bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physician Preferences Surrounding Urinary Tract Infection Management in Neonates
Authors: Joshi Neha S. , Lucas Brian P. , Schroeder Alan R. 
Published: January 2018

OBJECTIVES:
Variability exists in the treatment of neonates with urinary tract infection (UTI), potentially reflecting an overuse of resources. A cross-sectional vignette survey was designed to examine variability in physician preferences for intravenous (IV) antibiotic duration, genitourinary imaging, and prophylactic antibiotics and to evaluate drivers of resource use.

METHODS:
The survey was administered to a random sample of pediatricians through the American Medical Association’s Physician Masterfile. Respondents were provided with a case vignette of a 2-week-old neonate with a febrile UTI and asked to indicate preferences for IV antibiotic duration and rank drivers of this decision. Respondents were also asked whether they would obtain a voiding cystourethrogram (VCUG) and, regardless of preference, randomly presented with a normal result or bilateral grade II vesicoureteral reflux. The survey was delivered electronically to facilitate skip logic and randomization.

RESULTS:
A total of 279 surveys were completed. Preference for total IV antibiotic duration differed significantly (P &lt; .001) across specialty, with a median duration of 2 days for general pediatricians/hospitalists, 7 days for neonatologists, and 5 days for infectious disease pediatricians. For the 47% (n = 131) who did not want a VCUG, 24/61 (39%) wanted prophylactic antibiotics when presented with grade II vesicoureteral reflux (P &lt; .001).

CONCLUSIONS:
Subspecialty status appeared to be the most influential driver of IV antibiotic duration in the treatment of UTI. A substantial proportion of pediatricians who initially expressed a preference against ordering a VCUG wished to prescribe prophylactic antibiotics when results were abnormal, which suggests that even unwanted diagnostic test results drive treatment decisions.
Randomized Clinical Trial of Standard- Versus High-Calorie Formula for Methadone-Exposed Infants: A Feasibility Study
Authors: Bogen Debra L. , Hanusa Barbara H. , Baker Robyn , Medoff-Cooper Barbara , Cohlan Barbara 
Published: January 2018

BACKGROUND:
Newborns who are prenatally exposed to methadone are at risk for neonatal abstinence syndrome and the associated excess weight loss and poor weight gain. This pilot feasibility study aimed to evaluate early caloric enhancement on weight patterns among infants born to women receiving methadone maintenance therapy while pregnant.

METHODS:
In this double-blind pilot feasibility study, we randomly assigned infants with fetal methadone exposure to 24 or 20 kcal/oz formula from days 3 to 21. Randomization was stratified by any breastfeeding, sex of the infant, and gestational age. Eligible infants were ≥35 weeks’ gestation and weighed ≥2200 g. Outcomes were days to weight nadir, maximum percent weight loss, days to birth weight, percentage weight change per day, and feasibility.

RESULTS:
A total of 49 infants were randomly assigned (22 to standard- and 27 to high-calorie formula); groups had comparable demographic characteristics. Main outcomes comparing standard- to high-calorie formula groups were not significant (days to weight nadir, 5.0 vs 4.4 days; P = .20; maximum percent weight loss, −9.4% vs −8.6%; P = .15; days to birth weight, 14.7 vs 13.6 days; P = .07); however, in longitudinal analyses (days 4 to 21), the high-calorie group had a higher percent weight gained per day compared with the standard-calorie group (P &lt;.001). There were high levels of protocol adherence, and no adverse effects were observed.

CONCLUSIONS:
Study findings suggest that early initiation of high-calorie formula for infants with prenatal methadone exposure may be beneficial for weight gain; evaluation in a larger study is warranted.
A Novel Approach to Assessing Infants With Neonatal Abstinence Syndrome
Authors: Grossman Matthew R. , Lipshaw Matthew J. , Osborn Rachel R. , Berkwitt Adam K. 
Published: January 2018

OBJECTIVES:
Neonatal abstinence syndrome (NAS) is a growing problem and poses a significant burden on the health care system. The traditional Finnegan Neonatal Abstinence Scoring System (FNASS) assessment approach may lead to unnecessary opioid treatment of infants with NAS. We developed a novel assessment approach and describe its effect on the management of infants with NAS.

METHODS:
We retrospectively compared treatment decisions of 50 consecutive opioid-exposed infants managed on the inpatient unit at the Yale New Haven Children’s Hospital. All infants had FNASS scores recorded every 2 to 6 hours but were managed by using the Eat, Sleep, Console (ESC) assessment approach. Actual treatment decisions made by using the ESC approach were compared with predicted treatment decisions based on recorded FNASS scores. The primary outcome was postnatal treatment with morphine.

