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Role of insurance for children with special health care needs: a synthesis of the evidence.
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      Digital Social Media, Youth, and Nonmedical Use of Prescription Drugs: The Need for Reform

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          Abstract

          The tragic death of 18-year-old Ryan Haight highlighted the ethical, public health, and youth patient safety concerns posed by illicit online nonmedical use of prescription drugs (NUPM) sourcing, leading to a federal law in an effort to address this concern. Yet despite the tragedy and resulting law, the NUPM epidemic in the United States has continued to escalate and represents a dangerous and growing trend among youth and adolescents. A critical point of access associated with youth NUPM is the Internet. Internet use among this vulnerable patient group is ubiquitous and includes new, emerging, and rapidly developing technologies—particularly social media networking (eg, Facebook and Twitter). These unregulated technologies may pose a potential risk for enabling youth NUPM behavior. In order to address limitations of current regulations and promote online safety, we advocate for legislative reform to specifically address NUPM promotion via social media and other new online platforms. Using more comprehensive and modernized federal legislation that anticipates future online developments is critical in substantively addressing youth NUPM behavior occurring through the Internet.

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          Youth risk behavior surveillance - United States, 2011.

          Paul W. Harris, Andrea Hawkins-Daarud, Lisa Whittle … (2012)
          Priority health-risk behaviors, which are behaviors that contribute to the leading causes of morbidity and mortality among youth and adults, often are established during childhood and adolescence, extend into adulthood, and are interrelated and preventable. September 2010-December 2011. The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of obesity and asthma. YRBSS includes a national school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and large urban school district school-based YRBSs conducted by state and local education and health agencies. This report summarizes results from the 2011 national survey, 43 state surveys, and 21 large urban school district surveys conducted among students in grades 9-12. Results from the 2011 national YRBS indicated that many high school students are engaged in priority health-risk behaviors associated with the leading causes of death among persons aged 10-24 years in the United States. During the 30 days before the survey, 32.8% of high school students nationwide had texted or e-mailed while driving, 38.7% had drunk alcohol, and 23.1% had used marijuana. During the 12 months before the survey, 32.8% of students had been in a physical fight, 20.1% had ever been bullied on school property, and 7.8% had attempted suicide. Many high school students nationwide are engaged in sexual risk behaviors associated with unintended pregnancies and STDs, including HIV infection. Nearly half (47.4%) of students had ever had sexual intercourse, 33.7% had had sexual intercourse during the 3 months before the survey (i.e., currently sexually active), and 15.3% had had sexual intercourse with four or more people during their life. Among currently sexually active students, 60.2% had used a condom during their last sexual intercourse. Results from the 2011 national YRBS also indicate many high school students are engaged in behaviors associated with the leading causes of death among adults aged ≥ 25 years in the United States. During the 30 days before the survey, 18.1% of high school students had smoked cigarettes and 7.7% had used smokeless tobacco. During the 7 days before the survey, 4.8% of high school students had not eaten fruit or drunk 100% fruit juices and 5.7% had not eaten vegetables. Nearly one-third (31.1%) had played video or computer games for 3 or more hours on an average school day. Since 1991, the prevalence of many priority health-risk behaviors among high school students nationwide has decreased. However, many high school students continue to engage in behaviors that place them at risk for the leading causes of morbidity and mortality. Variations were observed in many health-risk behaviors by sex, race/ethnicity, and grade. The prevalence of some health-risk behaviors varied substantially among states and large urban school districts. YRBS data are used to measure progress toward achieving 20 national health objectives for Healthy People 2020 and one of the 26 leading health indicators; to assess trends in priority health-risk behaviors among high school students; and to evaluate the impact of broad school and community interventions at the national, state, and local levels. More effective school health programs and other policy and programmatic interventions are needed to reduce risk and improve health outcomes among youth.
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            The global counterfeit drug trade: patient safety and public health risks.

