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Lack of physical activity is a major cause of morbidity and mortality in the United States. Prior studies have documented a decline in physical activity during adolescence, though the nature of this decline is not well understood. This longitudinal study of 782 adolescents found that physical activity had declined by 26% during the subsequent 4 years, and this decline was primarily owing to a decrease in the number of physical activities in which adolescents participate. Adolescents who are not active in middle school are very unlikely to be physically active in high school.
Using data from the National Health Interview Survey, Schuster and colleagues found that 21 million children live in homes in the United States in which someone smokes on a regular basis. Even in many homes where no parent smokes, there is regular smoking by visitors. The United States is falling far short of the Healthy People 2010 goals of reducing children's exposure to environmental tobacco smoke. Interventions such as tax increases on cigarettes and intensive media campaigns are needed to reduce the current and future exposure of children to tobacco smoke.
There have been extensive efforts by the Centers for Disease Control and Prevention and the American Academy of Pediatrics to reduce the inappropriate use of antibiotics. Analysis of the National Ambulatory Medical Care Survey showed that children with upper respiratory tract infections or bronchitis were 31% less likely to receive antibiotics in 1998 as compared with 1995. Patients with sinusitis or otitis media were 70% less likely to have an inappropriate antibiotic prescribed in 1998 as compared with 1995. This study indicates that improvement has occurred with more appropriate prescribing, but almost half of patients with upper respiratory tract infections still received antibiotics.
The large number of non–English speaking people in the United States has the potential to create language barriers in the provision of medical care, and increase resource utilization. In this study of 4146 children visiting an emergency department for care, patients with a language barrier, but who were cared for with a professional interpreter, were 27% less likely to have tests, 70% more likely to be admitted, and had longer emergency department stays than patients who spoke English. Patients without interpreters were 160% more likely to be admitted and were 120% more likely to receive intravenous hydration in the emergency department. The cost of not providing language-concordant, culturally appropriate medical care is high.
Respiratory infections are the most common reason for admission of children to hospitals during the winter months. In this report, Todd and colleagues report on the effect of implementation of evidence-based guidelines for the care of children with bronchiolitis or viral pneumonia. The guidelines were associated with a decrease in respiratory syncytial virus testing, use of ribavirin, and chest physiotherapy, but there was no change in the overall use of bronchodilators. Guidelines may be a necessary component of measure to improve evidence-based care, but they are clearly not sufficient.
This Month in Archives of Pediatrics & Adolescent Medicine. Arch Pediatr Adolesc Med. 2002;156(11):1071. doi:10.1001/archpedi.156.11.1071
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