scholarly journals Longitudinal pathways of exclusive and polytobacco hookah use among youth, young adults and adults in the USA: findings from the PATH Study Waves 1–3 (2013–2016)

2020 ◽  
Vol 29 (Suppl 3) ◽  
pp. s155-s162 ◽  
Author(s):  
Eva Sharma ◽  
Maansi Bansal-Travers ◽  
Kathryn C Edwards ◽  
Michael J Halenar ◽  
Kristie A Taylor ◽  
...  
Keyword(s):  
Young Adults ◽  
Population Level ◽  
Health Study ◽  
Longitudinal Analyses ◽  
Common Pathway ◽  
Cross Sectional ◽  
Tobacco Products ◽  
The Usa ◽  
Nationally Representative ◽  
Exclusive Or

ObjectiveThe goal of this study is to examine cross-sectional rates of use and longitudinal pathways of hookah use among US youth (ages 12-17), young adults (ages 18-24), and adults 25+ (ages 25 and older).DesignData were drawn from the first three waves (2013–2016) of the Population Assessment of Tobacco and Health Study, a nationally representative, longitudinal cohort study of US adults and youth. Respondents with data at all three waves (youth, n=11 046; young adults, n=6478; adults 25+, n=17 188) were included in longitudinal analyses.ResultsYoung adults had higher ever, past 12-month (P12M) and past 30-day cross-sectional prevalence of hookah use at each wave than youth or adults 25+. The majority of Wave 1 (W1) hookah users were P12M users of other tobacco products (youth: 73.9%, young adults: 80.5%, adults 25+: 83.2%). Most youth and adult W1 P12M hookah users discontinued use in Wave 2 or Wave 3 (youth: 58.0%, young adults: 47.5%, adults 25+: 63.4%). Most W1 P12M hookah polytobacco users used cigarettes (youth: 49.4%, young adults: 59.4%, adults 25+: 63.2%) and had lower rates of quitting all tobacco than exclusive hookah users or hookah polytobacco users who did not use cigarettes.ConclusionsHookah use is more common among young adults than among youth or adults 25+. Discontinuing hookah use is the most common pathway among exclusive or polytobacco hookah users. Understanding longitudinal transitions in hookah use is important in understanding behavioural outcomes at the population level.

scholarly journals Longitudinal pathways of exclusive and polytobacco smokeless use among youth, young adults and adults in the USA: findings from the PATH Study Waves 1–3 (2013–2016)

2020 ◽  
Vol 29 (Suppl 3) ◽  
pp. s170-s177 ◽  
Author(s):  
Eva Sharma ◽  
Kathryn C Edwards ◽  
Michael J Halenar ◽  
Kristie A Taylor ◽  
Karin A Kasza ◽  
...  
Keyword(s):  
Young Adults ◽  
Age Groups ◽  
Health Impact ◽  
Health Study ◽  
Longitudinal Analyses ◽  
Common Pathway ◽  
Cross Sectional ◽  
Youth And Young Adults ◽  
The Usa ◽  
Nationally Representative

ObjectiveUse of smokeless tobacco (SLT) with other tobacco products is growing, yet gaps in understanding transitions among SLT and other product use remain. The aim of this study is to examine cross-sectional prevalence and longitudinal pathways of SLT use among US youth (12–17 years), young adults (18–24 years) and adults 25+ (25 years and older).DesignData were drawn from the first three waves (2013–2016) of the Population Assessment of Tobacco and Health Study, a nationally representative, longitudinal cohort study of US youth and adults. Respondents with data at all three waves (youth, n=11 046; young adults, n=6478; adults 25+, n=17 188) were included in longitudinal analyses.ResultsYoung adults had the highest current SLT use compared with other age groups. Among Wave 1 (W1) past 30-day youth and young adult SLT users, most were SLT and cigarette polytobacco users compared with adults 25+, who more often used SLT exclusively. Among W1 exclusive SLT users, persistent exclusive use across all three waves was more common among adults 25+, while transitioning from exclusive SLT use to SLT polytobacco use at Wave 2 or Wave 3 was more common among youth and young adults. Among W1 SLT and cigarette polytobacco users, a common pathway was discontinuing SLT use but continuing other tobacco use.ConclusionsOur results showed distinct longitudinal transitions among exclusive and SLT polytobacco users. Deeper understanding of these critical product transitions will allow for further assessment of population health impact of these products.

