Objective

To evaluate the impact of the School-Based Asthma Therapy trial on asthma symptoms among urban children with persistent asthma.

Design

Randomized trial, with children stratified by smoke exposure in the home and randomized to a school-based care group or a usual care control group.

Setting

Rochester, New York.

Participants

Children aged 3 to 10 years with persistent asthma.

Interventions

Directly observed administration of daily preventive asthma medications by school nurses (with dose adjustments according to National Heart, Lung, and Blood Institute Expert Panel guidelines) and a home-based environmental tobacco smoke reduction program for smoke-exposed children, using motivational interviewing.

Main Outcome Measure

Mean number of symptom-free days per 2 weeks during the peak winter season (November-February), assessed by blinded interviews.

Results

We enrolled 530 children (74% participation rate). During the peak winter season, children receiving preventive medications through school had significantly more symptom-free days compared with children in the control group (adjusted difference=0.92 days per 2 weeks; 95% confidence interval, 0.50-1.33) and also had fewer nighttime symptoms, less rescue medication use, and fewer days with limited activity (allP<.01). Children in the treatment group also were less likely than those in the control group to have an exacerbation requiring treatment with prednisone (12% vs 18%, respectively; relative risk=0.64; 95% confidence interval, 0.41-1.00). Stratified analyses showed positive intervention effects even for children with smoke exposure (n=285; mean symptom-free days per 2 weeks: 11.6 for children in the treatment group vs 10.9 for those in the control group; difference=0.96 days per 2 weeks; 95% confidence interval, 0.39-1.52).

Conclusions

The School-Based Asthma Therapy intervention significantly improved symptoms among urban children with persistent asthma. This program could serve as a model for improved asthma care in urban communities.

Objective

To assess long-term developmental outcome in children who received iron-fortified or low-iron formula.

Design

Follow-up at 10 years of randomized controlled trial (1991–1994) of 2 levels of formula iron. Examiners blind to group.

Setting

Urban areas around Santiago, Chile.

Participants

Original study enrolled healthy full-term infants in community clinics; 835 completed the trial. At 10 years, 573 were assessed (57%).

Intervention

Iron-fortified (12.7 mg/l) or low-iron (2.3 mg/l) formula from 6 to 12 months.

Main Outcome Measures

IQ, spatial memory, arithmetic achievement, visual-motor integration, visual perception, and motor functioning. We used covaried regression to compare iron-fortified and low-iron groups and consider hemogobin (HB) prior to randomization and sensitivity analyses to identify 6-month HB at which groups diverged in outcome.

Results

Compared to low-iron, the iron-fortified group scored lower on every 10-year outcome (significant for spatial memory, visual-motor integration; suggestive for IQ, arithmetic, visual perception, motor coordination; 1.4 – 4.6 points lower, effect sizes 0.13 – 0.21). Children with high 6-month HB (> 128 g/l) showed poorer outcome on these measures if they received iron-fortified formula (10.7 – 19.3 points lower; large effect sizes, 0.85 – 1.36); those with low HB (< 105 g/l) showed better outcome (2.6 – 4.5 points higher; small but significant effects, 0.22 – 0.36). High HB represented 5.5% of sample (n = 26); low HB, 17.0% (n = 87).

Conclusions

Long-term development may be adversely affected in infants with high HB who receive 12.7 mg/l iron-fortified formula. Optimal amounts of iron in infant formula warrant further study.

Context

Parental proxy reports have indicated poorer health for preterm children as compared to normal birth weight controls. The perspective of their children may however differ.

Objective

To compare the self reported health of preterm children to normal birth weight controls and the children’s perspective to that of their parents.

Design

Study of extremely low birth weight (<1kg) and normal birth weight children and their parents conducted 2006–2009.

Setting

Children’s hospital.

Participants

Eight year old extremely low birth weight (n=202) and normal birth weight (n=176) children of similar sociodemographic status.

Main Outcome Measures

The Child Health and Illness Profile child and parent reports.

Results

There was poor agreement between the parent and child ratings of health for both the extremely low birth weight and normal birth weight cohorts. Extremely low birth weight children rated their health similar to normal birth weight children. In contrast parents of extremely low birth weight children reported significantly poorer health for their children than parents of normal birth weight controls including poorer Satisfaction with health, Comfort and Achievement and less Risk avoidance.

