sara M., Holder-Hayes, Enver, and Jones, Christopher D.
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- 2014
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20. Annual Healthcare Spending Attributable to Cigarette Smoking: An Update.
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Xu, Xin, Bishop, Ellen E., Kennedy, Sara M., Simpson, Sean A., and Pechacek, Terry F.
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MEDICAL care research , *SMOKING prevention , *DISEASE prevalence , *PHYSIOLOGICAL effects of tobacco , *EPIDEMICS , *MEDICAID - Abstract
Background Fifty years after the first Surgeon General’s report, tobacco use remains the nation’s leading preventable cause of death and disease, despite declines in adult cigarette smoking prevalence. Smoking-attributable healthcare spending is an important part of overall smoking-attributable costs in the U.S. Purpose To update annual smoking-attributable healthcare spending in the U.S. and provide smoking-attributable healthcare spending estimates by payer (e.g., Medicare, Medicaid, private insurance) or type of medical services. Methods Analyses used data from the 2006–2010 Medical Expenditure Panel Survey linked to the 2004–2009 National Health Interview Survey. Estimates from two-part models were combined to predict the share of annual healthcare spending that could be attributable to cigarette smoking. The analysis was conducted in 2013. Results By 2010, 8.7% (95% CI=6.8%, 11.2%) of annual healthcare spending in the U.S. could be attributed to cigarette smoking, amounting to as much as $170 billion per year. More than 60% of the attributable spending was paid by public programs, including Medicare, other federally sponsored programs, or Medicaid. Conclusions These findings indicate that comprehensive tobacco control programs and policies are still needed to continue progress toward ending the tobacco epidemic in the U.S. 50 years after the release of the first Surgeon General’s report on smoking and health. [ABSTRACT FROM AUTHOR]
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- 2015
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21. Patterns of E-cigarette Use Frequency-National Adult Tobacco Survey, 2012-2014.
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Sharapova, Saida R., Singh, Tushar, Agaku, Israel T., Kennedy, Sara M., and King, Brian A.
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ELECTRONIC cigarettes , *TOBACCO products , *ADULTS , *HEALTH surveys , *SEXUAL orientation , *SUBSTANCE abuse , *COMPARATIVE studies , *HEALTH behavior , *RESEARCH methodology , *MEDICAL cooperation , *RESEARCH , *RESEARCH funding , *SMOKING cessation , *TOBACCO , *EVALUATION research - Abstract
Introduction: Accounting for occasional or intermittent e-cigarette use has yielded higher estimates of current use among U.S. adults. However, frequency of e-cigarette use by population subgroups is not well described. This study assessed e-cigarette use frequency by sociodemographic characteristics and other tobacco product use among U.S. adults.Methods: This study analyzed combined data from the 2012-2013 (n=60,192) and 2013-2014 (n=75,233) National Adult Tobacco Survey, a telephone-based survey of U.S. adults aged ≥18 years, to assess frequency of e-cigarette use (daily, some days, rarely) by sex, age, race/ethnicity, education, annual household income, U.S. region, marital status, sexual orientation, and cigarette smoking and other tobacco product use (cigars, cigarillos, little filtered cigars; traditional pipes; water pipes; and chewing tobacco, snuff, dip, snus, and dissolvable tobacco products). Analyses took place in 2016.Results: Among current e-cigarette users, 19.3% used daily, 29.3% used some days, and 51.4% used rarely. Daily use was lowest among younger adults, Hispanics, and those who were single, never married, or not living with a partner; and greatest among non-Hispanic Asians (p<0.0001). Among current e-cigarette users, 25.3% were cigarette-only smokers, 52.8% smoked cigarettes and used other tobacco products, 5.5% used other tobacco products only, 6.5% were former cigarette-only smokers, 6.7% were former users of cigarettes and other tobacco products, 1.3% were former other tobacco product users only, and 1.8% never used cigarettes or other tobacco products.Conclusions: E-cigarette use frequency varies by sociodemographic characteristics and other tobacco use. Further surveillance, particularly related to frequency of e-cigarette use and its impact on cigarette cessation, could inform public health policy, planning, and practice. [ABSTRACT FROM AUTHOR]- Published
- 2018