scholarly journals Longitudinal pathways of exclusive and polytobacco cigar use among youth, young adults and adults in the USA: findings from the PATH Study Waves 1–3 (2013–2016)

2020 ◽  
Vol 29 (Suppl 3) ◽  
pp. s163-s169 ◽  
Author(s):  
Kathryn C Edwards ◽  
Eva Sharma ◽  
Michael J Halenar ◽  
Kristie A Taylor ◽  
Karin A Kasza ◽  
...  
Keyword(s):  
Young Adults ◽  
Tobacco Use ◽  
Age Groups ◽  
Health Impact ◽  
Tobacco Product ◽  
Health Study ◽  
Longitudinal Analyses ◽  
Cross Sectional ◽  
The Usa ◽  
Nationally Representative

ObjectiveThe goal of this study is to examine the cross-sectional prevalence of use and 3-year longitudinal pathways of cigar use in US youth (12-17 years), young adults (18-24 years), and adults 25+ (25 years or older).DesignData were drawn from the first three waves (2013–2016) of the Population Assessment of Tobacco and Health Study, a nationally representative, longitudinal cohort study of US youth and adults. Respondents with data at all three waves (youth, n=11 046; young adults, n=6478; adults 25+, n=17 188) were included in longitudinal analyses.ResultsWeighted cross-sectional prevalence of past 30-day (P30D) use was stable for adults 25+ (~6%), but decreased in youth (Wave 1 (W1) to Wave 3 (W3)=2.5% to 1.2%) and young adults (W1 to W3=15.7% to 14.0%). Among W1 P30D cigar users, over 50% discontinued cigar use (irrespective of other tobacco use) by Wave 2 (W2) or W3. Across age groups, over 70% of W1 P30D cigar users also indicated P30D use of another tobacco product, predominantly cigar polytobacco use with cigarettes. Discontinuing all tobacco use by W2 or W3 was greater in adult exclusive P30D cigar users compared with polytobacco cigar users.ConclusionsAlthough the majority of P30D cigar users discontinued use by W3, adult polytobacco users of cigars were less likely to discontinue all tobacco use than were exclusive cigar users. Tracking patterns of cigar use will allow further assessment of the population health impact of cigars.

scholarly journals Longitudinal pathways of exclusive and polytobacco cigarette use among youth, young adults and adults in the USA: findings from the PATH Study Waves 1–3 (2013–2016)

2020 ◽  
Vol 29 (Suppl 3) ◽  
pp. s139-s146 ◽  
Author(s):  
Kristie A Taylor ◽  
Eva Sharma ◽  
Kathryn C Edwards ◽  
Michael J Halenar ◽  
Wendy Kissin ◽  
...  
Keyword(s):  
Young Adults ◽  
Age Groups ◽  
Tobacco Product ◽  
Health Study ◽  
Cigarette Use ◽  
Common Pathway ◽  
Common Pattern ◽  
Cross Sectional ◽  
The Usa ◽  
Nationally Representative

ObjectiveCigarettes are the most harmful and most prevalent tobacco product in the USA. This study examines cross-sectional prevalence and longitudinal pathways of cigarette use among US youth (12–17 years), young adults (18–24 years) and adults 25+ (25 years and older).DesignData were drawn from the first three waves (2013–2016) of the Population Assessment of Tobacco and Health Study, a nationally representative, longitudinal cohort study of US adults and youth. Respondents with data at all three waves (youth, N=11 046; young adults, N=6478; adults 25+, N=17 188) were included in longitudinal analyses.ResultsAmong Wave 1 (W1) any past 30-day (P30D) cigarette users, more than 60%, persistently used cigarettes across three waves in all age groups. Exclusive cigarette use was more common among adult 25+ W1 P30D cigarette users (62.6%), while cigarette polytobacco use was more common among youth (57.1%) and young adults (65.2%). Persistent exclusive cigarette use was the most common pathway among adults 25+ and young adults; transitioning from exclusive cigarette use to cigarette polytobacco use was most common among youth W1 exclusive cigarette users. For W1 youth and young adult cigarette polytobacco users, the most common pattern of use was persistent cigarette polytobacco use.ConclusionsCigarette use remains persistent across time, regardless of age, with most W1 P30D smokers continuing to smoke at all three waves. Policy efforts need to continue focusing on cigarettes, in addition to products such as electronic nicotine delivery systems that are becoming more prevalent.