Conclusion

There is poor agreement between child and parent reports of health. Eight year old extremely low birth weight children rate their health similar to that of normal birth weight controls. Their parents however report significantly poorer health. Both child and parent perspective needs to be considered when making health care decisions.

Objective

To determine the prevalence of medical and nonmedical use of prescription opioids among high school seniors in the United States, and to assess substance use behaviors based on medical and nonmedical use of prescription opioids.

Design

Nationally representative samples of high school seniors (modal age 18) were surveyed during the spring of their senior year via self-administered questionnaires.

Setting

Data were collected in public and private high schools.

Participants

The sample consisted of 7,374 students from three independent cohorts (2007-09).

Main Outcome Measures

Self-reports of medical and nonmedical use of prescription opioids and other substance use.

Results

An estimated 17.6% of high school seniors reported lifetime medical use of prescription opioids, while 12.9% reported nonmedical use of prescription opioids. Gender differences in the medical and nonmedical use were minimal, while racial/ethnic differences were extensive. Over 37% of nonmedical users reported intranasal administration of prescription opioids. An estimated 80% of nonmedical users with an earlier history of medical use had obtained prescription opioids from a prescription they had previously. The odds of substance use behaviors were greater among individuals who reported any history of nonmedical use of prescription opioids relative to those who reported medical use only.

Conclusions

Nearly one in every four high school seniors in the United States has ever had some exposure to prescription opioids either medically or nonmedically. The quantity of prescription opioids and number of refills prescribed to adolescents should be carefully considered and closely monitored to reduce subsequent nonmedical use of leftover medication.

Objectives

Both peer and parental influences have been associated with the use of addictive substances in adolescence. We evaluated the relationship between the parenting style of an adolescent’s peers’ parents and an adolescent’s substance use.

Design

Longitudinal survey

Setting

Adolescents across the United States were interviewed at school and at home

Participants

Nationally representative sample of adolescents in the United States

Main Exposure

Authoritative versus neglectful parenting style of adolescent’s parents and adolescent’s friends parents; adolescent substance use

Main Outcome Measures

Adolescent alcohol abuse, smoking, marijuana use, and binge drinking

Results

If an adolescent has a friend whose mother is authoritative, that adolescent is 40% (95% CI 12%–58%) less likely to drink to the point of drunkenness, 38% (95% CI 5%–59%) less likely to binge drink, 39% (95% CI 12%–58%) less likely to smoke cigarettes, and 43% (95% CI 1%–67%) less likely to use marijuana than an adolescent whose friend’s mother is neglectful, controlling for the parenting style of the adolescent’s own mother, school level fixed effects, and demographics. These results are only partially mediated by peer substance use.

Conclusion

Social network influences may extend beyond the homogeneous dimensions of own-peer or own-parent to include extra-dyadic influences of the wider network. The value of parenting interventions should be re-assessed to take into account these spillover effects in the greater network.

Objective

To understand why children exposed to adverse psychosocial experiences are at elevated risk for age-related disease, such as cardiovascular disease, by testing whether adverse childhood experiences predict enduring abnormalities in stress-sensitive biological systems, namely, the nervous, immune, and endocrine/metabolic systems.

Design

A 32-year prospective longitudinal study of a representative birth cohort.

Setting

New Zealand.

Participants

A total of 1037 members of the Dunedin Multidisciplinary Health and Development Study.

Main Exposures

During their first decade of life, study members were assessed for exposure to 3 adverse psychosocial experiences: socioeconomic disadvantage, maltreatment, and social isolation.

Main Outcome Measures

At age 32 years, study members were assessed for the presence of 3 age-related-disease risks: major depression, high inflammation levels (high-sensitivity C-reactive protein level >3 mg/L), and the clustering of metabolic risk biomarkers (overweight, high blood pressure, high total cholesterol, low high-density lipoprotein cholesterol, high glycated hemoglobin, and low maximum oxygen consumption levels.

Results

Children exposed to adverse psychosocial experiences were at elevated risk of depression, high inflammation levels, and clustering of metabolic risk markers. Children who had experienced socioeconomic disadvantage (incidence rate ratio, 1.89; 95% confidence interval, 1.36–2.62), maltreatment (1.81; 1.38–2.38), or social isolation (1.87; 1.38–2.51) had elevated age-related-disease risks in adulthood. The effects of adverse childhood experiences on age-related-disease risks in adulthood were nonredundant, cumulative, and independent of the influence of established developmental and concurrent risk factors.