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22. Screening for Depression, Anxiety, and Suicide Risk in Children and Adolescents: An Evidence Review for the U.S. Preventive Services Task Force
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Viswanathan M, Wallace I, Middleton JC, Kennedy SM, McKeeman J, Hudson K, Rains C, Vander Schaaf EB, and Kahwati L
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Purpose: To review the evidence on screening (benefits and harms of screening, accuracy of screening, benefits and harms of treatment) for suicide risk, anxiety, and depression in children and adolescents in settings relevant to primary care in the United States for the U.S. Preventive Services Task Force., Data Sources: PubMed, the Cochrane Library, PsycINFO, CINAHL and trial registries through July 19, 2021; bibliographies from retrieved articles, outside experts, and surveillance of the literature through June 1, 2022., Study Selection: Two investigators independently selected English-language studies using a priori defined criteria. We included trials that evaluated the benefits or harms of screening for suicide risk, anxiety, or depression compared with no screening or usual care. We included studies of screening with instruments feasible in primary care settings. For treatment benefits and harms, we included drugs approved for pediatric use by the Food and Drug Administration. For suicide and depression treatment studies, we included any eligible psychotherapy or collaborative care interventions. For anxiety, we restricted nonpharmacological interventions to cognitive behavioral therapy (CBT). Eligible outcomes included test accuracy, symptoms, response, remission, loss of diagnosis, all-cause mortality, functioning, suicide-related symptoms or events, withdrawal due to adverse events, serious adverse events, and harms from screening. We also included systematic reviews reporting on harms of treatment. We excluded studies with poor methodological quality., Data Extraction and Analysis: One investigator extracted data and a second checked accuracy. Two reviewers independently rated methodological quality for all included studies. When at least three similar studies were available, we conducted meta-analyses., Data Synthesis: We included 80 studies (in 106 publications). No studies evaluated the direct benefits of screening compared with no screening or usual care. Seventeen studies reported on accuracy of screening instruments for one or more conditions; of these, one reported on suicide (N=580), 10 on anxiety (N=3,260), seven on depression (N=3,316), and two on anxiety or depression (N=695). Studies reported a wide range for sensitivity and specificity across a variety of instruments, with no more than one or two studies on each instrument. For suicide, sensitivity ranged from 0.87 to 0.91, and specificity was 0.60. For anxiety, sensitivity generally ranged from 0.34 to 1.00, and specificity from 0.47 to 0.98. For depression, sensitivity ranged from 0.59 to 0.94, and specificity from 0.38 to 0.96. Two RCTs (N=2,675) compared short-term distress from screening for suicide risk and reported no significant differences between those screened and those who were not screened. Sixty randomized, controlled trials (RCTs) addressed benefits of treatment; of these, 16 reported on suicide risk interventions (N=3,034), 29 on anxiety treatment (N=2,970), 13 on depression treatment (N=2,156), and two on depression or anxiety treatment (N=236). Interventions addressing suicide risk or self-harm reported lower scores for the Beck Hopelessness Scale (pooled mean difference: −2.35 [95% confidence interval [CI], −4.06 to −0.65]; N=644; k=4) for intervention arms when compared with control arms. Findings for other measures were mixed or not statistically significantly different. Of the 29 RCTs on anxiety treatment, 22 were on CBT; six were on pharmacotherapy; and one had multiple arms evaluating CBT, sertraline, and CBT plus sertraline. The evidence suggests CBT was associated with gains on several pooled measures of symptom improvement (magnitude of change varies by outcome measure), response (pooled relative risk [RR]: 1.89 [95% CI, 1.17 to 3.05]; N=606; k=6; I2=64%), remission (RR: 2.68 [95% CI, 1.48 to 4.88]; N=321; k=4), and loss of diagnosis (RRs range from 3.02 to 3.09), when compared with usual care or wait-list. The evidence on functioning for CBT was mixed. The evidence suggests pharmacotherapy, when compared with placebo, was associated with gains on two pooled measures of symptom improvement (mean difference Pediatric Anxiety Rating Scale: −4.0 [95% CI, −5.5 to −2.5], N=726, k=5 and mean difference Clinical Global Impressions-Severity: −0.84 [95% CI, −1.13 to −0.55]; N=550, k=4) and response (RR: 2.11 [95% CI, 1.58 to 2.98]; N=370; k=5) but was mixed