scholarly journals Initiation of any tobacco and five tobacco products across 3 years among youth, young adults and adults in the USA: findings from the PATH Study Waves 1–3 (2013–2016)

2020 ◽  
Vol 29 (Suppl 3) ◽  
pp. s178-s190 ◽  
Author(s):  
Cassandra A Stanton ◽  
Eva Sharma ◽  
Elizabeth L Seaman ◽  
Karin A Kasza ◽  
Kathryn C Edwards ◽  
...  
Keyword(s):  
Young Adults ◽  
Age Groups ◽  
Tobacco Product ◽  
Health Study ◽  
Cross Sectional ◽  
Tobacco Products ◽  
Youth And Young Adults ◽  
The Usa ◽  
Nationally Representative ◽  
Tobacco Initiation

ObjectiveThis study reports weighted cross-sectional prevalence of never use of tobacco, and longitudinal past 12-month (P12M), past 30-day (P30D) and frequent P30D any tobacco or specific tobacco product initiation across three 1-year waves. Longitudinal three-wave pathways are examined to outline pathways of exclusive and polytobacco initiation, as well as pathways of new initiators of electronic nicotine delivery systems (ENDS) or cigarettes.DesignData were drawn from the first three waves (2013–2016) of the Population Assessment of Tobacco and Health Study, a nationally representative, longitudinal cohort study of US youth and adults. Respondents with data at all three waves (youth, N = 11 046; young adults, N = 6478; adults 25+, N = 17 188) were included in longitudinal analyses.ResultsAcross the three age groups, weighted cross-sectional analyses revealed never any tobacco use decreased each year from 2013 to 2016, reflecting overall increases in tobacco initiation in the population during this time. Compared with cigarettes, cigars, hookah and smokeless tobacco, ENDS had the highest proportion of P12M initiation from Wave 1 to Wave 3 (W3) for each age group. Among youth Wave 2 P30D initiators of exclusive ENDS or cigarettes, the most common W3 outcome was not using any tobacco (ENDS: 59.0% (95% CI 48.4 to 68.8); cigarettes: 40.3% (95% CI 28.7 to 53.1)).ConclusionsInitiation rates of ENDS among youth and young adults have increased the number of ever tobacco users in the US prevention strategies across the spectrum of tobacco products which can address youth initiation of tobacco products.

scholarly journals Longitudinal transitions of exclusive and polytobacco electronic nicotine delivery systems (ENDS) use among youth, young adults and adults in the USA: findings from the PATH Study Waves 1–3 (2013–2016)

2020 ◽  
Vol 29 (Suppl 3) ◽  
pp. s147-s154 ◽  
Author(s):  
Cassandra A Stanton ◽  
Eva Sharma ◽  
Kathryn C Edwards ◽  
Michael J Halenar ◽  
Kristie A Taylor ◽  
...  
Keyword(s):  
Young Adults ◽  
Delivery Systems ◽  
Health Study ◽  
Cross Sectional ◽  
Electronic Nicotine Delivery Systems ◽  
Nicotine Delivery ◽  
The Us ◽  
The Usa ◽  
Nationally Representative ◽  
Reasons For Use

ObjectiveElectronic nicotine delivery systems (ENDS; including e-cigarettes) are rapidly evolving in the US marketplace. This study reports cross-sectional prevalence and longitudinal pathways of ENDS use across 3 years, among US youth (12–17 years), young adults (18–24 years) and adults 25+ (25 years and older).DesignData were from the first three waves (2013–2016) of the Population Assessment of Tobacco and Health Study, a nationally representative, longitudinal cohort study of US youth and adults. Respondents with data at all three waves (youth, n=11 046; young adults, n=6478; adults 25+, n=17 188) were included in longitudinal analyses.ResultsWeighted cross-sectional ever use of ENDS increased at each wave. Across all three waves, young adults had the highest percentages of past 12-month, past 30-day (P30D) and daily P30D ENDS use compared with youth and adults 25+. Only about a quarter of users had persistent P30D ENDS use at each wave. Most ENDS users were polytobacco users. Exclusive Wave 1 ENDS users had a higher proportion of subsequent discontinued any tobacco use compared with polytobacco ENDS users who also used cigarettes.ConclusionsENDS use is most common among young adults compared with youth and adults 25+. However, continued use of ENDS over 2 years is not common for any age group. Health education efforts to reduce the appeal and availability of ENDS products might focus on reducing ENDS experimentation, and on reaching the smaller subgroups of daily ENDS users to better understand their reasons for use.