RESULTS:
By using the ESC approach, 6 infants (12%) were treated with morphine compared with 31 infants (62%) predicted to be treated with morphine by using the FNASS approach (P &lt; .001). The ESC approach started or increased morphine on 8 days (2.7%) compared with 76 days (25.7%) predicted by using the FNASS approach (P &lt; .001). There were no readmissions or adverse events reported.

CONCLUSIONS:
Infants managed by using the ESC approach were treated with morphine significantly less frequently than they would have been by using the FNASS approach. The ESC approach is an effective method for the management of infants with NAS that limits pharmacologic treatment and may lead to substantial reductions in length of stay.
Correlates of Allowing Alternative Tobacco Product or Marijuana Use in the Homes of Young Adults
Authors: Berg Carla J. , Haardörfer Regine , Wagener Theodore L. , Kegler Michelle C. , Windle Michael 
Published: January 2018

BACKGROUND:Given the increases in alternative tobacco product (ATP) and marijuana use, we examined self-reported likelihood of allowing ATP and marijuana use in the home among young adults.METHODS:We analyzed data from a study of students aged 18 to 25 years (n = 2865) at 7 Georgia colleges and universities. Variables included: personal, household members’, and friends’ tobacco (cigarettes, little cigars and cigarillos [LCCs], e-cigarettes, hookah) and marijuana use and the perceived harm to health, harm of byproducts, addictiveness, and social acceptability of each. Regression models were specified to examine correlates of the likelihood of allowing use of each product in the home.RESULTS:Personal use prevalence ranged from 5.5% for e-cigarettes to 12.5% for marijuana. E-cigarettes were most likely to be allowed in the home; cigarettes were least. Regression indicated that others’ use and the perceived social acceptability of using each product was correlated with greater likelihood of allowing the use of a product. A greater likelihood of allowing cigarette and LCC use in the home was only associated with cigarette or LCC use, respectively; a greater likelihood of allowing e-cigarette use was associated with current e-cigarette use; greater likelihood of allowing hookah use was associated with using any product except e-cigarettes; and greater likelihood of allowing marijuana use was associated with LCC and marijuana use. Perceived harm to health, byproduct harms, and addictiveness were differentially related to the likelihood of allowing use of different products.CONCLUSIONS:ATPs and marijuana may undermine efforts to protect against environmental toxins in the home, thus warranting interventions targeting young adults.
Adult Attitudes and Practices Regarding Smoking Restrictions and Child Tobacco Smoke Exposure: 2000 to 2015
Authors: McMillen Robert , Wilson Karen , Tanski Susanne , Klein Jonathan D. , Winickoff Jonathan P. 
Published: January 2018

BACKGROUND AND OBJECTIVES:
Since 2000, tobacco control efforts have greatly increased state and local protections from childhood tobacco smoke exposure. The objective of this study is to examine changes in attitudes and practices regarding smoking bans in multiple public and private settings from 2000 to 2015, as well as to examine the changes in pediatrician and family practitioner screening and counseling for tobacco smoke exposure.

METHODS:
Cross-sectional data from the annual Social Climate Survey of Tobacco Control were analyzed.

RESULTS:
The majority of adults, 69.3%, reported household smoking restrictions in 2000, and these restrictions increased to 79.5% through 2015 (P &lt; .05). Car smoking prohibitions increased from 68.3% to 81.8% (P &lt; .05). A growing majority of adults supports smoke-free policies in public settings, and tobacco counseling by child health care providers also increased. However, members of 1 in 5 households still permit smoking inside the home and family vehicle, and half of the US population is not protected by state or local laws prohibiting smoking inside of hospitality venues.

