1
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Sadler AG, Cheney AM, Mengeling MA, Booth BM, Torner JC, Young LB. Servicemen's Perceptions of Male Sexual Assault and Barriers to Reporting During Active Component and Reserve/National Guard Military Service. J Interpers Violence 2021; 36:NP3596-NP3623. [PMID: 29907078 DOI: 10.1177/0886260518780407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Despite growing recognition of the high rates of sexual violence experienced by men serving in the U.S. military, male victimization, specifically sexual assault in military (SAIM), is an understudied topic. We qualitatively describe servicemen's awareness and perceptions of male SAIM, and their understanding of common barriers to servicemen reporting sexual assault. Participants included Midwestern Active Component and Reserve and National Guard servicemen, actively serving or Veteran, who had returned from Iraq or Afghanistan deployments during Operation Enduring/Iraqi Freedom eras. Eleven focus groups were held with 34 servicemen (20 Reserve/National Guard and 14 Active Component). Qualitative analyses used inductive and deductive techniques. Servicemen reported a lack of awareness of male SAIM, a tendency to blame or marginalize male victims, and substantial barriers to reporting sexual assault. Reserve/National Guard participants emphasized barriers such as a perception of greater stigma due to their unique status as citizen-soldiers, an ethos of unit conformity and leadership modeling, and a lack of confidence in leadership and the SAIM reporting process. In contrast, Active Component servicemen emphasized the deployment location and sex of victim and perpetrator as key reporting barriers. Findings make an important contribution to the scant literature on risk and protective factors for male SAIM and servicemen's perceptions of sexual violence and assault reporting barriers by their service type and location. This work has implications for routine screening for sexual violence experiences of male service members and Veterans. Providers' knowledge of gender stereotypes regarding sexual assault, assault risks and experiences of deployed servicemen, and potential barriers to SAIM disclosure is vital for patient-centered care delivery. Additional research to address factors that influence post-SAIM care engagement of males is indicated.
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Affiliation(s)
- Anne G Sadler
- Iowa City VA Health Care System, IA, USA
- The University of Iowa, Iowa City, USA
| | - Ann M Cheney
- University of California, Riverside, USA
- VA Greater Los Angeles Healthcare System, CA, USA
| | | | - Brenda M Booth
- University of Arkansas for Medical Sciences, Little Rock, USA
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2
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Wong JJ, Cucciare MA, Booth BM, Timko C. Predicting Substance Use Patterns Among Rural Adults: The Roles of Mothers, Fathers, and Parenthood. Fam Process 2019; 58:431-445. [PMID: 29663337 PMCID: PMC6191389 DOI: 10.1111/famp.12362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study examined the role of parenthood and parental influences on substance use patterns for 710 stimulant users age 18-61 living in the rural Midwest and Mid-south U.S. Longitudinal growth analyses showed that a maternal history of drug use was associated with increased baseline drug use severity, lesser declines in severity, and greater plateau of drug use severity over time. Parental conflict was associated with lesser declines in drug use severity, and drug use severity declined more steeply for participants who were themselves parents. Participants with two parents having a history of alcohol use had a greater baseline severity of alcohol use, with paternal history of drug use associated with lower baseline alcohol use severity. These findings demonstrate the importance of identifying parental influences in evaluating adult substance use, and point to the inclusion of parents in efforts to prevent and treat substance use disorders.
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Affiliation(s)
- Jessie J. Wong
- Center for Innovation to Implementation, VA Palo Alto Health Care System
- Center on Health Policy/Center on Primary Care and Outcomes Research, Stanford University
| | - Michael A. Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System
- Department of Psychiatry, University of Arkansas for Medical Sciences
- VA South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System
| | - Brenda M. Booth
- Department of Psychiatry, University of Arkansas for Medical Sciences
| | - Christine Timko
- Center for Innovation to Implementation, VA Palo Alto Health Care System
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
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3
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Cucciare MA, Ounpraseuth ST, Curran GM, Booth BM. Predictors of mental health and substance use disorder treatment use over 3 years among rural adults using stimulants. Subst Abus 2019; 40:363-370. [PMID: 30810499 DOI: 10.1080/08897077.2018.1547809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Persons using substances, living in rural communities, tend to underutilize mental health (MH) and substance use disorder (SUD) treatment compared with their urban peers. However, no studies have examined longitudinal predictors of MH and SUD treatment use among rural persons using stimulants. Methods: Data were collected through interviews conducted between 2002 and 2008 from a natural history study of 710 adults using stimulants and living in rural counties of Arkansas, Kentucky, and Ohio. Each study site recruited participants using respondent-driven sampling (RDS). Participants were adults, not in drug treatment, and reporting past-30-day use of methamphetamine, crack cocaine, or powder cocaine. Study participants completed face-to-face baseline assessments and follow-up interviews using computer-assisted personal interviews. Follow-up interviews were conducted at 6-month intervals for 3 years. Results: Our results show that being male, nonwhite, and having a prior lifetime history of MH or SUD treatment use were associated with lower odds of using MH and SUD treatment over time; having medical insurance and living in a state with potentially greater availability of MH and SUD treatment were associated with higher odds of using MH and SUD treatment over the 3-year period. Further, reporting greater legal problems and alcohol severity were associated with greater odds of using MH and SUD care, whereas greater employment problems was associated with higher odds of SUD but not MH treatment use. Conclusions: Findings from this study could be used to inform clinical and public health strategies for improving linkage to MH and SUD care in this population. Our findings also highlight the importance of having medical insurance as a potential facilitator to utilizing SUD care in this population and support the need for health care policies that increase the ability of rural adults who use stimulants to pay for such services.
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Affiliation(s)
- Michael A Cucciare
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Central Arkansas Veterans Affairs Healthcare System, Center for Mental Health Care and Outcomes Research, North Little Rock, Arkansas, USA.,VA South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, Arkansas, USA
| | - Songthip T Ounpraseuth
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Geoffrey M Curran
- Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Brenda M Booth
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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4
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Fernandez AC, Waller R, Walton MA, Bonar EE, Ignacio RV, Chermack ST, Cunningham RM, Booth BM, Ilgen MA, Barry KL, Blow FC. Alcohol use severity and age moderate the effects of brief interventions in an emergency department randomized controlled trial. Drug Alcohol Depend 2019; 194:386-394. [PMID: 30485827 PMCID: PMC6342480 DOI: 10.1016/j.drugalcdep.2018.10.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/19/2018] [Accepted: 10/23/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The primary aim of this study was to examine the efficacy of two motivational interviewing-based alcohol brief interventions (BIs) among adults presenting to an emergency department (ED). The secondary aim was to evaluate moderators of intervention effects. METHODS Participants were 750 ED patients reporting recent alcohol misuse. Participants were randomly assigned to: 1) computer-delivered BI (Computer BI), 2) therapist-delivered BI with computer guidance (Therapist BI-CG), or 3) control. The BIs focused on reduction of alcohol use and risk behaviors. The outcome measure was trajectories of alcohol consumption (measured by the AUDIT-C) across baseline, 3-, 6- and 12-month follow-up assessments, analyzed using latent growth curve modeling. Moderation of intervention effect by gender, age, and baseline alcohol use disorder severity was examined. RESULTS Across the full sample (40% males, mean age = 35.8, SD = 12.3), there was an overall reduction in alcohol consumption across 12 months. The main effects of the Therapist and Computer BI were not significant relative to control. Moderation analysis revealed that the impact of Therapist BI-CG, relative to control, was greater on reductions in alcohol consumption in participants with moderate to severe symptoms of alcohol use disorder compared to those with mild symptoms. The effect of the Computer BI on alcohol use, relative to control, was greater among younger participants compared to older participants. CONCLUSIONS While no overall effect was shown, ED-based Therapist BI-CG with computer guidance may be effective among patients with moderate-severe drinking patterns, whereas Computer BIs may be more effective for younger participants.
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Affiliation(s)
- Anne C Fernandez
- Michigan Medicine, Addiction Center, Department of Psychiatry, Ann Arbor, MI, 48109, USA.
| | - Rebecca Waller
- University of Pennsylvania, Department of Psychology, Philadelphia, PA 19104, USA
| | - Maureen A Walton
- Michigan Medicine, Addiction Center, Department of Psychiatry, Ann Arbor, MI, 48109, USA; Michigan Medicine, Injury Prevention Center, Ann Arbor, MI, 48109, USA
| | - Erin E Bonar
- Michigan Medicine, Addiction Center, Department of Psychiatry, Ann Arbor, MI, 48109, USA; Michigan Medicine, Injury Prevention Center, Ann Arbor, MI, 48109, USA
| | - Rosalinda V Ignacio
- Michigan Medicine, Addiction Center, Department of Psychiatry, Ann Arbor, MI, 48109, USA; Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, 48109, USA
| | - Stephen T Chermack
- Michigan Medicine, Addiction Center, Department of Psychiatry, Ann Arbor, MI, 48109, USA; Veterans Affairs Ann Arbor Healthcare System, Mental Health Service, Ann Arbor, MI, 48105, USA
| | - Rebecca M Cunningham
- Michigan Medicine, Injury Prevention Center, Ann Arbor, MI, 48109, USA; Michigan Medicine, Department of Emergency Medicine, Ann Arbor, MI, 48109, United States; Hurley Hospital, Flint, MI, 48503, USA; University of Michigan, School of Public Health, Ann Arbor, MI, 48109, USA
| | - Brenda M Booth
- University of Arkansas for Medical Sciences, Department of Psychiatry, Little Rock, AR, 72205, USA
| | - Mark A Ilgen
- Michigan Medicine, Addiction Center, Department of Psychiatry, Ann Arbor, MI, 48109, USA; Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, 48109, USA; Veterans Affairs Ann Arbor Healthcare System, Mental Health Service, Ann Arbor, MI, 48105, USA
| | - Kristen L Barry
- Michigan Medicine, Addiction Center, Department of Psychiatry, Ann Arbor, MI, 48109, USA
| | - Frederic C Blow
- Michigan Medicine, Addiction Center, Department of Psychiatry, Ann Arbor, MI, 48109, USA; Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, 48109, USA
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5
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Goossen RP, Summers KM, Ryan GL, Mengeling MA, Booth BM, Torner JC, Syrop CH, Sadler AG. Ethnic Minority Status and Experiences of Infertility in Female Veterans. J Womens Health (Larchmt) 2018; 28:63-68. [PMID: 30481107 DOI: 10.1089/jwh.2017.6731] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In the general population, infertility is increasingly prevalent in ethnic minority women; these women suffer longer and are less likely to access care. There is a paucity of data regarding the issue of race and infertility in the growing female military veteran population. MATERIALS AND METHODS This cross-sectional observational study involved computer-assisted telephone interviews of 1,004 Veterans Administration (VA)-enrolled women aged ≤52 years. RESULTS Racial minority veterans were more likely than white veterans to self-report infertility (24% vs. 18%), equally likely to report infertility evaluation (52% vs. 52%), and less likely to report receiving infertility treatment (31% vs. 63%). Differences in self-reported infertility (odds ratios [OR]: 1.50, 95% confidence interval [CI]: 1.02-2.22) and infertility treatment (OR: 0.32, 95% CI: 0.13-0.81) were retained after controlling for age, income, marital status, education, insurance, history of pelvic inflammatory disease, and lifetime sexual assault. While racial minority veterans were equally as likely as white veterans to be evaluated for infertility, white and racial minority groups reported different reasons for not seeking evaluation. CONCLUSIONS Consistent with civilian studies, our data suggest that racial minority VA-enrolled female veterans are more likely to self-report infertility and less likely to receive infertility treatment. Future research should investigate whether these findings are consistent nationwide and regardless of VA enrollment, and if minority veterans have unique barriers to care. A better understanding of how the VA might improve awareness of infertility evaluation and treatment options, especially for racial minority veterans, is needed.
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Affiliation(s)
- Rachel P Goossen
- 1 Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Karen M Summers
- 2 Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Ginny L Ryan
- 2 Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa.,3 Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa
| | - Michelle A Mengeling
- 3 Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa.,4 VA Office of Rural Health (ORH), Veterans Rural Health Resource Center, Iowa City, Iowa.,5 Department of Internal Medicine, University of Iowa Carver College of Medicine Iowa City, Iowa City, Iowa
| | - Brenda M Booth
- 6 Center for Mental Healthcare Outcomes and Research, Central Arkansas Veterans Healthcare System, Little Rock, Alaska.,7 Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Alaska
| | - James C Torner
- 8 Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa.,9 Department of Neurosurgery and Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Craig H Syrop
- 2 Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Anne G Sadler
- 3 Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa.,10 Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa
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6
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Woodhead EL, Booth BM, Timko C, Tjemsland A, Han X, Cucciare MA. Longitudinal Health Outcomes and Treatment Utilization Among Emerging, Early-Mid, and Older Rural Adults Using Stimulants. J Adult Dev 2018. [DOI: 10.1007/s10804-018-9309-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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7
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Hudson TJ, Painter JT, Gressler LE, Lu L, Williams JS, Booth BM, Martin BC, Sullivan MD, Edlund MJ. Factors Associated with Opioid Initiation in OEF/OIF/OND Veterans with Traumatic Brain Injury. Pain Med 2018; 19:774-787. [PMID: 29036680 PMCID: PMC6659014 DOI: 10.1093/pm/pnx208] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective These analyses examined opioid initiation and chronic use among Iraq (OIF) and Afghanistan (OEF/OND) veterans with a new diagnosis of traumatic brain injury (TBI) in the Veterans Health Administration (VHA). Methods Data were obtained from national VHA data repositories. Analyses included OEF/OIF/OND veterans with a new TBI diagnosis in 2010-2012 who used the VHA at least twice, had not received a VHA opioid prescription in the 365 days before diagnosis, and had at least 365 days of data available after TBI diagnosis. Results Analyses included 35,621 veterans. Twenty-one percent initiated opioids; among new initiators, 23% used chronically. The mean dose was 24.0 mg morphine equivalent dose (MED) daily (SD = 24.26); mean days supplied was 60.52 (SD = 74.69). Initiation was significantly associated with age 36-45 years (odds ratio [OR] = 1.09, 95% CI = 1.01-1.17, P = 0.04), female gender (OR = 1.22, P < 0.001), having back pain (OR = 1.38, P < 0.0001), arthritis/joint pain (OR = 1.24, P < 0.0001), or neuropathic pain (OR = 1.415, P < 0.02). In veterans age 36-45 years, those living in small rural areas had higher odds of chronic opioid use (OR = 1.31, P < 0.0001, and OR = 1.33, P = 0.006, respectively) and back pain (OR = 1.36, P = 0.003). Headache/migraine pain was associated with decreased odds of chronic opioid use (OR = 0.639, P = 0.003). Conclusions Prevalence of opioid use is relatively low among OEF/OIF/OND veterans with newly diagnosed TBI who are using VHA. Among those who initiated opioids, about 25% use them chronically. Prescribing was mostly limited to moderate doses, with most veterans using opioids for approximately two months of the 12-month study period.
