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Krytus K, Kruger JS, Homish GG. What Predicts Graduate Public Health Student Success? Evidence for Admission Committees in a Post-Affirmative Action Landscape. Public Health Rep 2024:333549241236151. [PMID: 38504490 DOI: 10.1177/00333549241236151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/21/2024] Open
Abstract
OBJECTIVE A severe staff shortage and a dearth of professionals from underrepresented backgrounds in the public health workforce are contributing to poor health outcomes in the United States. Schools and programs can mitigate these problems by admitting more graduate public health students overall and from underrepresented backgrounds. We identified predictors of foundational graduate public health course grades and graduate grade point average (GPA), sharing evidence to remove application factors that are admission barriers and do not predict student outcomes. METHODS We conducted a linear regression analysis on demographic and academic factors from 564 graduate public health applications for students at the University at Buffalo who received their degree from January 1, 2016, to February 1, 2021, analyzing age, race and ethnicity, sex, income, undergraduate degree, verbal and quantitative Graduate Record Examination (GRE) percentiles, and undergraduate GPA. Outcomes were grades in foundational public health courses and cumulative graduate GPA. RESULTS Undergraduate GPA was the best predictor of graduate public health student success, explaining nearly 7% of foundational public health course grades and 29% of graduate GPA. Higher undergraduate GPA contributed to higher course grades and graduate GPA. GRE scores explained <1% of student outcomes. CONCLUSIONS Our findings add to the growing body of research showing that standardized test scores may not predict graduate student outcomes and provide further evidence for the field of public health to consider removing this admission barrier. By doing so, institutions could admit more students to graduate public health programs who can bring needed skills to the market, further diversifying the workforce and public health faculty, to better meet population health needs.
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Affiliation(s)
- Kimberly Krytus
- University at Buffalo School of Public Health and Health Professions, Buffalo, NY, USA
| | - Jessica S Kruger
- University at Buffalo School of Public Health and Health Professions, Buffalo, NY, USA
| | - Gregory G Homish
- University at Buffalo School of Public Health and Health Professions, Buffalo, NY, USA
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Vest BM, Hoopsick RA, Homish DL, Kulak JA, Homish GG. Longitudinal effects of military separation and mental health symptomatology on substance use among a cohort of reservists. J Stud Alcohol Drugs 2024. [PMID: 38319103 DOI: 10.15288/jsad.23-00160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/07/2024] Open
Abstract
OBJECTIVE The relationship between mental health and substance use among military populations is well-established, and evidence suggests these risks may be greater for those who have left the military. However, it is less clear what independent effects leaving the military may have on substance use behaviors. This study examined the longitudinal relationship between leaving the military and substance use outcomes (hazardous drinking, frequent heavy drinking, non-medical use of prescription drugs, illicit drug use) in a cohort of Reserve and National Guard (R/NG) soldiers. Further, we examined whether mental health symptoms moderate the relationship between leaving the military and substance use. METHOD Analyses used data (N=485 soldiers) from the first four annual waves of Operation: SAFETY, an ongoing prospective cohort study of US Army R/NG soldiers and their spouses. We used generalized estimating equations (GEE) to examine the relationships between military status (former vs. current soldier) and substance use outcomes over four years. Lastly, we examined interactions between military status and mental health indicators (anxiety, anger, depression, and PTSD) on substance use over time. RESULTS After controlling for sex, age, race, years of military service, sleep problems, bodily pain, and substance use norms, being a former soldier, compared to a current soldier, was associated with greater odds of current illicit drug use (AOR: 2.86; 95% CI: 1.47, 5.57; p<.01). Mental health symptomatology did not moderate the relationship between leaving the military and current drug use. CONCLUSIONS Leaving the military in and of itself may result in increased drug use for some individuals, regardless of mental health symptomatology.
