Objectives: E-cigarette use has increased dramatically among adolescents in the past 5 years alongside a steady increase in daily use of marijuana. This period coincides with a historic rise in depression and suicidal ideation among adolescents. In this study, we describe the associations between e-cigarette and marijuana use and depressive symptoms and suicidality in a large nationally representative sample of high school students. Methods: We used data from the 2 most recent waves (2015 and 2017) of the Youth Risk Behavior Survey. Our sample (n ¼ 26,821) included only participants with complete information for age, sex, race/ethnicity, and exposure to e-cigarettes and marijuana (89.5% of survey respondents). We performed multivariate logistic regressions to explore the associations between single or dual use of e-cigarette and marijuana and depressive and suicidal symptoms in the past year adjusting for relevant confounders.Results: E-cigarette-only use was reported in 9.1% of participants, marijuana-only use in 9.7%, and dual e-cigarette/marijuana use in 10.2%. E-cigarette-only use (vs no use) was associated with increased odds of reporting suicidal ideation (adjusted odds ratio [
Objective: This study aims to describe the use of telehealth in developmental behavioral pediatric (DBP) fellowship-affiliated practices during the coronavirus disease 2019 (COVID-19) global pandemic. Methods: An electronic survey was disseminated to all DBP fellowship-associated practice locations to determine the use of telehealth in DBP care provision, before and since the beginning of the COVID-19 pandemic. We analyzed responses using descriptive statistics. Results: A total of 35 of 42 eligible practice sites responded (83% response rate). Most sites (51.4%) reported using telehealth less than once per month before the COVID-19 pandemic. Since the onset of COVID-19, 100% of programs reported conducting videobased telehealth visits multiple days per week. Most sites reported conducting evaluations and follow-up visits for attention-deficit/hyperactivity disorder, autism spectrum disorder, behavioral concerns, developmental delay, genetic disorders, and learning disability. Most sites were able to continue medication management by telehealth (>88%), offer interpreter services for families with limited English proficiency participating in telehealth visits (>90%), and incorporate trainees and interdisciplinary team members in telehealth visits (>90%). Greater variability was observed in sites' ability to collect telehealth practice evaluation measures. Conclusion: Most sites are providing evaluations and ongoing care for DBP conditions through telehealth. The rapid adoption of telehealth can have ramifications for the way that DBP care is delivered in the future; therefore, it is imperative to understand current practice patterns and variations to determine the best use of telehealth.
Objective: The objective of this study was to identify factors associated with parent-reported problems accessing needed mental health services (MHS) in youth with autism spectrum disorder and anxiety. Methods: This study is a secondary analysis using the National Survey of Children's Health 2016 to 2017 data sets with multivariable logistic regression. Subjects are 6 to 17 year olds with parent-reported autism spectrum disorder (ASD) and anxiety. Outcome is parent-reported challenge accessing needed mental health treatment, dichotomized to not a problem versus problem. Covariates included race/ethnicity, intellectual disability, insurance, medical home, poverty level, and parent education level. Results: The sample included 568 youth with ASD and anxiety-78% male subjects, mean age 12.5 years, and 63% White, non-Hispanic. Fifty-three percent of youth with ASD and anxiety had parent-reported problems accessing needed MHS. Lack of medical home (adjusted odds ratio [aOR] 5.97, 95% confidence interval [CI] [2.72-13.09]) and coexisting intellectual disability (aOR 2.23, 95% CI [1.08-4.60]) were significantly associated with problems accessing MHS. Reported family incomes at 0% to 99% and 100% to 199% of the federal poverty level as compared with family income at 400% federal poverty level or above (aOR 0.32, 95% CI [0.11-0.94] and aOR 0.35, 95% CI [0.13-0.95], respectively) was associated with decreased problems accessing MHS. Conclusion: In this nationally representative study, more than half of youth with ASD and anxiety had parent-reported problems accessing needed MHS. Lack of a medical home, co-occurring intellectual disability, and higher socioeconomic status (SES) are associated with problems accessing MHS. Therefore, policies to support the medical home; increase mental health supports available for those with ASD, anxiety, and coexisting intellectual disability; and support access for all SES levels may increase mental health access.
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