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Parikh JM, Amolenda P, Rutledge J, Szabova A, Vidya Chidambaran. An update on the safety of prescribing opioids in pediatrics. Expert Opin Drug Saf 2019; 18:127-143. [PMID: 30650988 PMCID: PMC6446903 DOI: 10.1080/14740338.2019.1571037] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 01/14/2019] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The opioid abuse epidemic and its toll on the adolescent population have heightened awareness for safer opioid prescribing practices in pediatric pain management. Opioids remain the mainstay of therapy for severe pain, although there is an emphasis on multimodal therapy. Areas covered: In this update, the authors present information on parenteral/oral opioids commonly used in pediatrics. Recommendations for opioid use in special circumstances including neonates and developmental pharmacokinetic concerns are discussed. Due to noticeable interindividual variability, pharmacogenomics may be important for tailoring pain regimens. In particular, the role of CYP2D6 phenotypes on opioid selection/dosing and clinical implications are discussed. A summary of adverse effects and opioid safety data, and the role of regulations, risk assessment, Centers for Disease Control and Prevention guidelines, follow-up, and monitoring for compliance in opioid prescribing, are detailed. Expert opinion: 'One size does not fit all' describes the need for public policies focused on pediatric pain and opioid use, as children are not 'little adults.' Clinical trials to evaluate pharmacokinetics-pharmacodynamics of opioids are currently lacking. Development of novel biased opioid agonists, clinical integration of genetics in informed decision-making, and emphasis on top-down approaches to pain management will be key to decrease opioid reliance.
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Kelly SM, O’Grady KE, Gryczynski J, Gwin Mitchell S, Kirk A, Schwartz RP. The concurrent validity of the Problem Oriented Screening Instrument for Teenagers (POSIT) substance use/abuse subscale in adolescent patients in an urban federally qualified health center. Subst Abus 2017; 38:382-388. [PMID: 28686545 PMCID: PMC6317511 DOI: 10.1080/08897077.2017.1351413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The Problem Oriented Screening Instrument for Teenagers (POSIT) substance use/abuse subscale has been validated with high school students, adolescents with criminal justice involvement, and adolescent substance use treatment samples using the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III-R and DSM-IV. This study examines the concurrent validity of the POSIT's standard 17-item substance use/abuse subscale and a revised, shorter 11-item version using DSM-5 substance use disorder diagnoses. METHODS Adolescents (N = 525; 93% African American, 55% female) 12-17 years of age awaiting primary care appointments at a Federally Qualified Health Center in Baltimore, Maryland completed the 17-item POSIT substance use/abuse subscale and items from a modified World Mental Health Composite International Diagnostic Interview corresponding to DSM-5 alcohol use disorder (AUD) and cannabis use disorder (CUD). Receiver operating characteristic curves, sensitivities, and specificities were examined with DSM-5 AUD, CUD, and a diagnosis of either or both disorders for the standard and revised subscales using risk cutoffs of either 1 or 2 POSIT "yes" responses. RESULTS For the 17-item subscale, sensitivities were generally high using either cutoff (range: 0.79-1.00), although a cutoff of 1 was superior (sensitivities were 1.00 for AUD, CUD, and for either disorder). Specificities were also high using either cutoff (range: 0.81-0.95) but were higher using a cutoff of 2. For the 11-item subscale, a cutoff of 1 yielded higher sensitivities than a cutoff of 2 (ranges for 1 and 2: 0.96-1.00 and 0.79-0.86, respectively). Specificities for this subscale were higher using a cutoff of 2 (ranges for 1 and 2: 0.82-0.89 and 0.89-0.96, respectively). CONCLUSIONS Findings suggest that the POSIT's substance use/abuse subscale is a potentially useful tool for screening adolescents in primary care for AUD or CUD using a cutoff of 1 or 2. The briefer, revised subscale may be preferable to the standard subscale in busy pediatric practices.
