1
|
Stanikzai MH, Wahidi MW. Bio-Psycho-Social Profile of People with Substance Use Disorders Treated in Locally Assigned Treatment Facilities in Kandahar, Afghanistan. Subst Abuse Rehabil 2023; 14:89-98. [PMID: 37576434 PMCID: PMC10417592 DOI: 10.2147/sar.s412821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/02/2023] [Indexed: 08/15/2023] Open
Abstract
Background Substance use and its associated bio-psycho-social problems are public health concerns with harmful individual and social consequences. Objective This study assessed the bio-psycho-social profile of people with substance use disorders (SUD) treated at locally assigned treatment facilities in Kandahar, Afghanistan. Methods We conducted this facility-based cross-sectional study among 621 substance users receiving care at three locally assigned treatment facilities in November-December 2022. We performed multiple linear regression to determine factors associated with psychological symptoms. Results The mean age of the participants was 34.41 (± 10.10 SD) years. The majority of our subjects (81.2%) perceived their physical health as very good or fair. More than two-thirds (73.4%) rated their social support as high. Of all participants, 541 (87.1%) had symptoms of depression, 569 (91.6%) of anxiety, and 442 (71.2%) of stress. The prevalence of severe depression, anxiety, and stress was 34.8%, 65.8%, and 27.3%, respectively. The multiple linear regression showed that several attributes of people with substance use disorders [ie, having a low level of education (β=0.12, p=<0.001), being unemployed (β=0.31, p=<0.001), having a low level of social support (β=-0.35, p=<0.001), had a pre-existing medical condition (β=-0.28, p=<0.001), and having lived abroad in the past ten years (β=0.10, p=0.001)] were significantly associated with higher DASS-21 total scores. Conclusion This study highlights the importance of providing bio-psycho-social support programs and implementing therapeutic interventions to help people with substance use disorders, particularly those who are most susceptible to higher levels of bio-psycho-social problems.
Collapse
Affiliation(s)
| | - Mohammad Wahid Wahidi
- Department of Public Health, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| |
Collapse
|
2
|
Goldstick JE, Bonar EE, Myers M, Bohnert ASB, Walton MA, Cunningham RM. Within-Person Predictors of Same-Day Alcohol and Nonmedical Prescription Drug Use Among Youth Presenting to an Urban Emergency Department. J Stud Alcohol Drugs 2022; 83:85-90. [PMID: 35040763 PMCID: PMC8819893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Simultaneous alcohol and nonmedical prescription drug use (NMPDU) increases acute risks (e.g., overdose) associated with each; understanding social, substance use, and mental health predictors of same-day use may suggest intervention targets. METHOD At an urban emergency department, research assistants recruited youth ages 14-24 reporting past-6-month substance use (n = 599; 58.8% male). Participants self-administered validated measures of alcohol consumption, cannabis use severity (quantity and consequences), mental health symptoms, and social influences at baseline and at four biannual follow-ups. In addition, participants completed Timeline Followback calendars that assessed same-day use of alcohol and prescription drugs. We used negative binomial regression with person-level fixed effects to isolate within-person predictor effects on same-day use frequency. RESULTS Between 6.0% (baseline) and 8.6% (6-month follow-up) of youth reported same-day alcohol use and NMPDU across follow-ups. Within-person increases in alcohol consumption, cannabis use severity, and depression and anxiety symptoms all corresponded to greater same-day alcohol and NMPDU frequency, with consistent findings across genders. Increased positive peer behaviors corresponded to decreased same-day use frequency among males but not females. Decreased parental support and increased delinquent peer exposures corresponded to greater same-day use frequency among females but not males. CONCLUSIONS Substance use and mental health symptom escalation are robust predictors of greater same-day use frequency, whereas the roles of social factors appear gender-specific. Interrupting worsening trajectories of substance use and mental health symptoms, and enhancing social support and reducing delinquent peer exposures, may reduce same-day use frequency.
