Archives for April 2019

April 2019

April 19, 2019 by
Steven J. Goldstein, MD, FAAP

Steven J. Goldstein, MD, FAAP

Dear NYS AAP – Chapter 2 Member,

There is a lot going on in Pediatrics in New York State, around the world, and in the Chapter. This month’s newsletter highlights issues and events that should be of interest to you. We especially need your help and attention in dealing with the measles epidemic and in helping to pass our legislative priorities in Albany. One of our legislative goals is to end all vaccine exemptions except for legitimate medical reasons. Three other states have already accomplished this, and NY can as well, with your advocacy. Please read on, advocate, and join us for our upcoming events.

Steven J. Goldstein, MD, FAAP
President, NYS AAP – Chapter 2
SJG34@Cornell.edu

Measles Grows in Brooklyn

The number of measles cases in Brooklyn has increased dramatically in the past few weeks and some of us have been dealing with this in our offices, clinics, and ED’s. Chapter 2 has been in contact with the NYC DOH and a link to their measles page is posted on the Chapter’s home page.

An MMR vaccine should be given at 6 months of age in affected communities to offer early protection, but does not count towards the doses needed for school attendance. Any child with one MMR given on or after their first birthday may get a second dose 28 or more days later. This second dose will complete the series and is to capture the 3-5% of children who did not develop immunity with their first injection. I personally have seen measles in the office in the past weeks and the problem is compounded by not knowing who is in the 4-5 days pre-rash phase but nevertheless spreading disease in the office. The city has guidelines posted for post-exposure prophylaxis and the DOH will pick up swabs and blood for testing. Recommendations are to close the office/exam rooms for 2 hours after someone with measles has visited. We now prescreen our visits so that anyone with fever and rash is met outside the office so as not to expose others. There is a lot to say about this issue. For those of you in other communities, keep your eyes open. There were 2 cases in Queens last week.

Here are some good resources for dealing with the anti-vax/hesitancy issue and measles:

Pending Vaccine Legislation in New York State Worthy of Your Support

The bills listed below are a priority for us and we may have more influence in view of the measles issue.  The newly elected legislature is sympathetic to pediatric issues, so please express your opinion to your representatives by phone, letter, email, or even better, in person at their local office.  Click the links below to view the NYS AAP’s Memo of Support for each one:

Free CME Dinner Program – May 9th
“What Happens in Childhood Does Not Stay in Childhood: Why this is true and what we should do!

EVENT: “What Happens in Childhood Does Not Stay in Childhood: Why this is true and what we should do!”
PRESENTED BY: NYS AAP – Chapter 2
WHEN: May 9, 2019 from 6:30pm – 9:00pm
WHERE: NYU Winthrop Hospital | 101 Mineola Blvd. | Research and Academic Center, Conference Room G-18, Section A | Mineola, NY 11501

OVERVIEW:
At this CME dinner program for Chapter members, Dr. Andy Garner, co-author of “Thinking Developmentally: Nurturing Wellness in Childhood to Promote Lifelong Health,” will discuss the lifelong effects of childhood adversity/toxic stress and give pediatricians an evidence-based road map for building a healthier future for the next generation.

Register HereREGISTRATION FEE:

$10 Refundable Fee: NYS AAP – Chapter 2 or 3 Members (this fee will be refunded to Chapter members who attend)
$40: Non Member Pediatricians (this fee can be applied to Chapter dues)

AGENDA:

6:30pm Reception/Exhibit Hour

7:30pm Welcome and Introductions
Steven J. Goldstein, MD, FAAP
President, NYS AAP – Chapter 2

7:35pm What Happens in Childhood Does Not Stay in Childhood: Why this is true and what we should do!
Andrew Garner, MD, PhD, FAAP
Clinical Professor of Pediatrics
CWRU School of Medicine
Cleveland, OH

Objectives:

  • Explain the significance of recent advances in the basic sciences of development (e.g., epigenetics, developmental neuroscience)
  • Describe the ecobiodevelopmental model of disease and wellness, some of its advantages, and a few of the implications for medicine
  • Define relational health and at least three components of a public health approach to build relational health

8:30pm Questions & Answers with Panelists
Moderator: Steven J. Goldstein, MD, FAAP
President, NYS AAP – Chapter 2

Ellen J. Feldman, LCSW-R, CCTP
Supervisor of Education and Training
Child Abuse Prevention Services (CAPS)
Roslyn, NY

Andrew Garner, MD, PhD, FAAP
Clinical Professor of Pediatrics
CWRU School of Medicine
Cleveland, OH

