Differences in Pandemic-Related Factors Associated with Alcohol and Substance Use among Korean Adolescents:Nationwide Representative Study

The coronavirus disease 2019(COVID-19)pandemic has raised concerns about the mental health and social well-being of youth,including its potential to increase or exacerbate substance use behaviors[1].Among adolescents,the COVID-19pandemic has resulted in limited face-to-face school contact and thus missed milestones in preventing alcohol and substance use.

Global public concern of childhood and adolescence suicide:a new perspective and new strategies for suicide prevention in the post-pandemic era

Background Suicide is the second leading cause of death in young people worldwide and is responsible for about 52,000 deaths annually in children and adolescents aged 5-19 years.Familial,social,psychological,and behavioral factors play important roles in suicide risk.As traumatic events such as the COVID-19 pandemic may contribute to suicidal behaviors in young people,there is a need to understand the current status of suicide in adolescents,including its epidemiology,associated factors,the influence of the pandemic,and management initiatives.Data sources We investigated global and regional suicide mortality rates among children and adolescents aged 5-19 years using data from the Global Burden of Diseases,Injuries,and Risk Factors Study(GBD)2019.The suicide mortality rates from 1990 to 2019 were examined in 204 countries and territories across six World Health Organization(WHO)regions.Additionally,we utilized electronic databases,including PubMed/MEDLINE and Scopus,and employed various combinations of terms such as“suicide”,“adolescents”,“youth”,“children”,“risk factors”,“COVID-19 pandemic”,“prevention”,and“intervention”to provide a narrative review on suicide within the pediatric population in the post-pandemic era.Results Despite the decreasing trend in the global suicide mortality rate from 1990 to 2019,it remains high.The mortality rates from suicide by firearms or any other specified means were both greater in males.Additionally,Southeast Asia had the highest suicide rate among the six WHO regions.The COVID-19 pandemic seems to contribute to suicide risk in young people;thus,there is still a strong need to revisit appropriate management for suicidal children and adolescents during the pandemic.Conclusions The current narrative review integrates up-to-date knowledge on suicide epidemiology and the effects of the COVID-19 pandemic,risk factors,and intervention strategies.Although numerous studies have characterized trends in suicide among young people during the pre-pandemic era,further studies are required to investigate suicide during the pandemic and new strategies for suicide prevention in the post-pandemic era.It is necessary to identify effective prevention strategies targeting young people,particularly those at high risk,and successful treatment for individuals already manifesting suicidal behaviors.Care for suicidal children and adolescents should be improved with parental,school,community,and clinical involvement.

Prenatal and postnatal factors associated with sudden infant death syndrome:an umbrella review of meta-analyses

Background Comprehensive quantitative evidence on the risk and protective factors for sudden infant death syndrome(SIDS)effects is lacking.We investigated the risk and protective factors related to SIDS.Methods We conducted an umbrella review of meta-analyses of observational and interventional studies assessing SIDS-related factors.PubMed/MEDLINE,Embase,EBSCO,and Google Scholar were searched from inception until January 18,2023.Data extraction,quality assessment,and certainty of evidence were assessed by using A Measurement Tool Assessment Systematic Reviews 2 following PRISMA guidelines.According to observational evidence,credibility was graded and classified by class and quality of evidence(CE;convincing,highly suggestive,suggestive,weak,or not significant).Our study protocol was registered with PROSPERO(CRD42023458696).The risk and protective factors related to SIDS are presented as equivalent odds ratios(eORs).Results We identified eight original meta-analyses,including 152 original articles,covering 12 unique risk and protective factors for SIDS across 21 countries/regions and five continents.Several risk factors,including prenatal drug exposure[eOR=7.84(95%CI=4.81–12.79),CE=highly suggestive],prenatal opioid exposure[9.55(95%CI=4.87–18.72),CE=suggestive],prenatal methadone exposure[9.52(95%CI=3.34–27.10),CE=weak],prenatal cocaine exposure[4.38(95%CI=1.95–9.86),CE=weak],prenatal maternal smoking[2.25(95%CI=1.95–2.60),CE=highly suggestive],postnatal maternal smoking[1.97(95%CI=1.75–2.22),CE=weak],bed sharing[2.89(95%CI=1.81–4.60),CE=weak],and infants found with heads covered by bedclothes after last sleep[11.01(95%CI=5.40–22.45),CE=suggestive],were identified.On the other hand,three protective factors,namely,breastfeeding[0.57(95%CI=0.39–0.83),CE=non-significant],supine sleeping position[0.48(95%CI=0.37–0.63),CE=suggestive],and pacifier use[0.44(95%CI=0.30–0.65),CE=weak],were also identified.Conclusions Based on the evidence,we propose several risk and protective factors for SIDS.This study suggests the need for further studies on SIDS-related factors supported by weak credibility,no association,or a lack of adequate research.