Collapse
Affiliation(s)
- Jason E. Goldstick
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan,Injury Prevention Center, University of Michigan, Ann Arbor, Michigan,Correspondence may be sent to Jason E. Goldstick at the Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI 48109-2800, or via email at:
| | - Erin E. Bonar
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan,Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Matthew Myers
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan,Injury Prevention Center, University of Michigan, Ann Arbor, Michigan
| | - Amy S. B. Bohnert
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan,Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Maureen A. Walton
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan,Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Rebecca M. Cunningham
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan,Injury Prevention Center, University of Michigan, Ann Arbor, Michigan,Hurley Medical Center, Flint, Michigan
| |
Collapse
|
3
|
Goldstick JE, Lyons VH, Myers MG, Walton MA, Heinze JE, Cunningham RM. Within- and between-person associations with drug use disorder among adolescents and emerging adults presenting to an urban emergency department. Drug Alcohol Depend 2021; 221:108605. [PMID: 33631548 PMCID: PMC8026687 DOI: 10.1016/j.drugalcdep.2021.108605] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/15/2021] [Accepted: 02/04/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The distinction between within- and between-person associations with drug use disorder (DUD) has implications for intervention targets and content. We used longitudinal data from youth entering an urban emergency department (ED) to identify factors related to changes in DUD diagnosis, with particular emphasis on alcohol use. METHODS Research staff recruited youth age 14-24 (n = 599) reporting any past six-month drug use from a Level-1 ED; participants were assessed at baseline and four biannual follow-ups. Participants self-reported validated measurements of peer/parental behaviors, violence/crime exposure, drug use self-efficacy, and alcohol use. Research staff performed diagnostic interviews for DUD with nine substances, post-traumatic stress disorder (PTSD), and major depressive disorder (MDD). We used repeated measures logistic regression models with person-level covariate means, and person-mean-centered covariates, as separate variables, to separate within- and between-person covariate effects. RESULTS Among 2,630 assessments, 1,128 (42.9 %) were DUD diagnoses; 21.7 % were co-diagnoses with multiple drugs. Positive (aOR = 0.81, 95 %CI:[0.70, 0.94]) and negative (aOR = 1.73, 95 %CI:[1.45, 2.07]) peer behaviors related to DUD, primarily through between-person effects. Parental support (aOR = 0.92, 95 %CI:[0.83, 0.99]), community violence/crime (aOR = 1.28, 95 %CI:[1.14, 1.44]), PTSD/MDD diagnosis (aOR = 1.36, 95 %CI:[1.04, 1.79]), and alcohol use quantity (aOR = 1.06, 95 %CI:[1.02, 1.11]) were associated with DUD, showing primarily within-person effects. Other factors, such as interpersonal violence involvement (aOR = 1.47, 95 %CI:[1.21, 1.78]), showed both within- and between-person effects. CONCLUSIONS DUD is prevalent in this population, and within-person changes in DUD are predictable. Within-person effects suggest the importance of addressing escalating alcohol use, enhancing parental support, crime/violence exposure, and other mental health diagnoses as part of DUD intervention.
Collapse
Affiliation(s)
- Jason E Goldstick
- Department of Emergency Medicine, University of Michigan, E Medical Center Drive, Ann Arbor, MI, 48109, United States; Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, United States; Department of Health Behavior and Health Education, University of Michigan School of Public Health, 109 South Observatory Street, Ann Arbor, MI, 48109-2019, United States.
| | - Vivian H Lyons
- Harborview Injury Prevention and Research Center, University of Washington, Gerberding Hall G80 Box 351202, Seattle, WA, 98195, United States
| | - Matthew G Myers
- Department of Emergency Medicine, University of Michigan, E Medical Center Drive, Ann Arbor, MI, 48109, United States; Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, United States
| | - Maureen A Walton
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, United States; Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI, 48109, United States
| | - Justin E Heinze
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, United States; Department of Health Behavior and Health Education, University of Michigan School of Public Health, 109 South Observatory Street, Ann Arbor, MI, 48109-2019, United States; Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, United States
| | - Rebecca M Cunningham
- Department of Emergency Medicine, University of Michigan, E Medical Center Drive, Ann Arbor, MI, 48109, United States; Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, United States; Department of Health Behavior and Health Education, University of Michigan School of Public Health, 109 South Observatory Street, Ann Arbor, MI, 48109-2019, United States; Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, United States; Hurley Medical Center, Department of Emergency Medicine, 1 Hurley Plaza, Flint, MI, 48503, United States
| |
Collapse
|
4
|
Goldstick JE, Walton MA, Bohnert ASB, Heinze JE, Cunningham RM. Predictors of alcohol use transitions among drug-using youth presenting to an urban emergency department. PLoS One 2019; 14:e0227140. [PMID: 31891632 PMCID: PMC6938309 DOI: 10.1371/journal.pone.0227140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/12/2019] [Indexed: 11/19/2022] Open