Conclusions

Children exposed to adverse psychosocial experiences have enduring emotional, immune, and metabolic abnormalities that contribute to explaining their elevated risk for age-related disease. The promotion of healthy psychosocial experiences for children is a necessary and potentially cost-effective target for the prevention of age-related disease.

Objectives

To determine if adherence to the recommended well-child care (WCC) visit schedule, independent of continuity of care (COC), is associated with lower risk for Ambulatory Care Sensitive Hospitalizations (ACSH) and whether this association varies by chronic disease status.

Design

Population-based, retrospective cohort study

Setting

Hawaii’s largest health plan from 1999 to 2006

Patients/Participants

36,944 children ≤ 3.5 years-old who were eligible if they were enrolled prior to 2 months-old, had ≥ 4 outpatient visits during the study period, and had an enrollment period that overlapped with ≥ 1 WCC visit interval.

Main Exposure(s)

WCC visit adherence and COC Index

Main Outcome Measure(s)

Risk for ACSH (Hazard Ratio [HR])

Results

Overall, 8,921 (24%) children had ≥ 1 chronic disease. The proportions of ACSH among healthy children versus those with ≥ 1 chronic disease were 3% (n= 751) and 7% (n= 645), respectively. For children with chronic disease, those with the lowest WCC visit adherence (0–25%) had 1.9 times (HR: 1.9, 95% Confidence Interval [CI]: 1.5–2.5) the risk of ACSH compared to those in the highest category (75–100%). The risk of ACSH for children with chronic disease who fell into the lowest COC category (0–0.25) was 2.4 times (HR 2.4, 95% CI: 1.7–3.5) higher than for those who fell into the highest category (0.75–1.0).

Conclusions

For children with chronic disease, both low WCC visit adherence and COC are independently associated with an increased risk of ACSH. Providing access to a consistent source of primary care appears important for this vulnerable population.

Objective

To test how genomic loci identified in genome-wide association studies influence the development of obesity.

Design

A 38-year prospective longitudinal study of a representative birth cohort.

Setting

The Dunedin Multidisciplinary Health and Development Study, Dunedin, New Zealand.

Participants

One thousand thirty-seven male and female study members.

Main Exposures

We assessed genetic risk with a multilocus genetic risk score. The genetic risk score was composed of single-nucleotide polymorphisms identified in genome-wide association studies of obesity-related phenotypes. We assessed family history from parent body mass index data collected when study members were 11 years of age.

Main Outcome Measures

Body mass index growth curves, developmental phenotypes of obesity, and adult obesity outcomes were defined from anthropometric assessments at birth and at 12 subsequent in-person interviews through 38 years of age.

Results

Individuals with higher genetic risk scores were more likely to be chronically obese in adulthood. Genetic risk first manifested as rapid growth during early childhood. Genetic risk was unrelated to birth weight. After birth, children at higher genetic risk gained weight more rapidly and reached adiposity rebound earlier and at a higher body mass index. In turn, these developmental phenotypes predicted adult obesity, mediating about half the genetic effect on adult obesity risk. Genetic associations with growth and obesity risk were independent of family history, indicating that the genetic risk score could provide novel information to clinicians.

Conclusions

Genetic variation linked with obesity risk operates, in part, through accelerating growth in the early childhood years after birth. Etiological research and prevention strategies should target early childhood to address the obesity epidemic.

Objective

To evaluate the relation between excess body mass index (BMI)–years, a measure of the degree to which an individual’s BMI (calculated as weight in kilograms divided by height in meters squared) exceeds the reference BMI and the duration for which he or she carries excess BMI, and incident diabetes.

Design

Longitudinal analysis.

Setting

United States of America.

Participants

A total of 8157 adolescents and young adults aged 14 to 21 years at the start of the National Longitudinal Survey of Youth 1979 with self-reported measures of height, weight, and diabetes status (type unspecified) from 1981 through 2006.

Main Exposure

Excess BMI-years, which were calculated by subtracting the reference BMI (25.0 for adults or 85th percentile for adolescents) from the actual BMI for each study year and cumulating excess BMI for the study duration.

Main Outcome Measure

We conducted logistic regression models to predict presumed type 2 diabetes (after excluding presumed type 1 diabetes) as a function of age, sex, race, excess BMI-years, and specific interactions.

