enzodiazepines are widely used in the treatment of anxiety and sleep problems. 1-3 The efficacy of benzodiazepines surpasses placebos in controlling a range of anxiety symptoms 4,5 and reducing the onset of sleep latency. 6 Although practice guidelines recommend newer antidepressants in place of benzodiazepines as first-line treatments for anxiety disorders, 7 there is no evidence for the superior short-term efficacy of antidepressants for anxiety disorders. 8 Moreover, practice guidelines recommend that initial approaches to the management of primary insomnia should include behavioral interventions, 9,10 although behavioral interventions and benzodiazepines yield similar short-term sleep-related outcomes. 11 When benzodiazepines are used for extended periods of time, they may lead to problems associated with discontinuation and withdrawal symptoms 12,13 and abuse. 14 In 2008, there were approximately 272 000 emergency department visits in the United States involving nonmedical use of benzodiazepines, of which 40.0% also involved alcohol, 15 which increased to approximately 426 000 visits in 2011, of which 24.2% also involved alcohol. 16 Among older individuals, medical benzodiazepine use poses risks of serious adverse effects including impaired cognitive functioning, 17 reduced mobility and driving skills, 18,19 and increased risks of falls. 20 Research further indicates that the risks of falls is greater for benzodiaz-IMPORTANCE Although concern exists regarding the rate of benzodiazepine use, especially long-term use by older adults, little information is available concerning patterns of benzodiazepine use in the United States. OBJECTIVE To describe benzodiazepine prescription patterns in the United States focusing on patient age and duration of use. DESIGN, SETTING, AND PARTICIPANTS A retrospective descriptive analysis of benzodiazepine prescriptions was performed with the 2008 LifeLink LRx Longitudinal Prescription database (IMS Health Inc), which includes approximately 60% of all retail pharmacies in the United States. Denominators were adjusted to generalize estimates to the US population. MAIN OUTCOMES AND MEASURES The percentage of adults filling 1 or more benzodiazepine prescriptions during the study year by sex and age group (18-35 years, 36-50 years, 51-64 years, and 65-80 years) and among individuals receiving benzodiazepines, the corresponding percentages with long-term (Ն120 days) benzodiazepine use, prescription of a long-acting benzodiazepine, and benzodiazepine prescriptions from a psychiatrist. RESULTS In 2008, approximately 5.2% of US adults aged 18 to 80 years used benzodiazepines. The percentage who used benzodiazepines increased with age from 2.6% (18-35 years) to 5.4% (36-50 years) to 7.4% (51-64 years) to 8.7% (65-80 years). Benzodiazepine use was nearly twice as prevalent in women as men. The proportion of benzodiazepine use that was long term increased with age from 14.7% (18-35 years) to 31.4% (65-80 years), while the proportion that received a benzodiazepine prescription from a psychi...

Changes in practices for diagnosing autism have had a substantial effect on autism caseloads, accounting for one-quarter of the observed increase in prevalence in California between 1992 and 2005.

Background-The incidence of autism rose dramatically between 1992 and 2001, while the age at which children were first diagnosed declined. During this period the size and composition of the autism caseload has changed, but little is known about whether the factors associated with the timing of diagnosis may also have shifted. Using a multilevel analysis strategy, the individual and community-level factors associated with age of diagnosis were modelled across 10 birth cohorts of California children.

How do social movements promote diversity and alternative organizational forms? We address this question by analyzing how cooperative enterprise was affected by the Grange-a leading anticorporate movement in the United States during the late nineteenth and early twentieth centuries. State-level analyses across three industries yield three findings. First, the Grange had positive effects on cooperatives and mutuals during the nineteenth-century populist struggles over corporate capitalism. Second, these effects were stronger where corporations counter-mobilized to block challengers' political efforts. Grangers pursued economic organization as an alternative to politics and in response to blocked political access. Third, the Grange continued to foster cooperatives even as populist revolts waned. It did so, however, by buffering cooperatives from problems of group heterogeneity and population change, rendering them less dependent on supportive communities and specific economic conditions. These findings advance research at the movements/organizations interface by documenting movement effects and by isolating different causal pathways through which mobilization, countermobilization, and political opportunity shape economic organization. The results also provide economic sociology with new evidence on how social structure moderates economic forces, and help revise institutional analyses of American capitalism by showing how cooperatives emerged as significant, rather than aberrant, elements of the U.S. economy.

IMPORTANCE Despite concerns about rising treatment of young people with antipsychotic medications, little is known about trends and patterns of their use in the United States.OBJECTIVE To describe antipsychotic prescription patterns among young people in the United States, focusing on age and sex. DESIGN, SETTING, AND PARTICIPANTSA retrospective descriptive analysis of antipsychotic prescriptions among patients aged 1 to 24 years was performed with data from calendar years 2006 (n = 765 829), 2008 (n = 858 216), and 2010 (n = 851 874), including a subset from calendar year 2009 with service claims data (n = 53 896). Data were retrieved from the IMS LifeLink LRx Longitudinal Prescription database, which includes approximately 60% of all retail pharmacies in the United States. Denominators were adjusted to generalize estimates to the US population. MAIN OUTCOMES AND MEASURESThe percentage of young people filling 1 or more antipsychotic prescriptions during the study year by sex and age group (younger children, 1-6 years; older children, 7-12 years; adolescents, 13-18 years; and young adults, 19-24 years) was calculated. Among young people with antipsychotic use, percentages with specific clinical psychiatric diagnoses and 1 or more antipsychotic prescriptions from a psychiatrist and from a child and adolescent psychiatrist were also determined. RESULTSThe percentages of young people using antipsychotics in 2006 and 2010, respectively, were 0.14% and 0.11% for younger children, 0.85% and 0.80% for older children, 1.10% and 1.19% for adolescents, and 0.69% and 0.84% for young adults. In 2010, males were more likely than females to use antipsychotics, especially during childhood and adolescence: 0.16% vs 0.06% for younger children, 1.20% vs 0.44% for older children, 1.42% vs 0.95% for adolescents, and 0.88% vs 0.81% for young adults. Among young people treated with antipsychotics in 2010, receiving a prescription from a psychiatrist was less common among younger children (57.9%) than among other age groups (range, 70.4%-77.9%). Approximately 29.3% of younger children treated with antipsychotics in 2010 received 1 or more antipsychotic prescriptions from a child and adolescent psychiatrist. Among young people with claims for mental disorders in 2009 who were treated with antipsychotics, the most common diagnoses were attention-deficit/hyperactivity disorder in younger children (52.5%), older children (60.1%), and adolescents (34.9%) and depression in young adults (34.5%). CONCLUSIONS AND RELEVANCEAntipsychotic use increased from 2006 to 2010 for adolescents and young adults but not for children aged 12 years or younger. Peak antipsychotic use in adolescence, especially among boys, and clinical diagnosis patterns are consistent with management of developmentally limited impulsive and aggressive behaviors rather than psychotic symptoms.