scholarly journals Gut microbiome composition in the Hispanic Community Health Study/Study of Latinos is shaped by geographic relocation, environmental factors, and obesity

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Robert C. Kaplan ◽  
Zheng Wang ◽  
Mykhaylo Usyk ◽  
Daniela Sotres-Alvarez ◽  
Martha L. Daviglus ◽  
...  
Keyword(s):  
Community Health ◽  
Gut Microbiome ◽  
Alpha Diversity ◽  
Amplicon Sequencing ◽  
Shannon Index ◽  
Health Study ◽  
Rrna Gene ◽  
Cross Sectional ◽  
Hispanic Community ◽  
The Usa

Abstract Background Hispanics living in the USA may have unrecognized potential birthplace and lifestyle influences on the gut microbiome. We report a cross-sectional analysis of 1674 participants from four centers of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), aged 18 to 74 years old at recruitment. Results Amplicon sequencing of 16S rRNA gene V4 and fungal ITS1 fragments from self-collected stool samples indicate that the host microbiome is determined by sociodemographic and migration-related variables. Those who relocate from Latin America to the USA at an early age have reductions in Prevotella to Bacteroides ratios that persist across the life course. Shannon index of alpha diversity in fungi and bacteria is low in those who relocate to the USA in early life. In contrast, those who relocate to the USA during adulthood, over 45 years old, have high bacterial and fungal diversity and high Prevotella to Bacteroides ratios, compared to USA-born and childhood arrivals. Low bacterial diversity is associated in turn with obesity. Contrasting with prior studies, our study of the Latino population shows increasing Prevotella to Bacteroides ratio with greater obesity. Taxa within Acidaminococcus, Megasphaera, Ruminococcaceae, Coriobacteriaceae, Clostridiales, Christensenellaceae, YS2 (Cyanobacteria), and Victivallaceae are significantly associated with both obesity and earlier exposure to the USA, while Oscillospira and Anaerotruncus show paradoxical associations with both obesity and late-life introduction to the USA. Conclusions Our analysis of the gut microbiome of Latinos demonstrates unique features that might be responsible for health disparities affecting Hispanics living in the USA.

scholarly journals Determinants of COVID-19 preventive behaviours among adults with chronic diseases in the USA: an analysis of the nationally representative COVID-19 impact survey

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e044600
Author(s):  
Jessica Y. Islam ◽  
Denise C. Vidot ◽  
Marlene Camacho-Rivera
Keyword(s):  
Chronic Diseases ◽  
Rural Areas ◽  
Prevalence Ratio ◽  
Face Mask ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
High School Degree ◽  
The Usa ◽  
Nationally Representative

BackgroundPreventive behaviours have been recommended to control the spread of SARS-CoV-2. Adults with chronic diseases (CDs) are at higher risk of COVID-19-related mortality compared to the general population. Our objective was to evaluate adherence to COVID-19 preventive behaviours among adults without CDs compared with those with CDs and identify determinants of non-adherence to COVID-19 preventive behaviours.Study designCross-sectional.Setting and participantsWe used data from the nationally representative COVID-19 Impact Survey (n=10 760) conducted in the USA.Primary measuresAdults with CDs were categorised based on a self-reported diagnosis of diabetes, high blood pressure, heart disease/heart attack/stroke, asthma, chronic obstructive pulmonary disease (COPD), bronchitis or emphysema, cystic fibrosis, liver disease, compromised immune system, or cancer (54%).ResultsCompared with adults without CDs, adults with CDs were more likely to adhere to preventive behaviours including wearing a face mask (χ2-p<0.001), social distancing (χ2-p<0.001), washing or sanitising hands (χ2-p<0.001), and avoiding some or all restaurants (χ2-p=0.002) and public or crowded places (χ2-p=0.001). Adults with a high school degree or below [Adjusted prevalence ratio (aPR):1.82, 95% Confidence interval (CI)1.04 to 3.17], household income <US$50 000 (aPR:2.03, 95% CI 1.34 to 2.72), uninsured (aPR:1.65, 95% CI1.09 to 2.52), employed (aPR:1.48, 95% CI 1.02 to 2.17), residing in rural areas (aPR:1.70, 95% CI 1.01 to 2.85) and without any CD (aPR:1.78, 95% CI 1.24 to 2.55) were more likely to not adhere to COVID-19 preventive behaviours.ConclusionAdults with CDs are more likely to adhere to recommended COVID-19 preventive behaviours. Public health messaging targeting specific demographic groups and geographic areas, such as adults without CD or adults living in rural areas, should be prioritised.

