Background: Late adolescence is comprised of considerable developmental transitions, though brain maturational changes during this period are subtle and difficult to quantitatively evaluate from standard brain imaging acquisitions. To date, primarily cross-sectional studies have characterized typical developmental changes during adolescence, but these processes need further description within a longitudinal framework. Method:To assess the developmental trajectory of typical white matter development, we examined 22 healthy adolescents with serial diffusion tensor images (DTI) collected at a mean age of 17.8 years and 16-months later. Diffusion parameters fractional anisotropy, and mean, radial, and axial diffusivity were subjected to whole-brain voxelwise time point comparisons using tract-based spatial statistics.Results: At follow-up, adolescents showed significant change (≥ 153 contiguous voxels each at p<.01) in diffusion properties, including in bilateral superior longitudinal fasciculi, superior corona radiata, anterior thalamic radiations, and posterior limb of the internal capsule. Overall, correlations with cognitive performances suggested behavioral improvement corresponding with white matter changes. Conclusion:These longitudinal DTI findings support continued microstructural change in white matter during late adolescence, and suggest ongoing refinement of projection and association fibers into early adulthood.

Background Sex-specific trajectories in white matter development during adolescence may help explain cognitive and behavioral divergences between males and females. Knowledge of sex differences in typically developing adolescents can provide a basis for interpreting sexual dimorphisms in abilities and actions. Method We examined 58 healthy adolescents (12–14 years of age) with diffusion tensor imaging (DTI). Diffusion parameters fractional anisotropy (FA), and mean (MD), radial (RD), and axial diffusivities (AD) were subjected to whole-brain voxel-wise group comparisons using tract-based spatial statistics. Sex differences in white matter microstructure were examined in relation to pubertal development. Results Early adolescent females (n=29) evidenced higher FA in the right superior corona radiata, higher FA and AD in bilateral corticospinal tracts (≥164 µl, p<.01), and lower MD in the right inferior longitudinal fasciculus (ILF) and left forceps major (≥164 µl, p<.01) than age-matched males (n=29). Males did not show any areas of higher FA or lower MD than females, but had higher AD in the right superior longitudinal fasciculus, ILF, and forceps minor (≥ 164 µl, p<.01). Pubertal stage did not account for sex disparities. Conclusion In early adolescence, females’ motor tracts may reflect widespread changes, while males may undergo relatively more microstructural change in projection and association fibers.

Purpose: Rates of suicide are increasing rapidly among youth. Social media messages and online games promoting suicide are a concern for parents and clinicians. We examined the timing and location of social media posts about one alleged youth suicide game to better understand the degree to which social media data can provide earlier public health awareness. Methods: We conducted a search of all public social media posts and news articles on the Blue Whale Challenge (BWC), an alleged suicide game, from January 1, 2013, through June 30, 2017. Data were retrieved through multiple keyword search; sources included social media platforms Twitter, YouTube, Reddit, Tumblr, as well as blogs, forums, and news articles. Posts were classified into three categories: individual "pro"-BWC posts (support for game), individual "anti"-BWC posts (opposition to game), and media reports. Timing and location of posts were assessed. Results: Overall, 95,555 social media posts and articles about the BWC were collected. In total, over one-quarter (28.3%) were "pro"-BWC. The first U.S. news article related to the BWC was published approximately 4 months after the first English language U.S. social media post about the BWC and 9 months after the first U.S. social media post in any language. By the close of the study period, "pro"-BWC posts had spread to 127 countries. Conclusions: Novel online risks to mental health, such as prosuicide games or messages, can spread rapidly and globally. Better understanding social media and Web data may allow for detection of such threats earlier than is currently possible.

Background and Objectives: Increasing human papillomavirus vaccination (HPVV) uptake is critical to the prevention of cervical cancer. Effective physician communication and clinical workflow policies have a significant impact on vaccination rates. However, resident training programs vary in the inclusion of training in effective HPVV practices. At Dell Medical School in Austin, Texas, HPVV rates at primary care residents’ clinic sites vary. We examined HPVV-related knowledge, training, barriers, and practices among residents in pediatrics (Peds), family medicine (FM), obstetrics and gynecology (Ob/Gyn), and internal medicine (IM) with the aim of identifying interventional targets to improve vaccination rates. Methods: This was a mixed-method study including qualitative interviews and a survey. We interviewed a sample of residents from each specialty to assess their training experiences and how they discuss HPVV. We recorded, transcribed, and coded interviews for thematic analysis. All residents were offered the opportunity to complete an electronic survey to quantitatively evaluate knowledge and vaccine practices. We performed χ2 and Fisher exact analysis to compare results between disciplines. Results: HPVV-related knowledge was similar across all four specialties and between resident year. Peds residents reported always recommending the HPVV significantly more than FM and Ob/Gyn residents for 11-17-year-old females. Only Peds residents reported receiving evidence-based vaccine communication training. Among all residents, the primary HPVV barriers included forgetting to offer the vaccine and time constraints. When discussing the vaccine, many interviewed residents were not offering a confident recommendation to all eligible patients, and instead were using a risk-based approach to vaccination. Conclusions: There were inconsistencies across programs related to how and where residents receive HPVV training. This may impact the frequency and strength of resident vaccine recommendations. To increase HPVV rates, residency programs should prioritize implementation of multimodal interventions, including opt-out workflows and education on how to give confident vaccine recommendations.

Background: The sale of contraband tobacco allows for tobacco tax evasion, which can undermine the effectiveness of tobacco tax policies in reducing the number of smokers. Estimates of the proportion of contraband vary widely as do the methods used to measure the proportion of contraband being smoked. The purpose of this study is to determine the proportion of contraband use in two different jurisdictions. Methods: A cross-sectional direct collection of cigarette butts was conducted in Peel and Brantford, Ontario, Canada in 2013 and 2014, respectively. Cigarette butts were collected from a variety of locations within both regions. Cigarette butts were assessed and classified into one of the following categories: contraband, legal Canadian, legal Native, International, unknown, and discards. Results: The overall proportion of contraband cigarettes in Peel was 5.3 %, ranging from 2.8 to 8.6 % by location. In Brantford, the proportion of contraband was 33.0 %, with a range from 32.8 to 33.1 % by location. Conclusions: The direct collection of cigarette butts was determined to be a feasible method for a local public health unit in determining the proportion of contraband cigarettes. This approach showed that Brantford has a higher proportion of contraband consumption compared to Peel, which may be due to geographic location and proximity to the United States (US)-Canada border and Native Reserves. More research is needed to confirm this geographic association with other jurisdictions.