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Substance misuse and substance use disorder continue to be major causes of morbidity and mortality, and family physicians are well positioned to provide evidence-based prevention and management for these conditions. Of people 12 years and older, 13% reported using a nonprescribed controlled substance in the past month, and 24% had at least one episode of binge drinking of alcohol, defined as five or more drinks for men and four or more drinks for women on one occasion. Benzodiazepines are used by 12% of the U.S. population. Clinicians should incorporate standardized screening and brief intervention for use of alcohol and other substances into routine care of adult patients, as well as referral to specialized treatment services when indicated. Use of nonstigmatizing, person-first language has been shown to positively affect care for patients with substance use disorders. Alcohol screening and brief intervention have been shown to reduce excessive drinking by 40% in patients at 6 months postintervention. Office-based treatment of alcohol use disorder with medications approved by the U.S. Food and Drug Administration, such as acamprosate and naltrexone, remains underutilized, presenting another opportunity for family physicians to positively affect the health of their patients and communities. With elimination of the X-waiver, any clinician with Schedule III prescriptive authority can treat opioid use disorder with buprenorphine in their office-based practice. Opioid overdose education and naloxone coprescribing are other tools family physicians can employ to combat the overdose crisis. (Am Fam Physician. 2024; 109(5):430–440. Copyright © 2024 American Academy of Family Physicians.) Substance misuse and substance use disorder continue to be major causes of morbidity and mortality, and family physicians are well positioned to provide evidence-based prevention and management for these conditions. Of people 12 years and older, 13% reported using a nonprescribed controlled substance in the past month, and 24% had at least one episode of binge drinking of alcohol, defined as five or more drinks for men and four or more drinks for women on one occasion. Benzodiazepines are used by 12% of the U.S. population. Clinicians should incorporate standardized screening and brief intervention for use of alcohol and other substances into routine care of adult patients, as well as referral to specialized treatment services when indicated. Use of nonstigmatizing, person-first language has been shown to positively affect care for patients with substance use disorders. Alcohol screening and brief intervention have been shown to reduce excessive drinking by 40% in patients at 6 months postintervention. Office-based treatment of alcohol use disorder with medications approved by the U.S. Food and Drug Administration, such as acamprosate and naltrexone, remains underutilized, presenting another opportunity for family physicians to positively affect the health of their patients and communities. With elimination of the X-waiver, any clinician with Schedule III prescriptive authority can treat opioid use disorder with buprenorphine in their office-based practice. Opioid overdose education and naloxone coprescribing are other tools family physicians can employ to combat the overdose crisis. [ABSTRACT FROM AUTHOR]

Anxiety disorders are the most common psychiatric conditions in children and adolescents, affecting nearly 1 in 12 children and 1 in 4 adolescents. Anxiety disorders include specific phobias, social anxiety disorder, separation anxiety disorder, agoraphobia, panic disorder, and generalized anxiety disorder. Risk factors include parental history of anxiety disorders, socioeconomic stressors, exposure to violence, and trauma. The U.S. Preventive Services Task Force recommends screening for anxiety disorders in children eight years and older; there is insufficient evidence to support screening in children younger than eight years. Symptoms of anxiety disorders in children and adolescents are similar to those in adults and can include physical and behavioral symptoms such as diaphoresis, palpitations, and tantrums. Care should be taken to distinguish symptoms of a disorder from normal developmental fears and behaviors, such as separation anxiety in infants and toddlers. Several validated screening measures are useful for initial assessment and ongoing monitoring. Cognitive behavior therapy and selective serotonin reuptake inhibitors are the mainstay of treatment and may be used as monotherapies or in combination. Prognosis is improved with early intervention, caretaker support, and professional collaboration. (Am Fam Physician. 2022;106(6):657–664. Copyright © 2022 American Academy of Family Physicians.) Anxiety disorders are the most common psychiatric conditions in children and adolescents, affecting nearly 1 in 12 children and 1 in 4 adolescents. Anxiety disorders include specific phobias, social anxiety disorder, separation anxiety disorder, agoraphobia, panic disorder, and generalized anxiety disorder. Risk factors include parental history of anxiety disorders, socioeconomic stressors, exposure to violence, and trauma. The U.S. Preventive Services Task Force recommends screening for anxiety disorders in children eight years and older; there is insufficient evidence to support screening in children younger than eight years. Symptoms of anxiety disorders in children and adolescents are similar to those in adults and can include physical and behavioral symptoms such as diaphoresis, palpitations, and tantrums. Care should be taken to distinguish symptoms of a disorder from normal developmental fears and behaviors, such as separation anxiety in infants and toddlers. Several validated screening measures are useful for initial assessment and ongoing monitoring. Cognitive behavior therapy and selective serotonin reuptake inhibitors are the mainstay of treatment and may be used as monotherapies or in combination. Prognosis is improved with early intervention, caretaker support, and professional collaboration. [ABSTRACT FROM AUTHOR]

