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Cotempla XR-ODT approved for children, adolescents with ADHD
The Food and Drug Administration has approved the first methylphenidate extended-release orally disintegrating tablet for treating ADHD in patients aged 6-17 years old, Neos Therapeutics announced June 19.
The company said the approval came after a phase III trial showed that treatment in a laboratory classroom with the drug, called Cotempla XR-ODT, showed a significant improvement in attention-deficit/hyperactivity disorder symptom control when compared with a placebo across the classroom day (placebo-subtracted difference of –11). The onset of effect was shown at 1 hour post-dose and lasted through 12 hours. No serious adverse events were reported during the trial, and the adverse event profile was consistent with the established safety profile for other extended-release methylphenidate products.
Cotempla XR-ODT will be available commercially in a portable, child-resistant blister pack in the fall of 2017.
Find the full press release on Neos Therapeutics website.
The Food and Drug Administration has approved the first methylphenidate extended-release orally disintegrating tablet for treating ADHD in patients aged 6-17 years old, Neos Therapeutics announced June 19.
The company said the approval came after a phase III trial showed that treatment in a laboratory classroom with the drug, called Cotempla XR-ODT, showed a significant improvement in attention-deficit/hyperactivity disorder symptom control when compared with a placebo across the classroom day (placebo-subtracted difference of –11). The onset of effect was shown at 1 hour post-dose and lasted through 12 hours. No serious adverse events were reported during the trial, and the adverse event profile was consistent with the established safety profile for other extended-release methylphenidate products.
Cotempla XR-ODT will be available commercially in a portable, child-resistant blister pack in the fall of 2017.
Find the full press release on Neos Therapeutics website.
The Food and Drug Administration has approved the first methylphenidate extended-release orally disintegrating tablet for treating ADHD in patients aged 6-17 years old, Neos Therapeutics announced June 19.
The company said the approval came after a phase III trial showed that treatment in a laboratory classroom with the drug, called Cotempla XR-ODT, showed a significant improvement in attention-deficit/hyperactivity disorder symptom control when compared with a placebo across the classroom day (placebo-subtracted difference of –11). The onset of effect was shown at 1 hour post-dose and lasted through 12 hours. No serious adverse events were reported during the trial, and the adverse event profile was consistent with the established safety profile for other extended-release methylphenidate products.
Cotempla XR-ODT will be available commercially in a portable, child-resistant blister pack in the fall of 2017.
Find the full press release on Neos Therapeutics website.
Mydayis approved for teens, adults with ADHD
The Food and Drug Administration has approved a once-a-day treatment for patients aged 13 years and older with ADHD, Shire announced June 20 in a press release.
The approval of Mydayis was based on results from 16 clinical studies evaluating the medication in more than 1,600 adolescents (aged 13-17 years) and adults with attention-deficit/hyperactivity disorder. In the placebo-controlled clinical studies, Mydayis significantly improved symptoms of ADHD, as measured by the ADHD-RS-IV and the Permanent Product Measure of Performance (PERMP), in adults and adolescents. Improvement on the PERMP reached statistical significance beginning at 2 or 4 hours post dose and lasting up to 16 hours post dose.
The medication, an amphetamine product, consists of three different types of drug-releasing beads.
“With this approval, we hope to help patients who need a once-daily treatment option,” Flemming Ornskov, MD, MPH, said in a press release. Dr. Ornskov is CEO of Shire.
It is estimated that 4.4% of adults have ADHD in the United States, and 50%-66% of children with ADHD may continue to have symptoms of the disorder as adults.
Mydayis will be commercially available in the United States in the third quarter of 2017.
Read the full press release here.
The Food and Drug Administration has approved a once-a-day treatment for patients aged 13 years and older with ADHD, Shire announced June 20 in a press release.
The approval of Mydayis was based on results from 16 clinical studies evaluating the medication in more than 1,600 adolescents (aged 13-17 years) and adults with attention-deficit/hyperactivity disorder. In the placebo-controlled clinical studies, Mydayis significantly improved symptoms of ADHD, as measured by the ADHD-RS-IV and the Permanent Product Measure of Performance (PERMP), in adults and adolescents. Improvement on the PERMP reached statistical significance beginning at 2 or 4 hours post dose and lasting up to 16 hours post dose.
The medication, an amphetamine product, consists of three different types of drug-releasing beads.
“With this approval, we hope to help patients who need a once-daily treatment option,” Flemming Ornskov, MD, MPH, said in a press release. Dr. Ornskov is CEO of Shire.
It is estimated that 4.4% of adults have ADHD in the United States, and 50%-66% of children with ADHD may continue to have symptoms of the disorder as adults.
Mydayis will be commercially available in the United States in the third quarter of 2017.
Read the full press release here.
The Food and Drug Administration has approved a once-a-day treatment for patients aged 13 years and older with ADHD, Shire announced June 20 in a press release.
The approval of Mydayis was based on results from 16 clinical studies evaluating the medication in more than 1,600 adolescents (aged 13-17 years) and adults with attention-deficit/hyperactivity disorder. In the placebo-controlled clinical studies, Mydayis significantly improved symptoms of ADHD, as measured by the ADHD-RS-IV and the Permanent Product Measure of Performance (PERMP), in adults and adolescents. Improvement on the PERMP reached statistical significance beginning at 2 or 4 hours post dose and lasting up to 16 hours post dose.
The medication, an amphetamine product, consists of three different types of drug-releasing beads.
“With this approval, we hope to help patients who need a once-daily treatment option,” Flemming Ornskov, MD, MPH, said in a press release. Dr. Ornskov is CEO of Shire.
It is estimated that 4.4% of adults have ADHD in the United States, and 50%-66% of children with ADHD may continue to have symptoms of the disorder as adults.
Mydayis will be commercially available in the United States in the third quarter of 2017.
Read the full press release here.
Dengue vaccine appears safe, immunogenic in children aged 2-17 years
whether or not they previously have been exposed to the virus, said Xavier Sáez-Llorens, MD, of Hospital del Niño Dr José Renán Esquivel, Panama City, Republic of Panama, and his associates.
Studies show dengue to be the most common mosquito-borne viral disease affecting humans, occurring in 125 countries and causing approximately 100 million symptomatic infections annually. Vector control has not halted the global spread of dengue, necessitating development of vaccines. A vaccine for people aged 9 years and older has been licensed, but there remains the need for a safe and effective vaccine against all four dengue virus serotypes for all ages, said Dr. Sáez-Llorens and his associates.
Takeda’s live tetravalent dengue vaccine, TDV, has an “attenuated [dengue virus serotype] DENV-2 virus strain (TDV-2) and three chimeric (dengue–dengue) viruses containing the premembrane and envelope protein genes of DENV-1, DENV-3, and DENV-4 genetically engineered into the attenuated TDV-2 genome backbone (TDV-1, TDV-3, and TDV-4),” the investigators explained.
In an ongoing, randomized, double-blind, placebo-controlled study in dengue-endemic Panama, the Dominican Republic, and the Philippines, healthy children aged 2-17 years were randomly assigned to receive either one TDV dose at 0 months and one dose at 3 months (group 1); one dose at 0 months (group 2); one dose at 0 months and a booster at 12 months (group 3); or a placebo (group 4). At 6 months, 68% of children were seropositive for all four serotypes after one dose, and 85% were seropositive for all four serotypes after two doses; this occurred regardless of whether the children had previously been exposed to dengue. Group 3 has not yet received its 3-month booster.
The vaccine was well tolerated and safe. In children younger than 6 years, fever and irritability were the only systemic adverse events reported more often with the vaccine than with placebo. In children older than 6 years, only headache and myalgia were more common with the vaccine than with placebo, Dr. Sáez-Llorens and his associates noted.
“These data support phase III evaluation of the efficacy and safety of TDV given in a two-dose schedule 3 months apart, with analyses that take into account baseline age and dengue serostatus,” they concluded.
Read more in The Lancet Infectious Diseases (2017 June; 17[6]:615-25).
whether or not they previously have been exposed to the virus, said Xavier Sáez-Llorens, MD, of Hospital del Niño Dr José Renán Esquivel, Panama City, Republic of Panama, and his associates.
Studies show dengue to be the most common mosquito-borne viral disease affecting humans, occurring in 125 countries and causing approximately 100 million symptomatic infections annually. Vector control has not halted the global spread of dengue, necessitating development of vaccines. A vaccine for people aged 9 years and older has been licensed, but there remains the need for a safe and effective vaccine against all four dengue virus serotypes for all ages, said Dr. Sáez-Llorens and his associates.
Takeda’s live tetravalent dengue vaccine, TDV, has an “attenuated [dengue virus serotype] DENV-2 virus strain (TDV-2) and three chimeric (dengue–dengue) viruses containing the premembrane and envelope protein genes of DENV-1, DENV-3, and DENV-4 genetically engineered into the attenuated TDV-2 genome backbone (TDV-1, TDV-3, and TDV-4),” the investigators explained.
