High School Entry Research Articles

Poor Static Balance is a Novel Risk Factor for Non-contact Anterior Cruciate Ligament Injury

Objectives:The anterior cruciate ligament (ACL) injury is common and affects young individuals, particularly female, who are active in sports that involve jumping, pivoting, as well as change of direction. ACL injury is associated with potential long-term complications including reduction in activity levels and osteoarthritis. In recent years, the focus on the ACL injury prevention has increased and many studies exploring risk factors for ACL injury have been published. However, the influence of the static balance on ACL injuries is poorly documented. The purpose of this study was to investigate the relationship between the static balance and incidence of ACL injury among high school female athletes.Methods:A 3-year prospective cohort study was conducted with 287 high school female handball or basketball players. All subjects were 15 years old and included 111 handball players and 176 basketball players. At baseline, using gravicorder, postural sway was measured for 30 seconds during two-leg standing with eye open. The measured parameters of postural sway were locus length per time (LG), which indicates postural control function by proprioceptive reflexes, and environmental area (AR), which indicates the degree of equilibrium impairment. After the baseline examination was performed at high school entry, all players were followed for 36 months to register any subsequent incidence of ACL injury. We compared the differences in the static balance between injured and uninjured players using an unpaired t-test. Values of p < 0.05 were considered statistically significant.Results:In the present study, 28 of the 287 players (9.6%) suffered an ACL injury during the 3-year observation period. Two players suffered both knees. Twenty five injured players sustained a non-contact injury and three injured players sustained a contact injury. Sixteen players were injured during the game and other players were injured during the practice. In this study three contact injury players were excluded. There were not significantly different between the ACL injured group and uninjured group in the stature characteristics such as age, height and weight. The mean values for LG and AR for the two-leg standing of the eye-open test were 1.30 ± 0.36 cm/s and 2.44 ± 1.34cm2 (ACL injured group), 1.15 ± 0.26 cm/s and 1.98 ± 1.02 cm2 (uninjured group). There was significantly difference between the injured group and uninjured group in LG (p = 0.045). However there was no significant difference two groups in AR (P = 0.107). (Table1)Conclusion:In the present study, locus length per time was significantly longer in injured players compared with uninjured players. This result showed that the postural control function by proprioceptive reflexes is the one of the risk factors for non-contact ACL injury. The proprioceptive training may be effective in ACL prevention with clinical relevance.

2014년 12월 중국 정부 발표 ‘중국 대입제도 개혁안’ 고찰

This study was executed based on &lt;Opinion of Regular High School Education Level Examination&gt; and &lt;Opinion of Regular High School General Talent Assessment&gt; that were presented by the Chinese government in December, 2014. The object of this study is to examine the change and meaning of future curriculum of Chinese regular high school and university entry policies, to compare it with Korean university entry policies and to consider it. This study intensively analyzes 2020 reformation plan of university entry that was presented by China’s ministry of education such as the abolition of liberal arts and natural sciences, moving classes implementation, normalization of general talent assesment, dispersion of education level examination, reduction of additional points and polities for minorities. And they were compared to the current and planned Korean education policies, and I predicted the direction of Chinese education from now. The lists of detailed enforcement of educational reform plans of China have been gradually presented. This study needs to be supplemented by scoping on the process and results of educational reform with continuous observation on the regions that are implementing a test operation. Also, it is necessary to think what we can learn from educational reform process of China.

Adolescent alcohol use before and after the high school transition.

An important question is whether the high school (HS) entry is a critical developmental event associated with escalation of alcohol use. This study examined trajectories of adolescent alcohol use as a function of a normative developmental event-the HS entry. In addition, given that at-risk youth may be particularly vulnerable to the stress associated with this transition, we examined how these alcohol use trajectories may be shaped by a measure of early behavioral risk, early adolescent delinquency. Participants included 891 twelve-year-olds from the prospective National Longitudinal Survey of Youth 1997 for whom relevant longitudinal school data were available (51.2% boys; 61.4% White). Alcohol use after HS entry increased at a significantly greater rate than did use during the middle school years, even after accounting for students' age at transition. In addition, early delinquency emerged as a risk factor such that differences in alcohol use existed prior to the transition. That is, children with early delinquency characteristics displayed more rapid progression in alcohol use, but this effect was evident only during middle school. HS entry appears to be a critical developmental event associated with increased social risk for greater alcohol use that goes beyond the simple maturational (i.e., aging) factors. Youth with behavioral problems appears to be at greater risk in middle school, in contrast to lower risk youth for whom HS entry may be a more critical event, in part because HS may be a less restrictive environment and/or because alcohol use becomes more normative at that time. Adolescent substance use may be described as a series of distinct developmental stages that closely correspond to school transitions and suggest a critical period for targeted intervention that may differ as a function of preexisting risk.

