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Our findings suggest that declines in SUDs and some delinquent behaviors reflect a single trend related to an Externalizing-like trait. Identifying the factors contributing to this trend may facilitate continued improvement across a spectrum of adolescent risk behaviors.

Objective Little is known about recent trends in marijuana use disorders among adolescents in the United States. We analyzed trends in the past-year prevalence of DSM-IV marijuana use disorders among adolescents, both overall and conditioned on past-year marijuana use. Potential explanatory factors for trends in prevalence were explored. Method We assembled data from the adolescent samples of the 2002–2013 administrations of the National Survey on Drug Use and Health (N=216,852; ages 12–17). Main outcome measures were odds ratios describing the average annual change in prevalence and conditional prevalence of marijuana use disorders, estimated from models of marijuana use disorder as a function of year. Post hoc analyses incorporated measures of potentially explanatory risk and protective factors into the trend analyses. Results A decline in the past-year prevalence of marijuana use disorders was observed (OR=0.976 per year; 95% CI: 0.968, 0.984; p<.001). This was due to both a net decline in past-year prevalence of use and a decline in the conditional prevalence of marijuana use disorders. The trend in marijuana use disorders was accounted for by a decrease in the rate of conduct problems among adolescents (e.g., fighting, stealing). Conclusion Past-year prevalence of marijuana use disorders among US adolescents declined by an estimated 24% over the 2002–13 period. The decline may be related to trends toward lower rates of conduct problems. Identification of factors responsible for the reduction in conduct problems could inform interventions targeting both conduct problems and marijuana use disorders.

Most patients tested for C. difficile do not have clinically significant diarrhea and/or potential alternate causes for diarrhea. The prevalence of toxigenic C. difficile colonization among EIA- patients who met the IDSA/SHEA CDI guideline criteria for preferred patient population for C. difficile testing was 12%.

Background Uncomplicated urinary tract infections (UTIs) can often be diagnosed based solely on symptoms and should be treated with a short course of narrow spectrum antibiotics. However, clinicians often order urine analyses and prescribe long courses of broad spectrum antibiotics. Objective The objectives of our study are: 1) Understand how primary care providers and residents clinically approach UTIs and 2) to understand specific opportunities, based on provider type, to target future antibiotic stewardship interventions. Design and participants We conducted semi-structured qualitative interviews of community primary care providers (n = 15) and internal medicine residents (n = 15) in St. Louis, Missouri from 2018-2019. A 5point Likert scale was used to evaluate participant preferences for possible interventions. Interviews were transcribed, de-identified, and coded by two independent researchers using a combination inductive and deductive approach. Key results Several common themes emerged. Both providers and residents ordered urine tests to "confirm" presence of urinary tract infections. Antibiotic prescription decisions were often based on historical practice and anecdotal experience rather than local susceptibility data or clinical practice guidelines. Community providers were more comfortable treating patients over the phone than residents and tended to prescribe longer courses of antibiotics. Both community providers and residents voiced frustrations with guidelines being difficult to