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Lewis MA, Litt DM, Fairlie AM, Kilmer JR, Kannard E, Resendiz R, Walker T. Investigating Why and How Young Adults Utilize Protective Behavioral Strategies for Alcohol and Marijuana Use: Protocol for Developing a Randomized Controlled Trial (Preprint). JMIR Res Protoc 2022; 11:e37106. [PMID: 35438642 PMCID: PMC9066324 DOI: 10.2196/37106] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Melissa A Lewis
- Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Dana M Litt
- Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Anne M Fairlie
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Jason R Kilmer
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Emma Kannard
- Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Raul Resendiz
- Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Travis Walker
- Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, TX, United States
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The Consumption of Alcoholic Beverages and the Prevalence of Cardiovascular Diseases in Men and Women: A Cross-Sectional Study. Nutrients 2019; 11:nu11061318. [PMID: 31212846 PMCID: PMC6628509 DOI: 10.3390/nu11061318] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/08/2019] [Accepted: 06/11/2019] [Indexed: 12/11/2022] Open
Abstract
Associations between alcohol consumption and the prevalence of cardiovascular diseases have been the subject of several studies for a long time; however, the presence and nature of any associations still remain unclear. The aim of the study was to analyze the associations between the consumption of alcoholic beverages and the prevalence of cardiovascular diseases in men and women. The data of 12,285 individuals aged 37-66 were used in the analysis. Multiple logistic regression models were utilized to estimate odds ratios and confidence intervals. The multivariable models included several potential confounders including age, education, marital status, body mass index (BMI), physical activity, smoking, coffee consumption, and statin use. The analyses were performed separately for men and women. In the model adjusted for confounders, the consumption from 0.1 to 10.0 g of alcohol/day was related to a lower risk of coronary disease and stroke (p < 0.05), and the consumption from 0.1 to 15.0 g/day was related to a lower risk of hypertension in women (p < 0.05). In men, in the adjusted model, there were no associations between alcohol consumption and the occurrence of hypertension or stroke. The risk of circulatory failure was significantly lower in the group in which participants drank more than 20.0 g of alcohol/day (p < 0.05) compared to nondrinkers. The risk of coronary disease was lower in drinkers at every level of alcohol consumption (p < 0.05) compared to nondrinkers. Alcohol consumption was related to a lower prevalence of cardiovascular diseases (CVD), both in men and women.
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Vergés A, Ellingson JM, Schroder SA, Slutske WS, Sher KJ. Intensity of Daily Drinking and Its Relation to Alcohol Use Disorders. Alcohol Clin Exp Res 2018; 42:1674-1683. [PMID: 29894003 PMCID: PMC6120766 DOI: 10.1111/acer.13812] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/08/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Daily drinking is an important public health concern and informative for evaluating diagnostic classification. In particular, daily binge drinkers might be considered as the prototype of some forms of alcoholism, as this drinking pattern may drive many alcohol use disorder (AUD) symptoms. However, daily drinking potentially captures a wide range of drinkers, including light-moderate daily drinkers who exhibit presumed control over their drinking behavior and might benefit from salutary effects on health. This study examined the heterogeneity of daily drinkers in detail. METHODS Data from the 2 waves of the National Epidemiologic Survey on Alcohol and Related Conditions were used. Participants who reported drinking "every day" during the last 12 months were classified as daily drinkers. A series of regression and logistic regression analyses were conducted to investigate the association between daily drinking and various outcomes. RESULTS Daily drinkers were found to vary considerably from each other with respect to diagnostic status, level of consumption, demographic composition, and a range of drinking and health correlates. Further, a substantial number of daily binge drinkers were not diagnosed with AUD under the DSM-IV or DSM-5, although in most groups, the DSM-5 criteria diagnosed a larger percentage of participants. CONCLUSIONS Daily drinkers represent a highly heterogeneous group, and the correlates of daily drinking depend on the usual quantity of daily drinks and the frequency of alcohol-related problems in a given sample. Moreover, AUD, defined both according to DSM-IV and DSM-5, did not capture more than 68% of daily binge drinkers. Given that daily binge drinking is an extremely high threshold for use, this finding may present a challenge for our current classification system.
