The abstract, “Overprescription of Opioids in White Children from Higher Socioeconomic Backgrounds: Disparities in Opioid Utilization for Pediatric Supracondylar Humerus Fractures,” looked at the rates in opioid prescriptions following childhood broken elbow diagnoses from 2012 to 2021.

Apurva Shah, MD, MBA, Attending Surgeon, Orthopaedic Surgery at the Children’s Hospital of Philadelphia, who authored the abstract, also pointed to results that showed a third of patients in the abstract received at least one opioid dose during their visit.

“As orthopaedic surgeons, we clearly need improved opioid use stewardship to improve healthcare outcomes for our patients,” Dr. Shah said.

Results found disparities in patient racial backgrounds, with Black children 27% less likely to receive an opioid prescription compared to other patients. By comparison, white patients were also shown to be 10% more likely to be given opioids.

Other factors that impacted patients’ likelihood of being given opioids included age and where they live, according to Dr. Shah.

“Non-opioid pain management has proven sufficient for pain management,” Dr. Shah said. “Knowing this, along with this abstract, pediatricians must consider the potential harm these drugs can have on populations with disproportionately easier access to healthcare.”

This research was funded by Children’s Hospital of Philadelphia, Division of Orthopaedics.

Scott Mahon is scheduled to present the research, which is below, at 8:51 – 8:55  a.m. on Sunday, Sept. 29 during the Section on Orthopaedics program at Orange County Convention Center, West Building, W311H. To request an interview with the authors, contact Ashley Moore at moorea1@chop.edu.

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/ 

ABSTRACT

Program Name: 2024 AAP National Conference-Abstracts

Submission Type: Section on Orthopaedics

Abstract Title: Overprescription of Opioids in White Children from Higher Socioeconomic Backgrounds: Disparities in Opioid Utilization for Pediatric Supracondylar Humerus Fractures

Apurva Shah

Philadelphia, PA, United States

“Although the birth hospitalization lasts only a few days, it sets a critical foundation for establishing breastfeeding, which can influence health outcomes like childhood asthma,” said study author Laura Placke Ward MD, IBCLC, FAAP, co-director for the Center for Breastfeeding Medicine at Cincinnati Children’s Hospital Medical Center.

“Our study underscores the importance of hospital practices in supporting exclusive breastfeeding, as these early experiences may impact long-term health,” she added.

The 9,649 subjects included children born between 2017-2019.

The investigators reported that 81% of the children received some breast milk during their birth hospitalization, and 31% of them were fed exclusively with breast milk during their birth hospitalization.

Five percent were eventually diagnosed with asthma during childhood.

After adjusting for sex, race, and insurance status, newborns fed only with breast milk achieved a 22% lower rate of asthma during childhood compared to those who did not receive any breast milk or did not receive breast milk only.

“This finding highlights the need for greater emphasis on supporting and promoting exclusive breastfeeding during the early days of life,” Ward said. “By focusing on these crucial first days, we may impact children’s health and potentially reduce the risk of chronic conditions like asthma.”

A new study from King’s College London published in Nature Medicine reveals a new relationship between lipids and diseases impacting  metabolism in children, which could serve as an early warning system for conditions like liver disease.

Using machines that test blood plasma in babies that already exist in hospitals, the researchers suggest this could help doctors spot early signs of disease in children quicker and help them access the right treatment.

The findings also contest the common idea that cholesterol is a leading cause of complications around obesity in children, identifying new lipid molecules which contribute to health risks like blood pressure but are not only correlated with a child’s weight.

Lipids have traditionally been thought to be fatty acids in the body, either good or bad types of cholesterol or triglycerides, fats found in the bloodstream that is the most common in the human body. Recent studies from the same group of scientists have suggested that the picture is more complex.

Using a technique associated with chemistry called mass spectrometry, current evidence puts the types of different lipid present in the body in the thousands, each with separate functions.