In an ongoing, randomized, double-blind, placebo-controlled study in dengue-endemic Panama, the Dominican Republic, and the Philippines, healthy children aged 2-17 years were randomly assigned to receive either one TDV dose at 0 months and one dose at 3 months (group 1); one dose at 0 months (group 2); one dose at 0 months and a booster at 12 months (group 3); or a placebo (group 4). At 6 months, 68% of children were seropositive for all four serotypes after one dose, and 85% were seropositive for all four serotypes after two doses; this occurred regardless of whether the children had previously been exposed to dengue. Group 3 has not yet received its 3-month booster.
The vaccine was well tolerated and safe. In children younger than 6 years, fever and irritability were the only systemic adverse events reported more often with the vaccine than with placebo. In children older than 6 years, only headache and myalgia were more common with the vaccine than with placebo, Dr. Sáez-Llorens and his associates noted.
“These data support phase III evaluation of the efficacy and safety of TDV given in a two-dose schedule 3 months apart, with analyses that take into account baseline age and dengue serostatus,” they concluded.
Read more in The Lancet Infectious Diseases (2017 June; 17[6]:615-25).
whether or not they previously have been exposed to the virus, said Xavier Sáez-Llorens, MD, of Hospital del Niño Dr José Renán Esquivel, Panama City, Republic of Panama, and his associates.
Studies show dengue to be the most common mosquito-borne viral disease affecting humans, occurring in 125 countries and causing approximately 100 million symptomatic infections annually. Vector control has not halted the global spread of dengue, necessitating development of vaccines. A vaccine for people aged 9 years and older has been licensed, but there remains the need for a safe and effective vaccine against all four dengue virus serotypes for all ages, said Dr. Sáez-Llorens and his associates.
Takeda’s live tetravalent dengue vaccine, TDV, has an “attenuated [dengue virus serotype] DENV-2 virus strain (TDV-2) and three chimeric (dengue–dengue) viruses containing the premembrane and envelope protein genes of DENV-1, DENV-3, and DENV-4 genetically engineered into the attenuated TDV-2 genome backbone (TDV-1, TDV-3, and TDV-4),” the investigators explained.
In an ongoing, randomized, double-blind, placebo-controlled study in dengue-endemic Panama, the Dominican Republic, and the Philippines, healthy children aged 2-17 years were randomly assigned to receive either one TDV dose at 0 months and one dose at 3 months (group 1); one dose at 0 months (group 2); one dose at 0 months and a booster at 12 months (group 3); or a placebo (group 4). At 6 months, 68% of children were seropositive for all four serotypes after one dose, and 85% were seropositive for all four serotypes after two doses; this occurred regardless of whether the children had previously been exposed to dengue. Group 3 has not yet received its 3-month booster.
The vaccine was well tolerated and safe. In children younger than 6 years, fever and irritability were the only systemic adverse events reported more often with the vaccine than with placebo. In children older than 6 years, only headache and myalgia were more common with the vaccine than with placebo, Dr. Sáez-Llorens and his associates noted.
“These data support phase III evaluation of the efficacy and safety of TDV given in a two-dose schedule 3 months apart, with analyses that take into account baseline age and dengue serostatus,” they concluded.
Read more in The Lancet Infectious Diseases (2017 June; 17[6]:615-25).
FROM LANCET INFECTIOUS DISEASES
Tipoffs that an infant hospitalized with pertussis may require ICU
MADRID – Infants hospitalized for pertussis are more likely to develop severe disease requiring pediatric ICU admission if they are experiencing apnea, are unvaccinated against pertussis, or are less than 2 months old, Maria Arranz, MD, reported at the annual meeting of the European Society for Paediatric Infectious Diseases.
“The presence of these parameters on admission should warn us of possible severe disease,” said Dr. Arranz of Gregorio Maranon Hospital in Madrid.
Dr. Arranz presented a retrospective observational study of 101 children under 1 year of age who were hospitalized for pertussis at the Madrid tertiary center prior to the hospital’s 2016 shift to a strategy of maternal immunization during pregnancy as a means of preventing pertussis in infancy. Thirteen percent of the children required admission to the pediatric ICU and thus by definition had severe disease.
Half of infants in the study were not vaccinated against pertussis. That proved to be a powerful risk factor for severe disease requiring an ICU stay. Only 8% of children with severe pertussis were vaccinated, compared with a 58% vaccination rate among those who avoided the ICU.
Apneic pauses were noted in 67% of the severe disease group, compared with 28% of the infants who didn’t need the ICU.
The pertussis patients admitted to the pediatric ICU averaged 1 month of age, compared with age 2 months in the nonsevere group.
The maximum leukocyte, lymphocyte, and neutrophil counts during the hospital stay of the severe disease group averaged 23,600 cells/mm3, 18,000/mm3, and 5,000/mm3, respectively, significantly greater than the 15,300, 10,700, and 3,900 cells/mm3 in infants who did not require the ICU. Levels of all three cells also were higher at admission in the severe pertussis group than in those who didn’t make it to the ICU, albeit not statistically significantly so.
Dr. Arranz reported having no financial conflicts of interest regarding her study.
MADRID – Infants hospitalized for pertussis are more likely to develop severe disease requiring pediatric ICU admission if they are experiencing apnea, are unvaccinated against pertussis, or are less than 2 months old, Maria Arranz, MD, reported at the annual meeting of the European Society for Paediatric Infectious Diseases.
“The presence of these parameters on admission should warn us of possible severe disease,” said Dr. Arranz of Gregorio Maranon Hospital in Madrid.
Dr. Arranz presented a retrospective observational study of 101 children under 1 year of age who were hospitalized for pertussis at the Madrid tertiary center prior to the hospital’s 2016 shift to a strategy of maternal immunization during pregnancy as a means of preventing pertussis in infancy. Thirteen percent of the children required admission to the pediatric ICU and thus by definition had severe disease.
Half of infants in the study were not vaccinated against pertussis. That proved to be a powerful risk factor for severe disease requiring an ICU stay. Only 8% of children with severe pertussis were vaccinated, compared with a 58% vaccination rate among those who avoided the ICU.
Apneic pauses were noted in 67% of the severe disease group, compared with 28% of the infants who didn’t need the ICU.
The pertussis patients admitted to the pediatric ICU averaged 1 month of age, compared with age 2 months in the nonsevere group.
The maximum leukocyte, lymphocyte, and neutrophil counts during the hospital stay of the severe disease group averaged 23,600 cells/mm3, 18,000/mm3, and 5,000/mm3, respectively, significantly greater than the 15,300, 10,700, and 3,900 cells/mm3 in infants who did not require the ICU. Levels of all three cells also were higher at admission in the severe pertussis group than in those who didn’t make it to the ICU, albeit not statistically significantly so.
Dr. Arranz reported having no financial conflicts of interest regarding her study.
MADRID – Infants hospitalized for pertussis are more likely to develop severe disease requiring pediatric ICU admission if they are experiencing apnea, are unvaccinated against pertussis, or are less than 2 months old, Maria Arranz, MD, reported at the annual meeting of the European Society for Paediatric Infectious Diseases.
“The presence of these parameters on admission should warn us of possible severe disease,” said Dr. Arranz of Gregorio Maranon Hospital in Madrid.
Dr. Arranz presented a retrospective observational study of 101 children under 1 year of age who were hospitalized for pertussis at the Madrid tertiary center prior to the hospital’s 2016 shift to a strategy of maternal immunization during pregnancy as a means of preventing pertussis in infancy. Thirteen percent of the children required admission to the pediatric ICU and thus by definition had severe disease.
Half of infants in the study were not vaccinated against pertussis. That proved to be a powerful risk factor for severe disease requiring an ICU stay. Only 8% of children with severe pertussis were vaccinated, compared with a 58% vaccination rate among those who avoided the ICU.
Apneic pauses were noted in 67% of the severe disease group, compared with 28% of the infants who didn’t need the ICU.
The pertussis patients admitted to the pediatric ICU averaged 1 month of age, compared with age 2 months in the nonsevere group.
The maximum leukocyte, lymphocyte, and neutrophil counts during the hospital stay of the severe disease group averaged 23,600 cells/mm3, 18,000/mm3, and 5,000/mm3, respectively, significantly greater than the 15,300, 10,700, and 3,900 cells/mm3 in infants who did not require the ICU. Levels of all three cells also were higher at admission in the severe pertussis group than in those who didn’t make it to the ICU, albeit not statistically significantly so.
Dr. Arranz reported having no financial conflicts of interest regarding her study.
AT ESPID 2017
Key clinical point:
Major finding: Among infants hospitalized for pertussis, apneic pauses were present in two-thirds of those with severe disease, ultimately resulting in admission to the pediatric ICU, compared with 28% of those who didn’t require an ICU stay.
Data source: This retrospective observational study sought to identify factors associated with severe pertussis requiring an ICU stay in a group of 101 Spanish infants hospitalized with the disease.
Disclosures: The presenter reported having no financial conflicts of interest regarding her study.