Joaniko Kohchi, MPhil, LCSW, IMH-E® (IV-C)
Director, Institute for Parenting
Adelphi University
Garden City, NY

Jack M. Levine, MD, FAAP
Executive Committee, AAP Section on Developmental and Behavioral Pediatrics
Chair, NYS AAP – Chapter 2 Committee on Developmental-Behavioral Pediatrics/Children with Disabilities

Sandra Pensak, MA
Adjunct Lecturer and Field Supervisor
Queens College, CUNY
Flushing, NY

9:00pm Adjourn

ACCREDITATION STATEMENT:
This activity has been planned and implemented in accordance with the Accreditation Requirements and Policies of the Medical Society of the State of New York (MSSNY) through the joint providership of the Westchester Academy of Medicine and the NYS American Academy of Pediatrics Chapter 2. The Westchester Academy of Medicine is accredited by MSSNY to provide Continuing Medical Education for physicians.

The Westchester Academy of Medicine designates this live activity for a maximum of 1.5 AMA PRA Category I Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

FOR MORE INFORMATION:
Contact Jessica Geslani, Executive Director, at jgeslani@aap.org or 516-326-0310

Are You an Early Career Physician Looking for a Mentor?

We are excited to announce the launch of our Early Career Physician Mentoring project. We will be pairing our Early Career Physicians (<10 years out of training) with seasoned pediatricians in our area. We have amazing mentors including AAP local and national leadership who are ready to be paired with YOU for one on one mentoring!

Sign up online to be a Mentee.  Any questions? Contact: Dr. David Fagan, Chapter 2’s Mentoring Committee Chair, at dfagan@northwell.edu, or our Executive Director, Jessica Geslani, at jgeslani@aap.org.

The 2020 Census

As the Census approaches, please keep in mind that counting every child is important. More about this issue will be coming from the National AAP.

The Casey Foundation’s 2018 KIDS COUNT® Data Book warns that the 2020 census is mired in challenges that could shortchange the official census count by at least 1 million kids younger than age 5.  This discrepancy would put hundreds of millions of federal dollars at risk and, in doing so, underfund programs that are critical for family stability and opportunity.

To help spread the word, Nassau and Suffolk County high school students can participate in the Health & Welfare Council of Long Island’s 2020 Census Logo Design Contest. Entries are due by May 15th.

Wellness Radio Show

Tune into a VoiceAmerica.com radio show on wellness topics by Dr. Vidisha Patel, daughter of our Wellness Committee Co-Chair, Dr. Ishvar Patel.

RESOURCE: New York State Medicaid Managed Care (MMC) Pharmacy Benefit Information Center.

 

Having trouble figuring out which ADHD drug or inhaled steroid is covered for your patient?

The New York State Medicaid Managed Care (MMC) Pharmacy Benefit Information Center is a website that is designed to provide easy access for members and providers looking for information on the drugs and supplies covered by different Medicaid health care plans. While pharmacy benefits and participating pharmacies vary among health plans, all plans maintain their own web sites and customer service call centers.

Visit the website here: https://mmcdruginformation.nysdoh.suny.edu/

Chapter 2 Committee Openings

Our Committees are actively seeking your involvement and ideas!  There are openings and opportunities to make a difference in the following committees:

  • Disaster Preparedness
  • Environmental Health
  • Legislative
  • Membership and Diversity
  • Mentoring Committee (Mentors and Mentees wanted)
  • Parents (suggest a parent to work with us)
  • Pediatric Council
  • Prevention of Family Violence
  • Quality Improvement

View our full list of committees and contact information here.  Still don’t see your interest?  Talk to us about starting a new committee!

NATIONAL AAP NEWS – Presidential Elect Candidates

The National AAP National Nominating Committee has selected Dr. Lee Savio Beers of Washington, D.C., and Dr. Pamela K. Shaw of Kansas City, Kan., as candidates for AAP president-elect.

Additional information about the candidates, including profiles and position statements, will be published in upcoming issues of AAP News and online at www.aap.org/election.  Voting will begin September 7 and ends September 21, 2019.

 

We’ll help you pursue your passion within Pediatrics!

Send us an email describing your interest and we will connect you with the right people to get you involved.