The prospective association between sipping alcohol by the sixth grade and later substance use.

Although there is a clear association between early use of alcohol and short- and long-term adverse outcomes, it is unclear whether consumption of minor amounts of alcohol (less than a full drink) at a young age is prognostic of risk behaviors in later adolescence. Data were taken from 561 students enrolled in an ongoing prospective web-based study on alcohol initiation and progression (55% female; 25% White non-Hispanic). Based on a combination of monthly and semiannual surveys, we coded whether participants sipped alcohol before sixth grade and examined associations between early sipping and alcohol consumption by fall of ninth grade, as well as other indices of problem behavior. Participants also reported on the context of the first sipping event. The prevalence of sipping alcohol by fall of sixth grade was 29.5%. Most participants indicated that their first sip took place at their own home, and the primary source of alcohol was an adult, usually a parent. Youth who sipped alcohol by sixth grade had significantly greater odds of consuming a full drink, getting drunk, and drinking heavily by ninth grade than nonsippers. These associations held even when we controlled for temperamental, behavioral, and environmental factors that contribute to proneness for problem behavior, which suggests that sipping is not simply a marker of underlying risk. Our findings that early sipping is associated with elevated odds of risky behaviors at high school entry dispute the idea of sipping as a protective factor. Offering even just a sip of alcohol may undermine messages about the unacceptability of alcohol consumption for youth.

Alternatives to Suspending African American High School Males

The research site was one high school in the southern United States where African American males were suspended at greater rates than their counterparts. The purpose of this qualitative case study was to examine the perspectives of high school administrators and teachers regarding alternatives to suspending African American males in one southern high school within a public school district. Guided by the social learning theory, the research question focused on the suspensions of these students. Data were collected through in-depth, semi structured, face-to-face interviews with a purposive sample of 6 high school teachers and 2 administrators, and coded and analyzed for emergent themes. The findings revealed that African American high school males might benefit from education programs such as character education programs to develop social, academic, and discipline skills. The findings of this study may be used for professional development for teachers and administrators regarding strategies to reduce suspensions of African American high school males, which might facilitate their graduation from high school and subsequent entry into higher education or the workforce.lications to display the level of psychological strain and workplace stressors among nurses as part of the postmodern organizational problems.

Alternatives to Suspending African American High School Males

The research site was one high school in the southern United States where African American males were suspended at greater rates than their counterparts. The purpose of this qualitative case study was to examine the perspectives of high school administrators and teachers regarding alternatives to suspending African American males in one southern high school within a public school district. Guided by the social learning theory, the research question focused on the suspensions of these students. Data were collected through in-depth, semi structured, face-to-face interviews with a purposive sample of 6 high school teachers and 2 administrators, and coded and analyzed for emergent themes. The findings revealed that African American high school males might benefit from education programs such as character education programs to develop social, academic, and discipline skills. The findings of this study may be used for professional development for teachers and administrators regarding strategies to reduce suspensions of African American high school males, which might facilitate their graduation from high school and subsequent entry into higher education or the workforce.

Examining the link between traumatic events and delinquency among juvenile delinquent girls: A longitudinal study.

Researchers have postulated associations between childhood trauma and delinquency, but few have examined the direction of these relationships prospectively and, specifically, with samples of delinquent girls. The purpose of this study was to examine the relationship between traumatic events and delinquency for girls in the juvenile justice system using a cross-lagged model. Developmental differences in associations as a function of high school entry status were also examined. The sample included 166 girls in the juvenile justice system who were mandated to community-based out-of-home care due to chronic delinquency. Overall, study results provide evidence that trauma and delinquency risk pathways vary according to high school entry status. Implications for future research and practice are discussed.