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Affiliation(s)
- Teresa J Hudson
- HSR&D, Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jacob T Painter
- HSR&D, Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas
- Division of Pharmaceutical Outcome and Policy, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Laura E Gressler
- HSR&D, Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas
- Division of Pharmaceutical Outcome and Policy, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Liya Lu
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - J Silas Williams
- HSR&D, Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas
| | - Brenda M Booth
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Bradley C Martin
- Division of Pharmaceutical Outcome and Policy, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mark D Sullivan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Mark J Edlund
- Behavioral and Urban Health Epidemiology Program, RTI International, Research Triangle Park, Durham, North Carolina
- Behavioral Health Services, St Luke’s Health System, Twin Falls, Idaho, USA
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8
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Cucciare MA, Kennedy KM, Han X, Timko C, Zaller N, Booth BM. Utilization of outpatient medical care and substance use among rural stimulant users: Do the number of visits matter? J Subst Abuse Treat 2018; 86:78-85. [PMID: 29415855 DOI: 10.1016/j.jsat.2018.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/27/2017] [Accepted: 01/03/2018] [Indexed: 01/16/2023]
Abstract
Rural substance users are less likely than their urban peers to use formal substance use treatment. It is therefore important to understand how the utilization of potentially more appealing care options, such as outpatient medical care (OMC), may affect substance use over time. This study sought to examine whether the number of OMC visits, after controlling for important covariates, was associated with days of alcohol, crack and powder cocaine, and methamphetamine use among a sample of rural stimulant users over a three year period. Data were collected from a natural history study of 710 stimulant users living in rural communities in Arkansas, Kentucky, and Ohio. Participants were adults, not in drug treatment, and reporting stimulant use in the last 30days. In terms of alcohol use, for participants with higher employment-related problems, having 3 or more OMC visits (relative to none) was associated with fewer days of alcohol use. The results for days of cocaine and methamphetamine use were mixed. However, we did find that for participants reporting at least one substance use treatment or mutual help care visit in the past 6-months, having 1-2 OMC visits (compared to none) was associated with fewer days of crack cocaine use. Regarding methamphetamine use, results showed that for participants without medical insurance, having 3 or more OMC visits (compared to none) was associated with significantly fewer days of methamphetamine use if they also reported greater than or equal to a high school education. The findings from this study may help us begin to understand some of the characteristics of rural drug users, who utilize OMCs, associated with reductions in substance use. These findings may help health care administrators better plan, coordinate, and allocate resources to rural OMCs to more effectively address substance use in this population.
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Affiliation(s)
- Michael A Cucciare
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR 72205, USA; VA South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR 72205, USA.
| | - Kristina M Kennedy
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; Department of Psychology and Counseling, University of Central Arkansas, Conway, AR 72035, USA
| | - Xiaotong Han
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR 72205, USA
| | - Christine Timko
- Center for Innovation to Implementation, Veterans Affairs (VA) Health Care System, Menlo Park, CA 94025, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Nickolas Zaller
- College of Public Health, Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Brenda M Booth
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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9
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Sadler AG, Booth BM, Torner JC, Mengeling MA. Sexual assault in the US military: A comparison of risk in deployed and non-deployed locations among Operation Enduring Freedom/Operation Iraqi Freedom active component and Reserve/National Guard servicewomen. Am J Ind Med 2017; 60:947-955. [PMID: 28857214 DOI: 10.1002/ajim.22767] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND To determine whether sexual assault in the military (SAIM) among active component and Reserve/National Guard servicewomen is more likely to occur in deployed or non-deployed locations; and which location poses greater risk for SAIM when time spent in-location is considered. METHODS A total of 1337 Operation Enduring Freedom/Operation Iraqi Freedom era servicewomen completed telephone interviews eliciting socio-demographics, military and sexual assault histories, including attempted and completed sexual assault. RESULTS Half of the sample had been deployed (58%). Overall 16% (N = 245) experienced SAIM; a higher proportion while not deployed (15%; n = 208) than while deployed (4%; n = 52). However, the incidence of SAIM per 100 person-years was higher in deployed than in non-deployed locations: 3.5 vs 2.4. Active component and Reserve/National Guard had similar deployment lengths, but Reserve/National Guard had higher SAIM incidence rates/100 person-years (2.8 vs 4.0). CONCLUSIONS A higher proportion of servicewomen experienced SAIM while not deployed; however, adjusting for time in each location, servicewomen were at greater risk during deployment.
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Affiliation(s)
- Anne G. Sadler
- The Center for Comprehensive Access & Delivery Research and Evaluation (CADRE)Iowa City VA Health Care SystemIowa CityIowa
- Department of PsychiatryUniversity of Iowa Carver College of MedicineIowa CityIowa
| | - Brenda M. Booth
- Department of PsychiatryUniversity of Arkansas for Medical SciencesLittle RockArkansas
| | - James C. Torner
- Department of Epidemiology, University of Iowa College of Public Health, Departments of Neurosurgery and SurgeryUniversity of Iowa Carver College of MedicineIowa CityIowa
| | - Michelle A. Mengeling
- The Center for Comprehensive Access & Delivery Research and Evaluation (CADRE)Iowa City VA Health Care SystemIowa CityIowa
- VA Office of Rural Health (ORH)Veterans Rural Health Resource Center‐Iowa City (VRHRC‐IC)Iowa City VA Health Care SystemIowa CityIowa
- Department of Internal MedicineUniversity of Iowa Carver College of MedicineIowa CityIowa
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10
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Timko C, Booth BM, Han X, Schultz NR, Blonigen DM, Wong JJ, Cucciare MA. Criminogenic Needs, Substance Use, and Offending among Rural Stimulant Users. ACTA ACUST UNITED AC 2017; 41:110-122. [PMID: 29051795 DOI: 10.1037/rmh0000065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There is a need to understand the determinants of both substance use and criminal activity in rural areas in order to design appropriate treatment interventions for these linked problems. The present study drew on a predominant model used to assess and treat offenders -- the Risk-Need-Responsivity (RNR) model -- to examine risk factors for substance use and criminal activity in a rural drug using sample. This study extends the RNR model's focus on offenders to assessing rural-dwelling individuals using stimulants (N=462). We examined substance use and criminal justice outcomes at 6-month (91%) and 3-year (79%) follow-ups, and used Generalized Estimating Equations to examine the extent to which RNR criminogenic need factors at baseline predicted outcomes at follow-ups. Substance use and criminal justice outcomes improved at six months, and even more at three years, post-baseline. As expected, higher risk was associated with poorer outcomes. Antisocial personality patterns and procriminal attitudes at baseline predicted poorer legal and drug outcomes measured at subsequent follow-ups. In contrast, less connection to antisocial others and fewer work difficulties predicted lower alcohol problem severity, but more frequent alcohol use. Engagement in social-recreational activities was associated with fewer subsequent arrests and less severe alcohol and drug problems. The RNR model's criminogenic need factors predicted drug use and crime-related outcomes among rural residents. Services adapted to rural settings that target these factors, such as telehealth and other technology-based resources, may hasten improvement on both types of outcomes among drug users.
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Affiliation(s)
- Christine Timko
- Center for Innovation to Implementation, Veterans Affairs (VA) Health Care System, 795 Willow Rd, Menlo Park, CA 94025 USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94304 USA
| | - Brenda M Booth
- Division of Health Services Research, Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205
| | - Xiaotong Han
- Division of Health Services Research, Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205.,Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72205 USA.,VA South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR 92205 USA
| | | | - Daniel M Blonigen
- Center for Innovation to Implementation, Veterans Affairs (VA) Health Care System, 795 Willow Rd, Menlo Park, CA 94025 USA.,Palo Alto University, Palo Alto, CA 94304, USA
| | - Jessie J Wong
- Center for Innovation to Implementation, Veterans Affairs (VA) Health Care System, 795 Willow Rd, Menlo Park, CA 94025 USA.,Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA 94025 USA
| | - Michael A Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72205 USA.,VA South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR 92205 USA.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205 USA
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11
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Abraham TH, Wright P, White P, Booth BM, Cucciare MA. Feasibility and acceptability of shared decision-making to promote alcohol behavior change among women Veterans: Results from focus groups. J Addict Dis 2017; 36:252-263. [PMID: 28863271 DOI: 10.1080/10550887.2017.1373318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although rates of unhealthy drinking are high among women Veterans with mental health comorbidities, most women Veterans with mental comorbidities who present to primary care with unhealthy drinking do not receive alcohol-related care. Barriers to alcohol-related treatment could be reduced through patient-centered approaches to care, such as shared decision-making. AIMS We assessed the feasibility and acceptability of a telephone-delivered shared decision-making intervention for promoting alcohol behavior change in women Veterans with unhealthy drinking and co-morbid depression and/or probable post-traumatic stress disorder. METHODS We used 3, 2-hour focus group discussions with 19 women Veterans to identify barriers and solicit recommendations for using the intervention with women Veterans who present to primary care with unhealthy drinking and mental health comorbidities. Transcripts from the focus groups were qualitatively analyzed using template analysis. RESULTS Although participants perceived that the intervention was feasible and acceptable for the targeted patient population, they identified the treatment delivery modality, length of telephone sessions, and some of the option grid content as potential barriers. Facilitators included strategies for enhancing the telephone-delivered shared decision-making sessions and diversifying the treatment options contained in the option grids. Focus group feedback resulted in preliminary adaptations to the intervention that are mindful of women Veterans' individual preferences for care and realistic in the everyday context of their busy lives.
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Affiliation(s)
- Traci H Abraham
- a Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System , North Little Rock , Arkansas , USA.,b Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System , North Little Rock , Arkansas , USA.,c Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
| | - Patricia Wright
- d College of Nursing, University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
| | - Penny White
- b Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System , North Little Rock , Arkansas , USA
| | - Brenda M Booth
- c Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
| | - Michael A Cucciare
- a Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System , North Little Rock , Arkansas , USA.,b Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System , North Little Rock , Arkansas , USA.,c Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
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12
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Blow FC, Walton MA, Bohnert ASB, Ignacio RV, Chermack S, Cunningham RM, Booth BM, Ilgen M, Barry KL. A randomized controlled trial of brief interventions to reduce drug use among adults in a low-income urban emergency department: the HealthiER You study. Addiction 2017; 112:1395-1405. [PMID: 28127808 DOI: 10.1111/add.13773] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/20/2016] [Accepted: 01/26/2017] [Indexed: 11/27/2022]
Abstract
AIMS To examine efficacy of drug brief interventions (BIs) among adults presenting to a low-income urban emergency department (ED). DESIGN Randomized controlled trial on drug use outcomes at 3, 6 and 12 months. Participants were assigned to (1) computer-delivered BI (Computer BI), (2) therapist-delivered, computer-guided BI (Therapist BI) or (3) enhanced usual care (EUC-ED) for drug-using adults. Participants were re-randomized after the 3-month assessment to either adapted motivational enhancement therapy (AMET) booster or enhanced usual care booster (EUC-B). SETTING Patients recruited from low-income urban emergency departments (ED) in Flint, Michigan, USA. PARTICIPANTS A total of 780 ED patients reporting recent drug use, 44% males, mean age = 31 years. INTERVENTIONS Computer BI consisted of an interactive program guided by a virtual health counselor. Therapist BI included computer guidance. The EUC-ED conditions included review of community health and HIV prevention resources. The BIs and boosters were based on motivational interviewing, focusing on reduction of drug use and HIV risk behaviors. MEASUREMENTS Primary outcome was past 90 days using drugs at 6 and 12 months and secondary outcomes were weighted drug-days and days of marijuana use. FINDINGS Percentage changes in mean days used any drug from baseline to 12 months were: Computer BI + EUC-B: -10.9%, P = 0.0844; Therapist BI + EUC-B: -26.7%, P = 0.0041, for EUC-ED + EUC-B: -20.9, P = 0.0011. In adjusted analyses, there was no significant interaction between ED intervention and booster AMET for primary and secondary outcomes. Compared with EUC-ED, Therapist BI reduced number of days using any drug [95% confidence interval (CI) = -0.41, -0.07, P = 0.0422] and weighted drug-days (95% CI = -0.41, -0.08, P = 0.0283). Both Therapist and Computer BI had significantly fewer number of days using marijuana compared to EUC-ED (Therapist BI: 95% CI = -0.42, -0.06, P = 0.0104, Computer BI: 95% CI = -0.34, -0.01, P = 0.0406). Booster effects were not significant. CONCLUSIONS An emergency department-based motivational brief intervention, delivered by a therapist and guided by computer, appears to reduce drug use among adults seeking emergency department care compared with enhanced usual care.