Taking a control sample of 1,300 children with obesity, the team assessed their lipids in blood. Afterwards 200 of them were put on the HOLBAEK-model for a year, a lifestyle intervention for people with obesity popular in Denmark.

Subsequent readings showed that amongst the intervention group, counts of lipids tied to diabetes risk, insulin resistance and blood pressure decreased, despite limited improvements in some children’s BMI.

Dr Cristina Legido-Quigley, a group leader in Systems Medicine at King’s College London, Head of Systems Medicine at the Steno Diabetes Centre Copenhagen (SDCC) and principal author, said: “For decades, scientists have relied on a classification system for lipids that have split them into good and bad cholesterol, but now with a simple blood test we can assess a much broader range of lipid molecules that could serve as vital early warning signs for illness. In the future, this has the potential to be an entirely new way to evaluate someone’s personal risk of disease and by studying how to change lipid molecules in the body, we could even prevent metabolic diseases like diabetes altogether.”

Obesity continues to be a risk factor for conditions like fatty liver disease, but the team hope that doctors can use these measurements to treat children when they are at risk and not just a little larger than their peers.

Dr Karolina Sulek, who was part of the study and performed analysis at the SDCC, said: “Early recognition of children at risk for these life-threatening diseases is crucial. The study provides strong evidence of the great need for obesity management and gives parents confidence to intervene in their children’s life more compassionately, helping them to lose weight.”

The next step for the researchers is to help understand how genetics affects lipids and what this means for metabolic diseases, as well as how these lipids can be changed to improve health.

The results of the ELVIS-Kids randomised controlled trial were presented by Professor Steve Cunningham from Child Life and Health, University of Edinburgh, UK.

He said: “Children have up to 10 to 12 upper respiratory tract infections, what we refer to as colds, per year, which have a big impact on them and their families. There are medicines to improve symptoms, such as paracetamol and ibuprofen, but no treatments that can make a cold get better quicker.”

ELVIS-Kids Chief Investigator Dr Sandeep Ramalingam, consultant virologist, NHS Lothian, Edinburgh, UK, had noted that salt-water solutions are often used by people in South Asia, as nasal irrigation and gargling, to treat a cold and wanted to explore if this clinical benefit could be replicated in a large study.

The research team recruited 407 children aged up to six years to a study where they were given either hypertonic saline ~2.6% (salt-water) nasal drops or usual care when they developed a cold. Overall, 301 children developed a cold; for 150 of these, their parents were given sea salt and taught to make and apply salt-water nose drops to the children’s noses (three drops per nostril, a minimum of four times per day, until well) and 151 children had usual cold care.

Professor Cunningham explains: “We found that children using salt-water nose drops had cold symptoms for an average of six days where those with usual care had symptoms for eight days. The children receiving salt water nose drops also needed fewer medicines during their illness.

“Salt is made up of sodium and chloride. Chloride is used by the cells lining the nose and windpipes to produce hypochlorous acid within cells, which they use to defend against virus infection. By giving extra chloride to the lining cells this helps the cells produce more hypochlorous acid, which helps suppress viral replication, reducing the length of the virus infection, and therefore the duration of symptoms.”

When children got salt-water nose drops, fewer households reported family members catching a cold (46% vs 61% for usual care). Eighty-two per cent of parents said the nose drops helped the child get better quickly and 81% said they would use nose drops in the future.

Professor Cunningham added: “Reducing the duration of colds in children means that fewer people in their house also get a cold, with clear implications for how quickly a household feels better and can return to their usual activities like school and work etc.

“Our study also showed that parents can safely make and administer nose drops to their children and therefore have some control over the common cold affecting their children.”

Professor Alexander Möeller is Head of the ERS Paediatric Assembly and Head of the Department for Respiratory Medicine at the University Children’s Hospital Zurich, Switzerland, and was not involved in the research. He said: “This is an important study that is the first of its kind to investigate the impact of salty nose drops in children with colds. Although most colds usually don’t turn into anything serious, we all know how miserable they can be, especially for young children and their families.