PO-0842 Optimal Emotional Development In Young Children: The Role Of Parents And Paediatricians

Background Parents and paediatricians in partnership have a unique role in influencing the emotional development of young children. The opportunity presents when parents consult paediatricians about their child’s behaviour or developmental problems. Discussion Infants and young children learn by interacting with and reacting to their environment. Early relationships with their parents foster feelings of trust and security, which influences their relationships with others as they develop and mature. Paediatricians, through their knowledge of child development, are in a unique position to influence and guide parents in early child-rearing practices. They do newborn examinations and they assess young children through various stages of early development, preschool and school entry. They are often the point of contact in later transition periods such as high school entry and adolescence, particularly when behaviour becomes challenging. The presentation will touch on theories of development, early experiences, resilience and cultural factors that influence emotional development. It will provide a clinician’s perspective on the management of behaviour difficulties and the partnership with parents in order to facilitate optimal emotional development in young children. Conclusion Paediatricians have an opportunity to influence healthy and positive relationships between parents and their young children that will allow children to develop to the best of their ability and become responsible members of society in the long-term.

Control of varicella in the post-vaccination era in Australia: a model-based assessment of catch-up and infant vaccination strategies for the future.

In Australia, varicella vaccine was universally funded in late 2005 as a single dose at 18 months. A school-based catch-up programme for children aged 10-13 years without a history of infection or vaccination was funded until 2015, when those eligible for universal infant vaccination would have reached the age of high school entry. This study projects the impact of discontinuing catch-up vaccination on varicella and zoster incidence and morbidity using a transmission dynamic model, in comparison with alternative policy options, including two-dose strategies. At current vaccine coverage (83% at 2 years and 90% at 5 years), ceasing the adolescent catch-up programme in 2015 was projected to increase varicella-associated morbidity between 2035 and 2050 by 39%. Although two-dose infant programmes had the lowest estimated varicella morbidity, the incremental benefit from the second dose fell by 70% if first dose coverage increased from 83% to 95% by age 24 months. Overall zoster morbidity was predicted to rise after vaccination, but differences between strategies were small. Our results suggest that feasibility of one-dose coverage approaching 95% is an important consideration in estimating incremental benefit from a second dose of varicella vaccine.

High Psychological Competitive Ability Is Related to Incidence of Anterior Cruciate Ligament Injury in High School Female Athletes

Objectives:In a competitive sport situation, not only the exertions of performance but also the incidence of injury can be influenced by psychological factors. In recent years, the focus on anterior cruciate ligament (ACL) injury prevention has increased and many studies exploring risk factors for ACL injury have been published. However, the influence of psychological factors on ACL injuries is poorly documented. The purpose of this study was to investigate the relationship between psychological competitive ability and incidence of ACL injury among high school female athletes.Methods:A 3-year prospective cohort study was conducted with 220 high school female handball or basketball players. All subjects were 15 years old and included 77 handball players and 143 basketball players. At baseline, psychological competitive ability was assessed by a self-administered questionnaire, the Diagnostic Inventory of Psychological Competitive Ability (DIPCA.3). This inventory measures an athlete’s psychological abilities to fully display their skills and talents during competition via 52 questions categorized into 12 scales: Patience, Aggressiveness, Volition for self-realization, Volition for winning, Self-control, Ability to relax, Concentration, Confidence, Decision, Predictive ability, Judgment, and Cooperation. After the baseline examination was performed at high school entry, all players were followed for 36 months to register any subsequent incidence of ACL injury. We compared the differences in psychological competitive ability between injured and uninjured players using an unpaired t-test. Values of p < 0.05 were considered statistically significant. The purpose of this study was explained to the subjects and their parents and written informed consent to participate was obtained from them. This study was approved by the ethics committee of our institution.Results:In the present study, 20 of the 220 players (9.1%) suffered an ACL injury during the 3-year observation period. Eighteen of the 20 injured players sustained a non-contact injury to her knee. Eleven players were injured during the game and 9 players were injured during the practice. Between injured and uninjured players, injured players had significantly higher total DIPCA.3 scores [172.7 ± 18.3 points in injured players and 157.9 ± 20.9 points in uninjured players (p<0.001)]. Regarding the specific scales, injured players scored significantly higher on Patience, Aggressiveness, Volition for self-realization, Predictive ability, Judgment, and Cooperation. However, no significant differences were observed on Volition for winning, Self-control, Ability to relax, Concentration, Confidence and Decision.Conclusion:It is reported that players displaying higher competitive levels of performance or players with higher self-esteem in their own performance score higher on DIPCA.3. In the present study, DIPCA.3 scores were significantly higher in injured players compared with uninjured players. Among the high-scoring players, a strong emphasis on improvement of their performance may force them into situations associated with injury risk. The results of the present study suggest that psychological factors are associated with the incidence of ACL injury.