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Affiliation(s)
- Frederic C Blow
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA.,Injury Center, University of Michigan, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Maureen A Walton
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA.,Injury Center, University of Michigan, Ann Arbor, MI, USA
| | - Amy S B Bohnert
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA.,Injury Center, University of Michigan, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Rosalinda V Ignacio
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Stephen Chermack
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Healthcare System, Mental Health Service, Ann Arbor, MI, USA
| | - Rebecca M Cunningham
- Injury Center, University of Michigan, Ann Arbor, MI, USA.,Department of Emergency Medicine, University of Michigan, Ann Arbor, MI and Hurley Hospital, Flint, MI, USA.,School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Brenda M Booth
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Center for Mental Healthcare Outcomes and Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
| | - Mark Ilgen
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Healthcare System, Mental Health Service, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Kristen L Barry
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA
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13
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Cucciare MA, Han X, Timko C, Zaller N, Kennedy KM, Booth BM. Longitudinal associations between outpatient medical care use and substance use among rural stimulant users. Am J Drug Alcohol Abuse 2017; 44:235-243. [PMID: 28662352 DOI: 10.1080/00952990.2017.1339056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Negative views toward substance use treatment among some rural substance users and limited treatment resources in rural areas likely affect substance use utilization. It is therefore important to determine whether accessing healthcare options other than substance use treatment, specifically outpatient medical care (OMC), is associated with reductions in substance use. OBJECTIVES We examined whether use of OMC was associated with reductions in substance use among rural substance users over a three-year period. We also explored whether substance user characteristics, including substance-use severity and related-problems, moderated this potential relationship. METHODS Data were collected from an observational study of 710 (61% male) stimulant users using respondent-driven sampling. Participants were recruited from rural counties of Arkansas, Kentucky, and Ohio. RESULTS We found a significant main effect of having at least one OMC visit (relative to none) on fewer days of alcohol, crack cocaine, and methamphetamine use over time. Fewer days of alcohol, crack cocaine, and methamphetamine use were reported in participants with at least one OMC visit (relative to those with none) among those reporting higher Addiction Severity Index employment and psychiatric severity scores, and low education, respectively. CONCLUSION Our findings extend the results from prior studies with urban substance users to show that contact with an outpatient medical care clinic is associated with reductions in substance use over time among rural substance users with especially poorer functioning. These findings highlight the potential importance of OMCs in addressing unhealthy substance use in rural communities.
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Affiliation(s)
- Michael A Cucciare
- a Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , AR , USA.,b Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System (CAVHS) , North Little Rock , AR , USA.,c VA South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System (CAVHS) , North Little Rock , AR , USA
| | - Xiaotong Han
- a Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , AR , USA.,b Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System (CAVHS) , North Little Rock , AR , USA.,c VA South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System (CAVHS) , North Little Rock , AR , USA
| | - Christine Timko
- d Center for Innovation to Implementation, Veterans Affairs (VA) Health Care System , Menlo Park , CA , USA.,e Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , CA , USA
| | - Nickolas Zaller
- f College of Public Health, Department of Health Behavior and Health Education , University of Arkansas for Medical Sciences , Little Rock , AR , USA
| | - Kristina M Kennedy
- a Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , AR , USA.,g Department of Psychology and Counseling , University of Central Arkansas , Conway , AR , USA
| | - Brenda M Booth
- a Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , AR , USA
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Cucciare MA, Han X, Timko C, Zaller N, Kennedy KM, Booth BM. Correlates of three-year outpatient medical care use among rural stimulant users. J Subst Abuse Treat 2017; 77:6-12. [PMID: 28476274 DOI: 10.1016/j.jsat.2017.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/10/2017] [Accepted: 02/28/2017] [Indexed: 10/20/2022]
Abstract
Outpatient medical care (OMC) settings are a care context in which effective management of unhealthy substance use can occur. However, no studies have documented rates of OMC use and characteristics of OMC use among rural substance users. This study sought to examine the rates and frequency of OMC use in a sample of rural drug users over a three-year period. We also explored characteristics of participants associated with use of OMCs over time. Data were collected from June 2005 to September 2007 from a natural history study of 710 stimulant users living in rural communities. Participants were adults, not in drug treatment, and reporting recent methamphetamine, crack cocaine or powder cocaine use. Between 34 and 39% of participants reported any use of an OMC over the three-year follow-up period, with a mean average number of visits ranging from one to two at each follow-up. Having medical insurance, reporting any use of substance use disorder-related care (including formal substance use treatment or mutual-help groups), and higher Addiction Severity Index (ASI) medical and psychiatric composite scores were associated with greater odds of any OMC use and higher frequency of OMC use over time. Being male and having higher ASI alcohol and drug composite scores were associated with lower odds of any OMC use and lower frequency of OMC use. Our findings support the importance of public health efforts to increase OMC use among male rural drug users and those with more severe drug and alcohol use, the important role(s) of Federally Qualified Health Centers and other OMCs in rural communities that serve those with low rates of health insurance, and the need for public health efforts to increase the use of OMCs among rural drug users not experiencing more severe medical or psychiatric health problems.
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Affiliation(s)
- Michael A Cucciare
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR 72205, USA; VA South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR 72205, USA.
| | - Xiaotong Han
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; VA South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR 72205, USA
| | - Christine Timko
- Center for Innovation to Implementation, Veterans Affairs (VA) Health Care System, Menlo Park, CA 94025, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Nickolas Zaller
- College of Public Health, Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Kristina M Kennedy
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; Department of Psychology and Counseling, University of Central Arkansas, Conway, AR 72035, USA
| | - Brenda M Booth
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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15
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Goyal V, Mengeling MA, Booth BM, Torner JC, Syrop CH, Sadler AG. Lifetime Sexual Assault and Sexually Transmitted Infections Among Women Veterans. J Womens Health (Larchmt) 2017; 26:745-754. [PMID: 28281918 DOI: 10.1089/jwh.2016.5775] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Women veterans report a high prevalence of sexual assault. Unfortunately, there are limited data on the reproductive health sequelae faced by these women. Our objective was to evaluate the association between completed lifetime sexual assault (LSA) and sexually transmitted infections (STIs) among a cohort of women veterans, adjusting for sexual risk behaviors. MATERIALS AND METHODS We conducted a retrospective study among women veterans aged 51 years or younger who enrolled for care at two Veterans Administration (VA) healthcare sites between 2000 and 2008. Participants completed a telephone interview assessing reproductive health and sexual violence history. We compared the frequencies of past STI diagnoses among those who had and had not experienced LSA. We used logistic regression to assess the effect of sexual assault with history of an STI diagnosis after adjusting for age, sexual risk behaviors, and substance abuse treatment. RESULTS Among 996 women veterans, a history of STIs was reported by 32%, including a lifetime history of gonorrhea (5%), chlamydia (15%), genital herpes infection (8%), and human papillomavirus infection (15%), not mutually exclusive; 51% reported LSA. Women with a history of LSA were significantly more likely to report a history of STIs (unadjusted odds ratio [OR] 1.91, 95% confidence interval [CI] 1.45-2.50; adjusted OR 1.49, 95% CI 1.07-2.08). CONCLUSIONS Women veterans who have experienced LSA are at increased risk for lifetime STI diagnoses. To adequately address the reproductive health needs of the growing population of women veterans, STI risk assessments should include queries of military service and LSA histories.
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Affiliation(s)
- Vinita Goyal
- 1 South Texas Veterans Health Care System , San Antonio, Texas
| | - Michelle A Mengeling
- 2 Comprehensive Access & Delivery Research and Evaluation (CADRE), Iowa City Veterans Health Care System , Iowa City, Iowa.,3 VA Office of Rural Health, Veteran Rural Health Resource Center , Iowa City, Iowa.,4 Department of Internal Medicine, University of Iowa Carver College of Medicine , Iowa City, Iowa
| | - Brenda M Booth
- 5 Center for Mental Healthcare Outcomes and Research, Central Arkansas Veterans Healthcare System , Little Rock, Arkansas.,6 Department of Psychiatry, University of Arkansas for Medical Sciences , Little Rock, Arkansas
| | - James C Torner
- 7 Department of Epidemiology, University of Iowa College of Public Health , Iowa City, Iowa.,8 Department of Neurosurgery and Surgery, University of Iowa Carver College of Medicine , Iowa City, Iowa
| | - Craig H Syrop
- 9 Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine , Iowa City, Iowa
| | - Anne G Sadler
- 2 Comprehensive Access & Delivery Research and Evaluation (CADRE), Iowa City Veterans Health Care System , Iowa City, Iowa.,10 Department of Psychiatry, University of Iowa Carver College of Medicine , Iowa City, Iowa
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Abstract
African Americans (AAs) who use cocaine in the Southern region of the U.S. have a relatively high risk of HIV and need for HIV testing. Among this group, those residing in rural areas may have less favorable opinions about common HIV testing sites, which could inhibit HIV testing. We examined rural/urban variations in their acceptability of multiple HIV testing sites (private physician clinic, local health department, community health center, community HIV fair, hospital emergency department, blood plasma donation center, drug abuse treatment facility, and mobile van or community outreach worker). Results from partial proportional odds and logistic regression analyses indicate that rural AA who use cocaine have lower odds of viewing local health departments (OR = 0.09, 95 % CI = 0.03-0.21), physician offices (OR = 0.19, 95 % CI = 0.09-0.42), and drug use treatment centers (OR = 0.49; 95 % CI = 0.30-0.80) as acceptable relative to their urban counterparts. The findings have implications for further targeting HIV testing toward AAs who use of cocaine, particularly those residing in the rural South.
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Affiliation(s)
- D Keith Branham
- Department of Health Management and Policy, University of Kentucky, Lexington, KY, 40536, USA.
| | - Tyrone F Borders
- Department of Health Management and Policy, University of Kentucky, Lexington, KY, 40536, USA
| | - Katharine E Stewart
- Department of Psychology and Provost's Office, North Carolina State University, Raleigh, NC, USA
| | - Geoffrey M Curran
- Departments of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Brenda M Booth
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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17
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Chermack ST, Bonar EE, Ilgen MA, Walton MA, Cunningham RM, Booth BM, Blow FC. Developing an Integrated Violence Prevention for Men and Women in Treatment for Substance Use Disorders. J Interpers Violence 2017; 32:581-603. [PMID: 26002873 PMCID: PMC5995669 DOI: 10.1177/0886260515586369] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Rates of past-year partner and non-partner violence perpetration (VP) in substance use disorder (SUD) treatment samples exceed 50%, with studies showing rates of past-year VP exceeding 70% when considering violence occurring with either intimate partners or non-partners. However, SUD treatment programs typically do not include VP prevention interventions, and the few studies examining the impact of SUD interventions on VP have focused exclusively on partner VP. This study summarizes results of a randomized controlled pilot study of an Integrated Violence Prevention Treatment (IVPT) designed to address VP across partner and non-partner relationships as well as predictors of post-treatment VP. Participants were men (70%) and women (30%) in SUD treatment reporting past-year VP who were randomized to either IVPT or a control condition. The IVPT involved a Motivational Interviewing session targeting interpersonal conflicts, followed by five cognitive-behavioral therapy sessions focusing on VP prevention skills. The control condition included a session including a videotape and discussion of anger management, followed by five psycho-educational sessions common for SUD settings. Results showed that VP (total, partner, and non-partner) and cocaine use significantly decreased between baseline and 3-month follow-up for both conditions, and the IVPT group showed a significant decline in alcohol use. Analyses focusing on VP during follow-up revealed that baseline cocaine use and drinking during the follow-up predicted post-treatment VP. Together, these findings suggest that IVPT is a promising intervention (feasible, appears to impact drinking, an important factor related to violence) but that additional continuing care approaches may be indicated to sustain positive outcomes.
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Affiliation(s)
- Stephen T. Chermack
- University of Michigan, Ann Arbor, MI, USA
- Department of Veterans Affairs, Health Services Research & Development, Ann Arbor, MI, USA
| | | | - Mark A. Ilgen
- University of Michigan, Ann Arbor, MI, USA
- Department of Veterans Affairs, Health Services Research & Development, Ann Arbor, MI, USA
| | | | | | - Brenda M. Booth
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
- VA Center for Mental Health Outcomes and Research, Little Rock, AR, USA
- Central Arkansas Veterans Healthcare System, Little Rock, AR, USA
| | - Frederic C. Blow
- University of Michigan, Ann Arbor, MI, USA
- Department of Veterans Affairs, Health Services Research & Development, Ann Arbor, MI, USA
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Sadler AG, Mengeling MA, Booth BM, O'Shea AMJ, Torner JC. The Relationship Between US Military Officer Leadership Behaviors and Risk of Sexual Assault of Reserve, National Guard, and Active Component Servicewomen in Nondeployed Locations. Am J Public Health 2017; 107:147-155. [PMID: 27854521 PMCID: PMC5308164 DOI: 10.2105/ajph.2016.303520] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine if military leader behaviors are associated with active component and Reserve-National Guard servicewomen's risk of sexual assault in the military (SAIM) for nondeployed locations. METHODS A community sample of 1337 Operation Enduring Freedom and Operation Iraqi Freedom-era Army and Air Force servicewomen completed telephone interviews (March 2010-December 2011) querying sociodemographic and military characteristics, sexual assault histories, and leader behaviors. We created 2 factor scores (commissioned and noncommissioned) to summarize behaviors by officer rank. RESULTS A total of 177 servicewomen (13%) experienced SAIM in nondeployed locations. Negative leader behaviors were associated with increased assault risk, at least doubling servicewomen's odds of SAIM (e.g., noncommissioned officers allowed others in unit to make sexually demeaning comments; odds ratio = 2.7; 95% confidence interval = 1.8, 4.1). Leader behavior frequencies were similar, regardless of service type. Negative leadership behavior risk factors remained significantly associated with SAIM risk even after adjustment for competing risk. Noncommissioned and commissioned officer factor scores were highly correlated (r = 0.849). CONCLUSIONS The association between leader behaviors and SAIM indicates that US military leaders have a critical role in influencing servicewomen's risk of and safety from SAIM.