“This extremely cheap and simple intervention has the potential to be applied globally; providing parents with a safe and effective way to limit the impact of colds in their children and family would represent a significant reduction in health and economic burden of this most common condition.”

The team hope to further investigate the effect of saltwater nose drops on wheeze during colds, after initial results from this study showed that children who received the drops had significantly fewer episodes of wheeze (5% vs 19%).

The research, led by Durham University, found that almost half of dyslexia professionals in the study believed at least one unproven indicator for dyslexia, which could lead to children being misdiagnosed.

In a survey of 275 dyslexia professionals, the most common myth – which is not backed up by solid evidence – was that people with dyslexia read letters in reverse order, believed by 61 per cent of specialists.

Just over 30 per cent of professionals also believed that letters jumping around is a key feature of dyslexia. However, there is currently no evidence to show that either of these are reliable indicators of dyslexia.

The survey targeted a range of UK professionals involved in assessing students for dyslexia, such as dyslexia specialists, specialist assessors and educational psychologists. They were asked about the assessments they used, how they make their decisions on diagnosis and what they believe to be indicators of dyslexia.

Although over 75 per cent of professionals used assessments which are recommended by the Specific Learning Difficulty (SpLD) Assessment Standards Committee (SASC), more than 82 per cent of respondents also used additional measures. A further 71 different measures were listed by participants, indicating that there are many different tests used by professionals during the assessment process.

In the UK, there is currently no official policy guidance on defining and identifying students with dyslexia or other learning difficulties. Instead, the onus of developing diagnostic procedures and standards relies heavily on various independent professional organisations.

The researchers are calling for evidence-based knowledge to be built into the assessment procedures and for this to be guided by government policy.

The study, funded by the British Educational Research Association (BERA), is published in Annals of Dyslexia and involved researchers from Durham University and National Taiwan Normal University.

Lead author, Dr Johny Daniel from the School of Education at Durham University, said:

“Our findings show that there is a need for government policy to guide how students with reading disabilities should be assessed, based on reliable evidence.

“It’s also important that dyslexia and psychological associations in the UK ensure that any misconceptions amongst professionals are directly addressed in their guidelines so that children are assessed in a consistent way across the board.”

It’s estimated up to one in every 10 people in the UK has some degree of dyslexia.

The research uncovered a general lack of consensus amongst assessors on the process of identifying someone with dyslexia. Many did subscribe to the notion of dyslexia being a deficit in core areas of reading, but several others saw it as a discrepancy between individuals’ reading and cognitive abilities.

The dyslexia specialists in the study also used a number of other unsubstantiated dyslexia indicators such as high levels of creativity (17 per cent), motor skills issues or clumsiness (17 per cent), and difficulty with reading words in certain colours (15 per cent) or fonts (12 per cent). Empirical data do not support these to be indicators of dyslexia.

Dr Daniel added: “Early identification is absolutely crucial so that support can be put in place as quickly as possible. However, our study shows there is significant variability in the methods used for identifying reading disabilities such as dyslexia, which could lead to children being misdiagnosed or missed altogether.”

For the study, published in JAMA Network Open, researchers analyzed television ratings and advertising data from 2013 through 2022. The study authors found that a dramatic decline in food and drink advertisements during kids’ shows did not fully eliminate children’s exposure to ads for products high in saturated fat, trans fat, total sugars and sodium.

“Kids are still seeing about a thousand ads per year on other programs, and the majority of ads that kids see are still for unhealthy products,” said Lisa Powell, distinguished professor and director of health policy and administration in the UIC School of Public Health. “This is important as the World Health Organization has recognized that reducing children’s exposure to unhealthy food and beverage advertisements is a key strategy for improving both children’s diets and health.”

In 2006, a group of food, beverage and restaurant companies pledged to only advertise healthy products on children’s television programming, defined as shows where at least 35% of viewers are under the age of 12. Later revisions in 2014 and 2020 established nutritional criteria for what qualifies as unhealthy and therefore should not be advertised to young audiences.