Consider college immunization requirements when counseling about vaccines
, recommended Allison Noesekabel, a medical student at Wayne State University, Detroit, and Ada M. Fenick, MD, a pediatrician at Yale University, New Haven, Conn.
After identifying the 200 top-ranked U.S. universities in the US News and World Report 2014 National University rankings and sending a survey on university prematriculation immunization requirements (PIRs), the responding 124 universities spanned 44 states and the District of Columbia. Of those who responded, 94% had at least one PIR, 84% had at least two, 63% had at least three, and 16% required all the vaccines as required by any jurisdictional law for attendance at universities (hepatitis B, meningococcus, MMR, TdaP, and varicella). Only 6% of the universities had no immunization requirements.
Of the 121 universities with PIRs, 2% did not allow medical exemptions, 2% did not allow religious exemptions, and 46% did not allow philosophical belief exemptions. Medical exemptions were hardest to obtain for 24% of the 121 universities with PIRs, religious exemptions were the most difficult to obtain at 40%, and philosophical belief exemptions were hardest to obtain at 60% of the universities with PIRs. The most common administrative responses to lack of immunization were “the placement of a hold on registration of classes (89% of universities), additional registration fees (13%), and a hold on student housing (11%),” Ms. Noesekabel and Dr. Frenik reported.
Ms. Noesekabel and Dr. Frenik said they chose highly ranked universities for their study because these were likely to be desirable to vaccine-hesitant families, who tend to be highly educated and affluent. Therefore, the findings of this study may not be representative of all 4-year U.S. colleges, they said.
Read more at Vaccine (2017. doi: 10.1016/j.vaccine.2017.05.038).
, recommended Allison Noesekabel, a medical student at Wayne State University, Detroit, and Ada M. Fenick, MD, a pediatrician at Yale University, New Haven, Conn.
After identifying the 200 top-ranked U.S. universities in the US News and World Report 2014 National University rankings and sending a survey on university prematriculation immunization requirements (PIRs), the responding 124 universities spanned 44 states and the District of Columbia. Of those who responded, 94% had at least one PIR, 84% had at least two, 63% had at least three, and 16% required all the vaccines as required by any jurisdictional law for attendance at universities (hepatitis B, meningococcus, MMR, TdaP, and varicella). Only 6% of the universities had no immunization requirements.
Of the 121 universities with PIRs, 2% did not allow medical exemptions, 2% did not allow religious exemptions, and 46% did not allow philosophical belief exemptions. Medical exemptions were hardest to obtain for 24% of the 121 universities with PIRs, religious exemptions were the most difficult to obtain at 40%, and philosophical belief exemptions were hardest to obtain at 60% of the universities with PIRs. The most common administrative responses to lack of immunization were “the placement of a hold on registration of classes (89% of universities), additional registration fees (13%), and a hold on student housing (11%),” Ms. Noesekabel and Dr. Frenik reported.
Ms. Noesekabel and Dr. Frenik said they chose highly ranked universities for their study because these were likely to be desirable to vaccine-hesitant families, who tend to be highly educated and affluent. Therefore, the findings of this study may not be representative of all 4-year U.S. colleges, they said.
Read more at Vaccine (2017. doi: 10.1016/j.vaccine.2017.05.038).
, recommended Allison Noesekabel, a medical student at Wayne State University, Detroit, and Ada M. Fenick, MD, a pediatrician at Yale University, New Haven, Conn.
After identifying the 200 top-ranked U.S. universities in the US News and World Report 2014 National University rankings and sending a survey on university prematriculation immunization requirements (PIRs), the responding 124 universities spanned 44 states and the District of Columbia. Of those who responded, 94% had at least one PIR, 84% had at least two, 63% had at least three, and 16% required all the vaccines as required by any jurisdictional law for attendance at universities (hepatitis B, meningococcus, MMR, TdaP, and varicella). Only 6% of the universities had no immunization requirements.
Of the 121 universities with PIRs, 2% did not allow medical exemptions, 2% did not allow religious exemptions, and 46% did not allow philosophical belief exemptions. Medical exemptions were hardest to obtain for 24% of the 121 universities with PIRs, religious exemptions were the most difficult to obtain at 40%, and philosophical belief exemptions were hardest to obtain at 60% of the universities with PIRs. The most common administrative responses to lack of immunization were “the placement of a hold on registration of classes (89% of universities), additional registration fees (13%), and a hold on student housing (11%),” Ms. Noesekabel and Dr. Frenik reported.
Ms. Noesekabel and Dr. Frenik said they chose highly ranked universities for their study because these were likely to be desirable to vaccine-hesitant families, who tend to be highly educated and affluent. Therefore, the findings of this study may not be representative of all 4-year U.S. colleges, they said.
Read more at Vaccine (2017. doi: 10.1016/j.vaccine.2017.05.038).
FROM VACCINE
USPSTF recommends screening children, adolescents for obesity
Children and adolescents aged 6 years and older should be screened for obesity and referred to comprehensive, intensive behavioral interventions with at least 26 hours of intervention contact, according to a U.S. Preventive Services Task Force Recommendation Statement that was published online June 20 in JAMA.
This updated recommendation is largely consistent with the previous 2010 recommendation “but includes the word ‘adolescents’ to further clarify the population to which this recommendation applies,” according to a press release accompanying the Recommendation Statement and the Evidence Report on which it is based.
The behavioral interventions that proved most beneficial included at least 26 hours of contact over a period of 2-12 months. Those that included 52 or more hours of contact achieved even greater weight loss, as well as some improvements in cardiovascular and metabolic risk factors (JAMA. 2017 Jun 20. doi: 10.1001/jama.2017.6803).
In general, children and adolescents who received intensive behavioral intervention showed absolute reductions in BMI z scores of 0.20 and maintained their baseline weight within approximately 5 pounds, while control subjects showed small or no reductions in BMI z scores and typically gained a mean of 5-17 pounds.
The components of these comprehensive interventions varied, but the most successful ones included sessions involving both the child and the parent (separately, together, or both); offered both family and group sessions; provided education regarding healthy eating, exercising, and reading food labels; encouraged stimulus-control measures such as limiting access to unhealthy foods and limiting screen time (that is, physical inactivity); and included supervised physical activity. Additional beneficial components are assisting patients to identify and accomplish goals, self-monitor, and problem-solve, as well as teaching them coping skills and addressing their body image.
In contrast to behavioral interventions, pharmacotherapy was not endorsed by the USPSTF. The current evidence was deemed inadequate to determine whether the slight weight loss achieved with pharmacotherapy is clinically significant and whether it outweighs the harms of the medications.
The two agents currently used in this regard are metformin, which is not Food and Drug Administration–approved for this purpose, and orlistat, which is approved for patients aged 12 years and older. Orlistat in particular frequently causes adverse events including fatty or oily stools, abdominal pain or cramping, flatus with stool discharge, and fecal incontinence, Dr. Grossman and his associates said.
The USPSTF is an independent voluntary group supported by the U.S. Agency for Healthcare Research and Quality as mandated by Congress. The authors’ conflicts of interest are available at https://www.uspreventiveservicestaskforce.org/Page/Name/conflict-of-interest-disclosures.
Letter to the Editor
It is not surprising that there are so many overweight and obese children, despite the fact that in order to prevent bad feelings, children have to be much more overweight than adults to be classified as obese or overweight.
If one is waiting until age 6 years to screen for obesity, that horse will be long out of the barn. The problem begins when the rapid weight gain of infants does not slow down in the 2nd and 3rd years of life. This is also when bad food choices and eating habits often begin.
The other problem is that body mass index is a terrible tool and so is any indicator that tries to define obesity using only height and weight. None of these distinguish between the muscular child and the slender child with a large belly. Waist to height or body volume measurements are far better indicators.
Lastly, parents have come to see the mildly overweight child as the norm because so many children are. Until parents see pictures of children from a few decades ago and are educated as to what normal looks like, we will have great difficulty making a dent in this problem.
Richard H. Feuille Jr., MD
This USPSTF recommendation simply confirms what pediatric clinicians always do in the everyday care for children and adolescents: monitor growth, counsel on healthy lifestyles, and refer for specialized care when appropriate.
Intensive behavioral interventions are impractical for many families and frequently aren’t covered by insurance. At best, implementing this recommendation will have only a modest effect on obesity in the United States. At worst, it could divert attention and resources away from population-health approaches to prevention and toward weight management programs that are not well equipped to meet the demand and very often don’t exist within local communities.
Improving neighborhood walkability, increasing the availability of healthy foods, and providing safe physical spaces would be more effective at reducing childhood obesity, as would improving school nutrition and curtailing the marketing of sugar-sweetened drinks and other unhealthy foods to children.
Rachel L. J. Thornton, MD, PhD, Raquel G. Hernandez, MD, MPH; Tina L. Cheng, MD, MPH, are in the department of pediatrics at Johns Hopkins University, Baltimore. They reported having no relevant financial disclosures. They made these remarks in an editorial accompanying the USPSTF report (JAMA. 2017;317:2378-80).