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Affiliation(s)
- Anne G Sadler
- Anne G. Sadler, Michelle A. Mengeling, and Amy M. J. O'Shea are with the Center for Comprehensive Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City. Anne G. Sadler is also with the Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City. Michelle A. Mengeling and Amy M. J. O'Shea are also with the Department of Internal Medicine, University of Iowa Carver College of Medicine. Brenda M. Booth is with the Division of Health Services Research, Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock. James C. Torner is with the Department of Epidemiology, University of Iowa College of Public Health, and the Departments of Neurosurgery and Surgery, University of Iowa Carver College of Medicine
| | - Michelle A Mengeling
- Anne G. Sadler, Michelle A. Mengeling, and Amy M. J. O'Shea are with the Center for Comprehensive Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City. Anne G. Sadler is also with the Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City. Michelle A. Mengeling and Amy M. J. O'Shea are also with the Department of Internal Medicine, University of Iowa Carver College of Medicine. Brenda M. Booth is with the Division of Health Services Research, Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock. James C. Torner is with the Department of Epidemiology, University of Iowa College of Public Health, and the Departments of Neurosurgery and Surgery, University of Iowa Carver College of Medicine
| | - Brenda M Booth
- Anne G. Sadler, Michelle A. Mengeling, and Amy M. J. O'Shea are with the Center for Comprehensive Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City. Anne G. Sadler is also with the Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City. Michelle A. Mengeling and Amy M. J. O'Shea are also with the Department of Internal Medicine, University of Iowa Carver College of Medicine. Brenda M. Booth is with the Division of Health Services Research, Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock. James C. Torner is with the Department of Epidemiology, University of Iowa College of Public Health, and the Departments of Neurosurgery and Surgery, University of Iowa Carver College of Medicine
| | - Amy M J O'Shea
- Anne G. Sadler, Michelle A. Mengeling, and Amy M. J. O'Shea are with the Center for Comprehensive Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City. Anne G. Sadler is also with the Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City. Michelle A. Mengeling and Amy M. J. O'Shea are also with the Department of Internal Medicine, University of Iowa Carver College of Medicine. Brenda M. Booth is with the Division of Health Services Research, Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock. James C. Torner is with the Department of Epidemiology, University of Iowa College of Public Health, and the Departments of Neurosurgery and Surgery, University of Iowa Carver College of Medicine
| | - James C Torner
- Anne G. Sadler, Michelle A. Mengeling, and Amy M. J. O'Shea are with the Center for Comprehensive Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City. Anne G. Sadler is also with the Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City. Michelle A. Mengeling and Amy M. J. O'Shea are also with the Department of Internal Medicine, University of Iowa Carver College of Medicine. Brenda M. Booth is with the Division of Health Services Research, Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock. James C. Torner is with the Department of Epidemiology, University of Iowa College of Public Health, and the Departments of Neurosurgery and Surgery, University of Iowa Carver College of Medicine
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Abstract
BACKGROUND African Americans are incarcerated at rates much higher than other racial and ethnic groups in the United States. OBJECTIVES We sought to qualitatively explore the relationships between ongoing involvement in the criminal justice system and continued drug use in a population of urban and rural African American cocaine users in a southern state. METHODS Semi-structured qualitative interviews were conducted among African American cocaine users in Arkansas between 2010 and 2012. Participants resided in both rural (two counties located in the eastern Arkansas Mississippi delta region) and urban (the county including the capital city of Little Rock) areas. RESULTS Numerous important themes emerged from participants' narratives, including chronic involvement with the criminal justice system (being a "career criminal"), continued access to drugs while incarcerated, relapse, and reincarceration and lack of access to effective drug treatment. Conclusion/Importance: The themes which emerged from our data speak to the collective experience that many substance using populations in the United States face in dealing with the criminal justice system. Our findings highlight the need to better, more holistic ways of engaging African American substance users in community based substance use treatment and supportive services.
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Affiliation(s)
- Nickolas Zaller
- a Department of Health Behavior and Health Education , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
| | - Ann M Cheney
- b Department of Social Medicine and Population Health , University of California Riverside School of Medicine , Riverside , California , USA
| | - Geoffrey M Curran
- c Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
| | - Brenda M Booth
- c Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
| | - Tyrone F Borders
- d Department of Health Management and Policy , University of Kentucky , Lexington , Kentucky , USA
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20
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Sexton RL, Carlson RG, Leukefeld CG, Booth BM. Patterns of Illicit Methamphetamine Production ("Cooking") and Associated Risks in the Rural South: An Ethnographic Exploration. Journal of Drug Issues 2016. [DOI: 10.1177/002204260603600405] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article describes rural methamphetamine (MA) production (‘cooking”) and associated risks in Kentucky and Arkansas. It is based on qualitative interviews with 36 active MA users and one former user, a population that included 10 MA “cookers.” Participants reported that various forms of the Birch cooking method have become widespread locally over the past decade. There is an underground market in MA ingredients like pseudoephedrine pills and anhydrous ammonia and innovative methods to overcome restrictions on obtaining them. MA production is hazardous. Explosions, chemical spills, and injuries are associated with acquiring anhydrous ammonia. MA cooking is often undertaken by the inexperienced, those “high” on MA, or people who rush production because of fear of discovery or craving for the drug. Consequently, accidents and injuries sometimes occur. Lab waste is also a potential danger. Our preliminary findings can inform future research and the development of educational programs that address MA cooking and associated problems.
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Ehrlich PF, Roche JS, Cunningham RM, Chermack ST, Carter PM, Booth BM, Blow F, Barry K, Walton MA. Underage drinking, brief interventions, and trauma patients: Are they really special? J Trauma Acute Care Surg 2016; 81:149-55. [PMID: 27120317 PMCID: PMC4915985 DOI: 10.1097/ta.0000000000001093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND While the relationship between underage drinking and injury has been well established, few studies have examined whether presenting for an acute injury moderates the efficacy of a brief intervention (BI) on alcohol misuse. METHODS Patients (aged 14-20 years) in the emergency department screening positive for risky drinking (Alcohol Use Disorders Identification Test-Consumption score) completed a baseline assessment, were randomized to conditions (a standalone computer-delivered BI [n = 277], a therapist-delivered BI [n = 278], or a control condition [n = 281]), and completed a 3-month follow-up. This secondary analysis of Project U-Connect examined regression models (controlling for baseline values) to examine the main effects of injury and the interaction effects of injury by BI condition on alcohol consumption and consequences. RESULTS Among 836 youth enrolled in the randomized controlled trial (mean age, 18.6 years; 51.6% were male; 79.4% were white), 303 (36.2%) had a primary complaint of intentional or unintentional injury. At baseline, injured patients were more likely to be male (p < 0.001) and have higher alcohol consumption (p < 0.01), but were less likely to misuse prescription drugs (p = 0.02) than those presenting for medical reasons. Regression models (controlling for baseline values) demonstrated that injury presentation predicted greater alcohol consumption prior to a BI. The computer BI was more effective at reducing alcohol consequences among those presenting with injury than those presenting for other reasons. Injury did not affect the efficacy of the computer BI on alcohol consumption, and injury did not affect the efficacy of the therapist BI on alcohol outcomes. CONCLUSIONS A therapist or computer BI reduced alcohol consumption and consequences among risky drinkers regardless of reason for emergency department presentation highlighting the opportunity to reach a broad array of youth. Although the therapist BI was not moderated by injury presentation, the computer BI was particularly effective at reducing alcohol consequences among those presenting with injury at 3-month follow-up. LEVEL OF EVIDENCE Therapeutic/care management study, level III.
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Affiliation(s)
- Peter F Ehrlich
- From the Injury Center (P.F.E., J.S.R., R.M.C., P.M.C., B.M.B., F.B., M.A.W.), University of Michigan Medical School, Ann Arbor, Michigan; Department of Emergency Medicine (J.S.R., R.M.C., P.M.C.), University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Health Behavior and Health Education (R.M.C.), University of Michigan School of Public Health, Ann Arbor, Michigan; Michigan Youth Violence Prevention Center (J.S.R., R.M.C., P.M.C., M.A.W.), University of Michigan School of Public Health, Ann Arbor, Michigan; Addiction Center, Department of Psychiatry (S.T.C., F.B., K.B., M.A.W.), University of Michigan School of Medicine, Ann Arbor, Michigan; Center for Clinical Management Research, Department of Veterans Affairs (S.T.C., F.B., M.A.W.), Ann Arbor VA Healthcare System, Ann Arbor, Michigan; Department of Psychiatry College of Medicine, University of Arkansas for Medical Sciences, (B.M.B.), Little Rock, Arkansas; Section of Pediatric Surgery (P.F.E.), CS Mott Children's Hospital, Department of Surgery, University of Michigan School of Medicine, Ann Arbor Michigan; and Institute for Healthcare Policy and Innovation (R.M.C., F.B.), University of Michigan, Ann Arbor, Michigan
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Abstract
BACKGROUND Religiosity and perceived social support (SS) may serve as protective factors for more severe substance use in adults. OBJECTIVES This study sought to examine whether aspects of religiosity and SS are associated with longitudinal reductions in stimulant use over three years in an untreated sample of rural drug users. METHODS Respondent-driven sampling was used to recruit stimulant users (N = 710) from Arkansas, Kentucky, and Ohio. Follow-up interviews were conducted at 6-month intervals for 36 months. RESULTS Our bivariate findings indicate that higher religiosity was associated with lower odds and fewer days of methamphetamine and cocaine use. After controlling for covariates, higher religiosity was associated with fewer days of crack cocaine use, but more days of methamphetamine use among a small sample of users in the two final interviews. Higher SS from drug-users was also associated with higher odds and days of methamphetamine and powder cocaine use, while higher SS from nondrug users was associated with fewer days of methamphetamine use. CONCLUSIONS/IMPORTANCE Our bivariate findings suggest that higher levels of religiosity may be helpful for some rural individuals in reducing their drug use over time. However, our multivariate findings suggest a need for further exploration of the potential effects of religiosity on longer-term drug use, especially among those who continue to use methamphetamine and/or remain untreated. Our findings also highlight the potential deleterious effect of SS from drug users on the likelihood and frequency of methamphetamine and powder cocaine use over time among untreated rural drug users.
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Affiliation(s)
- Michael A Cucciare
- a Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA.,b Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System , North Little Rock , Arkansas , USA.,c VA South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System , North Little Rock , Arkansas , USA
| | - Xiaotong Han
- a Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA.,c VA South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System , North Little Rock , Arkansas , USA
| | - Geoffrey M Curran
- a Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA.,b Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System , North Little Rock , Arkansas , USA.,d Department of Pharmacy Practice , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
| | - Brenda M Booth
- a Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
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Abstract
BACKGROUND Research examining substance users' recovery has focused on individual-level outcomes while paying limited attention to the contexts within which individuals are embedded, and the social processes involved in recovery. OBJECTIVES This paper examines factors underlying African American cocaine users' decisions to reduce or quit cocaine use and uses practice theory to understand how lifestyle changes and shifts in social networks facilitate access to the capital needed to change cocaine use patterns. METHODS The study, an in-depth analysis of substance-use life history interviews carried out from 2010 to 2012, included 51 currently not-in-treatment African American cocaine users in the Arkansas Mississippi Delta region. A blended inductive and deductive approach to data analysis was used to examine the socio-cultural and economic processes shaping cocaine use and recovery. RESULTS The majority of participants reported at least one lifetime attempt to reduce or quit cocaine use; motivations to reduce use or quit included desires to meet social role expectations, being tired of using, and incarceration. Abstinence-supporting networks, participation in conventional activities, and religious and spiritual practices afforded access to capital, facilitating cocaine use reduction and sobriety. CONCLUSIONS Interventions designed to increase connection to and support from nondrug using family and friends with access to recovery capital (e.g., employment, faith community, and education) might be ideal methods to reduce substance use among minorities in low-income, resource-poor communities.