In the United States (US), morbidity and mortality from pediatric asthma are increasing. We explored racial inequities using the Multiple Causes of Death Files of the US National Center for Health Statistics and the Wide-ranging Online Data for Epidemiologic Research (WONDER) for 1–14-year-olds from 1999 to 2018. We obtained mortality rates, Black:White mortality rate ratios (MRRs) and Annual Percent Change (APC). We tested for significance with 95% confidence intervals and joinpoint regression. Of 2,731 deaths from asthma, Blacks comprised 65.25% and 21.25% of the population. Black:White MRRs were 6.43 for 1–4, 7.54 for 5–9 and 6.88 for 10–14-year-olds of 6.88. The APC decline of −2.56 (p < 0.05) was significant among Whites but not Blacks. MRRs increased significantly from 4.23 in 2000 to16.57 in 2015 and declined to 6.69 in 2018. Among Black boys and girls, mortality rates were highest in Large Central Metropolitan areas. For Whites, rates were similar by urbanization in girls but were highest in Non-core, Non-metropolitan rural areas in boys. These descriptive data demonstrate statistically significant racial inequities in mortality from pediatric asthma in the US. They generate hypotheses, including, but not limited to, those related to under-resourced families and communities as well as economic and social marginalization. These and other plausible hypotheses require direct testing in analytic epidemiologic studies designed a priori to do so. In the meanwhile, efforts are necessary to strengthen community-driven initiatives and focus attention on inequitable systems, hierarchies, social structure and institutional practices. These include multifactorial interventions for individual, environmental and societal risk factors and educational efforts toward health-care providers and their patients about structural racism; these may combat, at least in part, vulnerabilities in US children and youth and improve racial inequities overall and from pediatric asthma. [ABSTRACT FROM AUTHOR]

Background: Data are sparse about firearm fatalities among Texas schoolchildren. Purpose: Explore firearm fatalities among children ages 5-18 years from 1999 to 2020. Key Methods. We utilized publicly available Multiple Cause of Death Files from the National Center for Health Statistics (NCHS) and International Classification of Diseases (ICD) Codes (10th Edition) Accident (W32-W34), Suicide (X72-X74), Assault (X93-X95), and Undetermined Intent (Y22-Y24) to identify firearm fatality as an underlying or contributory cause. We used Annual Percent Change (APC) as a measure of the magnitude of effect and 95% confidence intervals (CIs), p values, and joinpoint regression analyses to test for statistical significance. Key Results: From 1999 to 2020 there were 4,090 firearm fatalities among Texas school-age children. Following significant declines from 1999 to 2013, firearm fatality rates significantly increased. The APC from 2013-2020 was 12.6 (95% CI 9.7, 15.6 p<0.001). The APCs were statistically significant for boys; non-Hispanic Black, non-Hispanic White, and Hispanic children; residents of Large Central Metropolitan areas, Medium Metropolitan, Large Fringe Metropolitan, and smaller areas; for residents of the Texas-Mexico Border and non-Border areas; and for residents of counties with a military base. From 2013 to 2020, rates were highest among non-Hispanic Black children, followed in order by non-Hispanic White, Hispanic, and Asian and Pacific Islander children. Public Health Significance: There are alarming increases in firearm fatalities among Texas school age children (5-18 years). Analytic epidemiologic studies designed a priori to do so are necessary to test hypotheses generated by these data. In the meanwhile, the data pose clinical and public health challenges. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic exacerbated disparities in mental healthcare and substance use disorder (SUD) treatment access, especially in under-resourced communities. This study aimed to comprehend the experiences of under-resourced women with SUD during the pandemic, their knowledge and attitudes toward it, and its impact on substance use and treatment access., Methods: A cross-sectional study included 66 under-resourced women receiving medically managed withdrawal treatment at a community residential SUD center. Data collection occurred between November 2021 and August 2022, utilizing a 75-item instrument covering COVID-19 exposure and its impact on health, substance use, treatment access, vaccination status, beliefs, and knowledge. Descriptive analyses summarized the data., Results: Participants faced various challenges during the pandemic. Many reported increased substance use, especially alcohol, opioids, benzodiazepines, and nicotine. Mental health stability was negatively affected, exacerbating existing disorders and limiting mental healthcare access. A majority (56.1%) reported that their chronic mental health disorder was less stable during the pandemic. Twenty (30.3%) participants reported that they had been diagnosed with a new mental health disorder since the pandemic, and 28.8% reported that it was harder for them to access mental healthcare during the pandemic. Job loss, housing instability, and financial strain were prevalent. Half (n=33, 50%) received a COVID-19 vaccine dose, while 27.3% (n=18) declined vaccination due to knowledge gaps and religious beliefs. The majority (n=41, 62.1%) worried about securing basic needs such as groceries and medication, with 64.6% (n=42) expressing a desire to cope using alcohol or drugs., Conclusions: This study expands upon previous research by examining the effect of the COVID-19 pandemic on mental health in the context of substance use disorder treatment. Unlike previous data, which focused solely on substance use behaviors, our study delves into the impact of the pandemic on co-occurring mental health disorders. Findings underscore the need for gender-responsive and culturally appropriate SUD treatment. Vaccine hesitancy, as reflected in the study, necessitates more effective, tailored evidence-based informational campaigns. Efforts must focus on enhancing mental healthcare access, reducing stigma, and supporting individuals with co-occurring conditions amidst this evolving COVID-19 health crisis., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. The Institutional Review Board of Baylor College of Medicine issued approval H-50771. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mejia et al.)