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Affiliation(s)
- Bonnie M Vest
- Department of Family Medicine, State University of New York at Buffalo, 77 Goodell Street, Suite 220, Buffalo, NY, 14203, USA
| | - Rachel A Hoopsick
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, 1206 S. Fourth St., 2017 Khan Annex, Huff Hall, Champaign, IL 61820, USA
| | - D Lynn Homish
- Department of Community Health and Health Behavior, State University of New York at Buffalo, 325 Kimball Tower, 3435 Main Street, Buffalo NY, 14214, USA
| | - Jessica A Kulak
- Department of Community Health and Health Behavior, State University of New York at Buffalo, 325 Kimball Tower, 3435 Main Street, Buffalo NY, 14214, USA
| | - Gregory G Homish
- Department of Community Health and Health Behavior, State University of New York at Buffalo, 325 Kimball Tower, 3435 Main Street, Buffalo NY, 14214, USA
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Kulak JA, Lopez J, Lawson SC, Arif M, Homish DL, Homish GG. Cannabis approval and perceived risk of use among minority U.S. Army Reservists. J Ethn Subst Abuse 2024:1-14. [PMID: 38270145 DOI: 10.1080/15332640.2024.2302312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
This study examined how minoritized U.S. Army Reserve/National Guard service members perceive cannabis use amid a continuously evolving societal and legal landscape in the United States. Logistic regression analyses were conducted to examine relationships between cannabis perceptions and race while considering illicit drug use norms, posttraumatic stress disorder symptomatology, and current drug use. Non-Hispanic Black soldiers had lower odds of approval for medicinal cannabis use and Hispanic soldiers had higher odds of perceived risk of cannabis use, both of which persisted when considering key covariates. These findings may be partly explained by a confluence of societal and cultural factors.
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Affiliation(s)
- Jessica A Kulak
- State University of New York at Buffalo, Buffalo, New York, USA
| | - Joel Lopez
- Columbia University, New York City, New York, USA
| | | | - Mehreen Arif
- State University of New York at Buffalo, Buffalo, New York, USA
| | - D Lynn Homish
- State University of New York at Buffalo, Buffalo, New York, USA
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Hoopsick RA, Vest BM, Homish DL, Homish GG. United States Army Reserve/National Guard soldiers' healthcare experiences, attitudes, and preferences: Differences based on deployment status. PSYCHOL HEALTH MED 2024:1-13. [PMID: 38193498 DOI: 10.1080/13548506.2024.2303409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/13/2022] [Accepted: 12/18/2023] [Indexed: 01/10/2024]
Abstract
Some United States Army Reserve/National Guard (USAR/NG) soldiers have substantial health needs, which may be service-related, but not necessarily resulting from deployment. However, most USAR/NG members need to have been deployed to qualify for Veterans Administration (VA) benefits. Therefore, many USAR/NG soldiers seek care from civilian healthcare providers (HCPs). Using a subset (N = 430 current/former soldiers) of Operation: SAFETY study data, we used regression models to examine differences in healthcare experiences, attitudes, and preferences by deployment status (never-deployed vs. previously-deployed). Final models controlled for age, sex, rank (enlisted vs. officer), military status (current vs. former military), and RAND SF-36 General Health Score. Over 40% of soldiers agreed that civilian HCPs should ask patients about their military service, but never-deployed soldiers were less likely to report being asked about their service (p < 0.05) or how their service affects their health (p < 0.10). Never-deployed soldiers were also less likely to attribute their health concerns to military service (p < 0.001). Although never-deployed soldiers were more likely to prefer receiving physical (p < 0.05) and mental (p < 0.05) healthcare outside of the VA than previously-deployed soldiers, never-deployed soldiers had low confidence in their HCP's understanding of their needs (49% thought that their civilian HCP did not understand them; 71% did not think that their civilian HCP could address military-related health concerns; 76% thought that their civilian HCP did not understand military culture). Findings demonstrate that although civilian HCPs may be the preferred (and only) choice for never-deployed USAR/NG soldiers, they may need additional support to provide care to this population.