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Affiliation(s)
| | - Kevin E. O’Grady
- Department of Psychology, University of Maryland, College Park, College Park, Maryland, USA
| | - Jan Gryczynski
- Friends Research Institute, Inc., Baltimore, Maryland, USA
| | | | | | - Robert P. Schwartz
- Friends Research Institute, Inc., Baltimore, Maryland, USA
- University of Maryland School of Medicine, Department of Psychiatry, Baltimore, Maryland, USA
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Min MO, Minnes S, Lang A, Weishampel P, Short EJ, Yoon S, Singer LT. Externalizing behavior and substance use related problems at 15 years in prenatally cocaine exposed adolescents. J Adolesc 2014; 37:269-79. [PMID: 24636687 PMCID: PMC3980446 DOI: 10.1016/j.adolescence.2014.01.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 10/30/2013] [Accepted: 01/15/2014] [Indexed: 11/17/2022]
Abstract
The effect of prenatal cocaine exposure (PCE) on externalizing behavior and substance use related problems at 15 years of age was examined. Participants consisted of 358 adolescents (183 PCE, 175 non-cocaine exposed (NCE)), primarily African-American and of low socioeconomic status, prospectively enrolled in a longitudinal study from birth. Regression analyses indicated that the amount of PCE was associated with higher externalizing behavioral problems (β = .15, p = .02). Adolescents with PCE were also 2.8 times (95% CI = 1.38-5.56) more likely to have substance use related problems than their NCE counterparts. No differences between PCE adolescents in non-kinship adoptive/foster care (n = 44) and PCE adolescents in maternal/relative care (n = 139) were found in externalizing behavior or in the likelihood of substance use related problems. Findings demonstrate teratologic effects of PCE persisting into adolescence. PCE is a reliable marker for the potential development of problem behaviors in adolescence, including substance use related problems.
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Affiliation(s)
- Meeyoung O Min
- Case Western Reserve University, Jack, Joseph and Morton Mandel School of Applied Social Sciences, USA.
| | - Sonia Minnes
- Case Western Reserve University, Jack, Joseph and Morton Mandel School of Applied Social Sciences, USA
| | - Adelaide Lang
- Case Western Reserve University, Jack, Joseph and Morton Mandel School of Applied Social Sciences, USA
| | - Paul Weishampel
- Case Western Reserve University, Jack, Joseph and Morton Mandel School of Applied Social Sciences, USA
| | | | - Susan Yoon
- Case Western Reserve University, Jack, Joseph and Morton Mandel School of Applied Social Sciences, USA
| | - Lynn T Singer
- School of Medicine, Department of Pediatrics, USA; School of Medicine, Department of Psychiatry, USA; School of Medicine, Department of Environmental Health Sciences, USA
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Wickman ME, Koniak-Griffin D. Invincibility fable: tool development to measure invincibility. J Pediatr Nurs 2013; 28:575-84. [PMID: 24036006 DOI: 10.1016/j.pedn.2012.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 04/02/2012] [Accepted: 05/16/2012] [Indexed: 01/25/2023]
Abstract
UNLABELLED Invincibility is a phase of social-cognitive development of the adolescent and has been associated with risk behavior involvement. OBJECTIVE To determine psychometric properties of the Adolescent Invincibility Tool (AIT). METHODS Reliability was assessed and validity was examined using principal components analysis. RESULTS Internal consistency was demonstrated with a Cronbach's alpha of .88; factor analysis led to the confirmation of subscales. Criterion validity was validated with similar and opposing measures of invincibility. DISCUSSION Initial testing suggests that the AIT is a valid and reliable tool for screening invincibility. Further testing is recommended to determine relevance for other populations of youth.
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Affiliation(s)
- Mary E Wickman
- Nursing Department, Vanguard University, Costa Mesa, CA.
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Roberts-Lewis AC, Welch-Brewer CL, Jackson MS, Pharr OM, Parker S. Female Juvenile Offenders with HEART: Preliminary Findings of an Intervention Model for Female Juvenile Offenders with Substance Use Problems. JOURNAL OF DRUG ISSUES 2010. [DOI: 10.1177/002204261004000304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This pilot study examined the effectiveness of an intensive, gender specific substance abuse treatment program, Holistic Enrichment for At-Risk Teens (HEART), on the psychosocial functioning of 30 incarcerated girls. A single-group multiple repeated measures design method was used to determine the effectiveness of the HEART program in reducing psychosocial problems associated with the behaviors of problem substance use and delinquency. The results showed that participants in the HEART program displayed significant improvement in eight of ten areas of psychosocial functioning: mental health, family relation, peer relations, educational status, vocational, leisure and recreational skills, and decreases in aggressive behaviors. The conclusion is that it is critical for juvenile correctional facilities to become sites where effective, empirically based treatment is provided.