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Affiliation(s)
- Alvaro Vergés
- Pontificia Universidad Católica de Chile, Escuela de Psicología
| | | | | | - Wendy S. Slutske
- University of Missouri-Columbia, Department of Psychological Sciences
| | - Kenneth J. Sher
- University of Missouri-Columbia, Department of Psychological Sciences
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Abstract
Older people consume less alcohol than any other adult age group. However, in recent years survey data on alcohol consumption in the United Kingdom have shown that while younger age groups have experienced a decline in alcohol consumption, drinking behaviours among the elderly have not reduced in the same way. This paper uses data from the English Longitudinal Study of Ageing to analyse both the frequency and quantity of older adult's alcohol consumption using a lifecourse approach over a ten-year period. Overall drinking declined over time and the analysis examined how socio-economic characteristics, partnership, employment and health statuses were associated with differences in drinking behaviours and how these changed over time. Higher wealth and level of education were associated with drinking more and drinking more frequently for men and women. Poorer self-rated health was associated with less frequent consumption and older people with poor and deteriorating health reported a steeper decline in the frequency of alcohol consumption over time. Men who were not in a partnership drank more than other men. For women, loss of a partner was associated with a steeper decline in drinking behaviours. These findings have implications for programmes to promote responsible drinking among older adults as they suggest that, for the most part, characteristics associated with sustaining wellbeing in later life are also linked to consuming more alcohol.
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Graham K, Cheng J, Bernards S, Wells S, Rehm J, Kurdyak P. How Much Do Mental Health and Substance Use/Addiction Affect Use of General Medical Services? Extent of Use, Reason for Use, and Associated Costs. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:48-56. [PMID: 27543084 PMCID: PMC5302109 DOI: 10.1177/0706743716664884] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To measure service use and costs associated with health care for patients with mental health (MH) and substance use/addiction (SA) problems. METHODS A 5-year cross-sectional study (2007-2012) of administrative health care data was conducted (average annual sample size = 123,235 adults aged >18 years who had a valid Ontario health care number and used at least 1 service during the year; 55% female). We assessed average annual use of primary care, emergency departments and hospitals, and overall health care costs for patients identified as having MH only, SA only, co-occurring MH and SA problems (MH+SA), and no MH and/or SA (MH/SA) problems. Total visits/admissions and total non-MH/SA visits (i.e., excluding MH/SA visits) were regressed separately on MH, SA, and MH+SA cases compared to non-MH/SA cases using the 2011-2012 sample ( N = 123,331), controlling for age and sex. RESULTS Compared to non-MH/SA patients, MH/SA patients were significantly ( P < 0.001) more likely to visit primary care physicians (1.82 times as many visits for MH-only patients, 4.24 for SA, and 5.59 for MH+SA), use emergency departments (odds, 1.53 [MH], 3.79 [SA], 5.94 [MH+SA]), and be hospitalized (odds, 1.59 [MH], 4.10 [SA], 7.82 [MH+SA]). MH/SA patients were also significantly more likely than non-MH/SA patients to have non-MH/SA-related visits and accounted for 20% of the sample but over 30% of health care costs. CONCLUSIONS MH and SA are core issues for all health care settings. MH/SA patients use more services overall and for non-MH/SA issues, with especially high use and costs for MH+SA patients.
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Affiliation(s)
- Kathryn Graham
- 1 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto/London, Ontario.,2 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario.,3 School of Psychology, Deakin University, Geelong, Australia.,4 National Drug Research Institute, Curtin University, Perth, Australia
| | - Joyce Cheng
- 1 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto/London, Ontario
| | - Sharon Bernards
- 1 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto/London, Ontario
| | - Samantha Wells
- 1 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto/London, Ontario.,2 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario.,3 School of Psychology, Deakin University, Geelong, Australia.,5 Department of Epidemiology, Western University, London, Ontario
| | - Jürgen Rehm
- 1 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto/London, Ontario.,2 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario.,3 School of Psychology, Deakin University, Geelong, Australia.,6 Klinische Psychologie & Psychotherapie, Technische Universität Dresden, Dresden, Germany.,7 Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Paul Kurdyak
- 1 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto/London, Ontario.,7 Department of Psychiatry, University of Toronto, Toronto, Ontario.,8 Institute for Clinical Evaluative Sciences, Toronto, Ontario
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Stein MD, Risi MM, Flori JN, Conti MT, Anderson BJ, Bailey GL. Gender Differences in the Life Concerns of Persons Seeking Alcohol Detoxification. J Subst Abuse Treat 2016; 63:34-8. [PMID: 26810131 DOI: 10.1016/j.jsat.2015.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 12/07/2015] [Accepted: 12/08/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study explored the life concerns of persons seeking alcohol detoxification, a group with multiple life and psychosocial challenges. Gender may be an important contributor to the particular life concerns of persons with alcohol use disorders. METHODS Using a 32-item, previously-validated life concerns survey that captures ten conceptual domains, we interviewed persons entering inpatient alcohol detoxification asking them to rate their level of concern about health and welfare items. RESULTS Participants (n=189) were 27% female, with a mean age of 43.5 years. Overall, concern about alcohol problems was perceived as the most serious, followed by mental health, cigarette smoking, financial, and relationship problems. Men were significantly more concerned than women about six of the ten domains including money, drug use, transmissible diseases, and physical illness. CONCLUSIONS Recognition of the daily worries of persons seeking inpatient alcohol detoxification persons could allow providers to better tailor their services to the context of their patients' lives. Focusing on pressing life concerns such as mental health, financial, relationship problems, and other drug use may influence detoxification services and aftercare treatment choices.