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Affiliation(s)
- Rachel A Hoopsick
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, IL, USA
| | - Bonnie M Vest
- Department of Family Medicine, State University of New York at Buffalo, Buffalo, NY, USA
| | - D Lynn Homish
- Department of Community Health and Health Behavior, State University of New York at Buffalo, Buffalo, NY, USA
| | - Gregory G Homish
- Department of Community Health and Health Behavior, State University of New York at Buffalo, Buffalo, NY, USA
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Kulak JA, Voit HE, Balfour CA, Homish GG. College health providers' knowledge and confidence in addressing students' vaping: Evidence from a pilot study in New York State. PEC Innov 2023; 2:100123. [PMID: 37214494 PMCID: PMC10194164 DOI: 10.1016/j.pecinn.2023.100123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 12/21/2022] [Accepted: 01/16/2023] [Indexed: 05/24/2023]
Abstract
Objective This study examines the knowledge and confidence of college healthcare providers in discussing vaping with their college student populations. Methods This is a mixed-methods descriptive study using a sequential-explanatory approach, consisting of a cross-sectional, online survey followed by qualitative interviews. Survey data was collected from 50 college health providers located at 26 colleges in the 64-campus State University of New York system. Targeted semi-structured interviews (N = 11) were conducted by telephone with providers who completed the survey. Results Despite high reported levels of knowledge and confidence, few providers had participated in educational activities relative to vaping. There was evidence of misinformation about e-cigarettes, and they did not know what product (nicotine/cannabis) students typically vape. Conclusions Findings indicate a potential disconnect between providers' perceived and actual knowledge of college student vaping and demonstrate areas of opportunity to assist college health providers in comprehensively addressing vaping with their college student populations. Innovation College health providers played a key role in lowering rates of combustible cigarette smoking, but little is known about how they are now are communicating with college students about e-cigarette and cannabis vaping. This paper examines college health providers' knowledge, confidence, and training needs relative to vaping communications.
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Affiliation(s)
- Jessica A. Kulak
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
| | - Hannah E. Voit
- Department of Health, Nutrition, and Dietetics, Buffalo State College, Buffalo, NY, USA
| | - Cierra A. Balfour
- Department of Health, Nutrition, and Dietetics, Buffalo State College, Buffalo, NY, USA
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
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Myneni AA, Simmonds I, Orom H, Anderson LM, Singh R, Homish GG, Wright AJ, Pigott S, Onoh JC, Hoffman AB, Noyes K. A qualitative analysis of Black men's attitudes toward obesity and bariatric surgery. Surg Obes Relat Dis 2023; 19:1100-1108. [PMID: 37147204 DOI: 10.1016/j.soard.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 03/13/2023] [Accepted: 03/21/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Metabolic and bariatric surgery (MBS) is a safe and highly effective treatment for morbid obesity and related co-morbidities. While MBS access and insurance coverage have greatly improved, sex and racial disparities remain in utilization of MBS. OBJECTIVE To identify novel intrinsic factors that may explain Black underutilization of surgical treatments for weight management. SETTING This study was conducted in metropolitan communities of Western New York. METHODS We conducted semistructured face-to-face interviews with 27 adult Black men with a history of obesity and at least 2 obesity-related conditions (diabetes, hypertension, and/or chronic kidney disease [CKD]), about their attitudes, beliefs, behaviors, and habits related to obesity and obesity management. Interview transcripts were reviewed using thematic analysis for patterns and themes. RESULTS Most participants did not perceive obesity as a serious health condition and those who had weight-loss goals did not aim for a healthy body mass index (BMI). Trust and respectful communication with physician were very important in making healthcare decisions. MBS was perceived as extreme and dangerous option for weight loss, and only participants with severe symptoms such as chronic pain were open to discussing MBS with their providers. Participants acknowledged lack of role models of similar background who had successfully undergone MBS for obesity. CONCLUSIONS This study identified misinformation about risks and benefits of MBS and lack of community role models as important factors contributing to Black men's unwillingness to consider MBS. Further research is needed to facilitate patient-provider communication about weight and improve provider's ability and motivation for weight management in primary care settings.
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Affiliation(s)
- Ajay A Myneni
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.