Results

A higher level of excess BMI-years was associated with an increased risk of diabetes. For example, on average, white men aged 40 years with 200 excess BMI-years had 2.94 times (95% confidence interval, 2.36-3.67) higher odds of developing diabetes compared with men of the same age and race with 100 excess BMI-years. For a given level of excess BMI-years, younger compared with older and Hispanic and black compared with white individuals had higher risk of developing diabetes. Our study is limited by use of self-reported data without specification of diabetes type.

Conclusions

Because younger compared with older individuals have a higher risk of self-reported diabetes for a given level of excess BMI-years and cumulative exposure to excess BMI is increasing among younger US birth cohorts, public health interventions should target younger adults.

Objective

To determine the association between type, chronicity, and severity of childhood hardships and smoking status during pregnancy, preterm birth, and low birth weight.

Design

Prospective cohort study

Setting

The National Child Development Study, a nationally representative study of births in Britain in 1958

Participants

4865 women with at least one singleton live birth

Main exposures

Hardship during childhood, indicated by several variables, including financial/structural hardship, lack of parental interest in education, family dysfunction, violence/mental health issues, and family structure.

Main outcome measures

Smoking in pregnancy, low birthweight (LBW), preterm birth (PTB).

Results

A consistent and graded association was seen between all types of childhood hardships and smoking status during pregnancy (odd ratio (OR) and 95% confidence interval (CI) for 4 or more hardships 2.02, 1.58–2.58; p<0.001 for all comparisons). Most hardships were also associated with risk of LBW and PTB, with associations between number of hardships and both outcomes persisting after controlling for smoking status and adult social class (for LBW, OR 1.51, 95% CI 1.10–2.06; for PTB, OR 1.44, 95% CI 1.08–1.92).

Conclusions

Childhood hardships have an enduring impact on future pregnancy outcomes, in part through their association with smoking during pregnancy and adult socioeconomic position.

Background

Metformin has been proffered as a therapy for adolescent obesity, although long-term controlled studies have not been reported.

Objective

To test the hypothesis that 48 weeks of daily metformin hydrochloride extended release (XR) therapy will reduce body mass index (BMI) in obese adolescents, as compared with placebo.

Design

Multicenter, randomized, double-blind, placebo-controlled clinical trial.

Setting

The 6 centers of the Glaser Pediatric Research Network from October 2003 to August 2007.

Participants

Obese (BMI≥95th percentile) adolescents (aged 13–18 years) were randomly assigned to the intervention (n = 39) or placebo groups.

Intervention

Following a 1-month run-in period, subjects following a lifestyle intervention program were randomized 1:1 to 48 weeks’ treatment with metformin hydrochloride XR, 2000 mg once daily, or an identical placebo. Subjects were monitored for an additional 48 weeks.

Main Outcome Measure

Change in BMI, adjusted for site, sex, race, ethnicity, and age and metformin vs placebo.

Results

After 48 weeks, mean (SE) adjusted BMI increased 0.2 (0.5) in the placebo group and decreased 0.9 (0.5) in the metformin XR group (P = .03). This difference persisted for 12 to 24 weeks after cessation of treatment. No significant effects of metformin on body composition, abdominal fat, or insulin indices were observed.

Conclusion

Metformin XR caused a small but statistically significant decrease in BMI when added to a lifestyle intervention program.

Objective

School districts nationwide are adopting school-based body-mass index (BMI) screening to address the pediatric obesity epidemic. The effect of school-based BMI screening and parental notification on pediatric obesity, however, remains unknown. We sought to assess the impact of BMI screening with parental notification on weight status for California public school students.

Design

A natural experiment wherein nearly all California school districts conducted annual BMI screening in 5th, 7th, and 9th grade, but parental notification of BMI screening results was optional.

Setting

Data from mandatory fitness testing in California public schools between 2001 and 2008.

Participants

Participants were 6,967,120 5th, 7th, and 9th grade youth (73% of enrolled).

Main outcome measure

BMI z-score was the main outcome in adjusted mixed effects linear regression models, assessing whether notifying parents of their child’s BMI in a given year predicted BMI z-score 2 years hence.

Results

Rates of parental notification of BMI screening results increased from 35% in 2001 to 52% in 2008. BMI notification in 5th and/or 7th grade had no impact on subsequent BMI z-scores (95% CI -0.03, 0.01) compared to no notification. No differences in the impact of notification were seen by race/ethnicity. Results did not vary with sensitivity analyses.