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Affiliation(s)
- Michael D Stein
- General Medicine Research Unit, Butler Hospital, Providence, RI 02906; Warren Alpert Medical School of Brown University, Providence, RI 02912.
| | - Megan M Risi
- General Medicine Research Unit, Butler Hospital, Providence, RI 02906
| | - Jessica N Flori
- General Medicine Research Unit, Butler Hospital, Providence, RI 02906
| | - Micah T Conti
- General Medicine Research Unit, Butler Hospital, Providence, RI 02906
| | | | - Genie L Bailey
- Warren Alpert Medical School of Brown University, Providence, RI 02912; Stanley Street Treatment and Resources, Inc., Fall River, MA 02720
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Erol A, Karpyak VM. Sex and gender-related differences in alcohol use and its consequences: Contemporary knowledge and future research considerations. Drug Alcohol Depend 2015; 156:1-13. [PMID: 26371405 DOI: 10.1016/j.drugalcdep.2015.08.023] [Citation(s) in RCA: 543] [Impact Index Per Article: 60.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 08/12/2015] [Accepted: 08/13/2015] [Indexed: 01/16/2023]
Abstract
AIMS To review the contemporary evidence reflecting male/female differences in alcohol use and its consequences along with the biological (sex-related) and psycho-socio-cultural (gender-related) factors associated with those differences. METHODS MEDLINE, PubMed, Web of Science, SCOPUS, PsycINFO, and CINAHL databases were searched for relevant publications, which were subsequently screened for the presence/absence of pre-specified criteria for high quality evidence. RESULTS Compared to men, more women are lifetime abstainers, drink less, and are less likely to engage in problem drinking, develop alcohol-related disorders or alcohol withdrawal symptoms. However, women drinking excessively develop more medical problems. Biological (sex-related) factors, including differences in alcohol pharmacokinetics as well as its effect on brain function and the levels of sex hormones may contribute to some of those differences. In addition, differences in alcohol effects on behavior may also be driven by psycho-socio-cultural (gender-related) factors. This is evident by variation in the magnitude of differences in alcohol use between countries, decreasing difference in the rates of alcohol consumption in recent generations and other findings. Evidence indicates that both sex and gender-related factors are interacting with alcohol use in complex manner, which differentially impacts the risk for development of the behavioral or medical problems and alcohol use disorders in men and women. CONCLUSIONS Discovery of the mechanisms underlying biological (sex-related) as well as psycho-socio-cultural (gender-related) differences in alcohol use and related disorders is needed for development of personalized recommendations for prevention and treatment of alcohol use disorders and related problems in men and women.
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Affiliation(s)
- Almila Erol
- Department of Psychiatry, Ataturk Education and Research Hospital, Basinsitesi, Izmir 35250, Turkey; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, 200 First Stret SW, Rochester, MN, 55905, USA.
| | - Victor M Karpyak
- Department of Psychiatry, Ataturk Education and Research Hospital, Basinsitesi, Izmir 35250, Turkey.