CONCLUSIONS:
Despite dramatic progress since 2000, these trend data reveal potential areas where child health care clinicians might focus effort at the family and community level to accelerate the protection of children from tobacco smoke exposure.
Referral Strategies to a Tobacco Quitline and Racial and/or Ethnic Differences in Participation
Authors: Russo Elizabeth T. , Reid Margaret , Taher Rashida , Sharifi Mona , Shah Snehal N. 
Published: January 2018

BACKGROUND:Tobacco use inflicts a disproportionate burden of disease on people of color. We evaluated the reach among African American and Hispanic smokers in Boston of 2 referral strategies to the Massachusetts quitline: (1) a provider-referred strategy based in pediatric and dental clinics and (2) a targeted media campaign to promote self-referral to the quitline.METHODS:Selected demographic characteristics of Boston quitline participants during the study period (2010–2012) were compared between strategies. Self-referred smoker characteristics were also compared in the years before and after the media campaign. Finally, the characteristics of quitline participants were compared with smokers in the 2010 Boston Behavioral Risk Factor Surveillance Survey.RESULTS:During the study period, 4066 smokers received cessation services from the quitline; 3722 (91.5%) were self-referred, and 344 (8.5%) were referred by pediatric and dental providers. The proportion of black (31.6%) and Hispanic (20.3%) participants referred by providers was higher than among self-referred participants (18.3% and 7.8%, respectively; P &lt;.001). Overall, provider-referred participants were less likely to be white (17.9%) than to be people of color. Self-referred smokers were more likely to be white (68.0%) than the estimated population of Boston smokers overall (62.9%; P &lt;.001).CONCLUSIONS:The large-scale media campaign, which promoted self-referral, was associated with higher quitline participation overall, but the provider-referred strategy based in community health centers yielded participation from a greater proportion of smokers of color. The 2 strategies reached different subpopulations of smokers, and their combined reach enhanced access to cessation services among smokers from different racial and ethnic backgrounds.
Smoke-Free Car Legislation and Student Exposure to Smoking
Authors: Patel Minal , Thai Chan L. , Meng Ying-Ying , Kuo Tony , Zheng Hong , Dietsch Barbara , McCarthy William J. 
Published: January 2018

BACKGROUND:Policies protecting children from exposure to secondhand smoke (SHS) may help prevent SHS-related negative health outcomes in children and discourage them from intending to smoke in the future. In this study, we assess the impact of California’s 2007 smoke-free vehicle law on changes in middle and high school students’ reported exposure to smoking in cars. Secondary aims included assessing the association of student-reported exposure to smoking in vehicles and lifetime asthma diagnosis and future intentions to smoke.METHODS:Population-weighted data from the California Student Tobacco Survey and the National Youth Tobacco Survey were used to evaluate California and national trends, respectively. Weighted logistic regression models using California Student Tobacco Survey 2011 data assessed the association between the number of days of exposure to smoking in cars and student-reported lifetime asthma diagnosis as well as intention to smoke in the future.RESULTS:The proportion of California students reporting exposure to smoking in cars in the last 7 days declined &lt;1% annually from 2001 through 2005, but declined 12% annually from 2007 to 2011. National trends did not show comparable declines after 2006. Students reporting exposure to smoking in vehicles were more likely to report having ever been diagnosed with asthma and intending to smoke in the future than students who were not exposed to SHS.CONCLUSIONS:These findings support the legislative intent that public policies that are designed to protect children from exposure to smoking in vehicles will yield better adolescent health outcomes and a lower risk of future adolescent cigarette smoking.
Implementing Tobacco Control Assistance in Pediatric Departments of Chinese Hospitals: A Feasibility Study
Authors: Abdullah Abu S. , Guangmin Nong , Kaiyong Huang , Jing Liao , Yang Li , Zhang Zhiyong , Winickoff Jonathan P. 
Published: January 2018

BACKGROUND AND OBJECTIVES:
Evidence-based tobacco control strategies delivered through pediatric settings could encourage parental smoking cessation and reduce children’s exposure to second hand smoke (SHS) in the United States. The extent to which these tobacco control strategies could be routinely implemented in the pediatric setting of a developing country is not known. We tested the feasibility and efficacy of implementing an evidence-based intervention, the Clinical Effort Against Secondhand Smoke Exposure (CEASE), in a Chinese hospital to address the second hand smoke exposure of children in the home and car and to address parental smoking.

METHODS:
We conducted a quasi-experimental trial of CEASE implementation in the pediatric inpatient departments of 2 Chinese hospitals, 1 assigned as the intervention hospital and another assigned as the control hospital. Data were collected through pre- and postsurveys of parents and clinicians, implementation process surveys, and chart review.

RESULTS:
In the intervention hospital, pediatricians’ rates of delivering different types of tobacco control assistance to smoking parents were all significantly (P &lt; .0001) higher during the post-CEASE implementation period than in the pre-CEASE implementation period. During the post-CEASE implementation period, pediatricians’ rates of delivery for all aspects of tobacco control assistance were significantly higher (all P &lt; .0001) in the intervention hospital than in the control hospital, whereas there was no difference during the pre-CEASE period.

