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In This Issue of JAMA Pediatrics
July 2014


JAMA Pediatr. 2014;168(7):593. doi:10.1001/jamapediatrics.2013.3351


Electronic cigarettes (e-cigarettes) are being aggressively marketed as smoking cessation aids, without any evidence that they are effective in smoking cessation and without any regulation by the Food and Drug Administration. Dutra and Glantz examine the relationship between e-cigarette use and conventional cigarette use and quitting among youth in grades 6 through 12 using data from the 2011 and 2012 National Youth Tobacco Surveys. Use of e-cigarettes was associated with higher odds of ever or current cigarette smoking; higher odds of established smoking; higher odds of planning to quit smoking among current smokers; and, among experimenters, lower odds of abstinence from conventional cigarettes. Chaloupka discusses the implications of these findings in an accompanying editorial and emphasizes the need for quick action by policy makers.

Editorial and Patient Page

Concerns about drug-impaired driving are of increasing importance in the United States, where state laws that reduce or remove penalties for marijuana are becoming more common. Whitehill and colleagues study the prevalence in underage college students’ driving after marijuana and/or alcohol use and riding as a passenger with an marijuana- or alcohol-using driver in 2 large state universities. Among students using any substances, past-28-day use of only marijuana was associated with a 6.24-fold increased risk of driving after substance use compared with using only alcohol. A 1% increase in the reported percentage of friends using marijuana was associated with a 2% increased risk of riding with a marijuana-using driver. In his accompanying editorial, Asbridge discusses the lessons learned from drunk driving that need to be applied to the problem of marijuana-impaired driving.


Treatment of bronchiolitis continues to be frustrating to clinicians and parents alike. Wu and colleagues compare the effect of nebulized 3% hypertonic saline vs 0.9% normal saline in the emergency department and during hospitalization on admission rate and length of stay in infants with bronchiolitis. The admission rate in the 3% hypertonic saline group was 28.9% compared with 42.6% in the normal saline group; there were no differences in length of stay or in respiratory distress between the 2 groups. The authors concluded that nebulized hypertonic saline in the emergency department is effective in decreasing admissions for bronchiolitis. Grewal and Klassen discuss the study in an accompanying editorial.


Florin and colleagues conducted a randomized clinical trial of nebulized 3% hypertonic saline compared with normal saline in the emergency department on infants presenting with acute bronchiolitis who had persistent distress after albuterol and nasal suctioning. Those who received a single dose of nebulized hypertonic saline in the emergency department had less improvement in respiratory distress compared with those receiving normal saline; there were no differences in hospitalization rate. In their editorial discussing this study and the study by Wu and colleagues, Grewal and Klassen place these studies into context with similar studies of hypertonic saline and the need for “living systematic reviews” that would be updated in real time as new trials are available for inclusion.


Journal Club and Continuing Medical Education