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Kim K, Kim JS. The association between alcohol consumption patterns and health-related quality of life in a nationally representative sample of South Korean adults. PLoS One 2015; 10:e0119245. [PMID: 25786249 PMCID: PMC4365041 DOI: 10.1371/journal.pone.0119245] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 01/19/2015] [Indexed: 11/24/2022] Open
Abstract
This study examined the relationship between alcohol consumption and health-related quality of life (HRQOL) in a nationally representative sample of middle-aged to older South Koreans. Data collected from 3,408 men and 3,361 women aged ≥ 40 years were obtained from the 2010 and 2011 Korea National Health and Nutrition Examination Survey. Based on the World Health Organization guidelines, the participants were categorized into zones I (0–7), II (8–15), III (16–19), or IV (20–40) according to their Alcohol Use Disorders Identification Test (AUDIT) scores, with a higher zone indicating a higher level of alcohol consumption. Data collected from the AUDIT and EuroQol 5-Dimension (EQ-5D) test were subjected to multiple regression analysis in order to examine the relationship between alcohol consumption patterns and health-related quality of life, and to identify intersex and interzone differences. Significant intersex differences were found for the mean total AUDIT and EQ-5D scores and the proportion of participants rating their pain/discomfort and impairment in mobility and usual activities as “moderate” or “severe” (p < 0.001). The analysis of the EQ-5D scores by alcohol consumption pattern and sex suggested the existence of an inverted U-shaped relationship between the total AUDIT and EQ-5D scores. The HRQOL of moderate alcohol drinkers was higher than that of non-drinkers and heavy drinkers. The results of this study will be valuable in designing appropriate interventions to increase the HRQOL impaired by the harmful use of alcohol, in comparing HRQOL among different countries, and in implementing alcohol-related health projects.
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Affiliation(s)
- KyungHee Kim
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Ji-Su Kim
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
- * E-mail:
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Szymczyk I, Wojtyna E, Lukas W, Kępa J, Pawlikowska T. How does gender influence the recognition of cardiovascular risk and adherence to self-care recommendations?: A study in Polish primary care. BMC FAMILY PRACTICE 2013; 14:165. [PMID: 24175983 PMCID: PMC3818445 DOI: 10.1186/1471-2296-14-165] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Accepted: 10/29/2013] [Indexed: 11/24/2022]
Abstract
Background Studies have shown a correlation between gender and an ability to change lifestyle to reduce the risk of disease. However, the results of these studies are ambiguous, especially where a healthy lifestyle is concerned. Additionally, health behaviors are strongly modified by culture and the environment. Psychological factors also substantially affect engagement with disease-related lifestyle interventions. This study aimed to examine whether there are differences between men and women in the frequency of health care behavior for the purpose of reducing cardiovascular risk (CVR), as well as cognitive appraisal of this type of risk. We also aimed to identify the psychological predictors of engaging in recommended behavior for reducing the risk of cardiovascular disease after providing information about this risk in men and women. Methods A total of 134 consecutive eligible patients in a family practice entered a longitudinal study. At initial consultation, the individual’s CVR and associated health burden was examined, and preventive measures were recommended by the physician. Self-care behavior, cognitive appraisal of risk, and coping styles were then assessed using psychological questionnaires. Six months after the initial data collection, the frequency of subjects’ self-care behavior was examined. Results We found an increase in health care behavior after providing information regarding the rate of CVR in both sexes; this increase was greater for women than for men. Women followed self-care guidelines more often than men, particularly for preventive measures and dietary advice. Women were more inclined to recognize their CVR as a challenge. Coping style, cognitive appraisal, age, level of health behaviors at baseline and CVR values accounted for 48% of the variance in adherence to self-care guidelines in women and it was 52% in men. In women, total risk of CVD values were most important, while in men, cognitive appraisal of harm/loss was most important. Conclusions Different predictors of acquisition of health behavior are encountered in men and women. Our results suggest that gender-adjusted motivation models influencing the recognition process need to be considered to optimize compliance in patients with CVR.
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Affiliation(s)
| | - Ewa Wojtyna
- Institute of Psychology, University of Silesia in Katowice, ul, Grażyńskiego 53, 40-126 Katowice, Poland.