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Wickman M, Greenberg C, Boren D. The relationship of perception of invincibility, demographics, and risk behaviors in adolescents of military parents. J Pediatr Health Care 2010; 24:25-33. [PMID: 20122475 DOI: 10.1016/j.pedhc.2008.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 11/14/2008] [Accepted: 11/15/2008] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The purpose of this research was to determine relationships among perceived invincibility, demographic variables, and risk behaviors in adolescents of active duty and retired military personnel. METHOD An instrument titled the Adolescent Invincibility Tool (AIT) was constructed and administered to a group of 125 adolescents of military parents. Correlation statistics were analyzed to determine variable relationships. RESULTS The AIT demonstrated reliability (Cronbach's alpha .88) in measuring invincibility in this sample. Participant characteristics and demographics were examined and revealed age, sex, ethnicity, and relocation frequency differences in relationship to the teen's level of perceived invincibility. Family relocation frequency and parent ranking/rating were significant variables for a military population. A significant positive relationship was identified between aggressive, delinquent behavior and invincibility; a negative correlation was demonstrated between worry and invincibility. DISCUSSION This study provided an opportunity to learn about unique influences related to being the teen of an active duty or retired military parent(s). Study findings indicate significant differences between military teens and national surveys in regard to risk taking and mental health indicators. Risk behaviors were found to occur at a lower frequency than the nationwide average, while depression occurred more frequently in this sample of military adolescents. Variations among teens of military parents in invincibility and worry scores provide direction for further study.
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Affiliation(s)
- Mary Wickman
- Pre-Licensure Programs, Department ofNursing, California State University, Fullerton, CA, USA.
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Passik SD, Kirsh KL, Casper D. Addiction-Related Assessment Tools and Pain Management: Instruments for Screening, Treatment Planning, and Monitoring Compliance. PAIN MEDICINE 2008. [DOI: 10.1111/j.1526-4637.2008.00486.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Karila L, Legleye S, Beck F, Corruble E, Falissard B, Reynaud M. [Validation of a questionnaire to screen for harmful use of alcohol and cannabis in the general population: CRAFFT-ADOSPA]. Presse Med 2007; 36:582-90. [PMID: 17276648 DOI: 10.1016/j.lpm.2007.01.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Adolescents and young adults seeing a nurse or physician for any reason should be screened for psychoactive substance use. Several English-language questionnaires are available to screen for and assess harmful use of psychoactive substances among adolescents, but to our knowledge, no such instrument exists in French. The aim of the ADOTECNO study was therefore to develop simple and efficient tools for this purpose. METHODS Two questionnaires widely used in French epidemiologic studies (CRAFFT-ADOSPA to screen for harmful use and POSIT to assess the seriousness of consumption from physical, psychological and social viewpoints) were completed by 1728 secondary and post-secondary school students. Statistical analyses assessed correlations between the questionnaires and calibrated optimal cutoff points for the different tools included in ADOTECNO. RESULTS Correlations between psychoactive substance consumption, responses to the CRAFFT-ADOSPA questionnaire, and POSIT factor A scores showed that CRAFFT-ADOSPA provided early detection of regular alcohol intoxication and of regular and daily cannabis use. At a score of 2, CRAFFT-ADOSPA detects harmful substance use, and at a score higher than or equal to 3 it demonstrates serious substance use. CONCLUSION These findings enabled us to recommend useful cutoff values for the CRAFFT-ADOSPA tools for screening subjects at moderate or high risk of substance abuse. This simple broad screening should be complemented for the subjects found to be at risk by a computer-assisted POSIT to guide practitioners in selecting an approach (educational, school, family, psychological, psychiatric, etc.) to care and management according to the specific types of impairment resulting from substance use.
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Affiliation(s)
- Laurent Karila
- Département d'Addictologie et de Psychiatrie, Hôpital Universitaire Paul Brousse, APHP INSERM U669, Villejuif.
