Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.

Miranda Hester

The sale of menthol cigarettes have been banned throughout Canada since 2017 and in England since May 2020. The US Food and Drug Administration may now make a similar move to try and reduce cigarette use among teenagers in the United States. A 

 examines the outcome of the bans of menthol cigarettes and offers some information on adolescent smokers.

The investigators used data from online repeat cross-sectional International Tobacco Control Youth Tobacco and Vaping Surveys that were conducted in 2018, 2019, February 2020, and August 2020. The participants included people aged 16 to 19 years who were past 30-day smokers. The 3 countries represented a country where a menthol ban existed (Canada), was implemented during the study period (England), and did not exist (United States).

There were 7067 participants in the sample, 4129 were female and 5019 were White. The weighted percentage of smokers who report smoking either a menthol or capsule cigarette brand was stable in the first 3 survey waves in England before the ban (2018 to February 2020, 9.4% vs 12.1%; adjusted odds ratio [AOR], 1.03; 95% CI, 0.99-1.06; P = .15), but a decrease of 3% was found following the ban (February 2020 vs August 2020, AOR, 1.07; 95% CI, 1.04-1.10; P < .001). The decrease was overall similar across all of the demographic groups, but was found to be greater among adolescents who considered themselves addicted to cigarettes.(AOR, 0.37; 95% CI, 0.41-0.97; P = .04). In Canada and the United States, the rate of menthol or capsule smoking was the same across all of the waves 2018 to August 2020: US, 33.6%-36.9%; Canada, 3.1%-2.3%). In addition, it was more prevalent in the United States than in England (AOR, 5.58; 95% CI, 4.63-6.72; P < .001). It was also more prevalent among English female smokers than male (10.9% vs 7.2%; AOR, 1.04; 95% CI, 1.01-1.06; P = .002); US smokers who were Black than those who were White (60.6% vs 31.9%; AOR, 1.33; 95% CI, 1.23-1.44; P < .001).

The investigators concluded that the ratio of adolescents smothers who smoked menthol cigarettes saw a significant decrease after the ban of their sale was enacted and this dip was consisted across a variety of demographic groups. This could be indicative of how the use of menthol products would change after a similar ban in the United States.

1. East K, Reid J, Burkhalter R, et al. Evaluating the outcomes of the menthol cigarette ban in England by comparing menthol cigarette smoking among youth in England, Canada, and the US, 2018-2020. 

. 2022;5(5):e2210029. doi:10.1001/jamanetworkopen.2022.10029

Articles

The US Food and Drug Administration has considered the banning of menthol products in an attempt to reduce tobacco use among adolescents. An investigation offers insight into how such bans impact the use of such products.

Effect of menthol bans on teen smoking rates

Anthony W. Gannon, MD, a pediatric endocrinilogist at Nemours Children's in Wilmington, Delaware, sat down with 

 to discuss a poster presented at the 2022 Pediatric Academic Societies meeting that examined the impact of a quality improvement program on improving 23-valent pneumococcal polysaccharide vaccine uptake in 3 groups that are at high risk. He shared the ins and outs of the research, how other health systems could consider a similar project, and what the next steps are.

Videos

A look at a recently presented study on improving 23-valent pneumococcal polysaccharide vaccine uptake in groups that are at high risk.

Improving vaccination rates in high-risk groups

Fractures in an infant often raise concerns of abuse, but if the child appears to be neurologically well, there’s an increased risk of clinically occult head injury. An 

 examines whether a wide variation in neuroimaging practices in suspected abuse cases exists and could represent an area rife for quality improvement.

Investigators included infants who had a femur fracture, a humerus fracture, or both that underwent an evaluation for abuse at 44 US children’s hospitals in the Pediatric Health Information System from January 2016 to March 2020, which included inpatient, observational, and emergency department encounters. The infants were aged younger than 12 months with a fracture that did not have overt signs or symptoms of a head injury. They excluded any infant who had billing codes that suggested overt neurologic symptoms. Computed tomography and magnetic resonance imaging scans were the neuroimaging forms examined.

The cohort included 2585 infants with fracture who were given abuse evaluations, of which 1726 were publicly insured and 1549 had neuroimaging performed. The median age was 6.1 months. Following multivariable analysis, the investigators found that payer type (odds ratio [OR] for public vs private insurance, 1.48; 95% CI, 1.18-1.85; P = .003), younger age (OR for ages <3 months vs ages 9 to <12 months, 13.2; 95% CI, 9.54-18.2; P < .001), fracture type (OR for femur and humerus fracture vs isolated femur fracture, 5.36; 95% CI, 2.11-13.6; P = .002), and the hospital (adjusted range in use of neuroimaging, 37.4% [95% CI 21.4%-53.5%] to 83.6% [95% CI 69.6%-97.5%]; P < .001) were tied to increased use of neuroimaging. However, race and ethnicity was not linked to increased use. Furthermore, infants insured publicly were more likely to be given neuroimaging(62.0%; 95% CI, 60.0%-64.1%) than those that were privately insured (55.1%; 95% CI, 51.8%-58.4%) (P = .001).