Knowledge and Beliefs Regarding Harm From Specific Tobacco Products: Findings From the H.I.N.T. Survey

2021 ◽  
pp. 089011712110261
Author(s):  
Wenxue Lin ◽  
Joshua E. Muscat
Keyword(s):  
Electronic Cigarettes ◽  
Multiple Linear Regression Model ◽  
Cross Sectional ◽  
Cigarette Smokers ◽  
Tobacco Products ◽  
Single Item ◽  
Knowledge And Beliefs ◽  
Nationally Representative ◽  
National Trends ◽  
Medical Recommendations

Purpose: Determine whether dual tobacco users have different levels of knowledge about nicotine addiction, perceived harm beliefs of low nicotine cigarettes (LNCs) and beliefs about electronic cigarettes (e-cigarettes) Design: Quantitative, Cross-sectional Setting: Health Information National Trends Survey 5 (Cycle 3, 2019) Participants: Nationally representative adult non-smokers (n=3113), exclusive cigarette smokers (n=302), and dual (cigarette and e-cigarette) users (n=77). Measures: The survey included single item measures on whether nicotine causes addiction and whether nicotine causes cancer. A five-point Likert scale assessed comparative harm of e-cigarettes and LNCs relative to conventional combustible cigarettes (1=much more harmful, 3=equally harmful…5 = much less harmful, or don’t know). Analysis: We used weighted multiple linear regression model to estimate means and 95% confidence intervals (CI) of e-cigarettes and LNCs beliefs by current tobacco user status. Results: Over 97% of dual users, 83% of non-smokers and 86% of exclusive cigarette smokers correctly identified that nicotine is addictive. The majority of subjects incorrectly identified nicotine as a cause of cancer, with dual users having the lowest proportion of incorrect responses (60%). Dual users rated e-cigarette harmfulness as less harmful than combustibles (mean=2.20; 95% CI=1.73, 2.66) while exclusive cigarette smokers and non-smokers rated them as similarly harmful. LNCs were considered equally harmful and addictive as conventional cigarettes. Conclusion: Dual users had a higher knowledge base of tobacco-related health effects. The effectiveness of policies or medical recommendations to encourage smokers to switch from cigarettes to LNCs or e-cigarettes will need to consider accurate and inaccurate misperceptions about the harm and addictiveness of nicotine. Improved public health messages about different tobacco products are needed.

scholarly journals Waterpipe tobacco package warning exposure’s impact on risk perceptions and use among young adults in the USA: a longitudinal analysis of the population assessment of tobacco and health study

2018 ◽  
Vol 28 (e1) ◽  
pp. e16-e23 ◽  
Author(s):  
Jessica L King ◽  
Beth A Reboussin ◽  
Jennifer Cornacchione Ross ◽  
Erin L Sutfin
Keyword(s):  
Young Adult ◽  
Risk Perceptions ◽  
Health Study ◽  
Regression Analyses ◽  
Population Assessment ◽  
High Exposure ◽  
Factors Associated ◽  
The Usa ◽  
Nationally Representative ◽  
Waterpipe Use

BackgroundAlthough Food and Drug Administration (FDA)-mandated waterpipe tobacco warnings were not required until August 2018, some waterpipe tobacco packaging (WTP) sold in the USA, contained warnings prior to this date. We examined the prevalence of WTP warning exposure and whether exposure influenced risk perceptions or use among young adult (aged 18–24 years) current waterpipe users.MethodsWe used data from waves 1 (2013–2014) and 2 (2014–2015) of the Population Assessment of Tobacco and Health Study, a nationally representative longitudinal study of US adults and youth. We conducted logistic regression analyses to identify factors associated with wave 1 warning exposure, and whether wave 1 WTP warning exposure predicted wave 2 relative risk perceptions and waterpipe use.ResultsMore than one-third of our sample (35.9%, 95% CI 33.5 to 38.4) reported past-month WTP warning exposure. Exposure was higher among males (adjusted OR (AOR)=1.34, 95% CI 1.04 to 1.72), those who usually do not share the waterpipe (AOR=3.10, 95% CI 1.45 to 6.60), those who purchased waterpipe tobacco (AOR=1.73, 95% CI 1.28 to 2.34), and those with a regular brand (AOR=1.84, 95% CI 1.26 to 2.68). Those exposed to WTP warnings at wave 1 were more likely than those not exposed to perceive waterpipe tobacco to be as or more harmful than cigarettes at wave 2 (AOR=1.35, 95% CI 1.02 to 1.78). There was no association between wave 1 WTP exposure and wave 2 waterpipe use.ConclusionsMore than one-third of US young adult current waterpipe users reported WTP warning exposure prior to FDA-mandated warning implementation. Findings suggest the mandated warning may result in high exposure among users; it will be critical to assess exposure’s impact on risk perceptions and behaviour after FDA-mandated warnings are implemented.