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Affiliation(s)
- Ann M Cheney
- a Center for Healthy Communities , University of California Riverside , Riverside , California , USA
| | - Brenda M Booth
- b Division of Health Services Research , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
| | - Tyrone F Borders
- d Department of Health Management and Policy , University of Kentucky , Lexington , Kentucky , USA
| | - Geoffrey M Curran
- c Department of Pharmacy Practice , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
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Ryan GL, Mengeling MA, Summers KM, Booth BM, Torner JC, Syrop CH, Sadler AG. Hysterectomy risk in premenopausal-aged military veterans: associations with sexual assault and gynecologic symptoms. Am J Obstet Gynecol 2016; 214:352.e1-352.e13. [PMID: 26475424 DOI: 10.1016/j.ajog.2015.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/30/2015] [Accepted: 10/06/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Several gynecological conditions associated with hysterectomy, including abnormal bleeding and pelvic pain, have been observed at increased rates in women who have experienced sexual assault. Previous findings have suggested that one of the unique health care needs for female military veterans may be an increased prevalence of hysterectomy and that this increase may partially be due to their higher risk of sexual assault history and posttraumatic stress disorder (PTSD). Although associations between trauma, PTSD, and gynecological symptoms have been identified, little work has been done to date to directly examine the relationship between sexual assault, PTSD, and hysterectomy within the rapidly growing female veteran population. OBJECTIVES The objective of the study was to assess the prevalence of hysterectomy in premenopausal-aged female veterans, compare with general population prevalence, and examine associations between hysterectomy and sexual assault, PTSD, and gynecological symptoms in this veteran population. STUDY DESIGN We performed a computer-assisted telephone interview between July 2005 and August 2008 of 1004 female Veterans Affairs (VA)-enrolled veterans ≤ 52 years old from 2 Midwestern US Veterans Affairs medical centers and associated community-based outreach clinics. Within the veteran study population, associations between hysterectomy and sexual assault, PTSD, and gynecological symptoms were assessed with bivariate analyses using χ(2), Wilcoxon-Mann-Whitney, and Student t tests; multivariate logistic regression analyses were used to look for independent associations. Hysterectomy prevalence and ages were compared with large civilian populations represented in the Behavioral Risk Factor Surveillance System and American College of Surgeons National Surgical Quality Improvement Program databases from similar timeframes using χ(2) and Student t tests. RESULTS Prevalence of hysterectomy was significantly higher (16.8% vs 13.3%, P = .0002), and mean age at hysterectomy was significantly lower (35 vs 43 years old, P < .0001) in this VA-enrolled sample of female veterans compared with civilian population-based data sets. Sixty-two percent of subjects had experienced attempted or completed sexual assault in their lifetimes. A history of completed lifetime sexual assault with vaginal penetration (LSA-V) was a significant risk factor for hysterectomy (age-adjusted odds ratio, 1.85), with those experiencing their first LSA-V in childhood or in military at particular risk. A history of PTSD was also associated with hysterectomy (age-adjusted odds ratio, 1.83), even when controlling for LSA-V. These associations were no longer significant when controlling for the increased rates of gynecological pain, abnormal gynecological bleeding, and pelvic inflammatory disease seen in those veterans with a history of LSA-V. CONCLUSION Premenopausal-aged veterans may be at higher overall risk for hysterectomy, and for hysterectomy at younger ages, than their civilian counterparts. Veterans who have experienced completed sexual assault with vaginal penetration in childhood or in military and those with a history of PTSD may be at particularly high risk for hysterectomy, potentially related to their higher risk of gynecological symptoms. If confirmed in future studies, these findings have important implications for women's health care providers and policy makers within both the VA and civilian health care systems related to primary and secondary prevention, costs, and the potential for increased chronic disease and mortality.
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Affiliation(s)
- Ginny L Ryan
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, IA; Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA.
| | - Michelle A Mengeling
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA; Veterans Affairs Office of Rural Health, Veterans Rural Health Resource Center-Central Region, Iowa City Veterans Affairs Health Care System, Iowa City, IA
| | - Karen M Summers
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Brenda M Booth
- Center for Mental Healthcare Outcomes and Research, Central Arkansas Veterans Healthcare System and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR
| | - James C Torner
- Department of Neurosurgery and Surgery, University of Iowa Carver College of Medicine, Iowa City, IA; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA
| | - Craig H Syrop
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Anne G Sadler
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA; Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA
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Wright PB, Borders TF, Booth BM, Han X, Stewart KE. Perceived need for HIV testing among rural and urban African American cocaine users. Addict Sci Clin Pract 2015. [PMCID: PMC4347606 DOI: 10.1186/1940-0640-10-s1-a74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Cunningham RM, Chermack ST, Ehrlich PF, Carter PM, Booth BM, Blow FC, Barry KL, Walton MA. Alcohol Interventions Among Underage Drinkers in the ED: A Randomized Controlled Trial. Pediatrics 2015; 136:e783-93. [PMID: 26347440 PMCID: PMC4586730 DOI: 10.1542/peds.2015-1260] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This study examined the efficacy of emergency department (ED)-based brief interventions (BIs), delivered by a computer or therapist, with and without a post-ED session, on alcohol consumption and consequences over 12 months. METHODS Patients (ages 14-20 years) screening positive for risky drinking were randomized to: BI (n = 277), therapist BI (n = 278), or control (n = 281). After the 3-month follow-up, participants were randomized to receive a post-ED BI session or control. Incorporating motivational interviewing, the BIs addressed alcohol consumption and consequences, including driving under the influence (DUI), and alcohol-related injury, as well as other concomitant drug use. The computer BI was an offline, Facebook-styled program. RESULTS Among 4389 patients screened, 1054 patients reported risky drinking and 836 were enrolled in the randomized controlled trial. Regression models examined the main effects of the intervention conditions (versus control) and the interaction effects (ED condition × post-ED condition) on primary outcomes. The therapist and computer BIs significantly reduced consumption at 3 months, consequences at 3 and 12 months, and prescription drug use at 12 months; the computer BI reduced the frequency of DUI at 12 months; and the therapist BI reduced the frequency of alcohol-related injury at 12 months. The post-ED session reduced alcohol consequences at 6 months, benefiting those who had not received a BI in the ED. CONCLUSIONS A single-session BI, delivered by a computer or therapist in the ED, shows promise for underage drinkers. Findings for the fully automated stand-alone computer BI are particularly appealing given the ease of future implementation.
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Affiliation(s)
- Rebecca M. Cunningham
- University of Michigan Injury Center, University of Michigan Medical School, Ann Arbor, Michigan;,Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan;,Department of Health Behavior and Health Education and,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan;,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Stephen T. Chermack
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan;,Center for Clinical Management Research, Ann Arbor, Veterans Affairs Healthcare System, Department of Veterans Affairs, Ann Arbor, Michigan
| | - Peter F. Ehrlich
- University of Michigan Injury Center, University of Michigan Medical School, Ann Arbor, Michigan;,Department of Surgery, Section of Pediatric Surgery, CS Mott Children’s Hospital, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Patrick M. Carter
- University of Michigan Injury Center, University of Michigan Medical School, Ann Arbor, Michigan;,Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan;,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Brenda M. Booth
- Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and
| | - Frederic C. Blow
- University of Michigan Injury Center, University of Michigan Medical School, Ann Arbor, Michigan;,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan;,University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan;,Center for Clinical Management Research, Ann Arbor, Veterans Affairs Healthcare System, Department of Veterans Affairs, Ann Arbor, Michigan
| | - Kristen L. Barry
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Maureen A. Walton
- University of Michigan Injury Center, University of Michigan Medical School, Ann Arbor, Michigan;,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan;,University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan
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Abstract
BACKGROUND Research assessments can confound the results of treatment outcome studies and can be themselves an intervention or form of aftercare. OBJECTIVE To determine the trajectory of substance use and substance severity in a sample of African American cocaine users participating in a community-based sexual risk reduction trial. METHODS Out-of-treatment participants were recruited using Respondent-Driven Sampling in two African American majority counties in rural Arkansas. They participated in either the sexual risk reduction condition or an active control focused on access to social services. They were interviewed at baseline, post-intervention, and 6 and 12 months post-intervention. Substance use outcome measures were use of crack cocaine, powder cocaine, marijuana, alcohol, and the Addiction Severity Index Alcohol and Drug Severity composites. A random sample of participants completed qualitative interviews post-12-month interview. RESULTS 251 were enrolled. Substance use outcomes did not differ among the two conditions at any point in the study. Use of measured substances and the ASI composites significantly decreased between baseline and post-intervention (p < 0.01), decreases that persisted at the 12-month assessment period compared to baseline. Qualitative findings suggested that many participants identified increased awareness of their drug use and need to control it through the programs. Participants also noted strong bonding with interviewers. CONCLUSION Clinical trials may have positive unexpected outcomes in terms of reduced substance use even though the trial is not substance use focused. Behavioral interventions for drug users that are not focused specifically on reducing drug use may nonetheless have unanticipated positive associations with reductions in drug use.
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Patton RA, Cunningham RM, Blow FC, Zimmerman MA, Booth BM, Walton MA. Transactional sex involvement: exploring risk and promotive factors among substance-using youth in an urban emergency department. J Stud Alcohol Drugs 2015; 75:573-9. [PMID: 24988256 DOI: 10.15288/jsad.2014.75.573] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The current study aims to evaluate individual, relational, and community-level risk and promotive factors for transactional sex involvement among substance-using youth. METHOD Youth (ages 14-24 years) presenting for care in an urban emergency department, who reported drug use within the past 6 months, were surveyed as part of a larger study assessing violence. Of the 600 youth enrolled in this study, 350 presented to the emergency department with violent injury. Based on youth presenting with violent injury, a proportionally selected (age and gender) comparison group of youth (n = 250) presenting without violent injury were enrolled. Participants were queried about both risk and promotive factors at the individual, relational, and community levels. RESULTS Of the sample, 7.3% reported involvement in transactional sex within the past month. Regression analyses indicated that being African American or other race (as compared with White), having more than one sexual partner, depressive symptoms, negative peer influence, and substance use treatment utilization were positively associated with transactional sex involvement. Increased school involvement was negatively related to involvement in transactional sex. CONCLUSIONS Drug-using youth who reported recent transactional sex involvement are more likely to experience increased HIV risk, depressive symptoms, and negative peer influence and are less likely to experience the promotive factors of school involvement. Future research is needed to better understand the bidirectional relationship between transactional sex involvement and both risk and promotive factors at multiple ecological levels.
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Affiliation(s)
- Rikki A Patton
- Department of Counseling, University of Akron, Akron, Ohio
| | - Rebecca M Cunningham
- Department of Psychiatry and Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | - Frederic C Blow
- Department of Psychiatry and Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | - Marc A Zimmerman
- Department of Psychiatry and Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | - Brenda M Booth
- Department of Psychiatry, University of Arkansas, Little Rock, Arkansas
| | - Maureen A Walton
- Department of Psychiatry and Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
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Stoddard SA, Epstein-Ngo Q, Walton MA, Zimmerman MA, Chermack ST, Blow FC, Booth BM, Cunningham RM. Substance use and violence among youth: a daily calendar analysis. Subst Use Misuse 2015; 50:328-39. [PMID: 25493643 PMCID: PMC4286439 DOI: 10.3109/10826084.2014.980953] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND While researchers have identified factors that contribute to youth violence, less is known about the details of violent incidents. In addition, substance use has been linked to youth violence; however, little is known about actual substance use on days in which violence occurs. OBJECTIVE This study examined reasons for peer violence and the association between substance use and violence using daily calendar-based analyses among at-risk urban youth. METHODS Data were collected from Emergency Department (ED) patients (ages 14-24; n = 599; 59% male, 65% African American) who screened positive for substance use in the past 6 months. Daily data regarding past 30-day substance use and violence and reasons for violent incidents were obtained via semi-structured interviews. Multi-level multinomial regression models were conducted to test the associations between substance use and peer violence incidents (i.e., none, moderate and severe). RESULTS Conflict over 'personal belongings' was a common reason for violence among males; 'jealousy'/'rumors' were common reasons among females. Moderate victimization was more likely to be reported on days in which participants reported alcohol and cocaine use. Severe victimization was more likely to be reported on days in which participants reported alcohol use. Moderate or severe aggression was more likely to be reported on days in which participants reported alcohol and non-medical sedative use. CONCLUSIONS RESULTS suggest that youth violence prevention that addresses differential reasons for violence among males and females as well as substance use would be beneficial.
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Affiliation(s)
- Sarah A Stoddard
- 1University of Michigan, School of Nursing , 400 North Ingalls, Room 3344, Ann Arbor , USA
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Bohnert KM, Walton MA, Ranney M, Bonar EE, Blow FC, Zimmerman MA, Booth BM, Cunningham RM. Understanding the service needs of assault-injured, drug-using youth presenting for care in an urban Emergency Department. Addict Behav 2015; 41:97-105. [PMID: 25452051 PMCID: PMC4324457 DOI: 10.1016/j.addbeh.2014.09.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 06/24/2014] [Accepted: 09/17/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Violence is a leading cause of injury among youth 15-24years and is frequently associated with drug use. To inform optimal violence interventions, it is critical to understand the baseline characteristics and intent to retaliate of drug-using, assault-injured (AI) youth in the Emergency Department (ED) setting, where care for violent injury commonly occurs. METHODS At an urban ED, AI youth ages 14-24 endorsing any past six-month substance use (n=350), and a proportionally-sampled substance-using comparison group (CG) presenting for non-assault-related care (n=250), were recruited and completed a baseline assessment (82% participation). Medical chart review was also conducted. Conditional logistic regression was performed to examine correlates associated with AI. RESULTS Over half (57%) of all youth met the criteria for drug and/or alcohol use disorder, with only 9% receiving prior treatment. Among the AI group, 1 in 4 intended to retaliate, of which 49% had firearm access. From bivariate analyses, AI youth had poorer mental health, greater substance use, and were more likely to report prior ED visits for assault or psychiatric evaluation. Based on multivariable modeling, AI youth had greater odds of being on probation/parole (AOR=2.26; CI=1.28, 3.90) and having PTSD (AOR=1.88; CI=1.01, 3.50) than the CG. CONCLUSIONS AI youth may have unmet needs for substance use and mental health treatment, including PTSD. These characteristics along with the risk of retaliation, increased ED service utilization, low utilization of other health care venues, and firearm access highlight the need for interventions that initiate at the time of ED visit.