on measures of functioning. Of the 13 RCTs on depression treatment, eight were on psychotherapy; two on pharmacotherapy; one on CBT, fluoxetine, and their combination; and one on collaborative care. Results for psychotherapy varied by measure. Two pooled estimates suggested that psychotherapy is associated with improved symptoms (Beck Depression Inventory [BDI] or BDI-II standardized mean difference: −0.58 [95% CI, −0.83 to −0.34]; N=471; k=4 and Hamilton Depression Scale mean difference: −2.25 [95% CI,−4.09 to −0.41]; N=262; k=3), clinical response (3 studies with statistically significant results using varying thresholds), and loss of diagnosis (RR: 1.73 [95% CI, 1.00 to 3.00; N=395; k=4) but no statistically significant differences for other measures. The evidence suggested statistically pharmacotherapy was associated with improvement for one measure of symptoms (Children’s Depression Rating Scale-Revised [CDRS-R] mean difference −3.76 [95% CI, −5.95 to −1.57, N=793; k=3), and pharmacotherapy was associated with improvement for remission, but the pooled differences were not statistically significant. The single collaborative care trial (N=101) found that collaborative care was associated with improved symptoms at 6 months (CDRS-R change: 8.5 [95% CI, 13.4 to −3.6]), response by 12 months (odds ratio [OR] for ≥50% reduction in CDRS-R score: 3.3 [95% CI, 1.4 to 8.2], and remission (OR for Patient Health Questionnaire-9 <5 at 6 months: 5.2 [95% CI, 1.6 to 17.3]). The study reported no statistically significant benefits on measures of functioning. Twenty studies (19 randomized controlled trials and 1 meta-analysis) addressed harms. Of these, two reported on suicide risk interventions (N=885), 11 on anxiety treatment (N=1,293), and seven on depression treatment (N=1,352). Two RCTs of interventions to reduce suicide risk or self-harm reported no statistically significant differences in adverse events. Of the 11 RCTs reporting harms of anxiety treatments, four evaluated CBT; six evaluated pharmacotherapy; and one evaluated CBT, sertraline, and their combination. The evidence from CBT studies yielded inconsistent results on suicide-related events; these studies also suggested lower rates of withdrawal due to adverse events and serious adverse events in the CBT arms. Suicide-related events and withdrawals due to adverse events in pharmacotherapy studies were rare and not statistically significant; however, they were more commonly reported in pharmacotherapy arms when compared with placebo arms. Of the seven studies reporting harms of depression treatment, three evaluated pharmacotherapy; two evaluated psychotherapy; one evaluated CBT, fluoxetine, and their combination; and one evaluated collaborative care (1,276 from trials). Suicide-related outcomes, withdrawal as a result of adverse events, and serious adverse events were not statistically significant between study arms but were more frequent for pharmacotherapy when compared with placebo; inconsistencies in the evidence further reduced certainty. The evidence from the collaborative care study was inconsistent., Limitations: No studies were available that reported benefits of screening compared with no screening. Limited evidence was available on harms of screening, long-term outcomes, test accuracy, and suicide risk and depression treatment in children. Treatment-as-usual comparators for suicide risk interventions included active treatments. The review was limited to drugs approved for pediatric use by the Food and Drug Administration (FDA). For anxiety, psychotherapy was limited to CBT., Conclusions: We found no eligible studies that reported on benefits directly arising from screening when compared with usual care or no screening. Limited direct evidence suggests no short-term harms from screening for suicide risk. The evidence for screening for suicide risk, anxiety, and depression in children and adolescents relied on indirect evidence on the accuracy of screening and the benefits and harms of treatment. The evidence suggests that some screening instruments are reasonably accurate for anxiety and depression, but the evidence is limited for suicide risk screening instruments. Both pharmacotherapy and psychotherapy treatments have some benefit for some depression and anxiety outcomes (specifically, CBT for anxiety alone was reviewed); the evidence is limited for suicide risk interventions. Harms are rare in treatment studies but more frequent in pharmacotherapy arms when compared with placebo. Evidence gaps persist in children younger than age 11 years for test accuracy; depression and suicide risk interventions; and screening and treatment differences by sex, race/ethnicity, sexual orientation, and gender identity.