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Tuttle J, Campbell-Heider N, David TM. Positive adolescent life skills training for high-risk teens: results of a group intervention study. J Pediatr Health Care 2006; 20:184-91. [PMID: 16675379 PMCID: PMC3074485 DOI: 10.1016/j.pedhc.2005.10.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION This study tested the addition of a cognitive-behavioral skill-building component called Positive Adolescent Life Skills (PALS) training to an existing intervention for urban adolescents to enhance resiliency. In previous pilot work with the existing intervention, called "Teen Club," it was found that participants in group meetings and intensive case management reported an enhanced ability to connect with positive resources. METHOD Sixteen adolescents aged 12 to 16 years (10 boys and 6 girls) attending an urban secondary school were randomly assigned to Teen Club or Teen Club plus PALS. Boys and girls met separately in one of the two conditions for 30 weeks. The Problem-Oriented Screening Instrument for Teenagers (POSIT) subscale scores were measured at baseline and at the completion of the program. RESULTS The sample consisted of 11 Black and five Hispanic teens. Between-group differences in the POSIT subscale scores were not significantly different in this small sample. Group interviews conducted at the conclusion of the intervention revealed that participants found the PALS intervention to be relevant and useful. DISCUSSION Results suggest that the PALS component strengthened the existing intervention and lend preliminary support for the continuation of this combination of interventions. Future research with larger numbers is needed.
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Affiliation(s)
- Jane Tuttle
- University of Rochester, School of Nursing, 601 Elmwood Ave, Box SON, Rochester, NY 14642, USA.
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Moore DJ, Atkinson JH, Akiskal H, Gonzalez R, Wolfson T, Grant I. Temperament and risky behaviors: a pathway to HIV? J Affect Disord 2005; 85:191-200. [PMID: 15780689 DOI: 10.1016/s0165-0327(03)00193-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2003] [Indexed: 11/28/2022]
Abstract
BACKGROUND Certain sexual behaviors and abuse of substances contribute to the risk of becoming HIV-infected. Because dispositional characteristics are likely to influence this process, we examined the association between temperament and HIV serostatus in subjects with heavy use of drugs and various sexual risk behaviors. METHODS Two hundred and thirty individuals (81% of whom were HIV-infected) were assessed for underlying temperamental characteristics, substance use, and risky sexual behaviors. Toward this goal, a factor analysis was conducted on a new self-rated Temperament Autoquestionnaire (Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire (TEMPS-A)). MANOVA was used to examine overall associations between risky behaviors and temperament. Additionally, directed MANOVAs were conducted for each of six drugs of abuse (alcohol, marijuana, cocaine, opioids, other stimulants, and sedative hypnotics). RESULTS Factor analysis confirmed the hypothesized temperament structure of five distinct factors: Cyclothymic, hyperthymic, anxious, irritable-explosive, and depressive. Heavy users of cocaine, other stimulants, and alcohol were more likely to have an irritable-explosive temperament. Interestingly, heavy users of opioids were more likely to show depressive and hyperthymic traits. The inclusion of HIV status as a predictor of temperament did not alter the results. Unlike a previous study, no direct significant relationships were found between risky sexual behaviors and specific temperaments. LIMITATIONS Relatively small sample size for a factor analytic study, and cross-sectional design, which cannot determine a cause and effect relationship. CONCLUSIONS We succeeded in studying and validating five distinct affective temperaments in a substance abuse population. Irritable-explosive, and to a lesser extent, depressive and hyperthymic traits, were associated with substance use, and may place individuals at risk for HIV infection via that mechanism. That current risky sexual practices were not directly linked to temperament may reflect modification in sexual behavior following the acquisition of HIV disease.