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Affiliation(s)
- Kipling M. Bohnert
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, 48105, USA,National Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, Michigan, 48105, USA
| | - Maureen A. Walton
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, 48105, USA,University of Michigan Injury Center, Ann Arbor, Michigan, 48106, USA,Michigan Youth Violence Prevention Center, Flint, Michigan, 48109, USA
| | - Megan Ranney
- Brown University, Department of Emergency Medicine, Providence, Rhode Island, 02903, USA,Brown University, Injury Prevention Center, Providence, Rhode Island, 02903, USA
| | - Erin E. Bonar
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, 48105, USA
| | - Frederic C. Blow
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, 48105, USA,National Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, Michigan, 48105, USA,University of Michigan Injury Center, Ann Arbor, Michigan, 48106, USA
| | - Marc A. Zimmerman
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, 48109, USA,University of Michigan Injury Center, Ann Arbor, Michigan, 48106, USA,Michigan Youth Violence Prevention Center, Flint, Michigan, 48109, USA
| | - Brenda M. Booth
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Rebecca M. Cunningham
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, 48109, USA,Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan, 48106, USA,Hurley Medical Center, Flint, Michigan, USA,University of Michigan Injury Center, Ann Arbor, Michigan, 48106, USA,Michigan Youth Violence Prevention Center, Flint, Michigan, 48109, USA
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Cunningham RM, Carter PM, Ranney M, Zimmerman MA, Blow FC, Booth BM, Goldstick J, Walton MA. Violent reinjury and mortality among youth seeking emergency department care for assault-related injury: a 2-year prospective cohort study. JAMA Pediatr 2015; 169:63-70. [PMID: 25365147 PMCID: PMC4306452 DOI: 10.1001/jamapediatrics.2014.1900] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Violence is a leading cause of morbidity and mortality among youth, with more than 700000 emergency department (ED) visits annually for assault-related injuries. The risk for violent reinjury among high-risk, assault-injured youth is poorly understood. OBJECTIVE To compare recidivism for violent injury and mortality outcomes among drug-using, assault-injured youth (AI group) and drug-using, non-assault-injured control participants (non-AI group) presenting to an urban ED for care. DESIGN, SETTING, AND PARTICIPANTS Participants were enrolled in a prospective cohort study from December 2, 2009, through September 30, 2011, at an urban level I ED and followed up for 24 months. We administered validated measures of violence and substance use and mental health diagnostic interviews and reviewed medical records at baseline and at each point of follow-up (6, 12, 18, and 24 months). EXPOSURE Follow-up over 24 months. MAIN OUTCOMES AND MEASURES Use of ED services for assault or mortality measured from medical record abstraction supplemented with self-report. RESULTS We followed 349 AI and 250 non-AI youth for 24 months. Youth in the AI group had almost twice the risk for a violent injury requiring ED care within 2 years compared with the non-AI group (36.7% vs 22.4%; relative risk [RR], 1.65 [95% CI, 1.25-2.14]; P<.001). Two-year mortality was 0.8%. Poisson regression modeling identified female sex (RR, 1.30 [95% CI, 1.02-1.65]), assault-related injury (RR, 1.57 [95% CI, 1.19-2.04), diagnosis of a drug use disorder (RR, 1.29 [95% CI, 1.01-1.65]), and posttraumatic stress disorder (RR, 1.47 [95% CI, 1.09-1.97]) at the index visit as predictive of ED recidivism or death within 24 months. Parametric survival models demonstrated that assault-related injury (P<.001), diagnosis of posttraumatic stress disorder (P=.008), and diagnosis of a drug use disorder (P= .03) significantly shortened the expected waiting time until the first ED return visit for violence or death. CONCLUSIONS AND RELEVANCE Violent injury is a reoccurring disease, with one-third of our AI group experiencing another violent injury requiring ED care within 2 years of the index visit, almost twice the rate of a non-AI comparison group. Secondary violence prevention measures addressing substance use and mental health needs are needed to decrease subsequent morbidity and mortality due to violence in the first 6 months after an assault injury.
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Affiliation(s)
- Rebecca M. Cunningham
- University of Michigan Injury Center, University of Michigan School of Medicine, Ann Arbor2Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor3Department of Health Behavior and Health Education, University of Michigan Sc
| | - Patrick M. Carter
- University of Michigan Injury Center, University of Michigan School of Medicine, Ann Arbor2Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor5Michigan Youth Violence Prevention Center, University of Michigan School of P
| | - Megan Ranney
- Injury Prevention Center, Department of Emergency Medicine, Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Marc A. Zimmerman
- University of Michigan Injury Center, University of Michigan School of Medicine, Ann Arbor3Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor5Michigan Youth Violence Prevention Center, University
| | - Fred C. Blow
- University of Michigan Injury Center, University of Michigan School of Medicine, Ann Arbor6Addiction Research Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor8National Serious Mental Illness Treatment, Resource and Ev
| | - Brenda M. Booth
- Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - Jason Goldstick
- University of Michigan Injury Center, University of Michigan School of Medicine, Ann Arbor5Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor
| | - Maureen A. Walton
- University of Michigan Injury Center, University of Michigan School of Medicine, Ann Arbor5Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor6Addiction Research Center, Department of Psychiatry, University
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Wright PB, Booth BM, Curran GM, Borders TF, Ounpraseuth ST, Stewart KE. Correlates of HIV testing among rural African American cocaine users. Res Nurs Health 2014; 37:466-77. [PMID: 25346379 DOI: 10.1002/nur.21629] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2014] [Indexed: 11/06/2022]
Abstract
Andersen's Revised Behavioral Model of Health Services Use (RBM) was used as a framework in this correlational cross-sectional study to examine factors associated with HIV testing among a sample of 251 rural African American cocaine users. All participants reported using cocaine and being sexually active within the past 30 days. Independent variables were categorized according to the RBM as predisposing, enabling, need, or health behavior factors. Number of times tested for HIV (never, one time, two to four times, five or more times) was the outcome of interest. In ordered logistic regression analyses, HIV testing was strongly associated with being female, of younger age (predisposing factors); having been tested for sexually transmitted diseases or hepatitis, ever having been incarcerated in jail or prison (enabling factors); and having had one sex partner the past 30 days (health behavior factor). Other sexual risk behaviors, drug use, health status, and perception of risk were not associated with HIV testing. Our findings confirm the importance of routine testing in all healthcare settings rather than risk-based testing.
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Affiliation(s)
- Patricia B Wright
- College of Nursing, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 529, Little Rock, AR, 72205
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Borders TF, Booth BM, Curran GM. African American cocaine users' preferred treatment site: variations by rural/urban residence, stigma, and treatment effectiveness. J Subst Abuse Treat 2014; 50:26-31. [PMID: 25456092 DOI: 10.1016/j.jsat.2014.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 10/03/2014] [Accepted: 10/06/2014] [Indexed: 10/24/2022]
Abstract
To encourage access, policy makers and providers need information about variations in drug users' treatment preferences. This study examined how rural/urban residence, stigma surrounding drug use, and perceived treatment availability and effectiveness are associated with African American cocaine users' preferences for the site of treatment (local, or in one's home town; nearby, or in a town nearby; and distant, or in a town farther away). Two hundred rural and 200 urban cocaine users were recruited using respondent-driven sampling and completed in-person interviews. Multinomial logit regression analyses were conducted to estimate the relative odds of preferring local vs. nearby and local vs. distant treatment. Rural cocaine users preferred distant (58%), and urban users preferred local (57%) treatment. Rural residence and a lifetime history of treatment were associated with higher odds of preferring nearby vs. local treatment; older age and greater perceived local treatment effectiveness were associated with lower odds of preferring nearby vs. local treatment. Rural residence, access to an automobile, higher rejection/discrimination stigma scores, and higher Brief Symptom Inventory-Global Severity Index scores were associated with higher odds of preferring distant vs. local treatment; older age, lower educational attainment, and greater perceived discrimination after treatment were associated with lower odds of preferring distant vs. local treatment. The findings from this study suggest that a regional approach to organizing drug use treatment services could better satisfy the preferences of rural African American cocaine users, whereas local treatment services should be expanded to meet the needs of urban cocaine users.
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Affiliation(s)
- Tyrone F Borders
- Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, KY, 40536, USA.
| | - Brenda M Booth
- Division of Health Services Research, Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA; Central Arkansas Veterans Healthcare System, North Little Rock, AR, 72114, USA
| | - Geoffrey M Curran
- Division of Health Services Research, Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA; Central Arkansas Veterans Healthcare System, North Little Rock, AR, 72114, USA; Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
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Booth BM, Stewart KE, Curran GM, Cheney AM, Borders TF. Beliefs and attitudes regarding drug treatment: application of the theory of planned behavior in African-American cocaine users. Addict Behav 2014; 39:1441-6. [PMID: 24930051 DOI: 10.1016/j.addbeh.2014.05.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 04/17/2014] [Accepted: 05/21/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The Theory of Planned Behavior (TPB) can provide insights into perceived need for cocaine treatment among African American cocaine users. METHODS A cross-sectional community sample of 400 (50% rural) not-in-treatment African-American cocaine users was identified through respondent-driven sampling in one urban and two rural counties in Arkansas. Measures included self-reports of attitudes and beliefs about cocaine treatment, perceived need and perceived effectiveness of treatment, and positive and negative cocaine expectancies. Normative beliefs were measured by perceived stigma and consequences of stigma regarding drug use and drug treatment. Perceived control was measured by readiness for treatment, prior drug treatment, and perceived ability to cut down on cocaine use without treatment. FINDINGS Multiple regression analysis found that older age (standardized regression coefficient β=0.15, P<0.001), rural residence (β=-0.09, P=0.025), effectiveness of treatment (β=0.39, P<0.001), negative cocaine expectancies (β=0.138, P=0.003), experiences of rejection (β=0.18, P<0.001), need for secrecy (β=0.12, P=0.002), and readiness for treatment (β=0.15, P<0.001) were independently associated with perceived need for cocaine treatment. CONCLUSIONS TPB is a relevant model for understanding perceived need for treatment among African-American cocaine users. Research has shown perceived need to be a major correlate of treatment participation. Study results should be applicable for designing interventions to encourage treatment participation.
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Abstract
BACKGROUND Alcohol brief interventions (BIs) delivered by therapists are promising among underage drinkers in the emergency department (ED); however, integration into routine ED care is lacking. Harnessing technology for identification of at-risk drinkers and delivery of interventions could have tremendous public health impact by addressing practical barriers to implementation. The paper presents baseline, within BI session, and posttest data from an ongoing randomized controlled trial (RCT) of youth in the ED. METHODS Patients (ages 14-20) who screened positive for risky drinking were randomized to computer BI (CBI), therapist BI (TBI), or control. Measures included demographics, alcohol consumption (Alcohol Use Disorders Identification Test--Consumption [AUDIT-C]), process questions, BI components (e.g., strengths, tools), and psychological constructs (i.e., importance of cutting down, likelihood of cutting down, readiness to stop, and wanting help). RESULTS Among 4389 youth surveyed (13.7% refused), 24.0% (n = 1053) screened positive for risky drinking and 80.3% (n = 836) were enrolled in the RCT; 93.7% (n = 783) completed the posttest. Although similar in content, the TBI included a tailored, computerized workbook to structure the session, whereas the CBI was a stand-alone, offline, Facebook-styled program. As compared with controls, significant increases were found at posttest for the TBI in "importance to cut down" and "readiness to stop" and for the CBI in "importance and likelihood to cut down." BI components positively associated with outcomes at posttest included greater identification of personal strengths, protective behavioral strategies, benefits of change, and alternative activities involving sports. In contrast, providing information during the TBI was negatively related to outcomes at posttest. CONCLUSIONS Initial data suggest that therapist and computer BIs are promising, increasing perceived importance of reducing drinking. In addition, findings provide clues to potentially beneficial components of BIs. Future studies are needed to identify BI components that have the greatest influence on reducing risky drinking behaviors among adolescents and emerging adults.
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Affiliation(s)
- Maureen A. Walton
- University of Michigan, Department of Psychiatry, Addiction Research Center, Ann Arbor, MI, USA
- University of Michigan, Injury Center, Ann Arbor, MI, USA
| | - Stephen T. Chermack
- Department of Veterans Affairs National Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI, USA
- University of Michigan, Department of Psychiatry, Mental Health Services Outcomes and Translation Section, Ann Arbor, MI, USA
| | - Frederic C. Blow
- Department of Veterans Affairs National Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI, USA
- University of Michigan, Department of Psychiatry, Mental Health Services Outcomes and Translation Section, Ann Arbor, MI, USA
| | - Peter F. Ehrlich
- University of Michigan, Injury Center, Ann Arbor, MI, USA
- University of Michigan Health System, C.S. Mott Children’s Hospital, Department of Surgery, Section of Pediatric Surgery, Ann Arbor, MI, USA
| | - Kristen L. Barry
- Department of Veterans Affairs National Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI, USA
- University of Michigan, Department of Psychiatry, Mental Health Services Outcomes and Translation Section, Ann Arbor, MI, USA
| | - Brenda M. Booth
- University of Arkansas for Medical Sciences, Department of Psychiatry, Little Rock, AR, USA
| | - Rebecca M. Cunningham
- University of Michigan, Injury Center, Ann Arbor, MI, USA
- University of Michigan, Department of Emergency Medicine, Ann Arbor, MI, USA
- University of Michigan, School of Public Health, Ann Arbor, MI, USA
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Borders TF, Booth BM, Stewart KE, Cheney AM, Curran GM. Rural/urban residence, access, and perceived need for treatment among African American cocaine users. J Rural Health 2014; 31:98-107. [PMID: 25213603 DOI: 10.1111/jrh.12092] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine how rural/urban residence, perceived access, and other factors impede or facilitate perceived need for drug use treatment, a concept closely linked to treatment utilization. STUDY DESIGN Two hundred rural and 200 urban African American cocaine users who were not receiving treatment were recruited via Respondent-Driven Sampling and completed a structured in-person interview. Bivariate and multivariate analyses were conducted to test the associations between perceived need and rural/urban residence, perceived access, and other predisposing (eg, demographics), enabling (eg, insurance), and health factors (eg, psychiatric distress). PRINCIPAL FINDINGS In bivariate analyses, rural relative to urban cocaine users reported lower perceived treatment need (37% vs 48%), availability, affordability, overall ease of access, and effectiveness, as well as lower perceived acceptability of residential, outpatient, self-help, and hospital-based services. In multivariate analyses, there was a significant interaction between rural/urban residence and the acceptability of religious counseling. At the highest level of acceptability, rural users had lower odds of perceived need (OR = 0.21); at the lowest level, rural users had higher odds of perceived need (OR = 3.97) than urban users. Among rural users, the acceptability of religious counseling was negatively associated with perceived need (OR = 0.65). Ease of access was negatively associated (OR = 0.71) whereas local treatment effectiveness (OR = 1.47) and the acceptability of hospital-based treatment (OR = 1.29) were positively associated with perceived need among all users. CONCLUSIONS Our findings suggest rural/urban disparities in perceived need and access to drug use treatment. Among rural and urban cocaine users, improving perceptions of treatment effectiveness and expanding hospital-based services could promote treatment seeking.