This USPSTF recommendation simply confirms what pediatric clinicians always do in the everyday care for children and adolescents: monitor growth, counsel on healthy lifestyles, and refer for specialized care when appropriate.
Intensive behavioral interventions are impractical for many families and frequently aren’t covered by insurance. At best, implementing this recommendation will have only a modest effect on obesity in the United States. At worst, it could divert attention and resources away from population-health approaches to prevention and toward weight management programs that are not well equipped to meet the demand and very often don’t exist within local communities.
Improving neighborhood walkability, increasing the availability of healthy foods, and providing safe physical spaces would be more effective at reducing childhood obesity, as would improving school nutrition and curtailing the marketing of sugar-sweetened drinks and other unhealthy foods to children.
Rachel L. J. Thornton, MD, PhD, Raquel G. Hernandez, MD, MPH; Tina L. Cheng, MD, MPH, are in the department of pediatrics at Johns Hopkins University, Baltimore. They reported having no relevant financial disclosures. They made these remarks in an editorial accompanying the USPSTF report (JAMA. 2017;317:2378-80).
This USPSTF recommendation simply confirms what pediatric clinicians always do in the everyday care for children and adolescents: monitor growth, counsel on healthy lifestyles, and refer for specialized care when appropriate.
Intensive behavioral interventions are impractical for many families and frequently aren’t covered by insurance. At best, implementing this recommendation will have only a modest effect on obesity in the United States. At worst, it could divert attention and resources away from population-health approaches to prevention and toward weight management programs that are not well equipped to meet the demand and very often don’t exist within local communities.
Improving neighborhood walkability, increasing the availability of healthy foods, and providing safe physical spaces would be more effective at reducing childhood obesity, as would improving school nutrition and curtailing the marketing of sugar-sweetened drinks and other unhealthy foods to children.
Rachel L. J. Thornton, MD, PhD, Raquel G. Hernandez, MD, MPH; Tina L. Cheng, MD, MPH, are in the department of pediatrics at Johns Hopkins University, Baltimore. They reported having no relevant financial disclosures. They made these remarks in an editorial accompanying the USPSTF report (JAMA. 2017;317:2378-80).
Children and adolescents aged 6 years and older should be screened for obesity and referred to comprehensive, intensive behavioral interventions with at least 26 hours of intervention contact, according to a U.S. Preventive Services Task Force Recommendation Statement that was published online June 20 in JAMA.
This updated recommendation is largely consistent with the previous 2010 recommendation “but includes the word ‘adolescents’ to further clarify the population to which this recommendation applies,” according to a press release accompanying the Recommendation Statement and the Evidence Report on which it is based.
The behavioral interventions that proved most beneficial included at least 26 hours of contact over a period of 2-12 months. Those that included 52 or more hours of contact achieved even greater weight loss, as well as some improvements in cardiovascular and metabolic risk factors (JAMA. 2017 Jun 20. doi: 10.1001/jama.2017.6803).
In general, children and adolescents who received intensive behavioral intervention showed absolute reductions in BMI z scores of 0.20 and maintained their baseline weight within approximately 5 pounds, while control subjects showed small or no reductions in BMI z scores and typically gained a mean of 5-17 pounds.
The components of these comprehensive interventions varied, but the most successful ones included sessions involving both the child and the parent (separately, together, or both); offered both family and group sessions; provided education regarding healthy eating, exercising, and reading food labels; encouraged stimulus-control measures such as limiting access to unhealthy foods and limiting screen time (that is, physical inactivity); and included supervised physical activity. Additional beneficial components are assisting patients to identify and accomplish goals, self-monitor, and problem-solve, as well as teaching them coping skills and addressing their body image.
In contrast to behavioral interventions, pharmacotherapy was not endorsed by the USPSTF. The current evidence was deemed inadequate to determine whether the slight weight loss achieved with pharmacotherapy is clinically significant and whether it outweighs the harms of the medications.
The two agents currently used in this regard are metformin, which is not Food and Drug Administration–approved for this purpose, and orlistat, which is approved for patients aged 12 years and older. Orlistat in particular frequently causes adverse events including fatty or oily stools, abdominal pain or cramping, flatus with stool discharge, and fecal incontinence, Dr. Grossman and his associates said.
The USPSTF is an independent voluntary group supported by the U.S. Agency for Healthcare Research and Quality as mandated by Congress. The authors’ conflicts of interest are available at https://www.uspreventiveservicestaskforce.org/Page/Name/conflict-of-interest-disclosures.
Letter to the Editor
It is not surprising that there are so many overweight and obese children, despite the fact that in order to prevent bad feelings, children have to be much more overweight than adults to be classified as obese or overweight.
If one is waiting until age 6 years to screen for obesity, that horse will be long out of the barn. The problem begins when the rapid weight gain of infants does not slow down in the 2nd and 3rd years of life. This is also when bad food choices and eating habits often begin.
The other problem is that body mass index is a terrible tool and so is any indicator that tries to define obesity using only height and weight. None of these distinguish between the muscular child and the slender child with a large belly. Waist to height or body volume measurements are far better indicators.
Lastly, parents have come to see the mildly overweight child as the norm because so many children are. Until parents see pictures of children from a few decades ago and are educated as to what normal looks like, we will have great difficulty making a dent in this problem.
Richard H. Feuille Jr., MD
Children and adolescents aged 6 years and older should be screened for obesity and referred to comprehensive, intensive behavioral interventions with at least 26 hours of intervention contact, according to a U.S. Preventive Services Task Force Recommendation Statement that was published online June 20 in JAMA.
This updated recommendation is largely consistent with the previous 2010 recommendation “but includes the word ‘adolescents’ to further clarify the population to which this recommendation applies,” according to a press release accompanying the Recommendation Statement and the Evidence Report on which it is based.
The behavioral interventions that proved most beneficial included at least 26 hours of contact over a period of 2-12 months. Those that included 52 or more hours of contact achieved even greater weight loss, as well as some improvements in cardiovascular and metabolic risk factors (JAMA. 2017 Jun 20. doi: 10.1001/jama.2017.6803).
In general, children and adolescents who received intensive behavioral intervention showed absolute reductions in BMI z scores of 0.20 and maintained their baseline weight within approximately 5 pounds, while control subjects showed small or no reductions in BMI z scores and typically gained a mean of 5-17 pounds.
The components of these comprehensive interventions varied, but the most successful ones included sessions involving both the child and the parent (separately, together, or both); offered both family and group sessions; provided education regarding healthy eating, exercising, and reading food labels; encouraged stimulus-control measures such as limiting access to unhealthy foods and limiting screen time (that is, physical inactivity); and included supervised physical activity. Additional beneficial components are assisting patients to identify and accomplish goals, self-monitor, and problem-solve, as well as teaching them coping skills and addressing their body image.
In contrast to behavioral interventions, pharmacotherapy was not endorsed by the USPSTF. The current evidence was deemed inadequate to determine whether the slight weight loss achieved with pharmacotherapy is clinically significant and whether it outweighs the harms of the medications.
The two agents currently used in this regard are metformin, which is not Food and Drug Administration–approved for this purpose, and orlistat, which is approved for patients aged 12 years and older. Orlistat in particular frequently causes adverse events including fatty or oily stools, abdominal pain or cramping, flatus with stool discharge, and fecal incontinence, Dr. Grossman and his associates said.
The USPSTF is an independent voluntary group supported by the U.S. Agency for Healthcare Research and Quality as mandated by Congress. The authors’ conflicts of interest are available at https://www.uspreventiveservicestaskforce.org/Page/Name/conflict-of-interest-disclosures.
Letter to the Editor
It is not surprising that there are so many overweight and obese children, despite the fact that in order to prevent bad feelings, children have to be much more overweight than adults to be classified as obese or overweight.
If one is waiting until age 6 years to screen for obesity, that horse will be long out of the barn. The problem begins when the rapid weight gain of infants does not slow down in the 2nd and 3rd years of life. This is also when bad food choices and eating habits often begin.
The other problem is that body mass index is a terrible tool and so is any indicator that tries to define obesity using only height and weight. None of these distinguish between the muscular child and the slender child with a large belly. Waist to height or body volume measurements are far better indicators.
Lastly, parents have come to see the mildly overweight child as the norm because so many children are. Until parents see pictures of children from a few decades ago and are educated as to what normal looks like, we will have great difficulty making a dent in this problem.
Richard H. Feuille Jr., MD
FROM JAMA
Key clinical point: with at least 26 hours of contact.
Major finding: Children and adolescents who received intensive behavioral intervention showed absolute reductions in BMI z scores of 0.20 and maintained their baseline weight within approximately 5 pounds, while control subjects showed small or no reductions in BMI z scores and typically gained a mean of 5-17 pounds.
Data source: A review of the literature since the previous USPSTF recommendation statement in 2010, including 45 studies of lifestyle-based interventions involving 7,099 overweight and obese children.