Prevention and Control of Meningococcal Disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP).

In January 2005, a tetravalent meningococcal polysaccharide-protein conjugate vaccine ([MCV4] Menactra, manufactured by Sanofi Pasteur, Inc., Swiftwater, Pennsylvania) was licensed for use among persons aged 11-55 years. CDCns Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination of young adolescents (defined in this report as persons aged 11-12 years) with MCV4 at the preadolescent health-care visit (at age 11-12 years). Introducing a recommendation for MCV4 vaccination among young adolescents might strengthen the role of the preadolescent visit and have a positive effect on vaccine coverage among adolescents. For those persons who have not previously received MCV4, ACIP recommends vaccination before high-school entry (at approximately age 15 years) as an effective strategy to reduce meningococcal disease incidence among adolescents and young adults. By 2008, the goal will be routine vaccination with MCV4 of all adolescents beginning at age 11 years. Routine vaccination with meningococcal vaccine also is recommended for college freshmen living in dormitories and for other populations at increased risk (i.e., military recruits, travelers to areas in which meningococcal disease is hyperendemic or epidemic, microbiologists who are routinely exposed to isolates of Neisseria meningitidis, patients with anatomic or functional asplenia, and patients with terminal complement deficiency). Other adolescents, college students, and persons infected with human immunodeficiency virus who wish to decrease their risk for meningococcal disease may elect to receive vaccine. This report updates previous reports from ACIP concerning prevention and control of meningococcal disease. It also provides updated recommendations regarding use of the tetravalent meningococcal polysaccharide vaccine (MPSV4) and on antimicrobial chemoprophylaxis.

The Net Black Advantage in Educational Transitions

Recent studies have found a net Black advantage in educational attainment. This pattern indicates that after controlling for socioeconomic and academic characteristics, Black students are more likely to continue education than are their White counterparts. Using an educational careers approach, this study examines selection and student expectations and parental aspirations as potential explanations of this pattern. Results indicate that a net Black advantage exists from high school entry through postsecondary enrollment and that student expectations and parental aspirations partially explain the net Black advantage. These findings call into question selection explanations of the net Black advantage, underscore the role of socioeconomic disparities for educational stratification, and highlight the utility of an educational careers approach for understanding how race structures educational attainment.

Comparing the cognitive, personality and moral characteristics of high school and graduate medical entrants to the Tehran University of Medical Sciences in Iran

Background: Tehran University of Medical Sciences has two streams of medical student admission: an established high school entry (HSE) route and an experimental graduate entry (GE) route.Aim: To compare the cognitive skills, personality traits and moral characteristics of HSE and GE students admitted to this university.Methods: The personal qualities assessment tool (PQA; www.pqa.net.au) was translated from English to Persian and then back-translated. Afterwards 35 individuals from the GE and 109 individuals from the 2007 to 2008 HSE completed the test. The results were compared by t-test and Chi-square.Results: The HSE students showed significantly higher ability in the cognitive skills tests (p < 0.001). They were also more libertarian (p = 0.022), but had lower ability to confront stress and unpleasant events (p < 0.001), and had lower self-awareness and self-control (p < 0.001).Conclusion: On the basis of their personal qualities, the GE students had more self-control and strength when coping with stress than the HSE students, but the latter had superior cognitive abilities. Hence it may be useful to include cognitive tests in GE students’ entry exam and include tests of personal qualities to exclude those with unsuitable characteristics.