Please contact me or our Executive Director, Jessica Geslani, at jgeslani@aap.org

Follow Chapter 2 on Twitter: @NYSAAPCh2

My best,
Steve Goldstein, Chapter President SJG34@Cornell.edu | Twitter: @SteveGoldstei10

and the Officers:
Shetal Shah, Vice President shetaldoc@hotmail.com | Twitter @NICUBatman
Robert Lee, Secretary rlee@aap.net
Sanjivan Patel, Treasurer sapatel@wyckoffhospital.org

Filed Under: Newsletters

Electronic Cigarettes Among Young People

April 11, 2019 by
Mary Cataletto, MD, MMM, FAAP

Mary Cataletto, MD, MMM, FAAP

(Dr. Mary Cataletto, MD, MMM, FAAP, FCCP is a pediatric pulmonologist and Associate Director of Pediatric Sleep Medicine at NYU Winthrop Hospital. She is chair of the Pediatric Chest Medicine NetWork of the American College of Chest Physicians and past chair of the Asthma Coalition of Long Island. She is Editor in Chief of Pediatric Allergy, Immunology and Pulmonology. She is the Nassau Pediatric Society Representative to NYS AAP Chapter 2.)

Published Online: March 8, 2019

Citation: US Respiratory & Pulmonary Diseases. 2019;4(1):Epub ahead of print

The Use of Sweetened and Flavored Electronic Cigarettes Among Young People—a Growing Concern

Electronic cigarettes (e-cigs) are often promoted as a safe alternative to conventional tobacco-based cigarettes and as an aid to smoking cessation.  The use of sweet and fruit-based flavorings, as well as targeted marketing strategies to attract teens, have resulted in a significant uptake in the use of these products in middle and high school students in the US.1 Potential customers can select from a vast array of flavoring options, and access information about e-cigs via social media and other online sources, as well as traditional marketing communication channels and face-to-face interaction with vape shop employees. The availability of sweetened and flavored brands has heightened their appeal for young people. However, despite substantial increases in e-cig consumption, little is known about the long-term health consequences of their use.

In an expert interview, Mary Cataletto discusses these issues, as well as a recent position statement of the Forum of International Respiratory Societies (FIRS) on the use of e-cigs in youths.

1. How prevalent is the use of electronic cigarettes in children and adolescents?

Based on the 2017 National Youth Survey published by the US Food and Drug Administration, 2.1 million American middle and high school students had used e-cigs in the past 30 days.1 E-cig use has surpassed the use of conventional tobacco cigarettes in this age group and they are the most commonly used tobacco product in middle and high school students.2

2. What role do flavorings play in adolescent electronic cigarette use?

The majority of youths, defined as between 12–17 years old, report that flavored e-cigs were their initiation into tobacco products, citing the availability of flavors and the ability to mix their favorite flavors as important factors.1–4 Adolescents who preferred more flavors used more e-cigs. Multimedia advertising promotes ‘natural’ flavors and aromas, so it is not surprising that flavors have also been reported as the main reason that teens continue to use them.5 There are thousands of flavors of e-cigs on the market (over 7,500 flavors estimated in 2014).6 The availability of multiple choices in flavors and the option to mix your own flavorings may help to maintain the novelty of e-cigs for teens and promote increased use. Fruit and sweet flavors are the most popular in youths. In a recent study by Kroemer at al., the addition of a sweet taste was shown to potentiate the reinforcing effects of nicotine.7

3. What has been the adult experience with flavored electronic cigarettes as an aid to smoking cessation?

Adult smokers are also influenced by flavorings, and the dual use of e-cigs and conventional tobacco is not uncommon.8 Many adults prefer menthol or tobacco flavor as they start to quit smoking, although sweet flavors become more popular as they continue to use e-cigs.3–4 It remains unclear whether e-cigs are an effective aid to smoking cessation.

4. Why is the use of sweetened electronic cigarettes among minors a controversial issue?

There is no safe amount of nicotine exposure, and e-cigs are not a safe alternative to conventional tobacco cigarettes.9 Many youths believe that e-cigs are safer and more socially acceptable.10 While more research is needed, it appears that the sensitization to nicotine in e-cigs promotes conventional tobacco use as the nicotine cravings increase. Few users recognize that they are a likely gateway to conventional tobacco cigarettes. The brain continues to develop throughout adolescence and is particularly vulnerable to the addictive effects of nicotine.9 The adverse effects of e-cigs include those ascribed to nicotine itself, the contents of the aerosol (vapor), or to the temperature modification of the content.11

The sale of both e-cigs and conventional tobacco products are banned to minors in the US, yet the 2017 US National Youth survey reported that approximately 2.1 million middle and high school students had used e-cigs in the past 30 days.1

5. What is being done to discourage the use of these products among minors?

FIRS issued a position statement on e-cigs and electronic nicotine delivery systems use in youth. FIRS reflects a collaboration of professional organizations and respiratory experts; it is made up of nine international societies: the American College of Chest Physicians, American Thoracic Society, Asian Pacific Society of Respirology, Asociación Latinoamericana de Tórax, the European Respiratory Society, the International Union Against Tuberculosis and Lung Disease, the Pan African Thoracic Society, the Global Initiative for Asthma and the Global Initiative for Chronic Obstructive Lung Disease.