101 National Trends in Emergency Department Ondansetron Use and Clinical Outcomes Among Children with Acute Gastroenteritis

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e72-e73
Author(s):  
Sarah Rogers ◽  
Stephen Freedman ◽  
Terry Klassen ◽  
Brett Burstein
Keyword(s):  
Emergency Department ◽  
Acute Gastroenteritis ◽  
Multivariable Analysis ◽  
Population Level ◽  
Subject Area ◽  
Fluid Administration ◽  
Cross Sectional ◽  
Ed Visits ◽  
Nationally Representative ◽  
Over Time

Abstract Primary Subject area Emergency Medicine - Paediatric Background Acute gastroenteritis (AGE) is among the most common illnesses for which children are evaluated in the Emergency Department (ED). Among children with AGE, ondansetron has been shown to reduce vomiting, intravenous (IV) fluid administration and hospitalizations when administered in the ED. Objectives To determine whether increasing ondansetron administration is associated with a concomitant decline in IV rehydration and hospitalization among children presenting with AGE in a broad, nationally representative ED sample. Design/Methods This was a cross-sectional analysis of the US Centers for Disease Control and Prevention (CDC) National Hospital Ambulatory Medical Care Survey (NHAMCS) database from 2006 to 2015. Children &lt; 18 years old with a discharge diagnosis of AGE were included for analysis. Survey weighting procedures were applied to generate population-level estimates and to perform multivariable logistic regression to identify factors associated with ondansetron administration. Results There were an estimated 15.1 million (95% CI 13.5-16.7) visits for AGE during the 10-year study period. AGE visits increased as a proportion of all pediatric ED visits over time (4.6% in 2006, 5.7% in 2015; p-trend=0.013). The mean patient age was 4.7 (95% CI 4.5-5.0) years, and most visits were to non-teaching (86.6%, 95% CI 83.3-89.3%) and non-pediatric (83.4%, 95% CI 78.2-87.5%) hospitals. The proportion of patients receiving ondansetron increased over time (11.8% in 2006, 62.5% in 2015; p-trend &lt; 0 .001), both in the ED (10.6% in 2006, 55.5% in 2015; p-trend &lt; 0 .001) and as outpatient prescriptions (3.3% in 2006, 45.3% in 2015; p-trend &lt; 0 .001). Over the same period, there was no change in hospitalizations (2.9% overall, 95% CI 2.2-3.7%; p-trend=0.144). IV hydration for AGE decreased (31.8% in 2006, 24.9% in 2015; p-trend &lt; 0 .048), as did IV fluid administration across all other pediatric ED visits (10.3% in 2006, 7.8% in 2015; p-trend &lt; 0 .023). After adjustment for patient- and hospital-level factors, the odds ratio for IV rehydration among children with AGE was 0.97 (95% CI 0.92-1.01). Multivariable analysis found younger age (aOR 0.94, 95% CI 1.04-1.09), Medicaid/Medicare insurance (aOR 0.74; 95% CI 0.57-0.97), and presentation to a teaching hospital (aOR 0.74; 95% CI 0.54-0.99) were inversely associated with ondansetron administration. Other antiemetics most commonly used were promethazine (7.4%, 95% CI 5.9-9.2%), metoclopramide (1.8%, 95% CI 1.3-2.5%) and trimethobenzamide (1.5%, 95% CI 1.1-2.1%). Antimotility agents, H2-receptor blockers, and probiotics were infrequently used. Conclusion Both ED and outpatient prescribing of ondansetron for children with AGE increased; however, no concomitant decline was observed in hospitalizations or IV rehydration. Guidelines and quality improvement efforts are needed to target ondansetron administration to children most likely to benefit to minimize adverse events and costs associated with overuse.

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