Disclosures: The USPSTF is an independent voluntary group supported by the U.S. Agency for Healthcare Research and Quality as mandated by Congress. The authors’ conflicts of interest are available at www.uspreventiveservicestaskforce.org.
MMR vaccine cut hospitalizations for unrelated respiratory infections
, said Giuseppe La Torre of the Sapienza University of Rome and his associates.
The 2-year retrospective database study included 11,004 children, 21% of whom did not receive the MMR vaccine; 49% received one dose, and 30% received two doses. There were 12 hospitalizations for measles (9 in unvaccinated children, 3 in those who received one dose, and none in those who received two doses), 2 hospitalizations for mumps (1 among vaccinated and 1 among unvaccinated children), and no hospitalizations for rubella (P less than .001).
There were 414 hospitalizations for all infectious diseases, 11% in unvaccinated children, 1.5% in those who had received one dose of vaccine, and 1% in those who had received two doses (P less than .001). MMR vaccine also was highly protective against hospitalizations for all infectious diseases (HR, 0.29).
Of 809 hospitalizations for respiratory diseases, 18% involved children who had not been vaccinated, 4% involved children who had received one dose, and 5.5% involved children vaccinated with two doses (P less than .001). MMR likewise was highly protective against hospitalizations for respiratory diseases (HR, 0.18).
Read more in the journal Human Vaccines & Immunotherapeutics (2017 Jun 12. doi: 10.1080/21645515.2017.1330733).
, said Giuseppe La Torre of the Sapienza University of Rome and his associates.
The 2-year retrospective database study included 11,004 children, 21% of whom did not receive the MMR vaccine; 49% received one dose, and 30% received two doses. There were 12 hospitalizations for measles (9 in unvaccinated children, 3 in those who received one dose, and none in those who received two doses), 2 hospitalizations for mumps (1 among vaccinated and 1 among unvaccinated children), and no hospitalizations for rubella (P less than .001).
There were 414 hospitalizations for all infectious diseases, 11% in unvaccinated children, 1.5% in those who had received one dose of vaccine, and 1% in those who had received two doses (P less than .001). MMR vaccine also was highly protective against hospitalizations for all infectious diseases (HR, 0.29).
Of 809 hospitalizations for respiratory diseases, 18% involved children who had not been vaccinated, 4% involved children who had received one dose, and 5.5% involved children vaccinated with two doses (P less than .001). MMR likewise was highly protective against hospitalizations for respiratory diseases (HR, 0.18).
Read more in the journal Human Vaccines & Immunotherapeutics (2017 Jun 12. doi: 10.1080/21645515.2017.1330733).
, said Giuseppe La Torre of the Sapienza University of Rome and his associates.
The 2-year retrospective database study included 11,004 children, 21% of whom did not receive the MMR vaccine; 49% received one dose, and 30% received two doses. There were 12 hospitalizations for measles (9 in unvaccinated children, 3 in those who received one dose, and none in those who received two doses), 2 hospitalizations for mumps (1 among vaccinated and 1 among unvaccinated children), and no hospitalizations for rubella (P less than .001).
There were 414 hospitalizations for all infectious diseases, 11% in unvaccinated children, 1.5% in those who had received one dose of vaccine, and 1% in those who had received two doses (P less than .001). MMR vaccine also was highly protective against hospitalizations for all infectious diseases (HR, 0.29).
Of 809 hospitalizations for respiratory diseases, 18% involved children who had not been vaccinated, 4% involved children who had received one dose, and 5.5% involved children vaccinated with two doses (P less than .001). MMR likewise was highly protective against hospitalizations for respiratory diseases (HR, 0.18).
Read more in the journal Human Vaccines & Immunotherapeutics (2017 Jun 12. doi: 10.1080/21645515.2017.1330733).
FROM HUMAN VACCINES & IMMUNOTHERAPEUTICS
VIDEO: Tocilizumab tested in children with sJIA under 2 years old
MADRID – The results of the first trial of a biologic agent in children less than 2 years of age with systemic juvenile idiopathic arthritis (sJIA) suggest that tocilizumab is likely to be effective in this age group.
“sJIA is the most severe form of childhood arthritis, and as you are aware, it’s the most difficult to treat as well,” said Navita L. Mallalieu, PhD, director of clinical pharmacology at Roche Innovation Center New York, the company that funded the study.
Tocilizumab (Actemra) has been available for the treatment of sJIA, both in the United States and the European Union since 2011, she observed at the European Congress of Rheumatology, but only for children aged 2 years or older at the current time.
Because of this prior history of use in sJIA, “we have confidence in the safety profile, and so we were able to go to the next step of testing children who were even younger than 2 years of age,” Dr. Mallalieu said in a video interview.
[polldaddy:9771949]
Dr. Mallalieu presented findings from an open-label, single-arm, phase I trial that evaluated a 12 mg/kg dosing regimen of tocilizumab, which was given intravenously every 2 weeks for 12 weeks. Eleven children were studied who had a mean age of 1.3 years and active disease for at least 1 month despite treatment with glucocorticoids or nonsteroidal anti-inflammatory drugs.
The primary endpoint was the pharmacokinetics of tocilizumab in this younger patient population, and secondary endpoints were safety, pharmacodynamics, and exploring the efficacy over 12 weeks on top of stable background therapy, she explained.
Results showed that tocilizumab in children under 2 years of age could achieve pharmacokinetics similar to those seen in older children in the TENDER trial (N Engl J Med. 2012;367:2385-95), which is the trial that helped the biologic get licensed for use in the older sJIA population. Reductions in soluble interleukin-6 receptor, C-reactive protein, and the erythrocyte sedimentation rate were seen, again to a similar extent as seen in the TENDER trial. There was also an indication that similar reductions in the Juvenile Arthritis Disease Activity Score (JADAS)-71 score could be achieved, Dr. Mallalieu reported.
While the pattern and nature of adverse events were similar to those seen in the TENDER trial, there were more cases of hypersensitivity in this phase I study. Four cases of hypersensitivity were clinically confirmed, three of which were deemed serious. The three serious cases were observed at day 15, with two of the cases associated with multiple signs and symptoms that were confounded by either subclinical macrophage activation syndrome (MAS) or a faster infusion rate. One patient had urticaria and was hospitalized for observation.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
MADRID – The results of the first trial of a biologic agent in children less than 2 years of age with systemic juvenile idiopathic arthritis (sJIA) suggest that tocilizumab is likely to be effective in this age group.
“sJIA is the most severe form of childhood arthritis, and as you are aware, it’s the most difficult to treat as well,” said Navita L. Mallalieu, PhD, director of clinical pharmacology at Roche Innovation Center New York, the company that funded the study.
Tocilizumab (Actemra) has been available for the treatment of sJIA, both in the United States and the European Union since 2011, she observed at the European Congress of Rheumatology, but only for children aged 2 years or older at the current time.
Because of this prior history of use in sJIA, “we have confidence in the safety profile, and so we were able to go to the next step of testing children who were even younger than 2 years of age,” Dr. Mallalieu said in a video interview.
[polldaddy:9771949]
Dr. Mallalieu presented findings from an open-label, single-arm, phase I trial that evaluated a 12 mg/kg dosing regimen of tocilizumab, which was given intravenously every 2 weeks for 12 weeks. Eleven children were studied who had a mean age of 1.3 years and active disease for at least 1 month despite treatment with glucocorticoids or nonsteroidal anti-inflammatory drugs.
The primary endpoint was the pharmacokinetics of tocilizumab in this younger patient population, and secondary endpoints were safety, pharmacodynamics, and exploring the efficacy over 12 weeks on top of stable background therapy, she explained.
Results showed that tocilizumab in children under 2 years of age could achieve pharmacokinetics similar to those seen in older children in the TENDER trial (N Engl J Med. 2012;367:2385-95), which is the trial that helped the biologic get licensed for use in the older sJIA population. Reductions in soluble interleukin-6 receptor, C-reactive protein, and the erythrocyte sedimentation rate were seen, again to a similar extent as seen in the TENDER trial. There was also an indication that similar reductions in the Juvenile Arthritis Disease Activity Score (JADAS)-71 score could be achieved, Dr. Mallalieu reported.
While the pattern and nature of adverse events were similar to those seen in the TENDER trial, there were more cases of hypersensitivity in this phase I study. Four cases of hypersensitivity were clinically confirmed, three of which were deemed serious. The three serious cases were observed at day 15, with two of the cases associated with multiple signs and symptoms that were confounded by either subclinical macrophage activation syndrome (MAS) or a faster infusion rate. One patient had urticaria and was hospitalized for observation.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
MADRID – The results of the first trial of a biologic agent in children less than 2 years of age with systemic juvenile idiopathic arthritis (sJIA) suggest that tocilizumab is likely to be effective in this age group.
“sJIA is the most severe form of childhood arthritis, and as you are aware, it’s the most difficult to treat as well,” said Navita L. Mallalieu, PhD, director of clinical pharmacology at Roche Innovation Center New York, the company that funded the study.