Using television ratings data from The Nielsen Company, UIC researchers found that following changes in companies’ self-regulation, the number of general food and beverage commercials seen during children’s programs fell by over 95%. However, they found that 60% of the remaining food and beverage ads were still for unhealthy products.

And overall, kids under the age of 12 still saw more than 1,000 food-related advertisements per year, on average. Because of the steep decline in food and beverage ads during children’s shows, as much as 90% of this exposure came from watching shows with lower child-audience shares.

That shift suggests that regulations against advertising unhealthy food and beverages during hours when children are likely to watch television would be more effective than focusing restrictions specifically on children’s shows, the authors write.

The researchers also found a persistent racial difference in exposure to food-related advertisements. While the number of these ads seen by both Black and white children declined from 2013 to 2022, Black children saw significantly more advertisements than their white counterparts, due in part to more time spent watching television.

In general, children’s time watching television has declined, indicating the need for research on their exposure to advertising on other media. Powell’s group is in the early stages of launching a new project to measure the ads children encounter through social media platforms and digital entertainment.

“We know that the media kids consume is changing. They’re spending more time on their mobile devices, whether it be a tablet or a phone, and they’re seeing a lot of ads,” Powell said. “We really need to understand where else the food companies target kids and what they’re seeing.”

In addition to Powell, UIC co-authors include Julien Leider, Rebecca Schermbeck and Aline Vandenbroeck, along with University of Connecticut co-author Jennifer Harris. The study was supported by grants from Bloomberg Philanthropies and the Robert Wood Johnson Foundation.

Written by Rob Mitchum

In the absence of US-specific nutrition or promotional guidelines for these foods, researchers at The George Institute for Global Health assessed data on 651 infant and toddler food products sold in the top ten US grocery chains held in the Institute’s FoodSwitch database against this international benchmark.²

Among all products, 70 percent failed to meet protein requirements and 44 percent exceeded total sugar requirements. A further one in four products did not meet calorie requirements and one in five exceeded recommended sodium limits.

Dr Elizabeth Dunford, Research Fellow at The George Institute, and Adjunct Assistant Professor, Department of Nutrition at the University of North Carolina said that the rising popularity of processed convenience foods for infants and young children was concerning.

“Early childhood is a crucial period of rapid growth and when taste preferences and dietary habits form, potentially paving the way for the development of chronic diseases such as obesity, diabetes and some cancers later in life,” she said.

“Time-poor parents are increasingly choosing convenience foods, unaware that many of these products lack key nutrients needed for their child’s development and tricked into believing they are healthier than they really are.”

Researchers found that baby food pouches are the fastest growing products in the sector, with a 900 percent increase in the proportion of sales deriving from pouches in the last 13 years. Concerningly, pouches ranked among the unhealthiest products assessed, with fewer than 7 percent meeting total sugar recommendations.*

The study also revealed the extent of misleading marketing practices, with almost all (99.4 percent) products featuring at least one prohibited claim on their packaging. On average, products displayed four prohibited claims, with some displaying as many as 11. Common claims included ‘non genetically modified (GM)’ (70 percent), ‘organic’ (59 percent), ‘no BPA’ (37 percent), and ‘no artificial colors/flavors’ (25 percent).

Dr Daisy Coyle, Research Fellow and Dietitian at The George Institute said that claims like these create a so-called ‘health halo’ around these products.

“The lack of regulation in this area leaves the door wide open for the food industry to deceive busy parents,” she said.

“We saw this not only in the use of misleading claims but also in the use of misleading names, where the product name did not reflect the main ingredients found on the ingredient list.”

“For example, snack and finger foods often referred to fruit or vegetables in the product name, despite primarily being made of flour or other starches,” Dr Coyle added.

