Prevalence and correlates of initiation of smoking behavior among preteen black and white children.

This study estimated smoking prevalence and identified factors associated with initiation among preteens in Nashville, TN. An anonymous, self-administrated questionnaire was given to 238 fifth- and sixth-graders in a middle-class neighborhood school. The mean age at initiation was 8.5 years (range 6-11 years). Overall, 10.5% of students had ever smoked; 16.1% of blacks and 9.3% of whites. Eighty-six percent continued to smoke. Black sixth-graders smoked (26.9%) four times the rate of black fifth-graders and 2.5 times that of white sixth-graders. Relatives initiated 78% of blacks while friends initiated 68% of whites. One-quarter of smokers got their cigarettes at home. Regular attendees of religious services had a lower smoking rate (6.9% versus 16.4%; p=0.01). Smoking rates decreased with increased knowledge of risks (p=0.00001). Among smokers, none believed that smoking is a risk factor for heart disease, 96% did not believe that smoking has any short-term health effects or is a risk factor for stroke. Few ever-smokers had a complete understanding of the health risks. Targeted messages and curriculum should be developed to teach preteens about the short- and long-term dangers of smoking. Clinicians can play a major role in educating their clients about the risks of smoking.

Impact of a Drug Abuse Resistance Education (D.A.R.E) program in preventing the initiation of cigarette smoking in fifth- and sixth-grade students.

An alarmingly high number of children become addicted to tobacco use. To teach children the skills to resist the influences surrounding the initiation of tobacco and other drug use, a Drug Abuse Resistance Education (D.A.R.E.) program is being implemented in three fourths of the schools in the United States. The purpose of this study is to examine the impact of this program in preventing smoking. A survey was conducted among 236 fifth and sixth graders in Nashville, Tennessee. Of the students included in the survey, 88% graduated from D.A.R.E. Approximately 11.6% of respondents had ever smoked cigarettes; 86% of them continued to smoke. The D.A.R.E. group had a significantly lower rate of smoking compared with their non-D.A.R.E. counterparts (8.7% vs. 28.0%; p = 0.0001). Logistic regression analysis shows that the D.A.R.E. group was five times (odds 4.9; p = 0.003; 95% CI: 1.7, 14.0) less likely to initiate smoking compared with the non-D.A.R.E. group. The D.A.R.E. group had a significantly (p = 0.002) higher knowledge score on the risk of smoking. The knowledge score has strong opposite correlation to smoking behavior (p = 0.00001). Students with top-quartile knowledge scores had a substantially lower rates of smoking (1.4% vs. 14.4%; p = 0.001). This finding is consistent for both African-American (0% vs. 19.6%; p = 0.001) and white children (1.9% vs. 13%; p = 0.001). The D.A.R.E. program may have an impact in preventing the initiation of smoking behavior.

Management of complex multi-space odontogenic infections.

The successful management of multi-space orofacial odontogenic infections involves identification of the source of the infection, the anatomical spaces encountered, the predominant microorganisms that are found during the various stages of odontogenic fascial space infection, the impact of the infectious process on defense systems, the ability to use and interpret laboratory data and imaging studies, and a thorough understanding of contemporary antibiotic and supportive care. The therapeutic goals, when managing multi-space odontogenic infections, are to restore form and/or function while limiting patient disability and preventing recurrence. Odontogenic infections are commonly the result of pericoronitis, carious teeth with pulpal exposure, periodontitis, or complications of dental procedures. The second and third molars are frequently the etiology of these multi-space odontogenic infections. Of the two teeth, the third molar is the more frequent source of infection. Diagnostic imaging modalities are selected based on the patient's history, clinical presentation, physical findings and laboratory results. Periapical and panoramic x-rays are reliable initial screening instruments used in determining etiology. Magnetic resonance imaging and computed tomography are ideal imaging studies that permit assessment of the soft tissue involvement to include determining fluid collections, distinguishing abscess from cellulitis, and offering insight as to airway patency. Antibiotics are administered to assist the host immune system's effort to control and eliminate invading microorganisms. Early infections, first three (3) days of symptoms, are primarily caused by aerobic streptococci which are sensitive to penicillin. Amoxicillin is classified as an extended spectrum penicillin. The addition of clavulanic acid to amoxicillin (Augmentin) increases the spectrum to staphylococcus and other anaerobes by conferring beta-lactamase resistance. In late infections, more than three (3) days of symptoms, the predominant microorganisms are anaerobes, predominantly Peptostreptococcus, Fusobacterium, or Bacteroides, that are resistant to penicillin. Clindamycin is an attractive alternative drug for first line therapy in the treatment of these infections. The addition of metronidazole to penicillin is also an excellent treatment choice. Alternatively, Unasyn (Ampicillin/Sublactam), should be considered. The mainstay of management of these infections remains appropriate culture for bacterial identification, timely and aggressive incision and drainage, and removal of the etiology. It is usually preferable to drain multi-space infections involving the submandibular, submental, masseteric, pterygomandibular, temporal, and/or lateral pharyngeal masticator spaces, as early as possible from an extraoral approach. Trismus and airway management are important considerations and may preclude the selection of other surgical approaches. The patients with multi-space infections should be hospitalized and patient care provided by experienced clinicians capable of management of airway problems, in administration of parenteral antibiotics and fluids, utilization of interpretation of laboratory and diagnostic imaging studies, and control of possible surgical complications.