Tocilizumab (Actemra) has been available for the treatment of sJIA, both in the United States and the European Union since 2011, she observed at the European Congress of Rheumatology, but only for children aged 2 years or older at the current time.
Because of this prior history of use in sJIA, “we have confidence in the safety profile, and so we were able to go to the next step of testing children who were even younger than 2 years of age,” Dr. Mallalieu said in a video interview.
[polldaddy:9771949]
Dr. Mallalieu presented findings from an open-label, single-arm, phase I trial that evaluated a 12 mg/kg dosing regimen of tocilizumab, which was given intravenously every 2 weeks for 12 weeks. Eleven children were studied who had a mean age of 1.3 years and active disease for at least 1 month despite treatment with glucocorticoids or nonsteroidal anti-inflammatory drugs.
The primary endpoint was the pharmacokinetics of tocilizumab in this younger patient population, and secondary endpoints were safety, pharmacodynamics, and exploring the efficacy over 12 weeks on top of stable background therapy, she explained.
Results showed that tocilizumab in children under 2 years of age could achieve pharmacokinetics similar to those seen in older children in the TENDER trial (N Engl J Med. 2012;367:2385-95), which is the trial that helped the biologic get licensed for use in the older sJIA population. Reductions in soluble interleukin-6 receptor, C-reactive protein, and the erythrocyte sedimentation rate were seen, again to a similar extent as seen in the TENDER trial. There was also an indication that similar reductions in the Juvenile Arthritis Disease Activity Score (JADAS)-71 score could be achieved, Dr. Mallalieu reported.
While the pattern and nature of adverse events were similar to those seen in the TENDER trial, there were more cases of hypersensitivity in this phase I study. Four cases of hypersensitivity were clinically confirmed, three of which were deemed serious. The three serious cases were observed at day 15, with two of the cases associated with multiple signs and symptoms that were confounded by either subclinical macrophage activation syndrome (MAS) or a faster infusion rate. One patient had urticaria and was hospitalized for observation.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT THE EULAR 2017 CONGRESS
Key clinical point:
Major finding: Similar pharmacokinetics were observed in children under 2 years of age as those seen in a prior study of older children.
Data source: Open-label, single-arm, phase I trial that evaluated a 12-mg/kg dosing regimen of tocilizumab given intravenously every 2 weeks for 12 weeks.
Disclosures: Roche funded the study. The presenter is an employee of Roche.
Teens’ overall tobacco use falls, but e-cigs now most popular product
Twenty percent of surveyed high school students and 7% of middle school students were using some kind of tobacco product in 2016 – and e-cigarettes were the most commonly used product among those groups, according to an analysis from federal researchers.
, although combustible tobacco product use declined in both groups, said Ahmed Jamal, MD, of the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, and his associates. That was determined using data from the 2011-2016 National Youth Tobacco Surveys, which assessed tobacco use in the past 30 days by groups of middle school and high school students numbering from more than 17,000 to almost 25,000.
High school boys had higher use of any tobacco product, two or more tobacco products, cigars, smokeless tobacco, and pipe tobacco than did high school girls. The most commonly used tobacco product among non-Hispanic white (13.7%) and Hispanic high school students (10%) were e-cigarettes; cigars were the most commonly used tobacco product among non-Hispanic black high school students (9.5%).
Seven percent of middle school students had used any tobacco product within the past 30 days, and 3% had used two or more tobacco products. Similar to high school students, e-cigarettes were the most commonly used tobacco product among middle school students (4.3%), followed by cigarettes (2%), cigars (2%), smokeless tobacco (2%), hookahs (2%), pipe tobacco (0.7%), and bidis (0.3%).
Use of any tobacco product among middle school boys was 8.3%, and among middle school girls use was 6%. Hispanic middle school students reported higher use of any tobacco product, were more likely to use two or more tobacco products, and said they used hookahs more often than did non-Hispanic white middle school students.
Looking at the changes from 2011 to 2016, current use of any tobacco product did not change significantly among high school students (falling from 24% to 20%), but there was a reduction in current use of any combustible tobacco product (22%-14%) and in use of two or more tobacco products (12%-9.6%) over this time period.
By product type, there were increases in current use of e-cigarettes (from 1.5% to 11.3%) and hookahs (from 4.1% to 4.8%) among high school students, as well as decreases in current use of cigarettes (from 16% to 8%), cigars (from 12% to 8%), smokeless tobacco (from 8% to 6%), pipe tobacco (from 4% to 1%), and bidis (from 2% to 0.5%).
Among middle school students during 2011-2016, there was a rise in current use of e-cigarettes (from 0.6% to 4%), and in current use of hookahs (from 1% to 2%). There was a drop in current use of any combustible tobacco products (from 6% to 4%), cigarettes (from 4% to 2%), cigars (from 3.5% to 2.2%), and pipe tobacco (from 2% to 0.7%).
“Since February 2014, the Food and Drug Administration’s first national tobacco public education campaign, the Real Cost, has broadcasted tobacco education advertising designed for youths aged 12-17 years; the campaign was associated with an estimated 348,398 U.S. youths who did not initiate cigarette smoking during February 2014–March 2016,” the investigators said. “Continued implementation of these strategies can help prevent and further reduce the use of all forms of tobacco product among U.S. youths.”
Read more in MMWR (2017 Jun 16;66[23]:597-603).
Twenty percent of surveyed high school students and 7% of middle school students were using some kind of tobacco product in 2016 – and e-cigarettes were the most commonly used product among those groups, according to an analysis from federal researchers.
, although combustible tobacco product use declined in both groups, said Ahmed Jamal, MD, of the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, and his associates. That was determined using data from the 2011-2016 National Youth Tobacco Surveys, which assessed tobacco use in the past 30 days by groups of middle school and high school students numbering from more than 17,000 to almost 25,000.
High school boys had higher use of any tobacco product, two or more tobacco products, cigars, smokeless tobacco, and pipe tobacco than did high school girls. The most commonly used tobacco product among non-Hispanic white (13.7%) and Hispanic high school students (10%) were e-cigarettes; cigars were the most commonly used tobacco product among non-Hispanic black high school students (9.5%).
Seven percent of middle school students had used any tobacco product within the past 30 days, and 3% had used two or more tobacco products. Similar to high school students, e-cigarettes were the most commonly used tobacco product among middle school students (4.3%), followed by cigarettes (2%), cigars (2%), smokeless tobacco (2%), hookahs (2%), pipe tobacco (0.7%), and bidis (0.3%).
Use of any tobacco product among middle school boys was 8.3%, and among middle school girls use was 6%. Hispanic middle school students reported higher use of any tobacco product, were more likely to use two or more tobacco products, and said they used hookahs more often than did non-Hispanic white middle school students.
Looking at the changes from 2011 to 2016, current use of any tobacco product did not change significantly among high school students (falling from 24% to 20%), but there was a reduction in current use of any combustible tobacco product (22%-14%) and in use of two or more tobacco products (12%-9.6%) over this time period.
By product type, there were increases in current use of e-cigarettes (from 1.5% to 11.3%) and hookahs (from 4.1% to 4.8%) among high school students, as well as decreases in current use of cigarettes (from 16% to 8%), cigars (from 12% to 8%), smokeless tobacco (from 8% to 6%), pipe tobacco (from 4% to 1%), and bidis (from 2% to 0.5%).
Among middle school students during 2011-2016, there was a rise in current use of e-cigarettes (from 0.6% to 4%), and in current use of hookahs (from 1% to 2%). There was a drop in current use of any combustible tobacco products (from 6% to 4%), cigarettes (from 4% to 2%), cigars (from 3.5% to 2.2%), and pipe tobacco (from 2% to 0.7%).
“Since February 2014, the Food and Drug Administration’s first national tobacco public education campaign, the Real Cost, has broadcasted tobacco education advertising designed for youths aged 12-17 years; the campaign was associated with an estimated 348,398 U.S. youths who did not initiate cigarette smoking during February 2014–March 2016,” the investigators said. “Continued implementation of these strategies can help prevent and further reduce the use of all forms of tobacco product among U.S. youths.”
Read more in MMWR (2017 Jun 16;66[23]:597-603).
Twenty percent of surveyed high school students and 7% of middle school students were using some kind of tobacco product in 2016 – and e-cigarettes were the most commonly used product among those groups, according to an analysis from federal researchers.
, although combustible tobacco product use declined in both groups, said Ahmed Jamal, MD, of the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, and his associates. That was determined using data from the 2011-2016 National Youth Tobacco Surveys, which assessed tobacco use in the past 30 days by groups of middle school and high school students numbering from more than 17,000 to almost 25,000.
High school boys had higher use of any tobacco product, two or more tobacco products, cigars, smokeless tobacco, and pipe tobacco than did high school girls. The most commonly used tobacco product among non-Hispanic white (13.7%) and Hispanic high school students (10%) were e-cigarettes; cigars were the most commonly used tobacco product among non-Hispanic black high school students (9.5%).