They recommended:

  1. To protect youths, [electronic nicotine delivery systems] should be considered tobacco products and regulated as such, including taxation of electronic cigarettes and supplies. The addictive power of nicotine and its adverse effects in youths should not be underestimated.
  2. Considering the susceptibility of the developing brain to nicotine addiction, the sale of electronic cigarettes to adolescents and young adults must be prohibited by all nations, and those bans must be enforced.
  3. All forms of promotion must be regulated and advertising of electronic cigarettes in media that are accessible to youths should cease.
  4. Because flavorings increase rates of youth initiation, they should be banned in electronic nicotine delivery products.
  5. As electronic cigarette vapor exposes nonusers to nicotine and other harmful chemicals, use should be prohibited in indoor locations, public parks, and places where children and youths are present.
  6. While their health risks are increasingly recognized, more research is needed to understand the physiological and deleterious effects of electronic cigarettes.
  7. Routine surveillance and surveys concerning combustible and electronic cigarette use should be carried out in many settings to better understand the scope and health threat of tobacco products to youths in different countries and regions.’ [sic]12

In conclusion, it is clear that flavorings can influence initiation and contribute to the ongoing use of e-cigs. Nicotine is an addictive substance, and preteens and teens are particularly vulnerable. Legislation and enforcement of existing restrictions to targeted marketing to teens, sale to minors, as well as restriction of sweet and fruit flavorings, are important steps to protect the future health of our children. Additional studies are needed to further evaluate the safety and efficacy of e-cigs as an aid in smoking cessation.13

______________________________________________________________________________

  1. Wang TW, Gentzke A, Sharapova S, et al. Tobacco product use among middle and high school students – United States, 2011–2017. MMWR Morb Mortal Wkly Rep. 2018;67:629–33.
  2. US Food & Drug Administration. Youth tobacco use: National Youth Tobacco Survey. 2018. Available at: fda.gov/TobaccoProducts/PublicHealthEducation/ProtectingKidsfromTobacco/ucm405173.htm (accessed January 22, 2019).
  3. Huang LL, Baker HM, Meernik C, et al. Impact of non-menthol flavors in tobacco products on perceptions and use among youth, young adults and adults: a systematic review. Tob Control. 2017;26:709–19.
  4. Harrell MB, Weaver SR, Loukas A, et al. Flavored e-cigarette use: characterizing youth, young adult, and adult users. Prev Med Rep. 2017;5:33–40.
  5. Centers for Disease Control and Prevention. Quick facts on the risks of e-cigarettes for kisd, teens, and young adults. 2018. Available at: cdc.gov/tobacco/basic_information/ecigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html?s_cid=osh-stu-home-slider-004%20 (accessed January 22, 2019).
  6. Zhu SH, Sun JY, Bonnevie E, et al. Four hundred and sixty brands of e-cigarettes and counting: implications for product regulation. Tob Control. 2014;23 Suppl. 3:iii3–9.
  7. Kroemer NB, Veldhuizen MG, Delvy R, et al. Sweet taste potentiates the reinforcing effects of e-cigarettes. Eur Neuropsychopharmacol. 2018;28:1089–102.
  8. Kasza KA, Ambrose BK, Conway KP, et al. Tobacco-product use by adults and youths in the United States in 2013 and 2014. N Engl J Med. 2017;376:342–53.
  9. Schraufnagel DE. Electronic cigarettes: vulnerability of youth. Pediatr Allergy Immunol Pulmonol. 2015;28:2–6.
  10. Pepper JK, Ribisl KM, Brewer NT. Adolescents’ interest in trying flavored e-cigarettes. Tob Control. 2016;25:ii62–6
  11. Lodrup Carlsen KC, Skjerven HO, Carlsen KH. The toxicity of e-cigarettes and children’s respiratory health. Paediatr Respir Rev. 2018;28:63–7.
  12. Ferkol TW, Farber HJ, La Grutta S, et al. Electronic cigarette use in youths: a position statement of the Forum of International Respiratory Societies. Eur Respir J. 2018;51:pii:1800278.
  13. Farsalinos K. Electronic cigarettes: an aid in smoking cessation, or a new health hazard? Ther Adv Respir Dis. 2018;12:1753465817744960.
Filed Under: Blog, Blog Archives