| | - Iman Simmonds
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York; Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut
| | - Heather Orom
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | | | - Ranjit Singh
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Gregory G Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Alexander J Wright
- Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Sydney Pigott
- Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York; Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Joshua C Onoh
- Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Aaron B Hoffman
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Katia Noyes
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York; Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
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Lawson SC, Arif M, Hoopsick RA, Homish DL, Homish GG. Exploring Racial/Ethnic Disparities in Substance Dependence and Serious Psychological Distress among US Veterans. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01753-9. [PMID: 37603224 PMCID: PMC10879463 DOI: 10.1007/s40615-023-01753-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 08/03/2023] [Accepted: 08/06/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVES There are substantial racial/ethnic disparities in substance use and mental health among civilian populations, but few studies have examined these disparities in veterans using a nationally representative sample. Thus, we examined differences in substance dependence and serious psychological distress (SPD) by race/ethnicity among a national sample of US veterans. METHODS We pooled cross-sectional data from the 2015-2019 waves of the National Survey on Drug Use and Health (N = 7,653 veterans aged 18-64 years). Regression models were utilized to examine racial/ethnic differences in DSM-IV substance dependence and SPD with a Benjamini-Hochberg correction applied. RESULTS Compared to non-Hispanic White veterans: American Indian/Alaska Native veterans had significantly higher odds of past-year alcohol dependence (AOR = 2.55, 95% CI: 1.28, 5.08); Asian American veterans had significantly lower odds of past-year alcohol dependence (AOR = 0.12, 95% CI: 0.02, 0.62); non-Hispanic Black (AOR = 0.60, 95% CI: 0.48, 0.77), Hispanic (AOR = 0.47, 95% CI: 0.34, 0.65), and veterans of more than one race (AOR = 0.55, 95% CI: 0.36, 0.83) had significantly lower odds of past-month nicotine dependence; Asian American veterans had significantly lower odds of past-year illicit drug dependence (AOR = 0.05, 95% CI: 0.01, 0.35); and non-Hispanic Black veterans had significantly lower odds of past-year SPD (AOR = 0.69, 95% CI: 0.55, 0.85) after correction for multiple comparisons. CONCLUSION Overall, racial/ethnic disparities in substance dependence and SPD among veterans are not as stark as in civilian populations, but some disparities remain.
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Affiliation(s)
- Schuyler C Lawson
- Graduate Research Assistant, Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA.
| | - Mehreen Arif
- Graduate Research Assistant, Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Rachel A Hoopsick
- Assistant Professor, Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana-Champaign, Champaign, IL, USA
| | - D Lynn Homish
- Project Director, Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Gregory G Homish
- Professor and Chair, Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
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Kulak JA, Homish DL, Kozlowski LT, Homish GG. Cannabis Use and Perceptions Among Current and Former Military Service Members. Cannabis 2023; 6:104-112. [PMID: 37484055 PMCID: PMC10361804 DOI: 10.26828/cannabis/2023/000150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Background Research indicates separation from the military may result in increased risk of alcohol use. However, there is little data on cannabis use among military service members, particularly when examining the period after separation from military service. This research examines cannabis-related perceptions and use among U.S. Army Reserve/National Guard (USAR/NG) current and former soldiers. Methods Data come from Operation: SAFETY (Soldiers And Families Excelling Through the Years), an ongoing study examining health among male and female USAR/NG soldiers. The current sample was comprised of 401 current and former USAR/NG soldiers. Logistic regression models examined the associations between past-year cannabis use, military status (i.e., current versus former), attitudes towards recreational cannabis, perceived ease of access, and perceived risk of cannabis use, while controlling for age, problematic alcohol use, and current cigarette smoking. Results Overall, 7.4% of current and 20.3% of former military service members used cannabis in the past year. Favorable attitudes towards cannabis use and perceived ease of accessing cannabis were associated with increased odds of use among all soldiers. In adjusted models, former military members had greater odds (AOR = 5.28, 95% CI = 2.16, 12.87) of past-year cannabis use compared to current service members. Conclusions Findings indicate that separation from the military may be an important risk factor to consider when assessing cannabis use in the military. Additional research is needed to examine socioenvironmental factors (e.g., access to post-deployment support services and healthcare, state legalization laws, other behavioral health conditions) that contribute to former service members' cannabis use.
