Health literacy and medication adherence in adolescents.

OBJECTIVE: To assess the relationship between health literacy levels and medication adherence in adolescents. STUDY DESIGN: A convenience sample of adolescents ages 12-21 years was recruited April-September 2011 at an urban adolescent health center. Health literacy and medication adherence was measured via the Rapid Estimate of Adult Literacy in Medicine-TEEN (REALM-TEEN) and Adherence to Refills and Medications Scale. The interrelated effects of age, sex, chronic illness, learning disability, health rating, and health literacy on adherence to medication were explored via the use of regression trees. RESULTS: Of 138 adolescents surveyed, 112 (81%) were included in the analysis because they reported ever taking a medication and completed all survey questions. Median participant age was 16.1 years, 94% were African American, and 64% were female. Median REALM-TEEN score was 57 (6th-7th grade; range 0-66). Median ARMS score was 21 (poor; range 0-56). A positive correlation was found between worse adherence (greater ARMS scores) and self-report of a learning disability (P = .041), and between ARMS scores and having a chronic illness (P = .003). The ARMS and REALM-TEEN scores were not correlated (P = .069). Regression tree analysis indicated that adolescents with both a chronic illness and a learning disability had worse ARMS scores (median score 24), compared with adolescents having only a chronic illness (median score 22), independent of health literacy scores. CONCLUSION: Almost one-quarter of adolescents reported having a learning disability and had worse medication adherence independent of health literacy levels. This finding suggests other cognitive factors, beyond reading, may play a role in medication adherence.

Health disparities and COVID-19: A retrospective study examining individual and community factors causing disproportionate COVID-19 outcomes in Cook County, Illinois.

Early data from the COVID-19 pandemic suggests that the disease has had a disproportionate impact on communities of color with higher infection and mortality rates within those communities. This study used demographic data from the 2018 US census estimates, mortality data from the Cook County Medical Examiner's office, and testing results from the Illinois Department of Public Health to perform bivariate and multivariate regression analyses to explore the role race plays in COVID-19 outcomes at the individual and community levels. We used the ZCTA Social Deprivation Index (SDI), a measure of ZCTA area level deprivation based on seven demographic characteristics to quantify the socio-economic variation in health outcomes and levels of disadvantage across ZCTAs. Principal findings showed that: 1) while Black individuals make up 22% of Cook County's population, they account for 28% of the county's COVID-19 related deaths; 2) the average age of death from COVID-19 is seven years younger for Non-White compared with White decedents; 3) residents of Minority ZCTA areas were 1.02 times as likely to test positive for COVID-19, (Incidence Rate Ratio (IRR) 1.02, [95% CI 0.95, 1.10]); 1.77 times as likely to die (IRR 1.77, [95% CI 1.17, 2.66]); and were 1.15 times as likely to be tested (IRR 1.15, [95% CI 0.99, 1.33]). There are notable differences in COVID-19 related outcomes between racial and ethnic groups at individual and community levels. This study illustrates the health disparities and underlying systemic inequalities experienced by communities of color.

The utility of video technology and enhanced infection control in reducing COVID-19 disease burden in a custodial setting.

We describe the use of video technology to enhance case interviews, identify COVID-19 contacts, and determine exposures risk within a large juvenile temporary detention center. We created a COVID-19 outbreak management protocol which included the formation of an outbreak management team and enhanced infection control practices using video surveillance. Currently, our institution's positivity rate remains low for both staff and residents largely because of the outbreak management team. Video technology combined with enhanced infection control practices can be a useful technique to reduce COVID-19 infections in custodial settings.

Years of potential life lost secondary to COVID-19: Cook County, Illinois.

The COVID-19 pandemic caused by the SARS-CoV-2 virus has led to substantial morbidity and mortality world-wide. Evidence suggests that ethnic and racial minorities have been disproportionately affected in the United States, particularly within major population centers. In this study, we evaluated the effect of the COVID-19 pandemic in Cook County, Illinois, and found that the rate of years of potential life lost (YPLL) was 4.8 times greater in the most affected racial group (YPLL: 2289/100,000 population in Hispanic people) than in the least affected group (YPLL: 480/100,000 population in Asian people).

Marijuana and the Pediatric Population.

Cannabinoids, the psychoactive compounds in marijuana, are one of the most commonly used substances in the United States. In this review, we summarize the impact of marijuana on child and adolescent health and discuss the implications of marijuana use for pediatric practice. We review the changing epidemiology of cannabis use and provide an update on medical use, routes of administration, synthetic marijuana and other novel products, the effect of cannabis on the developing brain, other health and social consequences of use, and issues related to marijuana legalization.

Control of measles in a juvenile custodial setting in the wake of the recent US outbreak.

The recent US measles outbreak is the largest since 1992. It is just a matter of time before measles is introduced into a juvenile custodial setting. Are we prepared? Should we be prepared? This short article addresses steps institutional settings should take to prevent the spread of measles in a contained setting.

Declining health risk exposure among Chicago public high school students: Trends from the Youth Risk Behavior Survey 1997-2017.

There have been improvements nationally in teenagers' self-reported health risk since the 1990s. This study provides an overview of trends in substance use, sexual health, violence and victimization, and suicide risk among Chicago Public High School (CPS) students over a 20-year period. We compared responses to 29 identically worded items from the 1997, 2007, and 2017 Chicago Youth Risk Behavior Survey (YRBS) in the four domains. We show changes in responses across individual items, mean changes across the four domains, and change in the proportion of students with highest risk exposure (≥10 affirmative responses). Analyses control for CPS students' grade, sex, and race/ethnicity. Reductions in substance use, sexual health risk, and violence and victimization (30, 40% and 40% in the mean number of affirmative responses, respectively) were observed. Suicide risk showed an initial improvement from 1997 to 2007, only to worsen by 2017 and show little difference from 1997. There was an approximate 70% decrease in the likelihood of being in the high multiple risk category (≥10 affirmative responses) in 2017 compared to 1997 (OR 0.33; CI 0.22-0.49). In alignment with national trends, our study documents significant improvement in Chicago public high school students' long-term health risk exposure over the 20-year study period, with the notable exception of suicide risk. This study emphasizes the need to invest in strategies both inside and outside of the classroom to mitigate the effect of adversity and promote protective factors, which are at the root of academic success and overall wellbeing.

COVID-19 and the Nigerian correctional service: need for structured data.

Although prisoners are considered a vulnerable population, no data repository currently exists to monitor the COVID-19 incidence in Nigerian prisons. To better understand the impact of COVID-19 within the Nigerian prison system, prisons should develop detailed COVID-19 response protocols, implement enhanced point-of-care testing, and initiate contact tracing with meticulous data collection.

Contemporary Dietary Practices: FODMAPs and Beyond.

There is no diet that is recommended for all individuals. Some special diets (eg, gluten-free for celiac disease) are necessary for health and quality of life. Other diets may be recommended for a short period of time to aid in symptom relief but may not be recommended for the long- term (eg, LFD). Popular diets continue to come and go with varying levels of success. When considering adolescents, continued growth and development are most important, and restrictive diets can lead to nutrient inadequacies and poor growth. Before making any recommendation, it is important to consider the goal of the diet and the cost versus benefits associated with following the diet. Adherence is always a challenge, regardless of the type of diet implemented. If a special diet is not warranted for the health, safety, and desired quality of life of the individual, it should not be implemented.