International medical electives undertaken by Australian medical students: current trends and future directions

To estimate the proportion of students in Australian medical schools who undertake international medical electives (IMEs), particularly in developing countries, and to ascertain which medical schools provide predeparture training and postelective debriefing. Extraction of data on the number of students undertaking electives from the Medical Schools Outcomes Database (MSOD) for the 2013s 2006 to 2010; and interviews with the directors of each medical school in Australia in May to July 2012 to ascertain the availability of predeparture training and postelective debriefing. The proportion of medical students undertaking IMEs overall and within developing countries and the proportion of medical schools with optional and mandatory predeparture training and postelective debriefing. Fifty-three per cent of graduate-entry (GE) program students and 35% of high-school entry (HSE) program students undertook IMEs. Fifty-nine per cent of electives undertaken by GE program students were in developing countries, compared with 56% for HSE program students. Predeparture training was offered by 12 of the 16 Australian medical schools, but it was mandatory in only six. Only eight schools offer postelective debriefing. A large proportion of Australian medical students undertake IMEs in developing countries. However, a considerable proportion of students do not undertake formal preparation for, or reflection on, their experiences. Predeparture training and postelective debriefing should be scaled up across Australian medical schools to provide students with the guidance and support to maximise the benefits and minimise risks associated with undertaking IMEs in developing countries.

The market phenomenon in Taiwanese junior high level education: behind the battles between streaming and mixed-ability grouping

In this article, the author explores the market phenomenon revealed in the practice of a mixed-ability grouping policy in Taiwan, and traces the influence of the wider educational contexts on the formation of the market phenomenon. Although there have been no major policies introduced with the intention of creating a market mechanism in Taiwanese education, the author found that the practice of the mixed-ability grouping policy in junior high level education has been shadowed by a self-initiated market mechanism. Junior high school educators perceive that parents value a high entry rate to the highest ranking academic high schools, and junior high schools develop strategies to boost pupils' academic performance and to attract future pupils. Under such circumstances, junior high level schooling and students are commodified on the basis of a single value – academic performance. The author argues that wider educational contexts, including the senior high school entry examination, and control over the provision of senior high level education, shape the market phenomenon in Taiwanese junior high level education.

The Number of Sexual Partners and Health-Risking Sexual Behavior: Prediction from High School Entry to High School Exit

Precursors to adolescent health-risking sexual behavior (HRSB) were examined in a normative sample of 373 adolescents (48.0% female, n=178). Using a variable-oriented approach, we regressed the number of sexual partners at high school exit (age 17) on parental monitoring, association with delinquent peers, romantic relationship status, problem behavior, physical maturity, and tobacco and alcohol use at high school entry (age 14); all emerged as significant predictors except alcohol use and physical maturity (we found sex differences in physical maturity and romantic relationship status, with females being more advanced in both areas). Sexual experimentation at high school entry served to partially or fully mediate the impact of these factors. A person-oriented approach, using a broader measure of HRSB, found three subgroups of adolescents: abstainers, low-risk-takers, and high-risk-takers. Results predicting membership in these groups generally followed those from the variable-oriented analysis. Implications for the prevention of HRSB and future research directions are discussed.

Uptake of meningococcal conjugate vaccine among adolescents in large managed care organizations, United States, 2005: Demand, supply and seasonality

BackgroundIn February 2005, the US Advisory Committee on Immunization Practices recommended the new meningococcal conjugate vaccine (MCV4) for routine use among 11- to 12-year-olds (at the preadolescent health-care visit), 14- to 15-year-olds (before high-school entry), and groups at increased risk. Vaccine distribution started in March; however, in July, the manufacturer reported inability to meet demand and widespread MCV4 shortages were reported. Our objectives were to determine early uptake patterns among target (11-12 and 14-15 year olds) and non-target (13- plus 16-year-olds) age groups. A post hoc analysis was conducted to compare seasonal uptake patterns of MCV4 with polysaccharide meningococcal (MPSV4) and tetanus diphtheria (Td) vaccines.MethodsWe analyzed data for adolescents 11-16 years from five managed care organizations participating in the Vaccine Safety Datalink (VSD). For MCV4, we estimated monthly and cumulative coverage during 2005 and calculated risk ratios. For MPSV4 and Td, we combined 2003 and 2004 data and compared their seasonal uptake patterns with MCV4.ResultsCoverage for MCV4 during 2005 among the 623,889 11-16 years olds was 10%. Coverage for 11-12 and 14-15 year olds was 12% and 11%, respectively, compared with 8% for 13- plus 16-year-olds (p < 0.001). Of the 64,272 MCV4 doses administered from March-December 2005, 73% were administered June-August. Fifty-nine percent of all MPSV4 doses and 38% of all Td doses were administered during June-August.ConclusionA surge in vaccine uptake between June and August was observed among adolescents for MCV4, MPSV4 and Td vaccines. The increase in summer-time vaccinations and vaccination of non-targeted adolescents coupled with supply limitations likely contributed to the reported shortages of MCV4 in 2005.