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- 2022
23. Screening for Hypertension in Children and Adolescents: Systematic Review for the U.S. Preventive Services Task Force
- Author
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Gartlehner G, Vander Schaaf EB, Orr C, Kennedy SM, Clark R, and Viswanathan M
- Abstract
Purpose: To review the evidence about screening for high blood pressure in children and adolescents to delay the onset of or reduce adverse health outcomes related to high blood pressure., Data Sources: MEDLINE, Embase, International Pharmaceutical Abstracts, the Cochrane Library, and trial registries through September 3, 2019; bibliographies from retrieved articles, outside experts, and surveillance of the literature through October 6, 2020., Study Selection: Two investigators independently selected studies using a priori defined inclusion and exclusion criteria. For this update, we included studies of screening for primary and secondary hypertension in asymptomatic children and adolescents. For benefits and harms of treatments or the association between hypertension in children and adolescents and intermediate outcomes in adults, we included participants with primary or secondary hypertension or elevated blood pressure. We selected studies that evaluated the diagnostic accuracy of blood pressure measurements in children and adolescents within primary care settings. We also included epidemiological studies that assessed the association between high blood pressure in children and adolescents and hypertension and other intermediate outcomes in adults. We included intermediate outcomes only if they were closely related to hypertension (e.g., left ventricular hypertrophy, urinary albumin excretion, retinal vascular changes, and intima media thickness). For treatment of hypertension, we selected controlled trials of pharmacological agents, lifestyle interventions, or combination treatments. We excluded studies with poor methodological quality and studies conducted in developing countries., Data Extraction and Analysis: One investigator extracted data and a second checked accuracy. Two reviewers independently rated methodological quality for all included studies using predefined criteria. Because data were insufficient for meta-analyses, we qualitatively synthesized findings for each key question., Data Synthesis: We included 42 studies (43 publications). We did not identify any studies directly evaluating health benefits or harms of screening. We also did not find studies assessing whether effective treatment of abnormal blood pressure during childhood has an impact on hypertension and other intermediate outcomes during adulthood. Furthermore, we did not find any studies that addressed screening for secondary hypertension in asymptomatic children. One fair study (n=247) assessed the diagnostic test accuracy of six office-based blood pressure measurements, 1 to 2 weeks apart, compared with ambulatory blood pressure monitoring as the reference standard. Office-based blood pressure measurements used recommendations of the Fourth Report as thresholds. Using systolic blood pressure (SBP) at the 90th percentile as a cutoff for abnormal blood pressure, the sensitivity of office-based measurements was 81.6 percent (confidence interval [CI] not reported) with a specificity of 70.3 percent (CI not reported). Twenty studies on data from nine national and international cohorts evaluated the association between high blood pressure in childhood and hypertension or other intermediate outcomes during adulthood. Despite substantial heterogeneity, studies consistently reported associations between abnormal blood pressure in childhood and abnormal blood pressure in adulthood. The strength of associations varied across studies (odds ratios [ORs] ranged from 1.1 to 4.5, relative risk [RR] ranged from 1.45 to 3.60, hazard ratios [HRs] ranged from 2.8 to 3.2; duration of followup ranged from 10 to 33 years). Studies also reported associations between abnormal blood pressure during childhood and carotid intima-media thickness (OR: 1.24, 95% CI, 1.13 to 1.37 [mean duration of followup was 25 years]; HRs ranged from 2.03 to 3.07 [duration of followup ranged from 10 to 21 years]; correlation coefficients ranged from 0.04 to 0.16 [duration of followup ranged from 21 to 31 years]), left ventricular hypertrophy (ORs ranged from 1.30 to 1.59, mean duration of followup was 25 years; HRs ranged from 1.92 to 3.41; duration of followup ranged from 10 to 21 years), and microalbuminuria (regression coefficients ranged from 0.016 to 0.315; mean duration of followup was 16.1 years). Twenty randomized, controlled trials (RCTs) and a meta-analysis assessing treatments for hypertension in children and adolescents met inclusion criteria. The majority of studies excluded children with known secondary