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Affiliation(s)
- Tyrone F Borders
- Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, Kentucky
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Cheney AM, Dunn A, Booth BM, Frith L, Curran GM. THE INTERSECTIONS OF GENDER AND POWER IN WOMEN VETERANS’ EXPERIENCES OF SUBSTANCE USE AND VA CARE. Annals of Anthropological Practice 2014. [DOI: 10.1111/napa.12030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ann M. Cheney
- Central Arkansas Veterans Healthcare System; Division of Health Services Research, University of Arkansas for Medical Sciences
| | | | - Brenda M. Booth
- Division of Health Services Research, University of Arkansas for Medical Sciences
| | - Libby Frith
- Division of Health Services Research, University of Arkansas for Medical Sciences
| | - Geoffrey M. Curran
- HSR&D, Central Arkansas Veterans Healthcare System; Division of Health Services Research, University of Arkansas for Medical Sciences
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Mengeling MA, Booth BM, Torner JC, Sadler AG. Reporting sexual assault in the military: who reports and why most servicewomen don't. Am J Prev Med 2014; 47:17-25. [PMID: 24854779 DOI: 10.1016/j.amepre.2014.03.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 02/14/2014] [Accepted: 03/03/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Public and congressional attention to the Department of Defense's (DoD's) efforts to prevent and respond to sexual assault in the military (SAIM) is increasing. To promote reporting, the DoD offers (1) restricted reporting, allowing confidential reporting to designated military personnel without triggering an official investigation, and (2) unrestricted reporting, which initiates a criminal investigation. PURPOSE To identify factors associated with officially reporting SAIM by examining demographic, military, and sexual assault characteristics and survey reporting perceptions and experiences. Differences between active component (AC) (full-time active duty) and Reserve and National Guard (RNG) were explored. METHODS A Midwestern community sample of currently serving and veteran servicewomen (1,339) completed structured telephone interviews. RNG interviews were conducted March 2010 to September 2010 and AC interviews from October 2010 to December 2011. Data were analyzed in 2013. Logistic regression analyses examined demographic, military, and SA characteristics related to SAIM reporting. Bivariate statistics tested differences between AC and RNG. RESULTS A total of 205 servicewomen experienced SAIM and 25% reported. More AC servicewomen experienced SAIM, but were no more likely to report than RNG servicewomen. Restricted reporting was rated more positively, but unrestricted reporting was used more often. Reporters' experiences corroborated non-reporters' concerns of lack of confidentiality, adverse treatment by peers, and beliefs that nothing would be done. Officers were less likely to report than enlisted servicewomen. CONCLUSIONS Actual and perceived reporting consequences deter servicewomen from reporting. SAIM undermines trust in military units, mission readiness, and the health and safety of all service members.
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Affiliation(s)
- Michelle A Mengeling
- Center for Comprehensive Access & Delivery Research & Evaluation, University of Iowa College of Public Health, Iowa City, Iowa; Veterans Affairs Office of Rural Health, Veterans Rural Health Resource Center-Central Region, University of Iowa College of Public Health, Iowa City, Iowa; Iowa City Veterans Affairs Health Care System, Department of Internal Medicine, University of Iowa College of Public Health, Iowa City, Iowa.
| | - Brenda M Booth
- Center for Mental Healthcare Outcomes and Research, Central Arkansas Healthcare System & Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - James C Torner
- Department of Neurosurgery and Surgery, University of Iowa College of Public Health, Iowa City, Iowa; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
| | - Anne G Sadler
- Center for Comprehensive Access & Delivery Research & Evaluation, University of Iowa College of Public Health, Iowa City, Iowa; Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Bonar EE, Whiteside LK, Walton MA, Zimmerman MA, Booth BM, Blow FC, Cunningham R. Prevalence and correlates of HIV risk among adolescents and young adults reporting drug use: Data from an urban Emergency Department in the U.S. J HIV AIDS Soc Serv 2014; 28:625-630. [PMID: 25126024 PMCID: PMC4128093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Adolescents and young adults who use substances are at particularly high risk for contracting Human Immunodeficiency Virus (HIV). The Emergency Department (ED) is a critical location for HIV prevention for at-risk youth. To inform future interventions in the ED, this study identifies correlates of HIV risk behaviors among substance using youth seeking ED care. Among 600 14-24-year-olds with past 6-month drug use, bivariate correlates of HIV risk included: older age, female gender, depressive symptoms, alcohol use, marijuana use, other drug use, and dating, peer, and community violence. Regression analyses indicated that older age, marijuana use, and dating violence were positively related to HIV risk. Results suggest HIV prevention efforts for youth in the urban ED should address marijuana use and dating violence as well as sexual risk behaviors.
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Affiliation(s)
- Erin E Bonar
- University of Michigan, Addiction Research Center, Department of Psychiatry, Ann Arbor, MI
| | - Lauren K Whiteside
- University of Washington, Division of Emergency Medicine, Seattle, Washington
| | - Maureen A Walton
- University of Michigan, Addiction Research Center, Department of Psychiatry, Ann Arbor, MI ; University of Michigan Injury Center, University of Michigan, Ann Arbor, Michigan
| | - Marc A Zimmerman
- University of Michigan Injury Center, University of Michigan, Ann Arbor, Michigan ; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Brenda M Booth
- University of Arkansas for Medical Sciences, Department of Psychiatry, Little Rock, AR, 72205, USA ; Center for Mental Healthcare Outcomes and Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 72114, USA
| | - Frederic C Blow
- University of Michigan, Department of Psychiatry, Ann Arbor, Michigan ; VA Ann Arbor Healthcare System, VA Center for Clinical Management Research, Ann Arbor, Michigan ; VA Ann Arbor Healthcare System, VA Serious Mental Illness Treatment and Evaluation Center (SMITREC), Ann Arbor, Michigan
| | - Rebecca Cunningham
- University of Michigan Injury Center, University of Michigan, Ann Arbor, Michigan ; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan ; Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
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Ryan GL, Mengeling MA, Booth BM, Torner JC, Syrop CH, Sadler AG. Voluntary and involuntary childlessness in female veterans: associations with sexual assault. Fertil Steril 2014; 102:539-47. [PMID: 24875400 DOI: 10.1016/j.fertnstert.2014.04.042] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 04/25/2014] [Accepted: 04/25/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess associations between lifetime sexual assault and childlessness in female veterans. DESIGN Cross-sectional, computer-assisted telephone interview study. SETTING Two Midwestern Veterans Administration (VA) medical centers. PATIENT(S) A total of 1,004 women aged ≤52 years, VA-enrolled between 2000 and 2008. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Sociodemographic variables, reproductive history and care utilization, and mental health. RESULT(S) A total of 620 veterans (62%) reported at least one attempted or completed sexual assault in their lifetime (LSA). Veterans with LSA more often self-reported a history of pregnancy termination (31% vs. 19%) and infertility (23% vs. 12%), as well as sexually transmitted infection (42% vs. 27%), posttraumatic stress disorder (32% vs. 10%), and postpartum dysphoria (62% vs. 44%). Lifetime sexual assault was independently associated with termination and infertility in multivariate models; sexually transmitted infection, posttraumatic stress disorder, and postpartum dysphoria were not. The LSA by period of life was as follows: 41% of participants in childhood, 15% in adulthood before the military, 33% in military, and 13% after the military (not mutually exclusive). Among the 511 who experienced a completed LSA, 23% self-reported delaying or foregoing pregnancy because of their assault. CONCLUSION(S) This study demonstrated associations between sexual assault history and pregnancy termination, delay or avoidance (voluntary childlessness), and infertility (involuntary childlessness) among female veterans. Improved gender-specific veteran medical care must attend to these reproductive complexities.
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Affiliation(s)
- Ginny L Ryan
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa.
| | - Michelle A Mengeling
- Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa; Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa; VA Office of Rural Health, Veterans Rural Health Resource Center-Central Region, Iowa City VA Health care System, Iowa City, Iowa
| | - Brenda M Booth
- Center for Mental Healthcare Outcomes and Research, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - James C Torner
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa; Department of Neurosurgery and Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Craig H Syrop
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Anne G Sadler
- Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa; Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Walton MA, Resko S, Barry KL, Chermack ST, Zucker RA, Zimmerman MA, Booth BM, Blow FC. A randomized controlled trial testing the efficacy of a brief cannabis universal prevention program among adolescents in primary care. Addiction 2014; 109:786-97. [PMID: 24372937 PMCID: PMC3984620 DOI: 10.1111/add.12469] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 06/19/2013] [Accepted: 12/12/2013] [Indexed: 11/28/2022]
Abstract
AIMS To examine the efficacy of a brief intervention delivered by a therapist (TBI) or a computer (CBI) in preventing cannabis use among adolescents in urban primary care clinics. DESIGN A randomized controlled trial comparing: CBI and TBI versus control. SETTING Urban primary care clinics in the United States. PARTICIPANTS Research staff recruited 714 adolescents (aged 12-18 years) who reported no life-time cannabis use on a screening survey for this study, which included a baseline survey, randomization (stratified by gender and grade) to conditions (control; CBI; TBI) and 3-, 6- and 12-month assessments. MEASUREMENTS Using an intent-to-treat approach, primary outcomes were cannabis use (any, frequency); secondary outcomes included frequency of other drug use, severity of alcohol use and frequency of delinquency (among 85% completing follow-ups). FINDINGS Compared with controls, CBI participants had significantly lower rates of any cannabis use over 12 months (24.16%, 16.82%, respectively, P < 0.05), frequency of cannabis use at 3 and 6 months (P < 0.05) and other drug use at 3 months (P < 0.01). Compared with controls, TBI participants did not differ in cannabis use or frequency, but had significantly less other drug use at 3 months (P < 0.05), alcohol use at 6 months (P < 0.01) and delinquency at 3 months (P < 0.01). CONCLUSIONS Among adolescents in urban primary care in the United States, a computer brief intervention appeared to prevent and reduce cannabis use. Both computer and therapist delivered brief interventions appeared to have small effects in reducing other risk behaviors, but these dissipated over time.
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Affiliation(s)
- Maureen A. Walton
- University of Michigan, Department of Psychiatry, Ann Arbor, Michigan, USA
| | - Stella Resko
- Wayne State University School of Social Work and Merrill Palmer Skillman Institute, Detroit, MI, USA
| | - Kristen L. Barry
- University of Michigan, Department of Psychiatry, Ann Arbor, Michigan, USA
- Department of Veterans Affairs, Center for Clinical Management Research, Health Services Research and Development, Ann Arbor, Michigan, USA
| | - Stephen T. Chermack
- University of Michigan, Department of Psychiatry, Ann Arbor, Michigan, USA
- Department of Veterans Affairs, Center for Clinical Management Research, Health Services Research and Development, Ann Arbor, Michigan, USA
| | - Robert A. Zucker
- University of Michigan, Department of Psychiatry, Ann Arbor, Michigan, USA
| | - Marc A. Zimmerman
- University of Michigan, School of Public Health, Ann Arbor, Michigan, USA
| | - Brenda M. Booth
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR and Central Arkansas Veterans Healthcare System
| | - Frederic C. Blow
- University of Michigan, Department of Psychiatry, Ann Arbor, Michigan, USA
- Department of Veterans Affairs, Center for Clinical Management Research, Health Services Research and Development, Ann Arbor, Michigan, USA
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Bonar EE, Cunningham RM, Chermack ST, Blow FC, Barry KL, Booth BM, Walton MA. Prescription drug misuse and sexual risk behaviors among adolescents and emerging adults. J Stud Alcohol Drugs 2014; 75:259-68. [PMID: 24650820 PMCID: PMC3965680 DOI: 10.15288/jsad.2014.75.259] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 08/16/2013] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate associations between prescription drug misuse (PDM) and sexual risk behaviors (SRBs) among adolescents and emerging adults. METHOD In a hospital emergency department, 2,127 sexually active 14- to 20-year-olds (61% female) reported on past-year alcohol use severity (using the Alcohol Use Disorders Identification Test-consumption [AUDIT-C]), cannabis use, PDM (n = 422), and SRBs (inconsistent condom use, multiple partners, intercourse following alcohol/other drug use). RESULTS Bivariately, AUDIT-C score, cannabis use, and PDM of stimulants, opioids, and sedatives were positively associated with each SRB. Because many participants reported PDM for multiple drug classes (i.e., sedatives, stimulants, opioids), participants were categorized as (a) no PDM (n = 1,705), (b) PDM of one class (n = 251), (c) PDM of two classes (n = 90), or (d) PDM of three classes (n = 81). Three hierarchical logistic regression models evaluated the associations of number of classes of PDM with SRBs separately, after accounting for demographics (age, gender, race), AUDIT-C score, and cannabis use. Adding PDM statistically improved each model beyond what was accounted for by demographics, alcohol, and cannabis use. For inconsistent condom use and substance use before sex, PDM of one, two, or three classes was significantly associated with increased odds of these SRBs. PDM of two or three classes was associated with increased odds of reporting multiple partners. CONCLUSIONS Findings suggest that PDM, especially poly-PDM, may be a pertinent risk factor for SRBs among youth. Event-based research could further evaluate how PDM, as well as other substance use, is related to SRBs at the event level in order to inform interventions.