Estimated prevalence and trends in smoking among adolescents in South Korea,2005-2021:a nationwide serial study

Background Although smoking is classified as a risk factor for severe COVID-19 outcomes,there is a scarcity of studies on prevalence of smoking during the COVID-19 pandemic.Thus,this study aims to analyze the trends of prevalence of smoking in adolescents over the COVID-19 pandemic period.Methods The present study used data from middle to high school adolescents between 2005 and 2021 who participated in the Korea Youth Risk Behavior Web-based Survey(KYRBS).We evaluated the smoking prevalence(ever or daily)by year groups and estimated the slope in smoking prevalence before and during the pandemic.Results A total of 1,137,823 adolescents participated in the study[mean age,15.04 years[95%confidence interval(CI)15.03-15.06];and male,52.4%(95%CI 51.7-53.1)].The prevalence of ever smokers was 27.7%(95%CI 27.3-28.1)between 2005 and 2008 but decreased to 9.8%(95%CI 9.3-10.3)in 2021.A consistent trend was found in daily smokers,as the estimates decreased from 5.4%(95%CI 5.2-5.6)between 2005 and 2008 to 2.3%(95%CI 2.1-2.5)in 2021.However,the downward slope in the overall prevalence of ever smokers and daily smokers became less pronounced in the COVID-19 pandemic period than in the pre-pandemic period.In the subgroup with substance use,the decreasing slope in daily smokers was significantly more pronounced during the pandemic than during the pre-pandemic period.Conclusions The proportion of ever smokers and daily smokers showed a less pronounced decreasing trend during the pandemic.The findings of our study provide an overall understanding of the pandemic's impact on smoking prevalence in adolescents.

National trends in alcohol and substance use among adolescents from 2005 to 2021:a Korean serial cross‑sectional study of one million adolescents

Background Although previous studies have provided data on early pandemic periods of alcohol and substance use in adolescents,more adequate studies are needed to predict the trends of alcohol and substance use during recent periods,including the mid-pandemic period.This study investigated the changes in alcohol and substance use,except tobacco use,throughout the pre-,early-,and mid-pandemic periods in adolescents using a nationwide serial cross-sectional survey from South Korea.Methods Data on 1,109,776 Korean adolescents aged 13–18 years from 2005 to 2021 were obtained in a survey operated by the Korea Disease Control and Prevention Agency.We evaluated adolescents’alcohol and substance consumption prevalence and compared the slope of alcohol and substance prevalence before and during the COVID-19 pandemic to see the trend changes.We define the pre-COVID-19 period as consisting of four groups of consecutive years(2005–2008,2009–2012,2013–2015,and 2016–2019).The COVID-19 pandemic period is composed of 2020(early-pandemic era)and 2021(midpandemic era).Results More than a million adolescents successfully met the inclusion criteria.The weighted prevalence of current alcohol use was 26.8%[95%confidence interval(CI)26.4–27.1]from 2005 to 2008 and 10.5%(95%CI 10.1–11.0)in 2020 and 2021.The weighted prevalence of substance use was 1.1%(95%CI 1.1–1.2)from 2005 to 2008 and 0.7%(95%CI 0.6–0.7)between 2020 and 2021.From 2005 to 2021,the overall trend of use of both alcohol and drugs was found to decrease,but the decline has slowed since COVID-19 epidemic(current alcohol use:βdiff 0.167;95%CI 0.150–0.184;substance use:βdiff 0.152;95%CI 0.110–0.194).The changes in the slope of current alcohol and substance use showed a consistent slowdown with regard to sex,grade,residence area,and smoking status from 2005 to 2021.Conclusion The overall prevalence of alcohol consumption and substance use among over one million Korean adolescents from the early and mid-stage(2020–2021)of the COVID-19 pandemic showed a slower decline than expected given the increase during the prepandemic period(2005–2019).

Psychosocial alterations during the COVID-19 pandemic and the global burden of anxiety and major depressive disorders in adolescents,1990-2021:challenges in mental health amid socioeconomic disparities

Background The coronavirus disease 2019(COVID-19)pandemic,a global health crisis,profoundly impacted all aspects of daily life.Adolescence,a pivotal stage of psychological and social development,is heavily influenced by the psychosocial and socio-cultural context.Hence,it is imperative to thoroughly understand the psychosocial changes adolescents experienced during the pandemic and implement effective management initiatives.Data sources We examined the incidence rates of depressive and anxiety disorders among adolescents aged 10–19 years globally and regionally.We utilized data from the Global Burden of Diseases,Injuries,and Risk Factors Study(GBD)2021 to compare pre-pandemic(2018–2019)and pandemic(2020–2021)periods.Our investigation covered 204 countries and territories across the six World Health Organization regions.We conducted a comprehensive literature search using databases including PubMed/MEDLINE,Scopus,and Google Scholar,employing search terms such as“psychosocial”,“adolescent”,“youth”,“risk factors”,“COVID-19 pandemic”,“prevention”,and“intervention”.Results During the pandemic,the mental health outcomes of adolescents deteriorated,particularly in terms of depressive and anxiety disorders.According to GBD 2021,the incidence rate of anxiety disorders increased from 720.26[95%uncertainty intervals(UI)=548.90–929.19]before the COVID-19 pandemic(2018–2019)to 880.87 per 100,000 people(95%UI=670.43–1132.58)during the COVID-19 pandemic(2020–2021).Similarly,the incidence rate of major depressive disorder increased from 2333.91(95%UI=1626.92–3138.55)before the COVID-19 pandemic to 3030.49 per 100,000 people(95%UI=2096.73–4077.73)during the COVID-19 pandemic.This worsening was notably pronounced in high-income countries(HICs).Rapid environmental changes,including heightened social anxiety,school closures,economic crises,and exacerbated racism,have been shown to adversely affect the mental well-being of adolescents.Conclusions The abrupt shift to remote learning and the absence of in-person social interactions heightened feelings of loneliness,anxiety,sadness,and stress among adolescents.This change magnified existing socioeconomic disparities,posing additional challenges.These complexities profoundly impact adolescents’well-being,especially vulnerable groups like those from HICs,females,and minorities.Acknowledging the underreporting bias in low-to middle-income countries highlights the importance of addressing these mental health alterations in assessments and interventions within these regions as well.Urgent interventions are crucial as the pandemic-induced mental stress may have lasting effects on adolescents’mental health.