Obesity in children aged two to five has more than doubled in the US since the 1970s, with approximately 13% of preschool children living with obesity.³ This has only worsened since the COVID-19 pandemic.⁴

“While reducing childhood obesity was a priority under the Obama administration, the issue appears to have fallen by the wayside in recent years,” added Dr Dunford.

“Our findings highlight the urgent need for better regulation and guidance in the infant and toddler foods market in the United States – the health of future generations depends on it.”

1. Coyle DH et al. An evaluation of the nutritional and promotional profile of commercial foods for infants and toddlers in the United States. Nutrients 2024. 16,0
2. World Health Organization. Nutrient and Promotion Profile Model: Supporting appropriate promotion of food products for infants and young children 6–36 months in the WHO European Region. 2022
   https://www.who.int/europe/publications/i/item/WHO-EURO-2022-6681-46447-67287
3. Fryar CD, et al. Prevalence of overweight, obesity, and severe obesity among children and adolescents aged 2–19 years: United States, 1963–1965 through 2017–2018. NCHS Health E-Stats. 2020. https://www.cdc.gov/nchs/data/hestat/obesity-child-17-18/overweight-obesity-child-H.pdf
4. Lange SJ et al. Longitudinal Trends in Body Mass Index Before and During the COVID-19 Pandemic Among Persons Aged 2–19 Years — United States, 2018–2020. MMWR Morb Mortal Wkly Rep 2021;70:1278–1283
   https://www.cdc.gov/mmwr/volumes/70/wr/mm7037a3.htm?s_cid=mm7037a3_w

*This represents 7 percent of all pouches, but fruit-based pouches (which contain the most sugar) aren’t included in the WHO criteria. This figure becomes 69% if fruit-base pouches are excluded.

“Our findings should raise alarm bells in nearly every nation worldwide,” said senior author Dariush Mozaffarian MD, Jean Mayer Professor of Nutrition and director of the Food is Medicine Institute at the Friedman School of Nutrition Science and Policy at Tufts University in Boston. “The intakes and trends we’re seeing pose a significant threat to public health, one we can and must address for the future of a healthier population.”

The investigators extracted and analyzed data from the Global Dietary Database, a comprehensive accounting of what people worldwide eat and drink.

They generated the first global estimates of trends in sugar-sweetened beverage consumption among young people.

They defined sugar-sweetened beverages as soda, juice drinks, energy drinks, sports drinks, and home-sweetened fruit drinks such as aguas frescas with added sugars and containing more than 50 kcal per 1 cup serving.

In 2018, sugar-sweetened beverage intake among young people varied significantly by world region, averaging 3.6 servings per week worldwide and ranging from 1.3 servings per week in South Asia to 9.1 in Latin America and the Caribbean..

They reported that sugar-sweetened beverage intake among children and adolescents increased by an average of 23% (0.68 servings/week) from 1990 to 2018. The largest increases were in sub-Saharan Africa (2.17 servings/week).

Notably, 56 (30%) of the 185 countries included in the analysis had an average sugar-sweetened beverage intake of 7 or more servings/week.

The authors concluded, “This study found that intakes of SSBs among children and adolescents aged 3-19 years in 185 countries increased by 23% from 1990 to 2018, parallel to the rise in prevalence of obesity among this population globally. SSB intakes showed large heterogeneity among children and adolescents worldwide and by age, parental level of education, and urbanicity. This research should help to inform policies to reduce SSB intake among young people, particularly those with larger intakes across all education levels in urban and rural areas in Latin America and the Caribbean, and the growing problem of SSBs for public health in sub-Saharan Africa.”

The study found that UPF consumption was highest among adolescents from deprived backgrounds, those of white ethnicity, and younger adolescents.

UPFs are food items that are manufactured from industrial substances and contain additives such as preservatives, sweeteners, colourings, flavourings, and emulsifiers. UPFs vary greatly, but tend to indicate poor dietary quality, with higher levels of added sugars, saturated fat, and sodium, as well as decreased fibre, protein, and micronutrient content. They have been suggested as one of the key drivers of the global rise in diseases such as obesity, type 2 diabetes, and cancer.