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Green CA, Johnson KM, Yarborough BJH. Seeking, delaying, and avoiding routine health care services: patient perspectives. Am J Health Promot 2013; 28:286-93. [PMID: 23971522 DOI: 10.4278/ajhp.120702-qual-318] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To explore/identify patient perspectives regarding seeking, delaying, and avoiding health care services, particularly barriers and facilitators. DESIGN Face-to-face interviews with health plan survey respondents. SETTING An integrated health plan providing comprehensive care to 480,000 people in Oregon and Washington. PARTICIPANTS Willing respondents randomly selected to maximize heterogeneity within the following strata: gender, health care utilization, and self-reported alcohol consumption (indicator of health practices). Participants were 75 men and 75 women (150 total), 21 to 64 years old, with ≥12 months of health plan membership. METHOD Participants were recruited by letter (52.5% agreed). Data collection stopped when planned interviews were completed; saturation (the point at which additional interviews were not producing novel information) was achieved for key study questions. Semi-structured interviews were recorded, transcribed, and coded. Reviews of codes related to care seeking and feelings/attitudes about providers produced common themes. RESULTS Facilitators of care seeking included welcoming staff, collaborative relationships with providers, and education about the value of preventive care. Barriers included costs, time needed for appointments, and cumbersome processes. Some participants delayed procedures, some avoided care until absolutely necessary, others framed care as routinely necessary. CONCLUSION Increasing comfort, improving appointment and visit-related processes, having positive patient-physician relationships, and enhancing communication and clinician-provided education may facilitate appropriate use of preventive services. Further research is needed with larger, representative samples to evaluate findings.
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Abstract
BACKGROUND Little is known about the medical care resources devoted to diagnosing and treating cancer-related symptoms before a definitive cancer diagnosis. Previous research using SEER-Medicare data to measure incremental costs and utilization associated with cancer started with the date of diagnosis. We hypothesized that health care use increases before diagnosis of a new primary cancer. METHODS We used a longitudinal case-control design to estimate incremental medical care utilization rates. Cases were 121,293 persons enrolled between January 2000 and December 2008 with ≥1 primary cancers. We selected 522,839 controls randomly from among all health plan members who had no tumor registry evidence of cancer before January 2009, and we frequency matched controls to cancer cases on a 5:1 ratio by age group, sex, and having health plan eligibility in the year of diagnosis of the index cancer case. Utilization data were extracted for all cases and controls for the period 2000 to 2008 from standardized distributed data warehouses. To determine when and the extent to which patterns of medical care use change preceding a cancer diagnosis, we compute hospitalization rates, hospital days, emergency department visits, same-day surgical procedures, ambulatory medical office visits, imaging procedures, laboratory tests, and ambulatory prescription dispensings per 1000 persons per month within integrated delivery systems. RESULTS One- to 3-fold increases in monthly utilization rates were observed during the 3 to 5 months before a cancer diagnosis, compared with matched noncancer control groups. This pattern was consistent for both aged and nonaged cancer patients. Aged cancer patients had higher utilization rates than nonaged cancer patients throughout the year before a cancer diagnosis. CONCLUSIONS The prediagnosis phase is a resource-intensive component of cancer care episodes and should be included in cost of cancer estimates. More research is needed to determine whether reliable prognostic markers can be identified as the start of a cancer episode before a pathology-based diagnosis.
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Webb JR, Hirsch JK, Toussaint L. Forgiveness and Alcohol Problems: A Review of the Literature and a Call for Intervention-Based Research. ALCOHOLISM TREATMENT QUARTERLY 2011. [DOI: 10.1080/07347324.2011.585922] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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The Impact of Weight Gain or Loss on Health Care Costs for Employees at the Johnson & Johnson Family of Companies. J Occup Environ Med 2011; 53:8-16. [DOI: 10.1097/jom.0b013e31820451fd] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Green CA, Polen MR, Leo MC, Perrin NA, Anderson BM, Weisner CM. Drinking Patterns, Gender and Health II: Predictors of Preventive Service Use. ADDICTION RESEARCH & THEORY 2010; 18:143-159. [PMID: 23814545 PMCID: PMC3694481 DOI: 10.3109/16066350903398494] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Chronic diseases and injuries are elevated among people with substance use problems/dependence, yet heavier drinkers use fewer routine and preventive health services than non-drinkers and moderate drinkers, while former drinkers and abstainers use more than moderate drinkers. Researchers hypothesize that drinking clusters with attitudes and practices that produce better health among moderate drinkers and that heavy drinkers avoid doctors until becoming ill, subsequently quitting and using more services. Gender differences in alcohol consumption, health-related attitudes, practices, and prevention-services use may affect these relationships. METHODS A stratified random sample of health-plan members (7884; 2995 males, 4889 females) completed a mail survey that was linked to 24 months of health-plan records. Data were used to examine relationships between alcohol use, gender, health-related attitudes/practices, health, and prevention-service use. RESULTS Controlling for attitudes, practices, and health, female lifelong abstainers and former drinkers were less likely to have mammograms; individuals with alcohol use disorders and positive AUDIT scores were less likely to obtain influenza vaccinations. AUDIT-positive women were less likely to undergo colorectal screening than AUDIT-positive men. Consistent predictors of prevention-services use were: self-report of having a primary care provider (positive); disliking visiting the doctor (negative); smoking cigarettes (negative), and higher BMI (negative). CONCLUSIONS When factors associated with drinking are controlled, patterns of alcohol consumption have limited effects on preventive service use. Individuals with stigmatized behaviors (e.g., hazardous/harmful drinking, smoking, or high BMIs) are less likely to receive care. Making care experiences positive and carefully addressing stigmatized health practices could increase preventive service use.
