Patterns of smokeless tobacco use by young adolescents.

The use of smokeless tobacco products by adolescents has reportedly increased. The purpose of this study was to examine the use of smokeless tobacco by young adolescents across geographic locations and to look at patterns of use and variables associated with continued use beyond experimentation. Participants were 2018 students in sixth through ninth grades. Forty-five percent were male and 76% were white. Use of smokeless tobacco products was reported by 12% of the total population, and 25% reported smoking. Smokeless tobacco use was associated with cigarette smoking, alcohol use, and parental substance abuse. Those reporting alcohol use were more than four times more likely to be users of smokeless tobacco than nondrinkers. We found increased age, being male, being white, smoking, drinking, perceived effects of smokeless tobacco use, and friends' smoking behavior to be significantly associated with continued use beyond experimentation. Smokeless tobacco use was reportedly greater in rural areas. Adolescents who reported initiating use between 6 and 8 years of age were using on a more frequent basis than those who had initiated use when older. This study demonstrated the need for targeting elementary schools for educational interventions aimed at reducing smokeless tobacco use.

An unusual presentation of liver laceration in a 13-yr-old football player.

Abdominal injury occurs infrequently from athletic trauma, yet when it does occur, it can be very serious. Although rupture of a major blood vessel can lead to rapid loss of blood, insidious blood loss can also result from apparently insignificant injury of the spleen, liver, or kidney and lead to delayed problems. Awareness of the potential for such injury is vital because outcome can be adversely affected by a low index of suspicion, and this can be compounded by the fact that the initial physical examination is not always a reliable indicator of the severity of injury. Classic reports of these injuries describe splenic injury from a left-sided blow and hepatic injury from right-sided trauma. We present a case report of liver laceration in a young football player not only to comment on its unusual mechanism and presentation, but also to illustrate the importance of rapid assessment and transport of the athlete with a serious abdominal injury to avoid the consequences of delayed diagnosis and treatment.

Rurality and gender. Effects on early adolescent alcohol use.

Previous studies of adolescent alcohol use have focused almost exclusively on urban and suburban youth, although alcohol is the most important drug of abuse among rural adolescents. Young adolescents, aged 11 to 14 years (N = 1601), from urban, suburban, and two different rural areas (delta and highland), were surveyed about health-compromising behaviors, such as alcohol use. Significant differences in the number of adolescents using alcohol and the patterns of alcohol use were noted across areas by gender. Youths from the delta area, especially girls, reported drinking less frequently and in less abusive patterns than did adolescents from other areas, while youths from the highland area reported rates and patterns of drinking similar to those of urban adolescents. The reasons for intrarural variation in adolescent drinking are unknown.