Globally, the availability and sales of UPFs have increased over time and previous evidence suggests that this has led to increased consumption among adolescents. To look at trends within the UK, researchers from Cambridge and Bristol analysed data from four-day food diaries of almost 3,000 adolescents in the UK National Diet and Nutrition Survey between 2008/09 and 2018/19.

In research published today in the European Journal of Nutrition, the researchers found that a mean of 66% of adolescents’ energy intake came from UPF consumption during this period, though there was a slight fall from 68% to 63% between 2008/09 and 2018/2019.

Parents’ occupation, ethnic group and UK region all influenced the proportion of calorie intake from UPFs:

• Adolescents from disadvantaged backgrounds consumed a higher proportion of their calorie intake from UPFs compared to adolescents from less disadvantaged backgrounds (68.4% compared with 63.8%).
• Adolescents from a non-white ethnicity consumed a lower proportion of their calorie intake from UPFs (59.0% compared with 67.3%).
• Adolescents living in the North of England consumed a higher proportion of their calorie intake from UPFs compared with those living in the South of England and London (67.4% compared with 64.1%).
• 18-year-olds consumed a lower proportion of their calorie intake from UPFs compared with 11-year-olds (63.4% compared with 65.6%).

Dr Yanaina Chavez-Ugalde from the Medical Research Council (MRC) Epidemiology Unit at the University of Cambridge, the study’s first author, said: “Adolescents’ food patterns and practices are influenced by many factors, including their home environment, the marketing they are exposed to and the influence of their friends and peers. But adolescence is also an important time in our lives where behaviours begin to become ingrained.

“It’s clear from our findings that ultra-processed foods make up the majority of adolescents’ diets, and their consumption is at a much higher level than is ideal, given their potential negative health impacts.”

The researchers argue that the observed reduction in UPF intake pre-pandemic could be partly explained by an increased public awareness and health concerns associated with sugar consumption, government-led campaigns, sugar-taxes in other countries and the reformulation of sugary drinks to reduce their sugar content.

Dr Esther van Sluijs from the MRC Epidemiology Unit at Cambridge, joint senior author, said: “Ultra-processed foods offer convenient and often cheaper solutions to time- and income-poor families, but unfortunately many of these foods also offer poor nutritional value. This could be contributing to the inequalities in health we see emerging across childhood and adolescence.”

Dr Zoi Toumpakari from the Centre for Exercise, Nutrition and Health Sciences at the University of Bristol, joint senior author, added: “Our findings suggest that disparities in consumption of ultra-processed foods are not just down to individual choices. We hope this evidence can help guide policymakers in designing more effective policies to combat the negative effects of ultra-processed food consumption among youth and the ripple effects this has on public health.”

This study was largely funded by the National Institute for Health and Care Research School for Public Health Research.

Reference
Chavez-Ugalde, Y et al. Ultra-processed food consumption in UK adolescents: distribution, trends, and sociodemographic correlates using the National Diet and Nutrition Survey 2008/09 to 2018/19. Eur J Nutr; 17 Jul 2024; DOI: 10.1007/s00394-024-03458-z

But first and foremost, current prescribing practice for these drugs, which include sedatives, anti-anxiolytics, antidepressants, antipsychotics, and melatonin, needs to be a lot safer, they insist.

The numbers of these drugs being prescribed to children and young people has been rising steadily, along with a tendency to prescribe them for longer periods, note the editorialists.

They cite previously published UK studies, showing that the prescribing rate of antipsychotics for children rose more than 3% every year between 2000 and 2019, while the prescribing rate of antidepressants more than doubled among 12-17 year olds between 2005 and 2017.

Another study shows that more than 56,000 under-17s were taking melatonin in 2022, which represents an increase of 168% on the equivalent figures for 2015.