hypertension. Thirteen fair-quality placebo-controlled RCTs and one meta-analysis evaluated the efficacy of various pharmacological treatments. All studies reported greater reductions of SBP and diastolic blood pressure (DBP) measurements in participants who received pharmacological treatments compared with those treated with placebo. The magnitude of reductions, however, varied, and not all differences reached statistical significance. Pooled reductions of SBP were −4.38 mmHg (95% CI, −2.16 to −7.27) for angiotensin-converting enzyme (ACE) inhibitors, −3.07 mmHg (95% CI, −1.44 to −4.99) for angiotensin receptor blockers (ARBs), −3.20 mmHg (95% CI, +2.23 to −8.69) for beta blockers, −3.10 mmHg (95% CI, +0.45 to −6.52) for calcium channel blockers, and −0.12 mmHg (95% CI, +3.46 to −3.69) for mineralocorticoid receptor antagonists. Followup of studies was limited to 2 to 4 weeks. One fair-quality trial, conducted from 1979 to 1981 in the United States and using a combination of a pharmacological treatment (low-dose propranolol/chlorthalidone) and lifestyle interventions (dietary and exercise modifications for children and parents), reported a statistically significant reduction of SBP (−7.6 mmHg) and DBP (−6.9 mmHg) after 6 months. A DASH (Dietary Approaches to Stop Hypertension) −type diet (high in fruits, vegetables, and low-fat dairy foods) achieved statistically significant reductions in SBP (−2.2 mmHg) and DBP (−2.8 mmHg) in a completers-only analysis of one fair-quality RCT. The effect did not last beyond the intervention period. Two fair-quality RCTs assessing physical exercise reported statistically significant decreases in SBP after 3 and 8 months (−8.3 and −4.9 mmHg, respectively) compared with lifestyle as usual. Only the study lasting 8 months reported a significant decrease in DBP (−3.8 mmHg vs. not reported). Based on evidence from three fair-quality trials, a low-sodium diet and progressive muscle relaxation did not achieve any significant or clinically relevant changes in SBP or DBP. Regarding harms of treatments, six fair-quality RCTs reported similar risks of adverse events between various pharmacological treatments (beta blocker, calcium channel blockers, angiotensin-converting enzyme, inhibitors or angiotensin receptor blockers) and placebo. The duration of trials, however, was limited to 2 to 4 weeks. One fair-quality RCT reported similar risks for adverse events between a combination of pharmacotherapy and lifestyle interventions and a control group without treatment over 6 months., Limitations: Only English-language studies were included. No direct evidence for the benefits or harms of screening was identified. In addition, the indirect evidence pathway from screening to improvement of health outcomes is scarce, of limited applicability, or entirely missing for some steps of the pathway. The evidence on diagnostic accuracy was limited to one poor quality study. Epidemiological studies determining associations between high blood pressure in childhood and adulthood used various definitions and thresholds; the results were generally consistent in demonstrating an association, although the strength of association varied. Pharmacological treatment studies were limited to durations of 2 to 4 weeks of followup and excluded children with secondary hypertension; no evidence was available for long-term effectiveness. The mean age of children in these studies ranged between 12 and 14 years; the generalizability of results to younger children or children with secondary hypertension is unknown. Studies of treatment were generally too short and underpowered for harm outcomes. We did not assess the comparative effectiveness or harms of treatments., Conclusions: We identified no direct evidence that compared screening with no screening in asymptomatic children and adolescents. Epidemiological studies indicate an association between hypertension in childhood and adolescence and hypertension in adulthood. Large longitudinal cohort studies also provide evidence that hypertension in adolescents and young adults is associated with end-stage renal disease and mortality from cerebrovascular events during adulthood. The proportion of spontaneous resolution of hypertension in children and the long-term benefits and harms of treatment, however, remain unclear. The evidence is also inconclusive whether the diagnostic accuracy of blood pressure measurements is adequate for screening asymptomatic children and adolescents in primary care. Short-term pharmacological treatments appear effective and safe, but no evidence with a followup of more than 4 weeks is available. No evidence exists to determine whether screening for hypertension is effective in identifying children with secondary hypertension who are asymptomatic. Most treatment studies excluded children with secondary hypertension.