The investigators concluded that there was variation in hospitals’ neuroimaging practices. They believe that the findings suggest that bridging the noted gaps could be an important opportunity for quality, safety, and equity improvement.

1. Henry M, Schilling S, Shults J, et al. Practice Variation in Use of Neuroimaging Among Infants With Concern for Abuse Treated in Children’s Hospitals. 

. 2022;5(4):e225005. doi:10.1001/jamanetworkopen.2022.5005

When an infant presents with fractures that suggest possible abuse, but appears to be neurologically fine, clinicians should make sure to rule out occult head injury. A report looks at whether many children’s hospitals are routinely following this guidance.

Is there room for improvement in neuroimage use in suspected abuse cases in infants?

Research in adults has shown that pulse oximetry fails to detect hypoxemia in Black patients more often than White patients. Because this measure is often utilized to manage acute illness in hospitalized children, it’s imperative to know whether a gap exists in detection rates in pediatric patients. An 

Investigators ran a cross-sectional study at a care center in Ann Arbor, Michigan, and examined patients aged 17 years and younger who were admitted between January 2015 and December 2020 who had been identified as Black or White.They collected arterial blood gas data, respiratory support, vasoactive support, diagnosis information, patient race, age, and pulse oximetry. The pulse oximetry readings were compared to arterial oxygen saturation readings that were measured by arterial blood gas, when the measurement was taken within 10 minutes of the same respiratory support.

They looked at 9023 pairs of pulse oximetry and arterial oxygen saturation readings from 1061 patients, of which 878 were White and 183 were Black. The median time between the readings was 4 minutes. Overall average pulse oximeter bias was 3.5% (5.0%) among White patients and 4.3% (5.0%) among Black patients (

 < .001). Occult hypoxemia frequency was 5.8% (95% CI, 4.6%-7.3%) among White patients and 9.6% (95% CI, 6.3%-14.5%) among Black patients. Following adjustment for a number of variables, the odds ratio for occult hypoxemia among pulse oximetry measurements was 2.16 (95% CI, 1.36-3.44) compared with White patients. Occult hypoxemia occurred in 134 of 860 White patients (15.6%; 95% CI, 13.3%-18.2%) and 38 of 180 Black patients (21.1%; 95% CI, 15.7%-27.7%).

The investigators concluded that Black children experienced occult hypoxemia more frequently than White children. In the pairs with pulse oximetry and arterial oxygen saturation readings, they found that the odds of a pulse oximetry failing to detect hypoxemia were more than twice as great when the pair came from a Black participant.

1. Andrist E, Nuppnau M, Barbaro R, Valley T, Sjoding M. Association of Race With Pulse Oximetry Accuracy in Hospitalized Children. 

 2022;5(3):e224584. doi:10.1001/jamanetworkopen.2022.4584

Previous investigation has shown that common measurements and tools may not be as accurate in non-White patients as they are in White patients. A new investigation dives into whether pulse oximetry falls into this category.

Pulse oximetry may fail to detect hypoxemia in Black kids more often than in White kids

Ensuring teenagers have the necessary and correct information to promote good sexual health is important. However, discomfort from the teenager, parent, and even clinician may lead to delays in having "the talk" or a full agenda for well visits may cause it to be pushed to the next time the teenager is in the office. Helen C. Wang, MD, a pediatician and assistant professor of pediatrics at UC San Diego School of Medicine in California, shares some highlights of the interactive session that she led with her colleagues Kanani Titchen, MD, FAAP, an adolescent and young adult medicine specialist at Rady Children's Hospital-San Diego and an assistant clinical professor of pediatrics at UC San Diego School of Medicine, and Samantha V. Hill, MD, MPH, adolescent medicine physician at University of Alabama at Birmingham.

Helen C. Wang, MD, shares key takeaways from the session she co-presented at PAS 2022.

Getting comfortable having "the talk" with teen patients

 editorial advisory board is key to ensuring that the magazine is providing the practical clinical guidance the pediatric provider needs to offer the best care possible. The series "Meet the Board" offers a chance to get to know the people who help shape the magazine.

For our next episode in the series, we sat down with one of our newest members: Jessica L. Peck, DNP, APRN, CPNP-PC, CNE, CNL, FAANP, FAAN, who is a pediatric nurse practitioner as well as a clinical professor at Baylor University Louise Herrington School of Nursing in Dallas, Texas.

Podcasts

In the latest episode of our podcast series, Jessica L. Peck, DNP, APRN, CPNP-PC, CNE, CNL, FAANP, FAAN shares why she got into medicine, the myths of pediatric, and what the future may hold for the specialty.