            Bryan A. Liang, Tim K. Mackey (2011)
            Counterfeit drugs are a global problem with significant and well-documented consequences for global health and patient safety, including drug resistance and patient deaths. This multibillion-dollar industry does not respect geopolitical borders, and threatens public health in both rich and resource-poor nations alike. The epidemiology of counterfeits is also wide in breadth and scope, including thousands of counterfeit incidents per year, encompassing all types of therapeutic classes, and employing a complex global supply chain network enabling this illegal activity. In addition, information technologies available through the Internet and sales via online pharmacies have allowed the criminal element to thrive in an unregulated environment of anonymity, deception, and lack of adequate enforcement. Though recent global enforcement efforts have led to arrests of online counterfeit sellers, such actions have not stemmed supplies from illegal online sellers or kept up with their creativity in illegally selling their products. To address this issue, we propose a global policy framework utilizing public-private partnership models with centralized surveillance reporting that would enable cooperation and coordination to combat this global health crisis. Copyright © 2011 Wiley-Liss, Inc.
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              Tweaking and Tweeting: Exploring Twitter for Nonmedical Use of a Psychostimulant Drug (Adderall) Among College Students

              Carl Hanson, Scott H Burton, Christophe Giraud-Carrier … (2013)
              Background Adderall is the most commonly abused prescription stimulant among college students. Social media provides a real-time avenue for monitoring public health, specifically for this population. Objective This study explores discussion of Adderall on Twitter to identify variations in volume around college exam periods, differences across sets of colleges and universities, and commonly mentioned side effects and co-ingested substances. Methods Public-facing Twitter status messages containing the term “Adderall” were monitored from November 2011 to May 2012. Tweets were examined for mention of side effects and other commonly abused substances. Tweets from likely students containing GPS data were identified with clusters of nearby colleges and universities for regional comparison. Results 213,633 tweets from 132,099 unique user accounts mentioned “Adderall.” The number of Adderall tweets peaked during traditional college and university final exam periods. Rates of Adderall tweeters were highest among college and university clusters in the northeast and south regions of the United States. 27,473 (12.9%) mentioned an alternative motive (eg, study aid) in the same tweet. The most common substances mentioned with Adderall were alcohol (4.8%) and stimulants (4.7%), and the most common side effects were sleep deprivation (5.0%) and loss of appetite (2.6%). Conclusions Twitter posts confirm the use of Adderall as a study aid among college students. Adderall discussions through social media such as Twitter may contribute to normative behavior regarding its abuse.
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                Author and article information

                Contributors
                Tim K Mackey:
                School of MedicineDepartment of AnesthesiologyUniversity of California, San Diego9500 Gilman DriveLa Jolla, CA, 92093-0629United States1 951 491 41611 619 515 1599tmackey@ucsd.edu
                Journal
                Journal ID (nlm-ta): J Med Internet Res
                Journal ID (publisher-id): JMIR
                Title: Journal of Medical Internet Research
                Publisher: JMIR Publications Inc. (Toronto, Canada )
                ISSN (Print): 1439-4456
                ISSN (Electronic): 1438-8871
                Publication date Collection: July 2013
                Publication date (Electronic): 26 July 2013
                Volume: 15
                Issue: 7
                Electronic Location Identifier: e143
                Affiliations
                [1] 1Institute of Health Law Studies California Western School of Law San Diego, CAUnited States
                [2] 2School of Medicine Department of Anesthesiology University of California, San Diego La Jolla, CAUnited States
                [3] 3San Diego Center for Patient Safety - School of Medicine Department of Anesthesiology University of California, San Diego San Diego, CAUnited States
                [4] 4Division of Global Public Health Department of Medicine University of California, San Diego San Diego, CAUnited States
                Author notes
                Corresponding Author: Tim K Mackey tmackey@ 123456ucsd.edu
                Article
                Publisher ID: v15i7e143
                DOI: 10.2196/jmir.2464
                PMC ID: 3742396
                PubMed ID: 23892156
                SO-VID: 7b67043f-ffb3-4370-a15a-bb0a495e207f
                Copyright © ©Tim K Mackey, Bryan A Liang, Steffanie A Strathdee. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 26.07.2013.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

                History
                Date received : 30 November 2012
                Date revision requested : 28 April 2013
                Date revision received : 21 May 2013
                Date accepted : 09 June 2013
                Categories
                Subject: Viewpoint

                ScienceOpen disciplines: Medicine
                Keywords: non-medical use of prescription medications (nupm),ehealth,internet,social media,youth and adolescents,drug abuse,substance abuse
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: non-medical use of prescription medications (nupm), ehealth, internet, social media, youth and adolescents, drug abuse, substance abuse

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