The UK is not alone when it comes to the growing reliance on these drugs to treat children’s mental health issues, the editorialists point out.

They cite data from a large US household survey showing a sharp rise in the numbers of young people being prescribed a cocktail of these drugs, despite mounting concerns about the safety and effectiveness of such an approach.

The safety of psychotropic use in children is poorly researched, emphasise the editorialists. But safety concerns about antipsychotic prescribing to children in foster care, in particular, have prompted the American Academy of Child and Adolescent Psychiatry to issue guidelines for clinicians, advocating a ‘start low, go slow’ approach.

These medications need to be regularly reviewed and discontinued at the earliest opportunity, say the editorialists. But the evidence suggests that clinicians in primary care don’t feel confident enough to taper the dose and frequency, while hospital doctors feel that inpatient stays aren’t long enough for this to be started.

“If psychotropic prescribing is to become a mainstay of the management of childhood mental health problems, and there is a limited evidence base to support such use, it needs to be safer,” write the editorialists.

“There is a need to better understand the level of risk that psychotropics pose, what doses are considered safe in different age groups, and at what point physical health monitoring should become mandatory,” they add.

And they conclude: “Better joined-up oversight and shared decision-making, involving young people and their families in discussions about medication both in primary and secondary care, to ensure that treatments are not continued when no longer required, is vital.”

Researchers compared use trends, sources and perceived availability of opioids, stimulants and benzodiazepines from 2009 to 2022. The research letter detailing the findings is scheduled to appear July 24 in JAMA, the Journal of the American Medical Association.

“To put these findings in context, the reduction over the past decade was like going from 1 in every 9 high school students using prescription drugs nonmedically down to 1 in every 40 high school students,” said Sean Esteban McCabe, U-M professor of nursing and director of the Center for the Study of Drugs, Alcohol, Smoking and Health.

“While this decrease is encouraging, we need to be vigilant because any amount of nonmedical use poses risks, especially with the danger posed by counterfeit pills.”

Other findings from 2009 through 2022:

• Lifetime medical use decreased from 24% to 16%.
• Past-year misuse declined from 11% to 2%.
• The percentage of adolescents who reported being given prescription medications by friends or buying them from friends, both fell by more than half.
• In 2009, adolescents who reported misusing prescription medications said the most common source was friends. Now, it is one’s own prescription (37%).
• Among adolescents who reported misuse, those with multiple sources for obtaining prescription medications dropped from 56% to 29%.
• Perceived difficulty of obtaining prescription medications for misuse declined across the three drug classes.
• The percentage of adolescents who reported that they thought it would be impossible to get prescription drugs for misuse increased from 36% to 49%.

School closures during COVID accounted for the largest changes because students had limited contact with each other, and opportunities to sell or give away prescription drugs to friends declined, McCabe said.

Study co-author Philip Veliz, research associate professor of nursing, said the declines may be partially due to changes in prescribing practices, especially for opioids. The study did not examine specific trends based on drug class.

“Prescribing practices have changed dramatically because we had an opioid epidemic, which turned into a heroin epidemic, and we’re still reeling from that, especially with fentanyl,” Veliz said. “A lot of this also has to do with parents having better knowledge and oversight of these medications.”

The steep decline in teens who misused prescription medications in the past year, from 11% to 2%, surprised researchers.

“That’s a massive decline. It used to be 1 in 9 kids, now it’s an incredibly rare event at this point,” Veliz said. “The second surprise was that … nearly half of kids say it’s probably impossible to get these drugs if they want to use them nonmedically right now. That’s a big chunk of the adolescent population, and this is just off the table.”

Another surprise is that the landscape has not returned to what it looked like before COVID, McCabe said.

“Adolescents have found it more difficult to obtain prescription stimulants for nonmedical use in recent years, which is a positive sign,” he said. “There needs to be more attention on stimulant use and diversion, and our team is currently working on such studies to help inform clinical guidelines for ADHD and stimulant use disorder.”