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Affiliation(s)
- David J Moore
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA 92103, USA
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Singer LT, Linares TJ, Ntiri S, Henry R, Minnes S. Psychosocial profiles of older adolescent MDMA users. Drug Alcohol Depend 2004; 74:245-52. [PMID: 15194202 DOI: 10.1016/j.drugalcdep.2003.12.015] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2003] [Revised: 12/19/2003] [Accepted: 12/26/2003] [Indexed: 11/30/2022]
Abstract
PURPOSE Using a case-control design, patterns of drug use, psychological symptoms, and behavioral characteristics associated with 3,4-methylenedioxymethamphetamine (MDMA ) use were surveyed in a sample of older adolescents (median age 20). METHODS One hundred (42 MDMA users; 58 non-MDMA users) older adolescents were recruited using the "snowball" technique and interviewed regarding their use of MDMA and other drugs. The Brief Symptom Inventory (BSI), the Problem Oriented Screening Instrument for Teenagers (POSIT), the HIV/sexually transmitted diseases (STD) risk scale, and the Childhood Trauma Questionnaire (CTQ) were also administered. RESULTS MDMA users were more likely to use other substances, endorse more symptoms of psychological distress, and had more problems in functional lifestyle areas. They also reported more childhood experiences of physical abuse, emotional neglect, and physical neglect than non-MDMA users. MDMA users also reported more sexually risky behaviors. CONCLUSIONS Occasional MDMA use among older adolescents was associated with polydrug use, multiple social difficulties, psychological symptoms, and health risk behaviors. Further research is warranted to understand the long term psychosocial consequences of chronic MDMA and polydrug usage.
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Affiliation(s)
- Lynn T Singer
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH 44106, USA.
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Latimer WW, O'Brien MS, McDouall J, Toussova O, Floyd LJ, Vazquez M. Screening for "substance abuse" among school-based youth in Mexico using the Problem Oriented Screening Instrument (POSIT) for Teenagers. Subst Use Misuse 2004; 39:307-29. [PMID: 15061563 DOI: 10.1081/ja-120028492] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Indices of classification accuracy of the Substance Use/Abuse scale of a Spanish-language version of the Problem Oriented Screening Instrument for Teenagers (POSIT) were evaluated among school-based youth in Mexico. Participants were 1203 youth attending one middle school (N = 619) and one high school (N = 584) in the third largest city of Coahuila, a northern border state in Mexico in May 1998. More than 94% of youth enrolled in the participating middle school and 89% of youth enrolled in the participating high school completed the International Longitudinal Survey of Adolescent Health. Indices of classification accuracy of the POSIT Substance Use/Abuse scale were evaluated against a "drug abuse" problem severity criterion that combined youth meeting DSM-IV criteria for alcohol abuse/dependence disorders with youth having used other illicit drugs five or more times in their lifetime. The present study findings suggest that using a cut score of one or two on the POSIT Substance Use/Abuse scale generally yields optimal classification accuracy indices that vary somewhat by gender and school subgroups. Further, classification accuracy indices of the POSIT Substance Use/Abuse scale are slightly better when used among high school males due, in part, to the higher base rate of serious involvement among this group compared to others.
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Affiliation(s)
- William W Latimer
- Department of Mental Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
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Sweet RI, Saules KK. Validity of the substance abuse subtle screening inventory-adolescent version (SASSI-A). J Subst Abuse Treat 2003; 24:331-40. [PMID: 12867207 DOI: 10.1016/s0740-5472(03)00049-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The construct and convergent validity of the Substance Abuse Subtle Screening Instrument-Adolescent (SASSI-A) were examined in a population of suburban youth offenders. The analysis was conducted on archived data of 490 adolescent offenders from a suburban Circuit Court-Juvenile Division. Exploratory factor analysis results best supported a 5-factor solution that accounted for a modest 32.5% of the total variance. This 5-factor solution had a poor goodness of fit with the purported factor structure upon which the formal SASSI-A scoring is based. The relationship between the SASSI-A and variables with known relationships to adolescent substance abuse (i.e., lack of religious involvement, single parent household, learning disability, early onset of use, conduct problems) was examined. Results revealed moderately strong relationships between the SASSI-A and these variables, indicating reasonable convergent validity. It is concluded that the SASSI-A face valid scales have moderate utility for identifying substance dependence within this sample, while the subtle scales do not.