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Affiliation(s)
- Jessica A. Kulak
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
| | - D. Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
| | - Lynn T. Kozlowski
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
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Fillo J, Goodell EMA, Homish DL, Homish GG. Sex differences in the relation between military sexual trauma and risk for alcohol misuse among U.S. Army Reserve and National Guard soldiers. Alcohol Clin Exp Res (Hoboken) 2023; 47:736-747. [PMID: 36869424 PMCID: PMC10351397 DOI: 10.1111/acer.15045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 08/31/2022] [Revised: 01/11/2023] [Accepted: 02/23/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Military sexual trauma (MST) is linked to a range of deleterious health outcomes. Extant literature has focused disproportionately on mental health sequelae of MST. Research is needed to better understand the extent to which MST contributes to alcohol misuse and related problems - key issues facing service members. Additionally, sex differences in the nature and prevalence of MST may impact sequelae. The present research examined (a) the prevalence of an MST history among female and male service members, (b) relations between MST history and risk for alcohol misuse and related problems, and (c) potential sex differences in these experiences and outcomes. METHODS Data from current and previous service members (334 males and 70 females) were drawn from Operation: SAFETY (Soldiers and Families Excelling Through the Years), a longitudinal study of U.S. Army Reserve and National Guard (USAR/NG) soldiers and their partners. Analyses examined the prevalence and types of MST experienced, relations between MST history and three alcohol-related variables (total consumption, heavy drinking frequency, and alcohol-related problems), and differences by sex. RESULTS Approximately one-third (33.7%) of service members reported an MST history. Females (61.4%) reported an MST history at more than twice the rate of males (27.8%). Interactions between MST and sex were significant for all alcohol-related variables. Among males, an MST history was related to 70% higher alcohol consumption, 86% higher heavy drinking frequency, and 45% higher alcohol problem scores. An MST history was unrelated to alcohol-related variables among females. CONCLUSION Findings suggest a higher prevalence of MST among USAR/NG service members than is often reported in the literature, particularly among males. An MST history was associated with higher and more hazardous/harmful current alcohol consumption among male service members, highlighting the need for greater screening, prevention, and intervention among a population already at high risk for problematic alcohol use. Results underscore that MST is an important and prevalent experience requiring greater study alongside more traditional notions of service-connected trauma.
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Affiliation(s)
- Jennifer Fillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina
| | - Erin M. Anderson Goodell
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University
| | - D. Lynn Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York
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Vest BM, Hoopsick RA, Homish DL, Homish GG. The Role of Military Identity in Substance Use and Mental Health Outcomes among U.S. Army Reserve and National Guard Soldiers. Mil Psychol 2023; 35:85-93. [PMID: 36568407 PMCID: PMC9770498 DOI: 10.1080/08995605.2022.2082812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/30/2022]
Abstract
We investigated how military identity (i.e., veteran identity centrality, the extent to which military service is central to an individual's sense of self) relates to substance use and mental health among U.S. Army Reserve and National Guard (USAR/NG) soldiers. Data were drawn from Operation: SAFETY, a longitudinal survey study of USAR/NG soldiers. Regression models (n=413 soldiers) examined relationships between military identity and substance use (i.e., alcohol problems, past 3-months non-medical use of prescription drugs (NMUPD), illicit drug use, tobacco use), and mental health (i.e., generalized anxiety, anger, depression, PTSD), controlling for sex, race, age, education, years of military service, military status (current/former), and deployment (ever/never). In adjusted models, stronger military identity was not related to alcohol, illicit drug, or tobacco use, but was associated with past 3-months NMUPD (OR: 1.40, 95% CI: 1.12, 1.75, p<.01) and greater symptoms of anger (IRR: 1.02, 95% CI: 1.01, 1.03, p<.01), generalized anxiety (IRR: 1.05, 95% CI: 1.01, 1.10, p<.01), depression (IRR: 1.06, 95% CI: 1.02, 1.10, p<.01), and PTSD (IRR: 1.07, 95% CI: 1.02, 1.12, p<.01). Findings demonstrate the importance of military identity for health-related outcomes. NMUPD suggests potential self-medication and an avoidance of help-seeking, as admitting difficulties may conflict with military identity.
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Affiliation(s)
| | - Rachel A. Hoopsick
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign
| | - D. Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, University at Buffalo
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Vest BM, Weiss-Laxer NS, Homish DL, Homish GG. Lifetime trauma exposure profiles and alcohol use over time among U.S. Reserve and National Guard soldiers. J Trauma Stress 2022; 35:1642-1655. [PMID: 35901312 PMCID: PMC10440733 DOI: 10.1002/jts.22867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/26/2022] [Accepted: 06/02/2022] [Indexed: 12/24/2022]
Abstract
Although trauma exposure is a recognized risk factor for alcohol use, research on military populations has emphasized combat exposure, with minimal consideration of exposure to other potentially traumatic events (PTEs). We aimed to (a) identify, characterize, and quantify subgroups of service members based on PTE patterns; (b) examine associations between trauma exposure subgroups and alcohol use; and (c) examine these associations longitudinally. Data were drawn from Operation: SAFETY, a longitudinal study of health and well-being among U.S. Army Reserve/National Guard soldiers (N = 478). Exposure to 15 PTEs, including childhood maltreatment, noninterpersonal events (e.g., natural disasters, accidents), interpersonal trauma, and military-related exposures, was assessed at baseline. Latent profile analysis was conducted to characterize mutually exclusive trauma profiles; profile membership was used to longitudinally predict alcohol use in generalized estimating equation models. Four exposure profiles were identified: intimate partner violence (IPV)/combat trauma (8.4%, n = 40), combat trauma (24.7%, n = 118), childhood trauma (8.4%, n = 40), and low trauma (58.6%, n = 280). In adjusted models, compared to the low trauma profile, IPV/combat profile membership was longitudinally associated with alcohol problems, OR = 2.44, p =.005. Membership in other trauma profiles was not associated with alcohol use. Within the IPV/combat profile, men had a higher risk of frequent heavy drinking than women. Results suggest a need to comprehensively screen for lifetime PTE exposure, particularly IPV, in military populations. Given the high prevalence of nonmilitary PTEs, an inclusive, trauma-informed approach to health care and service provision is warranted.