Conclusions

These findings suggest that while BMI screening itself could have benefits, parental notification in its current form may not reduce pediatric obesity. Until effective methods of notification are identified, schools should consider directing resources to policies and programs proven to improve student health.

Objective

To examine the impact of sexuality education practices on adolescent birthrates while controlling for demographic characteristics and religious/ political factors at a state level.

Design

Prospective cohort study.

Setting

Twenty-four states, from 1997 through 2005.

Participants

Girls aged 15 to 17 years.

Main Exposure

The state sexuality education practices (ie, sexually transmitted disease prevention, pregnancy prevention, condom efficacy) for 1996 through 2004 from the Centers for Disease Control and Prevention School Health Profiles Survey.

Main Outcome Measures

State birthrates for girls aged 15 to 17 years for 1997 through 2005 from the Centers for Disease Control and Prevention.

Results

In a longitudinal, unadjusted model, our findings provide evidence that increased sexuality education within school curricula is associated with lower adolescent birthrates (average sexuality education topics β=−0.61; P=.001). However, the effect of sexuality education disappeared when taking into consideration the demographic characteristics, religiosity, and abortion policies of the state (average sexuality education topics β=−0.12; P=.26). States with higher religiosity rankings and greater political conservatism had higher adolescent birthrates.

Conclusions

The effects of sexuality education were constrained by state characteristics and do not independently explain the considerable variations in adolescent birthrates found across states. Our findings underscore the strong influence of state characteristics on adolescent birthrates above and beyond sexuality education, which must be considered when evaluating the efficacy of sexuality education programs.

Objective

To assess learning problems in extremely preterm children in kindergarten and identify risk factors.

Design

Cohort study.

Setting

Children’s hospital.

Participants

A cohort of extremely preterm children born January 2001 – December 2003 (n=148), defined as <28 weeks gestation and/or <1000 g birth weight, and term-born normal birth weight classmate controls (n=111).

Main Interventions

The children were enrolled during their first year in kindergarten and assessed on measures of learning progress.

Main Outcome Measures

Achievement testing, teacher ratings of learning progress, and individual educational assistance.

Results

The extremely preterm children had lower mean standard scores than controls on tests of spelling (8.52 points, 95% CI: 4.58, 12.46) and applied mathematics (11.02 points, 95% CI: 6.76, 15.28). They also had higher rates of substandard learning progress by teacher report in written language (OR = 4.23, 95% CI: 2.32, 7.73) and mathematics (OR = 7.08, 95% CI: 2.79, 17.95). Group differences on mathematics achievement and in teacher ratings of learning progress were significant even in children without neurosensory deficits or low global cognitive ability. Neonatal risk factors, early childhood neurodevelopmental impairment, and socioeconomic status predicted learning problems in extremely preterm children, yet many of the children with problems were not in a special education program.

Conclusion

Learning problems in extremely preterm children are evident in kindergarten and are associated with neonatal and early childhood risk factors. The findings support efforts to provide more extensive monitoring and interventions both prior to and during the first year in school.

Objective

To identify predictors of developing a stress fracture among adolescent females during a seven-year period.

Design

Prospective cohort study

Setting

Adolescent females living throughout the United States

Participants

6831 females, aged 9–15 years at baseline, in the Growing Up Today Study (GUTS), an ongoing prospective cohort study.

Main Exposures

Exposures were assessed by self-report questionnaires completed by adolescent girls in 1996, 1997, 1998, 1999, 2000, 2001, and 2003. The adolescent girl’s history of stress fracture, including age when fracture occurred and site, were reported by their mothers, who are registered nurses, in 2004. Cox proportional hazards models were used in the analysis.

Main Outcome Measure

Incident stress fracture that occurred between 1997 and 2004.

Results

During seven years of follow-up, 267 females (3.9%) developed a stress fracture. Independent of age, age at menarche, family history of fracture, and hours per week of low and moderate impact activity, hours per week of running (relative risk (RR)=1.13, 95% confidence interval (CI) 1.04–1.23), basketball (RR=1.12, 95% CI 1.03–1.22) and cheerleading and gymnastics (RR=1.12, 95% CI 1.02–1.23) were significant predictors of developing a stress fracture. No other type of high impact activity was associated with an increased risk.

Conclusions

Females who engage in running, basketball, cheerleading, or gymnastics should be encouraged to include varied training in lower impact activities to decrease the cumulative amount of impact in order minimize their risk of stress fractures.