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Affiliation(s)
- Richard I Sweet
- Eastern Michigan University, Department of Psychology, 611 W. Cross Street, 48197, Ypsilanti, MI, USA
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Shrier LA, Harris SK, Kurland M, Knight JR. Substance use problems and associated psychiatric symptoms among adolescents in primary care. Pediatrics 2003; 111:e699-705. [PMID: 12777588 DOI: 10.1542/peds.111.6.e699] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Substance use disorders (SUDs) are associated with other mental disorders in adolescence, but it is unclear whether less severe substance use problems (SUPs) also increase risk. Because youths with SUPs are most likely to present first to their site of primary care, it is important to establish the presence and patterns of psychiatric comorbidity among adolescent primary care patients with subdiagnostic use of alcohol or other drugs. The objective of this study was to determine the association between level of substance use and psychiatric symptoms among adolescents in a primary care setting. METHODS Patients who were aged 14 to 18 years and receiving routine care at a hospital-based adolescent clinic were eligible. Participants completed the Problem Oriented Screening Instrument for Teenagers Substance Use/Abuse scale, which is designed to detect social and legal problems associated with alcohol and other drugs, and the Adolescent Diagnostic Interview, which evaluates for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnoses of substance abuse/dependence and 8 types of psychiatric symptoms. We examined gender-specific associations of no/nonproblematic substance use (NSU), SUP, and SUD with psychiatric symptom presence (any symptoms within each type), score (symptom scores summed across all types), and number of types (number of different symptom types endorsed). RESULTS Of 538 adolescents (68% female; mean +/- standard deviation age: 16.6 +/- 1.4 years), 66% were classified with NSU, 18% with SUP, and 16% with SUD, and 80% reported having at least 1 type of psychiatric symptom in the previous 12 months. Symptoms of anxiety were most common (60% of both boys and girls), followed by symptoms of depression among girls (51%) and symptoms of attention-deficit disorder (ADD) among boys (47%). Compared with those with NSU, youths with SUP and those with SUD were more likely to report symptom presence for several types of psychiatric symptoms. Girls with SUP or SUD had increased odds of reporting symptoms of mania, ADD, and conduct disorder; girls with SUD were at increased risk for symptoms of depression, eating disorders, and hallucinations or delusions. Boys with SUP had increased odds of ADD symptoms, whereas boys with SUD had increased odds of reporting hallucinations or delusions. Boys with SUP or SUD had increased odds of reporting symptoms of conduct disorder. Youths with SUP and SUD also had higher psychiatric symptom scores and reported a wider range of psychiatric symptom types (number of types) compared with youths with NSU. CONCLUSIONS Like those with SUD, adolescents with subdiagnostic SUP were at increased risk for experiencing a greater number of psychiatric symptoms and a wider range of psychiatric symptom types than youths with NSU. Specifically, adolescents with SUP are at increased risk for symptoms of mood (girls) and disruptive behavior disorders (girls and boys). These findings suggest the clinical importance of SUP and support the concept of a continuum between subthreshold and diagnostic substance use among adolescents in primary care. Identification of youths with SUP may allow for intervention before either the substance use or any associated psychiatric problems progress to more severe levels.
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Affiliation(s)
- Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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Teplin LA, Mericle AA, McClelland GM, Abram KM. HIV and AIDS risk behaviors in juvenile detainees: implications for public health policy. Am J Public Health 2003; 93:906-12. [PMID: 12773351 PMCID: PMC1447866 DOI: 10.2105/ajph.93.6.906] [Citation(s) in RCA: 140] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2002] [Indexed: 11/04/2022]
Affiliation(s)
- Linda A Teplin
- Psycho-Legal Studies Program, The Feinberg School of Medicine, Dept of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL 60611, USA.