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Affiliation(s)
| | | | - D. Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, University at Buffalo
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Hoopsick RA, Homish DL, Lawson SC, Homish GG. Drug use over time among never-deployed US Army Reserve and National Guard soldiers: The longitudinal effects of non-deployment emotions and sex. Stress Health 2022; 38:1045-1057. [PMID: 35500288 PMCID: PMC9853315 DOI: 10.1002/smi.3156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/22/2021] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 01/24/2023]
Abstract
Some US military service members who have never been deployed experience negative emotions related to never having been deployed, and some work shows these non-deployment emotions (NDE) are cross-sectionally associated with hazardous drinking for male, but not female, US Army Reserve/National Guard (USAR/NG) soldiers. However, it is not known if these effects extend to drug use or persist longitudinally, which is the focus of the current study. We conducted a longitudinal residual change analysis of a subset of data (N = 182 never-deployed soldiers) from Operation: SAFETY, an ongoing survey-based study of USAR/NG soldiers recruited from units across New York State. Outcome measures included current tobacco use, non-medical use of prescription drugs (NMUPD), current cannabis use, and other current illicit drug use (excluding cannabis) at four time points over a 3-year period. Results from bootstrapped residual change generalized estimating equation (GEE) models show that more negative NDE were longitudinally associated with a greater likelihood of current NMUPD among male, but not female, soldiers (p < 0.05). NDE were not longitudinally associated with current tobacco use, cannabis use, or other illicit drug use among male or female soldiers (ps > 0.05). NDE may contribute to ongoing NMUPD among male USAR/NG soldiers who have never been deployed. Never-deployed soldiers, especially those with negative emotions related to never having been deployed, should not be overlooked in military screening and intervention efforts.
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Affiliation(s)
- Rachel A. Hoopsick
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, 1206 S. Fourth Street, Champaign, IL 61820, USA
| | - D. Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY 14214, USA
| | - Schuyler C. Lawson
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY 14214, USA
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY 14214, USA
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13
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Hoopsick RA, Vest BM, Homish DL, Homish GG. Differences in alcohol screening and alcohol problems among United States veterans based on military service history. Psychol Serv 2022; 19:710-718. [PMID: 34516202 PMCID: PMC8918068 DOI: 10.1037/ser0000584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Military deployment is a risk factor for alcohol problems, and postdeployment alcohol problems are more prevalent among part-time reservists than full-time active duty service members. However, emerging research suggests that reservists who never experience deployment are also at risk. We examined if never-deployed/activated reserve veterans differed from active duty/deployed veterans in alcohol screening and misuse. Using pooled cross-sectional data from the National Survey on Drug Use and Health (NSDUH; 2015-2019), we estimated the prevalence of past-year self-reported alcohol screening by a health care provider and measured DSM-IV alcohol abuse and alcohol dependence among U.S. veterans aged 18-49 years with at least one health care visit in the past year (N = 4,148). We used regression models to examine for differences in these outcomes between never-deployed/activated reserve veterans and active duty/deployed veterans. Overall, 15% of veterans reported not being screened for alcohol use, despite 1 in 11 meeting DSM-IV criteria for alcohol abuse/dependence. Active duty/deployed veterans were more likely to have been screened for alcohol use than never-deployed/activated reserve veterans (p < .05). However, there was no difference in past-year alcohol abuse (p > .05) or dependence (p > .05) between never-deployed/activated reserve veterans and veterans with a history of active duty service/activation. Never-deployed/activated reserve veterans are less likely to be screened for alcohol use than active duty/deployed veterans, despite no significant difference in meeting alcohol abuse/dependence criteria. Providers may not recognize never-deployed reservists as veterans. We recommend systematic screening for military service history and alcohol use for all veterans, regardless of deployment/active duty service. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Rachel A. Hoopsick
- Department of Family Medicine, University at Buffalo, The State University of New York
| | - Bonnie M. Vest
- Department of Family Medicine, University at Buffalo, The State University of New York