CONCLUSIONS:
The findings of this study suggest that it is feasible to implement a system-level intervention of CEASE in the pediatric inpatient department of a major hospital in southern China. A large-scale trial incorporating measures to increase quit rates and including a long-term follow-up is needed to examine the effectiveness of CEASE implementation in China.
Airborne Nicotine, Secondhand Smoke, and Precursors to Adolescent Smoking
Authors: McGrath Jennifer J. , Racicot Simon , Okoli Chizimuzo T.C. , Hammond S. Katharine , O’Loughlin Jennifer 
Published: January 2018

BACKGROUND AND OBJECTIVES:
Secondhand smoke (SHS) directly increases exposure to airborne nicotine, tobacco’s main psychoactive substance. When exposed to SHS, nonsmokers inhale 60% to 80% of airborne nicotine, absorb concentrations similar to those absorbed by smokers, and display high levels of nicotine biomarkers. Social modeling, or observing other smokers, is a well-established predictor of smoking during adolescence. Observing smokers also leads to increased pharmacological exposure to airborne nicotine via SHS. The objective of this study is to investigate whether greater exposure to airborne nicotine via SHS increases the risk for smoking initiation precursors among never-smoking adolescents.

METHODS:
Secondary students (N = 406; never-smokers: n = 338, 53% girls, mean age = 12.9, SD = 0.4) participated in the AdoQuest II longitudinal cohort. They answered questionnaires about social exposure to smoking (parents, siblings, peers) and known smoking precursors (eg, expected benefits and/or costs, SHS aversion, smoking susceptibility, and nicotine dependence symptoms). Saliva and hair samples were collected to derive biomarkers of cotinine and nicotine. Adolescents wore a passive monitor for 1 week to measure airborne nicotine.

RESULTS:
Higher airborne nicotine was significantly associated with greater expected benefits (R2 = 0.024) and lower expected costs (R2 = 0.014). Higher social exposure was significantly associated with more temptation to try smoking (R2 = 0.025), lower aversion to SHS (R2 = 0.038), and greater smoking susceptibility (R2 = 0.071). Greater social exposure was significantly associated with more nicotine dependence symptoms; this relation worsened with higher nicotine exposure (cotinine R2 = 0.096; airborne nicotine R2 = 0.088).

CONCLUSIONS:
Airborne nicotine exposure via SHS is a plausible risk factor for smoking initiation during adolescence. Public health implications include limiting airborne nicotine through smoking bans in homes and cars, in addition to stringent restrictions for e-cigarettes.
An Office-Initiated Multilevel Intervention for Tobacco Smoke Exposure: A Randomized Trial
Authors: Collins Bradley N. , Lepore Stephen J. , Winickoff Jonathan P. , Nair Uma S. , Moughan Beth , Bryant-Stephens Tyra , Davey Adam , Taylor Daniel , Fleece David , Godfrey Melissa 
Published: January 2018

BACKGROUND:Provider adherence to best practice guidelines (ask, advise, refer [AAR]) for addressing child tobacco smoke exposure (TSE) motivates parents to reduce TSE. However, high-risk, vulnerable populations of smokers may require more intensive treatment. We hypothesized that a pragmatic, multilevel treatment model including AAR coupled with individualized, telephone-based behavioral counseling promoting child TSE reduction would demonstrate greater child TSE reduction than would standard AAR.METHODS:In this 2-arm randomized controlled trial, we trained pediatric providers in systems serving low-income communities to improve AAR adherence by using decision aid prompts embedded in routine electronic health record assessments. Providers faxed referrals to the study and received ongoing AAR adherence feedback. Referred participants were eligible if they were daily smokers, &gt;17 years old, and spoke English. Participants were randomly assigned to telephone-based behavioral counseling (AAR and counseling) or nutrition education (AAR and attention control). Participants completed prerandomization and 3-month follow-up assessments.RESULTS:Of providers, &gt;80% (n = 334) adhered to AAR procedures and faxed 2949 referrals. Participants (n = 327) were 83% women, 83% African American, and 79% low income (below poverty level). Intention-to-treat logistic regression showed robust, positive treatment effects: more parents in AAR and counseling than in AAR and attention control eliminated all sources of TSE (45.8% vs 29.9%; odds ratio 1.99 [95% confidence interval 1.44–2.74]) and quit smoking (28.2% vs 8.2%; odds ratio 3.78 [95% confidence interval 1.51–9.52]).CONCLUSIONS:The results indicate that the integration of clinic- and individual-level smoking interventions produces improved TSE and cessation outcomes relative to standalone clinic AAR intervention. Moreover, this study was among the first in which researchers demonstrated success in embedding AAR decision aids into electronic health records and seamlessly facilitated TSE intervention into routine clinic practice.
Neighborhood Factors and Urinary Metabolites of Nicotine, Phthalates, and Dichlorobenzene
Authors: Galvez Maida P. , McGovern Kathleen , Teitelbaum Susan L. , Windham Gayle , Wolff Mary S. 
Published: January 2018