- Published
- 2020
24. Treatment of Depression in Children and Adolescents: A Systematic Review
- Author
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Viswanathan M, Kennedy SM, McKeeman J, Christian R, Coker-Schwimmer M, Cook Middleton J, Bann C, Lux L, Randolph C, and Forman-Hoffman V
- Abstract
Background: Depressive disorders can affect long-term mental and physical health functioning among children and adolescents, including increased risk of suicide. Despite access to several nonpharmacological, pharmacological, and combined treatment options for childhood depression, clinicians contend with sparse evidence and are concerned about harms associated with treatment., Methods: We conducted a systematic review to evaluate the efficacy, comparative effectiveness, and moderators of benefits and harms of available nonpharmacological and pharmacological treatments for children and adolescents with a confirmed diagnosis of a depressive disorder (DD)—major depressive disorder (MDD), persistent depressive disorder (previously termed dysthymia) or DD not otherwise specified. We searched five databases and other sources for evidence available from inception to May 29, 2019, dually screened the results, and analyzed eligible studies., Results: We included in our analyses data from 60 studies (94 articles) that met our review eligibility criteria. For adolescents (study participants’ ages range from 12 to 18 years) with MDD, cognitive behavioral therapy (CBT), fluoxetine, escitalopram, and combined fluoxetine and CBT may improve depressive symptoms (1 randomized controlled trial [RCT] each, n ranges from 212 to 311); whether the magnitude of improvement is clinically significant is unclear. Among adolescents or children with MDD, CBT plus medications (8–17 years) may be associated with lower rates of relapse (1 RCT [n = 121]). In the same population (6–17 years), selective serotonin reuptake inhibitors (SSRIs) may be associated with improved response (7 RCTs [n = 1,525]; risk difference [RD], 72/1,000 [95% confidence interval (CI), 2 to 24], I
2 = 9%) and functional status (5 RCTs [n = 941]; standardized mean difference, 0.16 [95% CI, 0.03 to 0.29]; I2 = 0%). For adolescents or children with any DD (7–18 years), CBT or family therapy may be associated with improvements in symptoms, response, or functional status (1 RCT each, n ranges from 64 to 99). Among children with any DD (7–12 years), family-based interpersonal therapy may be associated with improved symptoms (1 RCT, n = 38). Psychotherapy trials did not report harms. SSRIs may be associated with a higher risk of serious adverse events among adolescents or children with MDD (7–18 years; 9 RCTs [n = 2,206]; RD, 20/1,000 [95% CI, 1 to 440]; I2 , 4%) and with a higher risk of withdrawal due to adverse events among adolescents with MDD (12–18 years; 4 RCTs [n = 1,296], RD, 26/1,000 [95% CI, 6 to 45]; I2 , 0%). Paroxetine (1 RCT [n = 180]) may be associated with a higher risk of suicidal ideation or behaviors among adolescents with MDD (12–18 years). Evidence was insufficient to judge the risk of suicidal ideation or behavior for other SSRIs for adolescents and children with MDD or other DD (7–18 years) (10 RCTs [n = 2,368]; relative risk, 1.14 [95% CI, 0.89 to 1.45]; I2 , 8%). However, this report excluded data on inpatients and those without depressive disorders, whom the Food and Drug Administration included in finding an increased risk of suicidality for all antidepressants across all indications., Conclusions: Efficacious treatments exist for adolescents with MDD. SSRIs may be associated with increased withdrawal and serious adverse events. No evidence on harms of psychotherapy were identified.- Published
- 2020
25. Reasons for Electronic Cigarette Use Among Middle and High School Students - National Youth Tobacco Survey, United States, 2016.
- Author
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Tsai J, Walton K, Coleman BN, Sharapova SR, Johnson SE, Kennedy SM, and Caraballo RS
- Subjects
- Adolescent, Child, Female, Health Surveys, Humans, Male, Schools statistics & numerical data, Students statistics & numerical data, United States, Vaping statistics & numerical data, Students psychology, Vaping psychology
- Abstract
Electronic cigarettes (e-cigarettes) were the most commonly used tobacco product among U.S. middle school and high school students in 2016 (1). CDC and the Food and Drug Administration (FDA) analyzed data from the 2016 National Youth Tobacco Survey (NYTS) to assess self-reported reasons for e-cigarette use among U.S. middle school (grades 6-8) and high school (grades 9-12) student e-cigarette users. Among students who reported ever using e-cigarettes in 2016, the most commonly selected reasons for use were 1) use by "friend or family member" (39.0%); 2) availability of "flavors such as mint, candy, fruit, or chocolate" (31.0%); and 3) the belief that "they are less harmful than other forms of tobacco such as cigarettes" (17.1%). The least commonly selected reasons were 1) "they are easier to get than other tobacco products, such as cigarettes" (4.8%); 2) "they cost less than other tobacco products such as cigarettes" (3.2%); and 3) "famous people on TV or in movies use them" (1.5%). Availability of flavors as a reason for use was more commonly selected by high school users (32.3%) than by middle school users (26.8%). Efforts to prevent middle school and high school students from initiating the use of any tobacco product, including e-cigarettes, are important to reduce tobacco product use among U.S. youths (2)., Competing Interests: No conflicts of interest were reported.
