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The Health Behavior in School-Aged Children Study has been an important source of international comparisons on the health and welfare of children. In this study of more than 93 000 15-year-olds, cannabis use in the prior 12 months was strongly associated with the frequency of spending evenings out with friends in both boys and girls. Reported cannabis use decreased in most of the countries between 2002 and 2006, and changes in the mean frequency of going out with friends were strongly linked to changes in the prevalence of cannabis use. Canada, Switzerland, and the United States remained the countries with the highest prevalence of cannabis use in 15-year-olds. The findings are consistent with the hypothesis that by going out less frequently at night with friends, adolescents had fewer opportunities to obtain and use cannabis. It is important to determine how to foster opportunities for social interactions among youth that do not provide exposure to substance use.
Hearing screening is a routine part of health maintenance visits for school-aged children. In this study of 1061 children aged 3 to 19 years who were screened for hearing loss in 1 of 8 pediatric practices, about 2.5% failed screening, but only 25% of these patients who were referred to audiologists were actually evaluated. Hearing loss was eventually diagnosed in 6% of those who failed screenings, but also in 3% of a random sample of those who passed office hearing examinations. The sensitivity of a failed screening in primary care offices was 50%, while the specificity was 78% and the positive predictive value was only 7.6%. The low sensitivity and specificity of the office hearing examination calls into question whether this routine procedure should be done. Other methods of hearing screening should be developed and evaluated.
Pediatric research should include children who are representative of the population to which the results can be generalized. This study by Rajakumar et al sought to determine parental mistrust of medical research in a sample of African American and white parents attending a primary care clinic. Two-thirds of African American parents were distrusting of medical research compared with half of white parents. Three-quarters of parents with only a high school education were distrusting compared with only 44% of college graduates. After adjusting for education, African American parents had a greater than 2-fold odds of being distrustful than white parents. For African American parents, provision of free medical care was negatively associated with trust. Parental distrust may be a substantial barrier to enrolling African American children in research and this must be addressed.
Association between distrust index score and race. Higher scores indicate higher levels of distrust of medical research.
Health literacy is an important concept and has been linked to poor compliance with treatment plans and poorer health status. Sanders and colleagues examined 215 articles on health literacy related to pediatric populations. Strikingly, while 1 in 3 adolescents and young adults had low health literacy, most child health information is written at the 10th-grade level or above. The impact of this low literacy on child health is broad and includes adverse health behaviors and increased use of health services in children with chronic illness. Caregiver health literacy may serve as an important, modifiable factor influencing child health disparities. Addressing health literacy should be a part of any effective framework to improve the delivery of quality child health services.
Model for health literacy as a social determinant of child health.
This Month in Archives of Pediatrics & Adolescent Medicine. Arch Pediatr Adolesc Med. 2009;163(2):101. doi:https://doi.org/10.1001/archpediatrics.2008.549
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