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Affiliation(s)
- Carla A. Green
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227-1110, USA
| | - Michael R. Polen
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227-1110, USA
| | - Michael C. Leo
- Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239-3098, USA
| | - Nancy A. Perrin
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227-1110, USA
| | - Bradley M. Anderson
- Addiction Medicine Department, Interstate Medical Office East, Kaiser Permanente Northwest, 3550 N. Interstate Avenue, Portland, OR 97227, USA
| | - Constance M. Weisner
- University of California, San Francisco, 401 Parnassus Ave, Box F-0984, San Francisco, CA 94143 and Kaiser Permanente Division of Research, 2000 Broadway, 3rd floor, Oakland, CA 94612, USA
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Green CA, Polen MR, Leo MC, Janoff SL, Anderson BM, Weisner CM, Perrin NA. Drinking Patterns, Gender and Health III: Avoiding vs. Seeking Healthcare. ADDICTION RESEARCH & THEORY 2010; 18:160-180. [PMID: 23795149 PMCID: PMC3686530 DOI: 10.3109/16066350903398502] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Inability to predict most health services use and costs using demographics and health status suggests that other factors affect use, including attitudes and practices that influence health and willingness to seek care. Alcohol consumption has generated interest because heavy, chronic consumption causes adverse health consequences, acute consumption increases injury, and moderate drinking is linked to better health while hazardous drinking and alcohol-related problems are stigmatized and may affect willingness to seek care. METHODS A stratified random sample of health-plan members completed a mail survey, yielding 7884 respondents (2995 male/4889 female). We linked survey data to 24 months of health-plan records to examine relationships between alcohol use, gender, health-related attitudes, practices, health, and service use. In-depth interviews with a stratified 150-respondent subsample explored individuals' reasons for seeking or avoiding care. RESULTS Quantitative results suggest health-related practices and attitudes predict subsequent service use. Consistent predictors of care were having quit drinking, current at-risk consumption, cigarette smoking, higher BMI, disliking visiting doctors, and strong religious/spiritual beliefs. Qualitative analyses suggest embarrassment and shame are strong motivators for avoiding care. CONCLUSIONS Although models included numerous health, functional status, attitudinal and behavioral predictors, variance explained was similar to previous reports, suggesting more complex relationships than expected. Qualitative analyses suggest several potential predictive factors not typically measured in service-use studies: embarrassment and shame, fear, faith that the body will heal, expectations about likelihood of becoming seriously ill, disliking the care process, the need to understand health problems, and the effects of self-assessments of health-related functional limitations.
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Affiliation(s)
- Carla A. Green
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227-1110, USA
| | - Michael R. Polen
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227-1110, USA
| | - Michael C. Leo
- Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239-3098, USA
| | - Shannon L. Janoff
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227-1110, USA
| | - Bradley M. Anderson
- Addiction Medicine Department, Interstate Medical Office East, Kaiser Permanente Northwest, 3550 N. Interstate Avenue, Portland, OR 97227, USA
| | - Constance M. Weisner
- University of California, San Francisco, 401 Parnassus Ave, Box F-0984, San Francisco, CA 94143 and Kaiser Permanente Division of Research, 2000 Broadway, 3rd floor, Oakland, CA 94612, USA
| | - Nancy A. Perrin
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227-1110, USA
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