This study was supported by the National Institute on Drug Abuse, and used data from 12th grade students collected in 2009 through 2022 from the Monitoring the Future study, an annual survey at University of Michigan that tracks student substance use and other related trends.

Co-authors include: Emily Pasman, Tim Wilens, Ty Schepis, Vita McCabe and Jason Ford.

Study: Adolescent use, diversion sources, and perceived difficulty of obtaining prescription medications (DOI: 10.1001/jama.2024.12030)

The sugar from soft drinks alone made up over half this total, the estimates suggest. But overall daily energy intake from free sugars levels are still higher than the updated recommendation from the World Health Organisation (WHO) of 5%—equivalent to 30 g/day for adults, 24 g for 7–10 year olds, and 19 g for 4–6 year olds—point out the researchers.

Mounting evidence implicates consumption of sugar sweetened drinks, which are a major source of dietary free sugars, particularly among children, in a heightened risk of weight gain, type 2 diabetes, coronary heart disease and premature death.

To date, more than 50 countries have introduced a sugar tax on soft drinks in a bid to persuade manufacturers to reformulate their products. The UK did so in 2018.

While the evidence suggests that sugar intake derived from these drinks fell in the year following its introduction, it’s not clear whether other sources of dietary sugar were substituted instead.

To assess the impact of the levy on total sugar intake, the researchers drew on 11 years of responses (2008–19) to the annual nationally representative UK National Diet and Nutrition Survey. This captures information on food consumption, nutrition, and nutrient intake in and outside of the home from 500 adults and 500 children over a 4-day period.

The researchers looked particularly at absolute and relative changes in total intake of dietary free sugars from all food and soft drinks combined and from soft drinks alone, to include full and low calorie soft drinks; semi-skimmed, whole and skimmed milk; fruit juice; and other milk drinks and cream.

Protein intake was used as a comparator because although not subject to a levy, it could still be affected by influential factors such as increases in food prices, say the researchers.

The results draw on information for 7999 adults and 7656 children, and estimated changes in free sugar consumption are based on the period January to March 2019 and compared with what would be expected had no sugar tax been announced and implemented.

In the period after the sugar tax was announced in 2016, free sugars consumed from all soft drinks more or less halved in children and fell by a third in adults compared with the period before the announcement.

Taking into consideration previous trends in free sugar consumption, the survey responses indicated that 1 year after the UK sugar tax had come into force children further reduced their free sugar intake from food and drink combined by around 5 g/day (relative reduction of 10%) and adults by around 11 g/day (relative reduction of 20%).

Over half of this total was from soft drinks alone, accounting for around 3 g/day (relative reduction of 23.5%) in children and around 5 g/ day (relative reduction of just under 40.5%) in adults. Protein intake remained stable throughout in children and adults.

“In children, a daily reduction of 4.8 g sugar equates to approximately 19.2 kilocalories out of an approximate daily intake of  2000 kilocalories which is equivalent to approximately 1% reduction in energy intake,” point out the researchers.

Energy intake from free sugars as a proportion of total energy consumed didn’t change significantly following the the introduction of the levy, indicating energy intake from free sugar was reducing at the same time as overall total energy intake, and suggesting that people didn’t change their diets substantially by substituting more sugary foods and drinks, say the researchers.

It wasn’t possible to study different age groups due to the limited number of participants, but falls in the levels of sugar in food and drink may have affected different age groups differently, say the researchers.

For example, the largest single contributor to free sugars in 4–10 year olds is cereal and cereal products, followed by soft drinks and fruit juice. By the age of 11–18, soft drinks provide the largest single source (29%). For adults the largest source of free sugars is sugar, preserves, and confectionery, followed by non-alcoholic drinks, they explain.

The fall in consumption of free sugars observed in the whole diet rather than just from soft drinks suggests that consumption of free sugar from food was also falling from as early as 2008, they add. This might be because of the public health signalling following the announcement, they suggest.