Anorexia nervosa and the COVID-19 pandemic among young people: a scoping review.

BACKGROUND: The extent to which the recent global COVID-19 Pandemic has impacted young people with restrictive eating disorders [i.e., anorexia nervosa (AN) and atypical anorexia nervosa (AAN)] is unclear. We conducted a scoping review of the literature to identify how the pandemic has impacted this population and to identify gaps in the current literature to inform future research efforts. MAIN BODY: We searched PubMed, EMBASE, the Web of Science, The Cochrane Library, PsycInfo, ProQuest Dissertations and Theses Global, LitCovid, Google Scholar, and relevant agency websites from 2019 to 2022. We included studies that focused on young people with AN/AAN globally. Of the 916 unduplicated articles screened, 17 articles met the inclusion criteria, reporting on 17 unique studies including 4,379 individuals. Three key findings were identified. First, an increase in hospitalizations related to eating disorders was found during COVID-19 among young people with AN and AAN. Multiple studies cited increased medical instability, even though the overall duration of disease was shorter compared to pre-pandemic levels. Second, changes in eating disorder-related symptomology during the pandemic were reported in this population, as well as poorer overall behavioral and mental health. Suggested reasons behind changes included boredom or minimal distraction from pathological thoughts, increased social isolation, increased social media and online use (e.g., reading blogs or watching YouTube), gym and school closures, changes in routines due to lockdowns and quarantines, and worries over gaining the "Quarantine 15". Third, there was an increase in the use of telemedicine as a treatment modality for the treatment of AN. Challenges were reported by both clinicians and patients regardless of past experience using telemedicine. When compared to no treatment, telemedicine was recognized as the best option during COVID-19 lockdowns; however some individuals expressed the preference for in-person treatment and planned to return to it once it became available. CONCLUSION: The pandemic significantly impacted young people with restrictive eating disorders as seen by increased hospitalizations and requests for outpatient care. A primary driver of the changes in eating disorder symptomatology may be lockdowns and quarantines. Further research investigating how the series of lockdowns and re-openings impacted individuals with AN/AAN is warranted.

Data collected from a scoping review of published peer-reviewed literature during the first two years of the COVID-19 pandemic have highlighted the impact that the global pandemic has had on young people with anorexia nervosa and atypical anorexia nervosa. We found an increase in medical hospitalizations related to eating disorders, changes in eating disorder-related symptomology as well as overall poorer behavioral and mental health among this population as a result of COVID-19. We also found an increase in the use of telemedicine as treatment modality, particularly during lockdowns, which sheds light on more diverse modalities for treatment. Further research investigating how the series of lockdowns and re-openings impacted individuals with AN/AAN is warranted.

Substance Misuse and Condomless Sex Among Transgender Youth.

Purpose: The purpose of this research is to explore the relationship between substance use and sexual risk behaviors among transgender youth. Methods: Data from the transgender subsample of the Survey of Today's Adolescent Relationships and Transitions (n=1567) were analyzed to assess associations between substance misuse (binge drinking, prescription drug misuse, illicit drugs) and sexual risk behaviors (condom use during sex). Multivariate logistic regression models calculated adjusted odds ratios (AORs) for substance use by sexual risk behavior controlling for race/ethnicity, gender identity (transgender male, transgender female, genderqueer/gender nonconforming), age, sexual identity, and region. Results: Among participants, lifetime marijuana use (AOR=0.45), cocaine use (AOR=0.46), prescription drug misuse (AOR=0.52), and injecting substances with a needle (AOR=0.45) were all associated with lower odds of reporting condom use during the last act of receptive anal sex. Similarly, marijuana use in the last 30 days (AOR=0.46), lifetime marijuana use (AOR=0.25), heroin use (AOR=0.29), methamphetamine use (AOR=0.32), misuse of prescription drugs (AOR=0.40), and injecting substances with a needle (AOR=0.17) were all associated with lower odds of reporting condom use during the last act of insertive anal sex. No associations between substance use and condom use during last act of receptive frontal (vaginal) sex were found. Conclusion: We found that transgender youth who reported any lifetime substance use were more likely to report condomless sex during receptive and insertive anal sex than those who did not report substance use. Significant differences exist among demographic groups, type of substance use, and sexual risk behaviors for respondents based on gender identity.

Health Care Utilization and Cost Outcomes of a Comprehensive Dementia Care Program for Medicare Beneficiaries.