A Study on the Personal Traits and Knowledge Base of Taiwanese Medical Students Following Problem-based Learning Instructions

Introduction: Problem-based learning (PBL), a pedagogic concept using a student-centred approach and problem-solving through small group discussions, has been adopted in varying degrees for years at all 11 medical institutes in Taiwan. Much evidence has shown that a number of factors can seriously affect student performance in PBL courses, such as the design of PBL scenarios, the tutors’ character and students’ attitudes and efforts. Materials and Methods: The aim of this study was to examine how the personal characters or knowledge base of Taiwanese medical students influence their performance in a hybrid-PBL curriculum. A total of 309 (234 male, 75 female) high-school entry undergraduate medical students participated in this survey. Self-assessed personal traits were presented in a 44-item questionnaire with a Big Five factor structure. Knowledge base was assessed by students’ score point average (SPA) based on their previous 4-year education in medical school. Peer-assessed performance of students in the PBL curriculum was carried out using a well-developed, reliable and validated evaluation form. Results: Each student’s peer-evaluated PBL performance can be divided into 5 principal components, which included control-lead, assist-coordinate, written organisation and compromise-comply (Eigen value &gt;1). The consistency and reliability of the Big Five questionnaire on personal traits was analysed and discordant items were deleted (Cronbach’s alpha = 0.72 to 0.86 after deletion). The relationship between the personal traits, knowledge base and PBL performance, as analysed by simple regression, showed that “extraversion” and “openness to experience” were positively related to the “assist-coordinate” characteristic in PBL performance, and “conscientiousness” was positively related to the “control-lead” characteristic in PBL performance. The SPA was positively related to the “assist-coordinate” or “control-lead” characteristic in PBL performance. The “agreeableness” was negatively correlated with the “control-lead” characteristic in PBL performance. After stepwise regression between the Big Five and each component of PBL performance, only the correlation between conscientiousness and control/lead, and between extraversion and assist/coordinate remained significant. Conclusion: Knowledge and personality characteristics appear to be associated with student performance in a hybrid-PBL curriculum. The implications of this study on the future development and application of this assessment tool in medical schools are presented. Key words: Big-Five, Performance, Score point average

Cost-Effectiveness of Conjugate Meningococcal Vaccination Strategies in the United States