- Published
- 2018
- Full Text
- View/download PDF
26. Cigarette, Cigar, and Marijuana Use Among High School Students - United States, 1997-2013.
- Author
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Rolle IV, Kennedy SM, Agaku I, Jones SE, Bunnell R, Caraballo R, Xu X, Schauer G, and McAfee T
- Subjects
- Adolescent, Ethnicity psychology, Ethnicity statistics & numerical data, Female, Humans, Male, Marijuana Smoking ethnology, Schools, Students statistics & numerical data, United States epidemiology, Marijuana Smoking epidemiology, Students psychology, Tobacco Products statistics & numerical data
- Abstract
What is already known on this topic? Since 2010, the proportion of U.S. 12th grade students who reported using marijuana during the preceding 30 days (21.4%) has surpassed the proportion reporting use of cigarettes during the preceding 30 days (19.2%).What is added by this report? During 1997–2013, the proportion of white, black, and Hispanic high school students overall who were exclusive cigarette or cigar users decreased 64%, from 20.5% to 7.4%. The proportion of white, black, and Hispanic students who were exclusive marijuana users more than doubled from 4.2% to 10.2%, and among cigarette or cigar users, marijuana use increased, with considerable increases identified among black and Hispanic students toward the end of the study period.What are the implications for public health practice? Despite significant declines since 1997, approximately 30% of white, black, and Hispanic U.S. high school students were current users of cigarettes, cigars, or marijuana in 2013. Policy and programmatic efforts might benefit from integrated approaches that focus on reducing the use of tobacco and marijuana among youths.
- Published
- 2015
- Full Text
- View/download PDF
27. Tobacco use among middle and high school students--United States, 2013.
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Arrazola RA, Neff LJ, Kennedy SM, Holder-Hayes E, and Jones CD
- Subjects
- Adolescent, Child, Cross-Sectional Studies, Female, Health Surveys, Humans, Male, United States epidemiology, Smoking epidemiology, Students statistics & numerical data
- Abstract
Tobacco use is the leading preventable cause of disease and death in the United States, and nearly all tobacco use begins during youth and young adulthood. Among U.S. youths, cigarette smoking has declined in recent years; however, the use of some other tobacco products has increased, and nearly half of tobacco users use two or more tobacco products. CDC analyzed data from the 2013 National Youth Tobacco Survey to determine the prevalence of ever (at least once) and current (at least 1 day in the past 30 days) use of one or more of 10 tobacco products (cigarettes, cigars, hookahs, smokeless tobacco, electronic cigarettes [e-cigarettes], pipes, snus, bidis, kreteks, and dissolvable tobacco) among U.S. middle school (grades 6-8) and high school (grades 9-12) students. In 2013, 22.9% of high school students reported current use of any tobacco product, and 12.6% reported current use of two or more tobacco products; current use of combustible products (i.e., cigarettes, cigars, pipes, bidis, kreteks, and/or hookahs) was substantially greater (20.7%) than use of other types of tobacco. Also, 46.0% of high school students reported having ever tried a tobacco product, and 31.4% reported ever trying two or more tobacco products. Among middle school students, 3.1% reported current use of cigars, and 2.9% reported current use of cigarettes, with non-Hispanic black students more than twice as likely to report current use of cigars than cigarettes. Monitoring the prevalence of the use of all available tobacco products, including new and emerging products, is critical to support effective population-based interventions to prevent and reduce tobacco use among youths as part of comprehensive tobacco prevention and control programs.
- Published
- 2014
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