Abstract
Background Precipitants of alcohol use transitions can differ from generalized risk factors. We extend prior research by predicting transitions in alcohol use disorder (AUD) during adolescence and emerging adulthood. Methods From 12/2009-9/2011, research assistants recruited 599 drug-using youth age 14–24 from Level-1 Emergency Department in Flint, Michigan. Youth were assessed at baseline and four biannual follow-ups, including a MINI Neuropsychiatric interview to diagnose AUD (abuse/dependence). We modeled AUD transitions using continuous time Markov Chains with transition probabilities modulated by validated measures of demographics, anxiety/depression symptoms, cannabis use, peer drinking, parental drinking, and violence exposure. Separate models were fit for underage (<21) and those of legal drinking age. Results We observed 2,024 pairs of consecutive AUD states, including 264 transitions (119 No-AUD→AUD; 145 AUD→No-AUD); 194 (32.4%) individuals were diagnosed with AUD at ≥1 assessment. Among age 14–20, peer drinking increased AUD onset (No-AUD→AUD transition) rates (Hazard ratio—HR = 1.70; 95%CI: [1.13,2.54]), parental drinking lowered AUD remission (AUD→No-AUD transition) rates (HR = 0.53; 95%CI: [0.29,0.97]), and cannabis use severity both hastened AUD onset (HR = 1.18; 95%CI: [1.06,1.32]) and slowed AUD remission (HR = 0.85; 95%CI: [0.76,0.95]). Among age 21–24, anxiety/depression symptoms both increased AUD onset rates (HR = 1.35; 95%CI: [1.13,1.60]) and decreased AUD remission rates (HR = 0.74; 95%CI: [0.63,0.88]). Friend drinking hastened AUD onset (HR = 1.18, 95%CI: [1.05,1.33]), and slowed AUD remission (HR = 0.84; 95%CI: [0.75,0.95]). Community violence exposure slowed AUD remission (HR = 0.69, 95%CI: [0.48,0.99]). In both age groups, males had >2x the AUD onset rate of females, but there were no sex differences in AUD remission rates. Limitations, most notably that this study occurred at a single site, are discussed. Conclusions Social influences broadly predicted AUD transitions in both age groups. Transitions among younger youth were predicted by cannabis use, while those among older youth were predicted more by internalizing symptoms and stress exposure (e.g., community violence). Our results suggest age-specific AUD etiology, and contrasts between prevention and treatment strategies.
Collapse
Affiliation(s)
- Jason E. Goldstick
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States of America
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States of America
- * E-mail:
| | - Maureen A. Walton
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States of America
- Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, MI, United States of America
| | - Amy S. B. Bohnert
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States of America
- Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, MI, United States of America
| | - Justin E. Heinze
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States of America
- Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
| | - Rebecca M. Cunningham
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States of America
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States of America
- Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
- Hurley Medical Center, Department of Emergency Medicine, Flint, MI, United States of America
| |
Collapse
|
5
|
Dora-Laskey AD, Goldstick JE, Buckley L, Bonar EE, Zimmerman MA, Walton MA, Cunningham RM, Carter PM. Trajectories of Driving after Drinking among Marijuana-Using Youth in the Emergency Department: Substance Use, Mental Health, and Peer and Parental Influences. Subst Use Misuse 2019; 55:175-187. [PMID: 31502499 PMCID: PMC6980673 DOI: 10.1080/10826084.2019.1660675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: The psychosocial correlates and longitudinal trajectories of driving after drinking (DAD) among youth remain understudied in at-risk populations. Objectives: We investigated the relationships of DAD trajectories and negative peer and parental influences, substance use, and mental health among predominantly marijuana-using youth seeking emergency department (ED) treatment. Methods: Data were from a 2-year prospective cohort study of drug-using patients (97.4% used marijuana) ages 14-24 seeking ED care for assault injury, or as part of a non-assaulted comparison group. Validated surveys measured DAD behaviors and correlates at baseline, 6, 12, 18, and 24 months. Latent class growth analysis identified characteristic DAD trajectory groups; baseline predictors were analyzed descriptively and using multinomial logistic regression. Results: Three DAD trajectory groups were identified among driving-age youth (n = 580): no DAD (NDAD; 55.2%), low-steady (LDAD; 29.0%), and high-declining (HDAD; 15.9%). In unadjusted analyses, HDAD youth were older, but otherwise similar to other groups demographically. Compared to NDAD, LDAD and HDAD group members had higher rates of drug and alcohol use disorders (p < .001). Further, HDAD group members had higher rates of anxiety symptoms and were more likely to be diagnosed with PTSD or depression than NDAD or LDAD youth (p < .05). Negative peer and parent influences were significantly higher in progressively more severe trajectory groups (p < .01). Adjusted effects from the multinomial model were analogous for peer and parental influences and substance use disorders, but not mental health. Conclusion: DAD is strongly associated with negative social influences and substance use disorders among marijuana-using youth, reinforcing their importance when developing interventions.