Seven percent of middle school students had used any tobacco product within the past 30 days, and 3% had used two or more tobacco products. Similar to high school students, e-cigarettes were the most commonly used tobacco product among middle school students (4.3%), followed by cigarettes (2%), cigars (2%), smokeless tobacco (2%), hookahs (2%), pipe tobacco (0.7%), and bidis (0.3%).
Use of any tobacco product among middle school boys was 8.3%, and among middle school girls use was 6%. Hispanic middle school students reported higher use of any tobacco product, were more likely to use two or more tobacco products, and said they used hookahs more often than did non-Hispanic white middle school students.
Looking at the changes from 2011 to 2016, current use of any tobacco product did not change significantly among high school students (falling from 24% to 20%), but there was a reduction in current use of any combustible tobacco product (22%-14%) and in use of two or more tobacco products (12%-9.6%) over this time period.
By product type, there were increases in current use of e-cigarettes (from 1.5% to 11.3%) and hookahs (from 4.1% to 4.8%) among high school students, as well as decreases in current use of cigarettes (from 16% to 8%), cigars (from 12% to 8%), smokeless tobacco (from 8% to 6%), pipe tobacco (from 4% to 1%), and bidis (from 2% to 0.5%).
Among middle school students during 2011-2016, there was a rise in current use of e-cigarettes (from 0.6% to 4%), and in current use of hookahs (from 1% to 2%). There was a drop in current use of any combustible tobacco products (from 6% to 4%), cigarettes (from 4% to 2%), cigars (from 3.5% to 2.2%), and pipe tobacco (from 2% to 0.7%).
“Since February 2014, the Food and Drug Administration’s first national tobacco public education campaign, the Real Cost, has broadcasted tobacco education advertising designed for youths aged 12-17 years; the campaign was associated with an estimated 348,398 U.S. youths who did not initiate cigarette smoking during February 2014–March 2016,” the investigators said. “Continued implementation of these strategies can help prevent and further reduce the use of all forms of tobacco product among U.S. youths.”
Read more in MMWR (2017 Jun 16;66[23]:597-603).
FROM MMWR
Child firearm suicide at highest rate in more than a decade
Boys, older children, and minorities are disproportionately affected when it comes to firearm injuries and deaths in U.S. children and adolescents, and child firearm suicide rates are at the highest they have been in more than a decade, new study results revealed.
Around 19 children are either medically treated for a gunshot wound or killed by one every day in the United States. “The majority of these children are boys 13-17 years old, African American in the case of firearm homicide, and white and American Indian in the case of firearm suicide. Pediatric firearm injuries and deaths are an important public health problem in the United States, contributing substantially each year to premature death, illness, and disability of children,” said Katherine A. Fowler, PhD, of the National Center for Injury Prevention and Control, Atlanta, and her associates. “Finding ways to prevent such injuries and ensure that all children have safe, stable, nurturing relationships and environments remains one of our most important priorities” (Pediatrics. 2017;140(1):e20163486).
“From 2012 to 2014, the average annual case fatality rate was 74% for firearm-related self-harm, 14% for firearm-related assaults, and 6% for unintentional firearm injuries,” the investigators reported.
Boys accounted for 82% of all child firearm deaths from 2012 to 2014. In this time period, the annual rate of firearm death for boys was 4.5 times higher than the annual rate for girls (2.8 vs. 0.6 per 100,000). This difference was even more pronounced by age, with the rate for 13- to 17-year-old boys being six times higher than the rate for same-aged girls. Similarly, boys suffer the majority of nonfatal firearm injuries treated in U.S. emergency departments, accounting for 84% of all nonfatal firearm injuries medically treated each year from 2012 to 2014. The average annual rate of nonfatal firearm injuries for boys was five times the rate for girls at 13 vs. 3 per 100,000.
The annual rate of firearm homicide was 10 times higher among 13- to 17-year-olds versus 0- to 12-year-olds (3 vs. 0.3 per 100,000). Unintentional firearm death rates were approximately twice as high when comparing these two groups (0.2 vs. 0.1 per 100,000).
Dr. Fowler and her associates wrote, “Our findings indicate that most children who died of unintentional firearm injuries were shot by another child in their own age range and most often in the context of playing with a gun or showing it to others. More than one-third of the deaths of older children occurred in incidents in which the shooter thought that the gun was unloaded or thought that the safety was engaged.”
“Child firearm suicide rates showed a significant upward trend between 2007 and 2014, increasing 60% from 1.0 to 1.6 (P less than .05) to the highest rate seen over the period examined,” Dr. Fowler and her associates said.
Firearm suicide rates were 11 times higher among 13- to 17-year-olds vs. 10- to 12-year-olds (2 vs. 0.2 per 100,000). Older children also accounted for 88% of all nonfatal firearm injuries treated in an ED. The overall average annual rate of nonfatal firearm injuries for older children was 19 times that of younger children (24 vs. 1 per 100,000).
The annual firearm homicide rate for African American children was nearly 10 times higher than the rate for white children (4 vs. 0.4 per 100,000). However, the annual rate of firearm suicide among white children was nearly four times higher than the rate for African American children (2. vs. 0.6 per 100,000).
Awareness of the availability of firearms during times of crisis is crucial because suicides are often impulsive in young people, Dr. Fowler and her associates said, “with previous findings indicating that many who attempt suicide spend 10 minutes or less deliberating. Safe storage practices (i.e., unloading and locking all firearms and ammunition) can potentially be lifesaving in these instances,” as the results of previous studies in this age group attest.
Firearm deaths are the third leading cause of death overall among children in the United States aged 1-17 years, beating pediatric congenital anomalies, heart disease, influenza/pneumonia, chronic lower respiratory disease, and cerebrovascular causes. Understanding the nature, scale, and impact of firearm violence against children is an important first step, concluded Dr. Fowler and her associates.
Dr. Fowler and her associates said they had no relevant financial disclosures.
Dr. Fowler’s study brings a lot of uncomfortable statistics to light. Subsequently we are left wondering, What can we do about it? With firearm injury mortality rates in children increasing over the past 2 years according to the CDC’s Web-based Injury Statistics Query and Reporting System, it is crucial that we continue to demand the appropriate support for this public health crisis.
Recognizing the prevalence of guns in homes and the potential dangers of easy access to them makes it essential to ask about firearms as part of our injury prevention guidance and offer counseling to parents and children about safe gun storage, gun locks, or support for legislation to protect children from gun violence.
It is important to engage gun owners about gun safety and “point out that parents may underestimate kids’ propensity to handle guns unsafely, even when they’ve been taught,” as well as the “impulsivity, risk-taking, and unpredictability of adolescence. ... We pediatric clinicians tend not to discuss firearm injury prevention much,” but a recent review of the problem offers some excellent guidance that “may help us to do more,” according to Dr. Nelson (Adolesc Med State Art Rev. 2016;27[2]:323-40).
However problematic it may be to confront the problem of firearm injuries in children and adolescents, we cannot ignore the scale of this current epidemic.
Eliot W. Nelson, MD, is a pediatrician at the University of Vermont Children’s Hospital. He reported having no relevant financial disclosures. These remarks are adapted from an editorial accompanying the report by Fowler et al. (Pediatrics. 2017. doi: 10.1542/peds.2017-1300).
Dr. Fowler’s study brings a lot of uncomfortable statistics to light. Subsequently we are left wondering, What can we do about it? With firearm injury mortality rates in children increasing over the past 2 years according to the CDC’s Web-based Injury Statistics Query and Reporting System, it is crucial that we continue to demand the appropriate support for this public health crisis.
Recognizing the prevalence of guns in homes and the potential dangers of easy access to them makes it essential to ask about firearms as part of our injury prevention guidance and offer counseling to parents and children about safe gun storage, gun locks, or support for legislation to protect children from gun violence.
It is important to engage gun owners about gun safety and “point out that parents may underestimate kids’ propensity to handle guns unsafely, even when they’ve been taught,” as well as the “impulsivity, risk-taking, and unpredictability of adolescence. ... We pediatric clinicians tend not to discuss firearm injury prevention much,” but a recent review of the problem offers some excellent guidance that “may help us to do more,” according to Dr. Nelson (Adolesc Med State Art Rev. 2016;27[2]:323-40).
However problematic it may be to confront the problem of firearm injuries in children and adolescents, we cannot ignore the scale of this current epidemic.
Eliot W. Nelson, MD, is a pediatrician at the University of Vermont Children’s Hospital. He reported having no relevant financial disclosures. These remarks are adapted from an editorial accompanying the report by Fowler et al. (Pediatrics. 2017. doi: 10.1542/peds.2017-1300).
Dr. Fowler’s study brings a lot of uncomfortable statistics to light. Subsequently we are left wondering, What can we do about it? With firearm injury mortality rates in children increasing over the past 2 years according to the CDC’s Web-based Injury Statistics Query and Reporting System, it is crucial that we continue to demand the appropriate support for this public health crisis.