Shepard CW, Ortega-Sanchez IR, Scott RD, Rosenstein NE, and the ABCs Team. Pediatrics 2005;115:1220-32 Context The US Food and Drug Administration approved a meningococcal conjugate A/C/Y/W-135 vaccine (MCV-4) for use in persons 11 to 55 years of age in January, 2005; licensure for use in younger age groups is expected in 2 to 4 years. Objective To evaluate and compare the projected health and economic impact of MCV-4 vaccination of US adolescents, toddlers, and infants. Design Cost-effectiveness analysis from a societal perspective based on data from Active Bacterial Core Surveillance (ABCs) and other published and unpublished sources. Sensitivity analyses in which key input measures were varied over plausible ranges were performed. Participants A hypothetical 2003 US population cohort of children 11 years of age and a 2003 US birth cohort. Interventions: Hypothetical routine vaccination of adolescents (1 dose at 11 years of age), toddlers (1 dose at 1 year of age), and infants (3 doses at 2, 4, and 6 months of age). Each vaccination scenario was compared with a “no-vaccination” scenario. Main Outcome Measures Meningococcal cases and deaths prevented, cost per case prevented, cost per life-year saved, and cost per quality-adjusted life-year saved. Results Routine MCV-4 vaccination of US adolescents (11 years of age) would prevent 270 meningococcal cases and 36 deaths in the vaccinated cohort over 22 years, a decrease of 46% in the expected burden of disease. Before program costs are counted, adolescent vaccination would reduce direct disease costs by $18 million and decrease productivity losses by $50 million. At a cost per vaccination (average public-private price per dose plus administration fees) of $82.50, adolescent vaccination would cost society $633,000 per meningococcal case prevented and $121,000 per life-year saved. Key variables influencing results were disease incidence, case-fatality ratio, and cost per vaccination. The cost-effectiveness of toddler vaccination is essentially equivalent to adolescent vaccination, whereas infant vaccination would be much less cost-effective. Conclusions Routine MCV-4 vaccination of US children would reduce the burden of disease in vaccinated cohorts but at a relatively high net societal cost. The projected cost-effectiveness of adolescent vaccination approaches that of recently adopted childhood vaccines under conditions of above-average meningococcal disease incidence or at a lower cost per vaccination. Comment The peak incidence of meningococcal disease in the United States occurs during infancy, but the peak fatality rate from meningococcal disease falls during adolescence and young adulthood. The American Academy of Pediatrics and the Centers for Disease Control's (CDC) Advisory Committee on Immunization Practices have recommended that quadrivalent MCV-4 be administered to adolescents at routine visits for 11- to 12-year-olds, and at visits before high school entry and before living in college dormitories or entering the military for those not previously immunized. The authors, from the CDC, conducted a cost-effectiveness analysis from the societal perspective (accounting for both medical and nonmedical [ie, work loss] costs), comparing an adolescent MCV-4 immunization program with other program options targeted at infants and toddlers. They conclude from their mathematical models that the adolescent strategy is the most cost-effective of these options, at $121,000 per life-year saved. Such a program would cost almost $5 million per death averted, and would be expected to save 36 lives over the 22-year time horizon of their study. As the authors indicate, the cost-effectiveness ratio in excess of $100,000 per life-year saved compares unfavorably with ratios for other currently recommended childhood vaccines. For example, varicella vaccination and hepatitis B vaccination programs are cost-saving, and vaccination with 7-valent pneumococcal conjugate vaccine has been estimated to cost $80,000 per life-year saved. Nonetheless, the specter of meningococcal disease may spur providers, parents, and payers to invest in the protection that the MCV-4 vaccine offers, which is superior to that provided by the meningococcal polysaccharide vaccine that preceded it. In our increasingly cost-constrained healthcare environment, the eventual adoption rates of vaccines such as MCV-4—as well as others such as combined tetanus-diphtheria-acellular pertussis and human papillomavirus vaccines that are currently pending either licensure or review for possible recommendation—will likely depend on their economic costs and benefits, in addition to anticipated health effects and safety. Studies such as this will help multiple stakeholders weigh their options carefully.

Examining developmental trajectories in adolescent alcohol use using piecewise growth mixture modeling analysis.

This study examined issues of heterogeneity in multiple stage development as it corresponds to qualitatively different developmental trajectories in alcohol use during adolescence. Using a piecewise growth mixture modeling methodology, a two-piece growth model capturing growth trajectories in adolescent alcohol use from middle school (Grades 6 through 8) to high school (Grades 9 through 12) was examined (N = 179; 54% male). It was hypothesized that (1) two stages of alcohol use development with varying trajectories would exist in these data (the first corresponding to development during middle school, followed by a second stage of continuing growth during high school) and (2) there would be multiple growth trajectories (subgroups) of alcohol use in the stage-wise development, with varying effects in initial alcohol use and growth rates of alcohol use. Results indicated the tenability of the two-piece growth model of alcohol use with heterogeneity in the population comprising two distinct latent developmental trajectory classes. Class 1, with a high initial status of alcohol use at Grade 6, showed an upward increase in trajectory only during high school. Class 2, with a low initial status of alcohol use at Grade 6, showed a linear increase in middle school with a second growth spurt at high school entry and continuity in growth throughout the high school years. Analyses, incorporating time-invariate covariates, indicated varying influences of gender, early levels of deviant behavior, family structure (single vs two parent), peer encouragement and parent disapproval of alcohol use, and adolescent deviant behavior upon high school entry, on the two trajectory classes. Results also showed effects of the identified trajectories, with varying magnitudes, on later substance use in young adulthood, with Class 1 showing the strongest continuity in later substance use. Findings suggest heterogenous development of alcohol use in the adolescent population, associated with varying background and covariate influences. In addition, this heterogeneity is linked to alcohol and other substance use in young adulthood.