Collapse
Affiliation(s)
- Aaron D Dora-Laskey
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
- University of Michigan Addiction Center, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
- Hurley Medical Center, Flint, Michigan, USA
| | - Jason E Goldstick
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
| | - Lisa Buckley
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
- The University of Queensland, St. Lucia, Queensland, Australia
| | - Erin E Bonar
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
- University of Michigan Addiction Center, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Marc A Zimmerman
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
- University of Michigan Youth Violence Prevention Center, Ann Arbor, Michigan, USA
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan, USA
| | - Maureen A Walton
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
- University of Michigan Addiction Center, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Rebecca M Cunningham
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
- Hurley Medical Center, Flint, Michigan, USA
- University of Michigan Youth Violence Prevention Center, Ann Arbor, Michigan, USA
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan, USA
| | - Patrick M Carter
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
- University of Michigan Youth Violence Prevention Center, Ann Arbor, Michigan, USA
| |
Collapse
|
6
|
Goldstick JE, Carter PM, Heinze JE, Walton MA, Zimmerman M, Cunningham RM. Predictors of transitions in firearm assault behavior among drug-using youth presenting to an urban emergency department. J Behav Med 2019; 42:635-645. [PMID: 31367929 PMCID: PMC6999855 DOI: 10.1007/s10865-019-00021-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 02/14/2019] [Indexed: 12/14/2022]
Abstract
Risk and protective factors for firearm assault (FA) have been established, but little is known about factor preceding transitions in FA behavior. We modeled covariate effects on individuals' transitions in FA behavior (Yes/No) using inhomogeneous, continuous-time, Markov Chains. 3287 assessments were made across five initial biannual follow-ups, and two additional biannual follow-ups (an average of 2.2 years later) from a follow-on study; 2687 pairs of transitions were observed (2414 No-FA → No-FA; 89 No-FA → FA; 121 FA → No-FA; 63 FA → FA). Non-firearm peer violence (HR = 2.31, 95% CI [1.28,4.21]), firearm victimization (HR = 2.57, 95% CI [1.31,5.04]), and marijuana ASSIST sum (HR = 1.27, 95% CI [1.05,1.54]) all preceded transitions into FA, but not transitions out of FA. Delinquent peer associations both hastened transitions into FA (HR = 1.19, 95% CI [1.00,1.40]) and slowed transitions out of FA (HR = 0.84, 95% CI:[0.72,1.00]), with analogous findings regarding attitudes favoring retaliation. Efforts to prevent FA initiation should focus on those currently reporting firearm violence victimization, and on factors indicating an escalating delinquency trajectory (e.g. non-firearm violence, substance use), while programs focusing on peer influences and social norms may be effective at preventing FA regardless of current FA status.
Collapse
Affiliation(s)
- Jason E Goldstick
- Department of Emergency Medicine, University of Michigan, E Medical Center Drive, Ann Arbor, MI, 48109, USA.
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, USA.
| | - Patrick M Carter
- Department of Emergency Medicine, University of Michigan, E Medical Center Drive, Ann Arbor, MI, 48109, USA
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, USA
- Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Justin E Heinze
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, USA
- Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 109 South Observatory Street, Ann Arbor, MI, 48109-2019, USA
| | - Maureen A Walton
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, USA
- Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
- University of Michigan Addiction Center, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Marc Zimmerman
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, USA
- Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 109 South Observatory Street, Ann Arbor, MI, 48109-2019, USA
| | - Rebecca M Cunningham
- Department of Emergency Medicine, University of Michigan, E Medical Center Drive, Ann Arbor, MI, 48109, USA
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, USA
- Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 109 South Observatory Street, Ann Arbor, MI, 48109-2019, USA
- Department of Emergency Medicine, Hurley Medical Center, 1 Hurley Plaza, Flint, MI, 48503, USA
| |
Collapse
|
7
|
Psychiatric Disorders and Alcohol Consumption Among Low-Income African Americans:Gender Differences. Brain Sci 2019; 9:brainsci9040086. [PMID: 31003459 PMCID: PMC6523251 DOI: 10.3390/brainsci9040086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 01/18/2023] Open
Abstract
Background: Although cooccurrence of nonsubstance use disorders (non-SUDs) and substance use is well-established in the literature, most of what we know in this regard is derived from studies that have recruited predominantly White sample populations. As a result, there is a gap in knowledge on this link among low-income African Americans (AAs). There is also a need to understand how low-income AA men and women differ in these associations. Objective: To study whether there is an association between number of non-SUDs and amount of alcohol consumption by AA adults, and whether this association varies between AA men and women. Methods: This cross-sectional study recruited a nonrandom sample of 150 AA adults with non-SUDs (i.e., major depression, bipolar disorders, obsessive–compulsive disorder, paranoid disorder, panic disorder, posttraumatic stress disorder (PTSD), and schizoaffective disorder). The independent variable was the number of non-SUDs. The dependent variable was the amount of alcohol consumption. Age, socioeconomic status (educational attainment and household income), and self-rated health were covariates. Gender was the moderator. Linear regression models were used to analyze the data. Results: A higher number of non-SUDs was not associated with a higher amount of alcohol use in the pooled sample of AA adults. We, however, found a significant interaction between gender and number of non-SUDs on the amount of alcohol use, suggesting a stronger effect of non-SUDs on alcohol consumption in AA men than in AA women. Gender-stratified linear regression models showed a positive association between number of non-SUDs and amount of alcohol consumption in AA men but not in AA women. Conclusion: Non-SUDs impact alcohol use of AA men but not women. Future research should test whether AA men may have a higher tendency to turn to alcohol to regulate their emotions and cope with psychological pain due to multiple non-SUDs. The results also suggest that integration of services for SUDs and non-SUDs may be more relevant to provision of mental health services for AA men than AA women.