Importance: An estimated 4 to 5 million Americans have Alzheimer disease or another dementia. Objective: To determine the health care utilization and cost outcomes of a comprehensive dementia care program for Medicare fee-for-service beneficiaries. Design, Setting, and Participants: In this case-control study, we used a quasiexperimental design to compare health care utilization and costs for 1083 Medicare fee-for-service beneficiaries enrolled in the University of California Los Angeles Health System Alzheimer and Dementia Care program between July 1, 2012, and December 31, 2015, with those of 2166 similar patients with dementia not participating in the program. Patients in the comparison cohort were selected using the zip code of residence as a sampling frame and matched with propensity scores, which included demographic characteristics, comorbidities, and prior-year health care utilization. We used Medicare claims data to compare utilization and cost outcomes for the 2 groups. Interventions: Patients in the dementia care program were comanaged by nurse practitioners and physicians, and the program consisted of structured needs assessments of patients and their caregivers, creation and implementation of individualized dementia care plans with input from primary care physicians, monitoring and revising care plans, referral to community organizations for dementia-related services and support, and access to a clinician for assistance and advice 24 hours per day, 7 days per week. Main Outcomes and Measures: Admissions to long-term care facilities; average difference-in-differences per quarter over the 3-year intervention period for all-cause hospitalization, emergency department visits, 30-day hospital readmissions, and total Medicare Parts A and B costs of care. Program costs were included in the cost estimates. Results: Program participants (n = 382 men, n = 701 women; mean [SD] age, 82.10 [7.90] years; age range 54-101 years) were less likely to be admitted to a long-term care facility (hazard ratio, 0.60; 95% CI, 0.59-0.61) than those not participating in the dementia care program (n = 759 men, n = 1407 women; mean [SD] age, 82.42 [8.50] years; age range, 34-103 years). There were no differences between groups in terms of hospitalizations, emergency department visits, or 30-day readmissions. The total cost of care to Medicare, excluding program costs, was $601 less per patient per quarter (95% CI, -$1198 to -$5). After accounting for the estimated program costs of $317 per patient per quarter, the program was cost neutral for Medicare, with an estimated net cost of -$284 (95% CI, -$881 to $312) per program participant per quarter. Conclusions and Relevance: Comprehensive dementia care may reduce the number of admissions to long-term care facilities, and depending on program costs, may be cost neutral or cost saving. Wider implementation of such programs may help people with dementia stay in their communities.

The Association Between Body Image and Behavioral Misperception (BIBM) and Alcohol Use Among High School Girls: Results From the 2013 Youth Risk Behavioral Survey.

OBJECTIVE: The need to be thin is pervasive in adolescent culture and is associated with increased risk outcomes among adolescent girls. Body image and behavioral misperception (BIBM) exists when there is a disconnect between body weight perception and actions taken related to perceived weight status. To understand this further, we examined the relationship between BIBM and alcohol use among high school girls in the United States. METHOD: Using 2013 Youth Risk Behavior Survey data, we ran survey-weighted multivariable logistic regression analyses to examine BIBM and (a) lifetime alcohol use, (b) current alcohol use, and (c) current heavy episodic drinking (≥5 drinks in a few hours) among female high school students (N = 6,579). RESULTS: A total of 37.5% of high school females screened positive for BIBM, and 67.7%, 32.9%, and 17.8% reported lifetime alcohol use, current alcohol use, and heavy episodic drinking, respectively. In the final model, controlling for demographics, reporting a BIBM was associated with a 1.29 (95% CI [1.10, 1.51], p = .002) greater odds of lifetime alcohol use compared with those who did not; however, reporting BIBM was not significantly associated with current alcohol use. BIBM was also associated with a 1.22 (95% CI [1.02, 1.47], p = .03) greater odds of heavy episodic drinking compared with those without BIBM. CONCLUSIONS: The phenomenon of BIBM was associated with lifetime and heavy episodic drinking, but not current alcohol use, indicating that timing of alcohol use and onset of BIBM may be related. Potential explanations include shared underlying risk factors and using alcohol excessively as a coping mechanism, weight-gain strategy, or weight-loss strategy.

Trying to Lose Weight and Alcohol Misuse Among High School Girls: Findings From the U.S. National 2011 Youth Risk Behavior Survey.

BACKGROUND: Trying to lose weight has been associated with alcohol use among college-aged females. Excessive drinking along with purging as a method for weight control has been documented in this population. However, little is known about the relationship between alcohol use and trying to lose weight among high school girls. OBJECTIVES: To examine the relationship between trying to lose weight and past 30-day (1) alcohol use and (2) binge drinking (separately). METHODS: Using data from the National 2011 YRBS, we examined these relationships among 5,106 girls aged 14-18+ who reported ever using alcohol. Survey-weighted iterative logistic regression models were conducted. RESULTS: 44.0% of girls reported current alcohol use with 27.8% reporting binge drinking. While a significant relationship was not found between trying to lose weight and current alcohol use in the final multivariable model, a significant relationship was found between trying to lose weight and binge drinking (AOR: 1.24, 95% CI: 1.02-1.52). Additional variables that were found to be associated with an increased odds of binge drinking included: being in 11th and 12th grades compared to being in 9th grade, screening positively for depression, and current cigarette use. Variables associated with a decreased odds included: talking to an adult/teacher about a problem, and identifying as Black/African American compared to White. CONCLUSIONS/IMPORTANCE: Understanding the relationship between trying to lose weight and binge drinking among high school students is important, as these behaviors may be a precursor to risk behaviors later in life and need to be more fully examined.