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Affiliation(s)
- Erin E Bonar
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Rebecca M Cunningham
- Injury Center, University of Michigan, Ann Arbor, Michigan
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Stephen T Chermack
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
- Department of Veterans Affairs, National Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, Michigan
| | - Frederic C Blow
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
- Department of Veterans Affairs, National Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, Michigan
| | - Kristen L Barry
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Brenda M Booth
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Center for Mental Healthcare Outcomes and Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas
| | - Maureen A Walton
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
- Injury Center, University of Michigan, Ann Arbor, Michigan
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Cheney AM, Booth BM, Davis TD, Mengeling MA, Torner JC, Sadler AG. The role of borderline personality disorder and depression in the relationship between sexual assault and body mass index among women veterans. Violence Vict 2014; 29:742-756. [PMID: 25905125 DOI: 10.1891/0886-6708.vv-d-12-00171] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This article examines lifetime sexual assault (LSA) and mental health history as risk factors associated with body mass index (BMI) in a population of women veterans. This cross-sectional study of a retrospective cohort of 948 Veterans Affairs (VA)-enrolled midwestern enlisted rank women veterans included computer-assisted telephone interviews. Findings show that 33.4% of the participants had a BMI of 30.0 or more meeting the criteria for obesity and 62.5% reported lifetime attempted or completed sexual assault. Greater BMI was positively associated with older age, less education, LSA, depression, and borderline personality disorder (BPD) and negatively associated with current substance use disorder in multivariate models. Mediation analysis found that the relationship between sexual assault and BMI was completely mediated by BPD and depression. Interventions should combine physical and mental health care in gender-specific services for overweight women veterans with trauma histories and mental health conditions.
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Bohnert KM, Walton MA, Resko S, Barry KT, Chermack ST, Zucker RA, Zimmerman MA, Booth BM, Blow FC. Latent class analysis of substance use among adolescents presenting to urban primary care clinics. Am J Drug Alcohol Abuse 2013; 40:44-50. [PMID: 24219231 DOI: 10.3109/00952990.2013.844821] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Polysubstance use during adolescence is a significant public health concern. However, few studies have investigated patterns of substance use during this developmental window within the primary care setting. OBJECTIVES This study used an empirical method to classify adolescents into substance use groups, and examines correlates of the empirically defined groups. METHODS Data came from patients, ages 12-18 years, presenting to an urban, primary care community health clinics (Federally Qualified Health Centers) in two cities in the Midwestern United States (n = 1664). Latent class analysis (LCA) was used to identify classes of substance users. Multinomial logistic regression was used to examine variables associated with class membership. RESULTS LCA identified three classes: class 1 (64.5%) exhibited low probabilities of all types of substance use; class 2 (24.6%) was characterized by high probabilities of cannabis use and consequences; and class 3 (10.9%) had the highest probabilities of substance use, including heavy episodic drinking and misuse of prescription drugs. Those in class 2 and class 3 were more likely to be older and have poorer grades, poorer health, higher levels of psychological distress and more sexual partners than those in class 1. Individuals in class 3 were also less likely to be African-American than those in class 1. CONCLUSION Findings provide novel insight into the patterns of substance use among adolescents presenting to low-income urban primary care clinics. Future research should examine the efficacy of interventions that address the complex patterns of substance use and concomitant health concerns among adolescents.
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Affiliation(s)
- Kipling M Bohnert
- National Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs , Ann Arbor, MI , USA
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Walton MA, Bohnert K, Resko S, Barry KL, Chermack ST, Zucker RA, Zimmerman MA, Booth BM, Blow FC. Computer and therapist based brief interventions among cannabis-using adolescents presenting to primary care: one year outcomes. Drug Alcohol Depend 2013; 132:646-53. [PMID: 23711998 PMCID: PMC3770780 DOI: 10.1016/j.drugalcdep.2013.04.020] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 04/12/2013] [Accepted: 04/15/2013] [Indexed: 12/30/2022]
Abstract
AIMS This paper describes outcomes from a randomized controlled trial examining the efficacy of brief interventions delivered by a computer (CBI) or therapist (TBI) among adolescents in urban primary care clinics. METHODS Patients (ages 12-18) self-administered a computer survey. Adolescents reporting past year cannabis use completed a baseline survey and were randomized to control, CBI or TBI, with primary (cannabis use, cannabis related consequences - CC) and secondary outcomes [alcohol use, other drug use (illicit and non-medical prescription drugs), and driving under the influence of cannabis (DUI)] assessed at 3, 6, and 12 months. RESULTS 1416 adolescents were surveyed; 328 reported past year cannabis use and were randomized. Comparisons of the CBI relative to control showed that at 3 months the group by time interaction (G × T) was significant for other drug use and CC, but not for cannabis use, alcohol use, or DUI; at 6 months, the G × T interaction was significant for other drug use but not for cannabis use, alcohol use, or CC. For analyses comparing the TBI to control, at 3 months the G×T interaction was significant for DUI, but not significant for cannabis use, alcohol use, or CC; at 6 months, the G×T interaction was not significant for any variable. No significant intervention effects were observed at 12 months. CONCLUSION Among adolescent cannabis users presenting to primary care, a CBI decreased cannabis related problems and other drug use and a TBI decreased cannabis DUI in the short-term. Additional boosters may be necessary to enhance these reductions over time.
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Affiliation(s)
- Maureen A Walton
- University of Michigan, Department of Psychiatry, Ann Arbor, MI, USA.
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Bonar EE, Walton MA, Cunningham RM, Chermack ST, Bohnert ASB, Barry KL, Booth BM, Blow FC. Computer-enhanced interventions for drug use and HIV risk in the emergency room: preliminary results on psychological precursors of behavior change. J Subst Abuse Treat 2013; 46:5-14. [PMID: 24035142 DOI: 10.1016/j.jsat.2013.08.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 07/31/2013] [Accepted: 08/01/2013] [Indexed: 11/16/2022]
Abstract
This article describes process data from a randomized controlled trial among 781 adults recruited in the emergency department who reported recent drug use and were randomized to: intervener-delivered brief intervention (IBI) assisted by computer, computerized BI (CBI), or enhanced usual care (EUC). Analyses examined differences between baseline and post-intervention on psychological constructs theoretically related to changes in drug use and HIV risk: importance, readiness, intention, help-seeking, and confidence. Compared to EUC, participants receiving the IBI significantly increased in confidence and intentions; CBI patients increased importance, readiness, confidence, and help-seeking. Both groups increased relative to the EUC in likelihood of condom use with regular partners. Examining BI components suggested that benefits of change and tools for change were associated with changes in psychological constructs. Delivering BIs targeting drug use and HIV risk using computers appears promising for implementation in healthcare settings. This trial is ongoing and future work will report behavioral outcomes.
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Affiliation(s)
- Erin E Bonar
- University of Michigan, Department of Psychiatry, Ann Arbor, MI, 48109, USA.
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Abstract
OBJECTIVES We investigated possible associations between pain frequency and the 5 most common substance use disorders: alcohol abuse/dependence, cocaine abuse/dependence, methamphetamine abuse/dependence, opioid abuse/dependence, and marijuana abuse/dependence. METHODS We used data from the Rural Stimulant Study, a longitudinal (7 waves), observational study of at-risk stimulant users (cocaine and methamphetamine) in Arkansas and Kentucky (n=462). In fixed-effects logistic regression models, we regressed our measures of substance use disorders on the number of days with pain in the past 30 days and depression severity. RESULTS Time periods when individuals had 1 to 15 days [odds ratio (OR)=1.85, P<0.001] or 16+ days (OR=2.18, P<0.001) with pain in the past 30 days were more likely to have a diagnosis of alcohol abuse/dependence, compared with time periods when individuals had no days with pain. Compared with time periods when individuals had no pain days in the past 30 days, time periods when individuals had 16+ pain days were more likely to have a diagnosis of opioid abuse/dependence (OR=3.32, P=0.02). Number of days with pain was not significantly associated with other substance use disorders. DISCUSSION Pain frequency seems to be associated with an increased risk for alcohol abuse/dependence and opioid abuse/dependence in this population, and the magnitude of the association is medium to large. Further research is needed to investigate this in more representative populations and to determine causal relationships.
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Affiliation(s)
- Mark J. Edlund
- Behavioral Health Epidemiology, RTI International, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194
| | - Mark D. Sullivan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195-6560 Seattle, WA 98195-6560
| | - Xiaotong Han
- Division of Health Services Research, Department of Psychiatry, University of Arkansas for Medical Sciences, 4310 W Markham St Slot 755, Little Rock, AR 72205
| | - Brenda M. Booth
- Division of Health Services Research, Department of Psychiatry, University of Arkansas for Medical Sciences, 4310 W Markham St Slot 755, Little Rock, AR 72205
- Center for Mental Health Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Dr, Bldg 58, North Little Rock, AR 72114
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Cheney AM, Curran GM, Booth BM, Sullivan S, Stewart K, Borders TF. The Religious and Spiritual Dimensions of Cutting Down and Stopping Cocaine Use: A Qualitative Exploration Among African Americans in the South. J Drug Issues 2013; 44:94-113. [PMID: 25364038 DOI: 10.1177/0022042613491108] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study qualitatively examines the religious and spiritual dimensions of cutting down and stopping cocaine use among African Americans in rural and urban areas of Arkansas. The analyses compare and contrast the narrative data of 28 current cocaine users living in communities where the Black church plays a fundamental role in the social and cultural lives of many African Americans, highlighting the ways that participants used religious symbols, idiomatic expression, and Biblical scriptures to interpret and make sense of their substance-use experiences. Participants drew on diverse religious and spiritual beliefs and practices, including participation in organized religion, reliance on a personal relationship with God, and God's will to cut down and stop cocaine use. Our findings suggest that culturally sensitive interventions addressing the influence of religion and spirituality in substance use are needed to reduce cocaine use and promote recovery in this at-risk, minority population.
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Epstein-Ngo QM, Cunningham RM, Whiteside LK, Chermack ST, Booth BM, Zimmerman MA, Walton MA. A daily calendar analysis of substance use and dating violence among high risk urban youth. Drug Alcohol Depend 2013; 130:194-200. [PMID: 23219602 PMCID: PMC3622164 DOI: 10.1016/j.drugalcdep.2012.11.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 11/07/2012] [Accepted: 11/08/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dating violence (DV) among youth is an important public health problem. This study examined reasons for physical DV and the association between substance use and youth DV using daily calendar-based analyses among at-risk urban youth. METHODS Patients (aged 14-24) presenting to an urban Emergency Department (ED) for a violent injury and a proportionally selected comparison sample of non-violently injured youth who screened positive for substance use in the past 6 months (n=599) were enrolled in this study. Multi-level, multinomial regressions were conducted using daily-level substance use data from Time Line Follow Back (TLFB) responses and physical DV data that were obtained by coding Time Line Follow Back - Aggression Module responses for the 30 days prior to visiting the ED. RESULTS The two most commonly reported reasons for physical dating aggression and victimization, across sexes, were "jealousy/rumors" or "angry/bad mood." Multi-level multinomial regression models, adjusting for clustering within individual participants, showed that among females, cocaine use and sedative/opiate use were associated with severe dating victimization and alcohol use was associated with severe dating aggression. CONCLUSIONS Use of TLFB data offers a unique opportunity to understand daily-level factors associated with specific incidents of DV in more detail. This study provides novel data regarding reasons for DV and the relationship between daily substance use and DV among urban youth, with alcohol, cocaine, and sedative/opiate use being associated with various types of DV. ED based DV interventions should be tailored to address youths' reasons for DV as well as reducing their substance use.
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Affiliation(s)
- Quyen M Epstein-Ngo
- University of Michigan Substance Abuse Research Center, University of Michigan, Ann Arbor, MI 48109, USA.
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Sadler AG, Mengeling MA, Torner JC, Smith JL, Franciscus CL, Erschens HJ, Booth BM. Feasibility and desirability of web-based mental health screening and individualized education for female OEF/OIF reserve and national guard war veterans. J Trauma Stress 2013; 26:401-4. [PMID: 23696367 DOI: 10.1002/jts.21811] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Reserve and National Guard (RNG) service members have an increased risk for postdeployment mental health (MH) and readjustment problems, yet most do not access needed care. It is unknown if RNG servicewomen experiencing postdeployment readjustment symptoms are aware these may signify treatable MH concerns or if this knowledge activates care-seeking. The aims of this proof-of-concept study were to determine the feasibility of web-based MH screening for postdeployment MH symptoms to inform individualized psychoeducation, and to assess user perceptions about the online instrument and process, MH care access, and VA and other MH care. A midwestern sample (N = 131) of recently deployed (past 24 months) OEF/OIF RNG Army and Air Force servicewomen participated. High rates of combat experiences (95%) and military sexual trauma (50%) were reported. Positive screens for key symptoms of MH problems were prevalent. One third (31%) of satisfaction survey completers indicated online information reduced discomfort with seeking MH care; 42% reported they would subsequently seek MH assessment. Participants interviewed by telephone indicated that stigma and limited knowledge about women-specific services were key reasons servicewomen do not use MH care. This study demonstrated web-based screenings with individualized psychoeducation are implementable and favorable to RNG servicewomen.
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Affiliation(s)
- Anne G Sadler
- Comprehensive Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa 52246, USA.
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