Collapse
|
8
|
Roche JS, Clery MJ, Carter PM, Dora-Laskey A, Walton MA, Ngo QM, Cunningham RM. Tracking Assault-injured, Drug-using Youth in Longitudinal Research: Follow-up Methods. Acad Emerg Med 2018; 25:1204-1215. [PMID: 30381864 PMCID: PMC6494734 DOI: 10.1111/acem.13495] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/14/2018] [Accepted: 05/31/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Violence is one of the leading causes of death among youth ages 14 to 24. Hospital- and emergency department (ED)-based violence prevention programs are increasingly becoming a critical part of public health efforts; however, evaluation of prevention efforts is needed to create evidence-based best practices. Retention of study participants is key to evaluations, although little literature exists regarding optimizing follow-up methods for violently injured youth. This study aims to describe the methods for retention in youth violence studies and the characteristics of hard-to-reach participants. METHODS The Flint Youth Injury (FYI) Study is a prospective study following a cohort of assault-injured, drug-using youth recruited in an urban ED, and a comparison population of drug-using youth seeking medical or non-violence-related injury care. Validated survey instruments were administered at baseline and four follow-up time points (6, 12, 18, and 24 months). Follow-up contacts used a variety of strategies and all attempts were coded by type and level of success. Regression analysis was used to predict contact difficulty and follow-up interview completion at 24 months. RESULTS A total of 599 patients (ages 14-24) were recruited from the ED (mean ± SD age = 20.1 ± 2.4 years, 41.2% female, 58.2% African American), with follow-up rates at 6, 12, 18, and 24 months of 85.3%, 83.7% 84.2%, and 85.3%, respectively. Participant contact efforts ranged from two to 53 times per follow-up time frame to complete a follow-up appointment, and more than 20% of appointments were completed off site at community locations (e.g., participants' homes, jail/prison). Participants who were younger (p < 0.05) and female (p < 0.01) were more likely to complete their 24-month follow-up interview. Participants who sought care in the ED for assault injury (p < 0.05) and had a substance use disorder (p < 0.01) at baseline required fewer contact attempts to complete their 24-month follow-up, while participants reporting a fight within the immediate 3 months before their 24-month follow-up (p < 0.01) required more intensive contact efforts. CONCLUSIONS The FYI study demonstrated that achieving high follow-up rates for a difficult-to-track, violently-injured ED population is feasible through the use of established contact strategies and a variety of interview locations. Results have implications for follow-up strategies planned as part of other violence prevention studies.
Collapse
Affiliation(s)
- Jessica S. Roche
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48105,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan, 48109
| | - Michael J. Clery
- Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48105
| | - Patrick M. Carter
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48105,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan, 48109
| | - Aaron Dora-Laskey
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48105,Hurley Medical Center, Department of Emergency Medicine, 1 Hurley Plaza, Flint, Michigan, 48503
| | - Maureen A. Walton
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan, 48109,University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Rd, Ann Arbor, Michigan 48109
| | - Quyen M. Ngo
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Institute for Research on Women and Gender, University of Michigan, 1136 Lane Hall, 204 S. State Street, Ann Arbor, MI 48109-1290
| | - Rebecca M. Cunningham
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48105,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan, 48109,Hurley Medical Center, Department of Emergency Medicine, 1 Hurley Plaza, Flint, Michigan, 48503,Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, Michigan, 48109
| |
Collapse
|