Recognizing the prevalence of guns in homes and the potential dangers of easy access to them makes it essential to ask about firearms as part of our injury prevention guidance and offer counseling to parents and children about safe gun storage, gun locks, or support for legislation to protect children from gun violence.
It is important to engage gun owners about gun safety and “point out that parents may underestimate kids’ propensity to handle guns unsafely, even when they’ve been taught,” as well as the “impulsivity, risk-taking, and unpredictability of adolescence. ... We pediatric clinicians tend not to discuss firearm injury prevention much,” but a recent review of the problem offers some excellent guidance that “may help us to do more,” according to Dr. Nelson (Adolesc Med State Art Rev. 2016;27[2]:323-40).
However problematic it may be to confront the problem of firearm injuries in children and adolescents, we cannot ignore the scale of this current epidemic.
Eliot W. Nelson, MD, is a pediatrician at the University of Vermont Children’s Hospital. He reported having no relevant financial disclosures. These remarks are adapted from an editorial accompanying the report by Fowler et al. (Pediatrics. 2017. doi: 10.1542/peds.2017-1300).
Boys, older children, and minorities are disproportionately affected when it comes to firearm injuries and deaths in U.S. children and adolescents, and child firearm suicide rates are at the highest they have been in more than a decade, new study results revealed.
Around 19 children are either medically treated for a gunshot wound or killed by one every day in the United States. “The majority of these children are boys 13-17 years old, African American in the case of firearm homicide, and white and American Indian in the case of firearm suicide. Pediatric firearm injuries and deaths are an important public health problem in the United States, contributing substantially each year to premature death, illness, and disability of children,” said Katherine A. Fowler, PhD, of the National Center for Injury Prevention and Control, Atlanta, and her associates. “Finding ways to prevent such injuries and ensure that all children have safe, stable, nurturing relationships and environments remains one of our most important priorities” (Pediatrics. 2017;140(1):e20163486).
“From 2012 to 2014, the average annual case fatality rate was 74% for firearm-related self-harm, 14% for firearm-related assaults, and 6% for unintentional firearm injuries,” the investigators reported.
Boys accounted for 82% of all child firearm deaths from 2012 to 2014. In this time period, the annual rate of firearm death for boys was 4.5 times higher than the annual rate for girls (2.8 vs. 0.6 per 100,000). This difference was even more pronounced by age, with the rate for 13- to 17-year-old boys being six times higher than the rate for same-aged girls. Similarly, boys suffer the majority of nonfatal firearm injuries treated in U.S. emergency departments, accounting for 84% of all nonfatal firearm injuries medically treated each year from 2012 to 2014. The average annual rate of nonfatal firearm injuries for boys was five times the rate for girls at 13 vs. 3 per 100,000.
The annual rate of firearm homicide was 10 times higher among 13- to 17-year-olds versus 0- to 12-year-olds (3 vs. 0.3 per 100,000). Unintentional firearm death rates were approximately twice as high when comparing these two groups (0.2 vs. 0.1 per 100,000).
Dr. Fowler and her associates wrote, “Our findings indicate that most children who died of unintentional firearm injuries were shot by another child in their own age range and most often in the context of playing with a gun or showing it to others. More than one-third of the deaths of older children occurred in incidents in which the shooter thought that the gun was unloaded or thought that the safety was engaged.”
“Child firearm suicide rates showed a significant upward trend between 2007 and 2014, increasing 60% from 1.0 to 1.6 (P less than .05) to the highest rate seen over the period examined,” Dr. Fowler and her associates said.
Firearm suicide rates were 11 times higher among 13- to 17-year-olds vs. 10- to 12-year-olds (2 vs. 0.2 per 100,000). Older children also accounted for 88% of all nonfatal firearm injuries treated in an ED. The overall average annual rate of nonfatal firearm injuries for older children was 19 times that of younger children (24 vs. 1 per 100,000).
The annual firearm homicide rate for African American children was nearly 10 times higher than the rate for white children (4 vs. 0.4 per 100,000). However, the annual rate of firearm suicide among white children was nearly four times higher than the rate for African American children (2. vs. 0.6 per 100,000).
Awareness of the availability of firearms during times of crisis is crucial because suicides are often impulsive in young people, Dr. Fowler and her associates said, “with previous findings indicating that many who attempt suicide spend 10 minutes or less deliberating. Safe storage practices (i.e., unloading and locking all firearms and ammunition) can potentially be lifesaving in these instances,” as the results of previous studies in this age group attest.
Firearm deaths are the third leading cause of death overall among children in the United States aged 1-17 years, beating pediatric congenital anomalies, heart disease, influenza/pneumonia, chronic lower respiratory disease, and cerebrovascular causes. Understanding the nature, scale, and impact of firearm violence against children is an important first step, concluded Dr. Fowler and her associates.
Dr. Fowler and her associates said they had no relevant financial disclosures.
Boys, older children, and minorities are disproportionately affected when it comes to firearm injuries and deaths in U.S. children and adolescents, and child firearm suicide rates are at the highest they have been in more than a decade, new study results revealed.
Around 19 children are either medically treated for a gunshot wound or killed by one every day in the United States. “The majority of these children are boys 13-17 years old, African American in the case of firearm homicide, and white and American Indian in the case of firearm suicide. Pediatric firearm injuries and deaths are an important public health problem in the United States, contributing substantially each year to premature death, illness, and disability of children,” said Katherine A. Fowler, PhD, of the National Center for Injury Prevention and Control, Atlanta, and her associates. “Finding ways to prevent such injuries and ensure that all children have safe, stable, nurturing relationships and environments remains one of our most important priorities” (Pediatrics. 2017;140(1):e20163486).
“From 2012 to 2014, the average annual case fatality rate was 74% for firearm-related self-harm, 14% for firearm-related assaults, and 6% for unintentional firearm injuries,” the investigators reported.
Boys accounted for 82% of all child firearm deaths from 2012 to 2014. In this time period, the annual rate of firearm death for boys was 4.5 times higher than the annual rate for girls (2.8 vs. 0.6 per 100,000). This difference was even more pronounced by age, with the rate for 13- to 17-year-old boys being six times higher than the rate for same-aged girls. Similarly, boys suffer the majority of nonfatal firearm injuries treated in U.S. emergency departments, accounting for 84% of all nonfatal firearm injuries medically treated each year from 2012 to 2014. The average annual rate of nonfatal firearm injuries for boys was five times the rate for girls at 13 vs. 3 per 100,000.
The annual rate of firearm homicide was 10 times higher among 13- to 17-year-olds versus 0- to 12-year-olds (3 vs. 0.3 per 100,000). Unintentional firearm death rates were approximately twice as high when comparing these two groups (0.2 vs. 0.1 per 100,000).
Dr. Fowler and her associates wrote, “Our findings indicate that most children who died of unintentional firearm injuries were shot by another child in their own age range and most often in the context of playing with a gun or showing it to others. More than one-third of the deaths of older children occurred in incidents in which the shooter thought that the gun was unloaded or thought that the safety was engaged.”
“Child firearm suicide rates showed a significant upward trend between 2007 and 2014, increasing 60% from 1.0 to 1.6 (P less than .05) to the highest rate seen over the period examined,” Dr. Fowler and her associates said.
Firearm suicide rates were 11 times higher among 13- to 17-year-olds vs. 10- to 12-year-olds (2 vs. 0.2 per 100,000). Older children also accounted for 88% of all nonfatal firearm injuries treated in an ED. The overall average annual rate of nonfatal firearm injuries for older children was 19 times that of younger children (24 vs. 1 per 100,000).
The annual firearm homicide rate for African American children was nearly 10 times higher than the rate for white children (4 vs. 0.4 per 100,000). However, the annual rate of firearm suicide among white children was nearly four times higher than the rate for African American children (2. vs. 0.6 per 100,000).
Awareness of the availability of firearms during times of crisis is crucial because suicides are often impulsive in young people, Dr. Fowler and her associates said, “with previous findings indicating that many who attempt suicide spend 10 minutes or less deliberating. Safe storage practices (i.e., unloading and locking all firearms and ammunition) can potentially be lifesaving in these instances,” as the results of previous studies in this age group attest.
Firearm deaths are the third leading cause of death overall among children in the United States aged 1-17 years, beating pediatric congenital anomalies, heart disease, influenza/pneumonia, chronic lower respiratory disease, and cerebrovascular causes. Understanding the nature, scale, and impact of firearm violence against children is an important first step, concluded Dr. Fowler and her associates.
Dr. Fowler and her associates said they had no relevant financial disclosures.
FROM PEDIATRICS
Key clinical point:
Major finding: Firearm suicide rates were 11 times higher among 13- to 17-year-olds versus 10- to 12-year-olds (2 vs. 0.2 per 100,000).
Data source: National 2012-2014 data from CDC’s National Vital Statistics System and the National Electronic Injury Surveillance System.
Disclosures: Dr. Fowler and her associates said they had no relevant financial disclosures.