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Knight JR, Sherritt L, Harris SK, Gates EC, Chang G. Validity of Brief Alcohol Screening Tests Among Adolescents: A Comparison of the AUDIT, POSIT, CAGE, and CRAFFT. Alcohol Clin Exp Res 2003. [DOI: 10.1111/j.1530-0277.2003.tb02723.x] [Citation(s) in RCA: 290] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Development and Validation of a POSIT-Short Form: Screening for Problem Behaviors Among Adolescents at Risk for Substance Use. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2002. [DOI: 10.1300/j029v11n03_02] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Knight JR, Goodman E, Pulerwitz T, DuRant RH. Reliability of the Problem Oriented Screening Instrument for Teenagers (POSIT) in adolescent medical practice. J Adolesc Health 2001; 29:125-30. [PMID: 11472871 DOI: 10.1016/s1054-139x(00)00206-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE To determine the internal consistency and 1-week test-retest reliability of the Problem Oriented Screening Instrument for Teenagers (POSIT) among adolescent medical patients. METHODS A research assistant administered the POSIT to a consecutive sample of 15- to 18-year-old patients arriving for routine medical care at a hospital-based adolescent medical practice. Each subject returned for a retest 1 week later. Internal consistency for each scale on test and retest was calculated using Cronbach alpha, and 1-week test-retest reliability by the intraclass correlation coefficient (r) and the kappa coefficient (kappa). RESULTS The Substance Use/Abuse, Mental Health Status, Educational Status, and Aggressive Behavior/Delinquency scales had favorable alpha scores (>.70). Others, including Physical Health Status, had lower alpha scores. High intraclass correlation coefficients were found for all 10 POSIT scales (r =.72 to.88), although (r) was lower for males on two of the scales. Kappa coefficients for all scales indicated good reproducibility beyond chance (kappa =.42 to.73). CONCLUSIONS This study provided supportive evidence for the reliability of the POSIT in primary care medical settings, although some POSIT scales could likely be improved. The 20- to 30-min administration time is most practical in settings that are dedicated to adolescent medicine, and computerized administration and scoring are needed.
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Affiliation(s)
- J R Knight
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
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Knight JR. The role of the primary care provider in preventing and treating alcohol problems in adolescents. AMBULATORY PEDIATRICS : THE OFFICIAL JOURNAL OF THE AMBULATORY PEDIATRIC ASSOCIATION 2001; 1:150-61. [PMID: 11888392 DOI: 10.1367/1539-4409(2001)001<0150:trotpc>2.0.co;2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Adolescents use alcohol more frequently and heavily than all other illicit drugs combined. Given the myriad health, developmental, and social problems associated with alcohol use, it is not surprising that the American Medical Association's Guidelines for Adolescent Preventive Services recommends that adolescents be asked annually about their use of alcohol, and those who report any use during the past year should be assessed further. However, routine alcohol screening of adolescents in primary care and emergency medical settings is not universally applied. In March 2000, the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health and the Agency for Health care Research and Quality jointly sponsored a meeting entitled The Expanding Role of Primary Care in the Prevention and Treatment of Alcohol-Use Disorders. The purpose of the meeting was to bring together researchers, policymakers, clinicians, insurance providers, and medical education specialists to determine the best approaches to increase the involvement of primary care physicians and other health care professionals in screening and intervening for alcohol problems in their patients. The National Institute on Alcohol Abuse and Alcoholism and Agency for Health care Research and Quality believe that the evidence of efficacy for primary care involvement is compelling and are working together to promote the translation of these findings into clinical practice. The following article summarizes what is currently known about adolescent alcohol use and how it can be addressed in primary care settings. It provided the background for the meeting's focus on adolescent issues.
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Affiliation(s)
- J R Knight
- Department of Pediatrics and Division of Addictions, Harvard Medical School, Boston, MA 02115, USA.
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McPherson TL, Hersch RK. Brief substance use screening instruments for primary care settings: a review. J Subst Abuse Treat 2000; 18:193-202. [PMID: 10716103 DOI: 10.1016/s0740-5472(99)00028-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Chemical dependence, including nicotine, alcohol, prescription drugs, and illicit drugs, is one of the leading causes of morbidity and mortality in the United States. Primary care physicians and nurses routinely provide preventive health care and rely on routine screening to detect diseases and promote wellness. These primary care practitioners are in a unique position to assess and detect such dependence at its earliest stages. However, previous research indicates that little such screening is actually conducted. This literature review gathered and examined substance use screening instruments in four categories to assess their feasibility for use in primary care settings. Although substance use screening tools are available, most are not appropriate for screening in a primary care setting. There clearly remains a need for the development of a valid, reliable screening instrument that can be easily incorporated into the practices and procedures found in primary care settings.
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Affiliation(s)
- T L McPherson
- Institute for Social Analysis, ISA Associates, Alexandria, VA 22314, USA.
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Use of the POSIT Among Arrested Youths Entering a Juvenile Assessment Center: A Replication and Update. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 1998. [DOI: 10.1300/j029v06n03_02] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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