Objectives

To determine the past-year medical misuse prevalence for 4 controlled medication classes (pain, stimulant, sleeping, and antianxiety) among adolescents, and to assess substance use outcomes among adolescents who report medical misuse.

Design

A Web-based survey was self-administered by 2744 secondary school students in 2009-2010.

Setting

Two southeastern Michigan school districts.

Participants

The sample had a mean age of 14.8 years and was 51.1% female. The racial/ethnic distribution was 65.0% white, 29.5% African American, 3.7% Asian, 1.3% Hispanic, and 0.5% other.

Main Outcome Measures

Past-year medical use and misuse of 4 controlled medication classes.

Results

Eighteen percent of the sample reported past-year medical use of at least 1 prescribed controlled medication. Among past-year medical users, 22.0% reported misuse of their controlled medications, including taking too much, intentionally getting high, or using to increase alcohol or other drug effects. Medical misusers were more likely than nonmisusers to divert their controlled medications and to abuse other substances. The odds of a positive screening result for drug abuse were substantially higher among medical misusers (adjusted odds ratio, 7.8; 95% confidence interval, 4.3-14.2) compared with medical users who used their controlled medications appropriately. The odds of drug abuse did not differ between medical users who used their controlled medications appropriately and nonusers.

Conclusions

Most adolescents who used controlled medications took their medications appropriately. Substance use and diversion of controlled medications were more prevalent among adolescents who misused their controlled medications. Careful therapeutic monitoring could reduce medical misuse and diversion of controlled medications among adolescents.

Objective

To evaluate associations between human immunodeficiency virus (HIV) disease severity and psychiatric and functional outcomes in youth with perinatal HIV infection.

Design

Cross-sectional analysis of entry data from an observational, prospective 2-year study. Logistic and linear regression models adjusted for potential confounders were used.

Setting

Twenty-nine sites of the International Maternal Pediatrics Adolescent AIDS Clinical Trials Group study in the United States and Puerto Rico.

Participants

Youth aged 6 to 17 years who had HIV infection (N=319).

Main Exposures

Antiretroviral treatment and perinatal HIV infection.

Main Outcome Measures

Youth and primary care-givers were administered an extensive battery of measures that assessed psychiatric symptoms; cognitive, social, and academic functioning; and quality of life.

Results

Characteristics of HIV were a current CD4 percentage of 25% or greater (74% of participants), HIV RNA levels of less than 400 copies/mL (59%), and current highly active antiretroviral therapy (81%). Analyses indicated associations of past and current Centers for Disease Control and Prevention class C designation with less severe attention-deficit/hyperactivity disorder inattention symptoms, older age at nadir CD4 percentage and lower CD4 percentage at study entry with more severe conduct disorder symptoms, higher RNA viral load at study entry with more severe depression symptoms, and lower CD4 percentage at study entry with less severe symptoms of depression. There was little evidence of an association between specific antiretroviral therapy and severity of psychiatric symptoms. A lower nadir CD4 percentage was associated with lower quality of life, worse Wechsler Intelligence Scale for Children Coding Recall scores, and worse social functioning.

Conclusion

Human immunodeficiency virus illness severity markers are associated with the severity of some psychiatric symptoms and, notably, with cognitive, academic, and social functioning, all of which warrant additional study.

Trial Registration

clinicaltrials.gov Identifier: NCT00100542

Objective

To examine if antenatal steroids modify the immediate and long-term effects of prophylactic indomethacin in extremely low birth weight infants.

Design

Post-hoc subgroup analysis of data from the Trial of Indomethacin Prophylaxis in Preterms.

Setting

Thirty-two neonatal intensive care units in Canada, the United States, Australia, New Zealand, and Hong Kong.

Participants

A total of 1195 infants with birth weights of 500 to 999 g and known exposure to antenatal steroids. We defined as “adequate” any exposure to antenatal steroids that occurred at least 24 hours before delivery.

Intervention

Indomethacin or placebo intravenously once daily for the first three days.

Outcome Measures

Death or survival to 18 months with 1 or more of cerebral palsy, cognitive delay, severe hearing loss, and bilateral blindness; severe peri-and intraventricular hemorrhage; patent ductus arteriosus; and surgical closure of a patent ductus arteriosus.