BACKGROUND AND OBJECTIVES:
Exposures to environmental chemicals are ubiquitous in the US. Little is known about how neighborhood factors contribute to exposures.

METHODS:
Growing Up Healthy is a prospective cohort study of environmental exposures and growth and development among Hispanic and African American children (n = 506) in New York City. We sought to determine associations between neighborhood-level factors (eg, housing type, school, time spent indoors versus outdoors) and urinary biomarkers of chemical exposures suspected to be associated with these characteristics (cotinine, 2,5-dichlorophenol, and phthalate metabolites) adjusted by age, sex, race, and caregiver education and language.

RESULTS:
Urinary cotinine concentrations revealed a prevalent exposure to secondhand smoke; children living in public housing had higher concentrations than those in private housing. In homes with 1 smoker versus none, we found significant differences in urinary cotinine concentrations by housing, although not in homes with 2 or more smokers. Children in charter or public schools had higher urinary cotinine concentrations than those in private schools. School type was associated with exposures to both low- and high-molecular-weight phthalates, and concentrations of both exposure biomarkers were higher for children attending public versus private school. 2,5-Dichlorophenol concentrations declined from 2004 to 2007 (P = .038) and were higher among charter school children.

CONCLUSIONS:
Housing and school type are associated with chemical exposures in this minority, inner city population. Understanding the role of neighborhood on environmental exposures can lead to targeted community-level interventions, with the goal of reducing environmental chemical exposures disproportionately seen in urban minority communities.
Parental Smoking Cessation: Impacting Children’s Tobacco Smoke Exposure in the Home
Authors: Caldwell Alice Little , Tingen Martha S. , Nguyen Joshua T. , Andrews Jeannette O. , Heath Janie , Waller Jennifer L. , Treiber Frank A. 
Published: January 2018

OBJECTIVES:
There is no safe or risk-free level of tobacco use or tobacco smoke exposure. In this randomized controlled trial, we tested a tobacco control intervention in families and specifically evaluated a tailored cessation intervention for the parents and/or caregivers (Ps/Cs) who were smokers while their children were simultaneously enrolled in tobacco prevention.

METHODS:
Ps/Cs and children were recruited from 14 elementary schools across rural and urban settings. Approximately one-fourth (24.3%; n = 110) of the total Ps/Cs enrolled in the randomized controlled trial (n = 453) were smokers, predominantly women (80.9%), with a mean age of 37.7 years. (SD 12.2); 62.7% were African American, 44% had less than a high school education, and 58% earned &lt;$20 000 annually. P/C smokers were offered a tailored cessation intervention in years 1 and 2. Self-report smoking status and saliva cotinine were obtained at baseline, the end of treatment (EOT) and/or year 2, and in the year 4 follow-up.

RESULTS:
Ps/Cs in the intervention group showed a larger increase in self-reported smoking abstinence over time (EOT: 6.5% [SE = 5.7%]; year 4: 40.6% [SE = 5.7%]) than the control group (EOT: 0.0% [SE = 6.5%]; year 4: 13.2% [SE = 6.4%]; F = 4.82; P = .0306). For cotinine, the intervention group showed a decrease from baseline (239.9 [SE = 1.3]) to EOT 99.3 [SE = 1.4]) and then maintenance through year 4 (109.6 [SE = 1.4]), whereas the control group showed increases from baseline (221.1 [SE = 1.4]) to EOT (239.0 [SE = 1.4]) to year 4 (325.8 [SE = 14]; F = 5.72; P = .0039).

CONCLUSIONS:
This study provides evidence that tailored cessation offered to Ps/Cs in their children’s schools during their children’s enrollment in tobacco prevention may contribute to more robust success in P/C cessation and a reduction of tobacco smoke exposure in children.