Results

Of the 1195 infants in this analysis cohort, 670 had adequate and 525 had inadequate exposure to antenatal steroids. There was little statistical evidence of heterogeneity in the effects of prophylactic indomethacin between the subgroups for any of the outcomes. The adjusted p values for interaction were as low as 0.15 for the end point of death or impairment at 18 months, and as high as 0.80 for the outcome of surgical duct closure.

Conclusion

There was little evidence that the effects of prophylactic indomethacin vary in extremely low birth weight infants with and without adequate exposure to antenatal steroids.

Objective

To determine whether the heightened risk of developmental delays seen in infancy in patients with deformational plagiocephaly (DP) continues into the toddler years.

Design

Longitudinal study comparing the development of children with and without DP, with assessments in infancy (mean age, 7 months) and at age 18 months.

Setting

Infants with DP were recruited from a large craniofacial center, and unaffected infants were recruited from a research registry.

Participants

The study included 227 children with DP and 232 children without previously diagnosed DP.

Main Exposure

Diagnosis of DP by a craniofacial specialist.

Main Outcome Measures

Bayley Scales of Infant and Toddler Development, Third Edition, scores.

Results

Toddlers with DP scored lower than did unaffected children on all the scales of the Bayley Scales of Infant and Toddler Development, Third Edition. Motor score differences were smaller and cognitive and language score differences were greater than those observed in infancy.

Conclusions

Toddlers with DP continue to exhibit evidence of developmental delays relative to toddlers without DP. These findings do not necessarily imply a causal relationship between DP and development because children with delays may be more likely to develop DP. Nonetheless, it seems that increased developmental surveillance is warranted in this population.

Objective

To examine young adult outcomes in a nationally representative US cohort of young adults who grew up with a chronic illness.

Design

Secondary analysis of nationally representative data from Wave III (2001) of the National Longitudinal Study of Adolescent Health.

Setting

United States

Participants

The analytic sample included 13,236 young adults 18–28 years old at Wave III.

Main Exposure

Self-report of a chronic physical illness (asthma, cancer, diabetes or epilepsy) in adolescence. Respondents with (1) asthma or (2) non-asthma chronic illness (cancer, diabetes, or epilepsy) were compared to subjects without these conditions.

Main Outcome Measures

Self-report of high school graduation, ever having a job, having a current job, living with parents, and ever receiving public assistance.

Results

Three percent of young adults had non-asthma chronic illness (cancer, diabetes, or epilepsy) and 16% had asthma. The majority of young adults with chronic illness graduated high school (81%) and were currently employed (60%). However, compared to healthy young adults, those with a non-asthma chronic illness were significantly less likely to graduate high school, ever have a job, or have a current job and were more likely to receive public assistance. When compared to young adults with asthma, young adults with non-asthma chronic illness again had significantly worse young adult outcomes on all measures.

Conclusions

Most young adults growing up with chronic illness graduate high school and are employed. However, these young adults are significantly less likely than their healthy peers to achieve these important educational and vocational milestones.

Objectives

To assess the co-occurrence of past-month physical assault of a dating partner and violence against peers and siblings among a locally representative sample of high school students and to explore correlates of dating violence (DV) perpetration.

Design

Cross-sectional survey design.

Setting

Twenty-two public high schools in Boston, Massachusetts.

Participants

A sample of urban high school students (n = 1398) who participated in the Boston Youth Survey, implemented January through April of 2008.

Main Outcomes Measures

Self-reported physical DV in the month before the survey, defined as pushing, shoving, slapping, hitting, punching, kicking, or choking a dating partner 1 or more times.

Results

Among the respondents, 18.7%, 41.2%, and 31.2% of students reported past-month perpetration of physical DV, peer violence, and sibling violence, respectively. Among violence perpetrators, the perpetration of DV only was rare (7.9%). Controlling for age and school, the association between sibling violence and DV was strong for boys (adjusted prevalence ratio, 3.81;95% confidence interval, 2.07-6.99) and for girls (1.83; 1.44-2.31), and the association between peer violence and DV perpetration was strong for boys (5.13; 3.15-8.35) and for girls (2.57; 1.87-3.52). Dating violence perpetration was also associated with substance use, knife carrying, delinquency, and exposure to community violence.

Conclusions

Adolescents who perpetrated physical DV were also likely to have perpetrated peer and/or sibling violence. Dating violence is likely one of many co-occurring adolescent problem behaviors, including sibling and peer violence perpetration, substance use, weapon carrying, and academic problems.