| | - D. Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, New York
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, New York
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14
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Vest BM, Goodell EMA, Homish DL, Homish GG. Effects of Social Network Characteristics on Mental Health Outcomes Among United States Army Reserve and National Guard Soldiers. Community Ment Health J 2022; 58:1268-1278. [PMID: 34981277 PMCID: PMC9250539 DOI: 10.1007/s10597-021-00935-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/25/2021] [Accepted: 12/12/2021] [Indexed: 11/30/2022]
Abstract
We sought to examine the relative salience of multiple social network structural characteristics (e.g., size, composition, quality, substance use) for understanding soldiers' mental health symptoms (anger, anxiety, depression, PTSD). Data are drawn from soldiers (N = 421) participating in the Operation: SAFETY study. Negative binomial regression models examined the relationship between ten social network characteristics and mental health outcomes, controlling for age, sex, years of military service, and deployment history. Greater number of close network ties was associated with fewer symptoms of anger, anxiety, and depression (ps < 0.05), but not PTSD. Having more illicit drug-using network ties was associated with greater severity of anxiety symptoms (p < 0.05). Finally, more days spent drinking with network members was related to higher levels of anger (p < 0.05). Interpersonal relationships that entail substance use are associated with greater anxiety and anger while a greater number of close ties is associated with fewer anger, anxiety, and depression symptoms.
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Affiliation(s)
- Bonnie M Vest
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 77 Goodell Street, Suite 220, Buffalo, NY, 14203, USA.
| | - Erin M Anderson Goodell
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - D Lynn Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Gregory G Homish
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 77 Goodell Street, Suite 220, Buffalo, NY, 14203, USA
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
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15
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Vest BM, Hoopsick RA, Fillo J, Homish DL, Homish GG. Problems With Sleep Are Common and Predict Increased Risk for Alcohol and Drug Use Among Reserve and National Guard Soldiers. J Stud Alcohol Drugs 2022. [DOI: 10.15288/jsad.2022.83.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Bonnie M. Vest
- Department of Family Medicine, University at Buffalo, The State University of New York, Buffalo, New York
| | - Rachel A. Hoopsick
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, Illinois
| | - Jennifer Fillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina
| | - D. Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, New York
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, New York
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16
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Vest BM, Hoopsick RA, Fillo J, Homish DL, Homish GG. Problems With Sleep Are Common and Predict Increased Risk for Alcohol and Drug Use Among Reserve and National Guard Soldiers. J Stud Alcohol Drugs 2022; 83:537-545. [PMID: 35838431 PMCID: PMC9318696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Sleep problems are common among military members and may increase substance use risk. This study examines longitudinal associations between sleep problems and substance use among U.S. Army Reserve and National Guard (USAR/NG) soldiers as well as differences between current and former soldiers. METHOD Data are drawn from Operation: SAFETY (Soldiers and Families Excelling Through the Years), an ongoing prospective study of the health and well-being of USAR/NG soldiers and their spouses. We used generalized estimating equation models (N = 485 soldiers; 79.8% male) to examine residual change in substance use (alcohol problems, heavy drinking, current use of any drug, nonmedical use of prescription drugs [NMUPD], and illicit drugs) associated with sleep problems (globally and particular dimensions) over 3 years, controlling for probable post-traumatic stress disorder, age, sex, and substance use at the prior time point. Interaction models examined differences by military status (current vs. former soldier). RESULTS Sleep problems were associated with increased risk of heavy drinking (p < .05), any current drug use (p < .05), current NMUPD (p < .01), and current illicit use (p < .05). There were significant interactions between sleep quality and military status on any current drug use (p < .01) and current illicit use (p < .05) and between sleep duration and military status on current NMUPD (p < .05), such that the risk of substance use was greater for former compared with current soldiers. CONCLUSIONS Sleep problems are prevalent among USAR/NG soldiers and are longitudinally associated with alcohol and drug use. This risk may increase for soldiers who have separated from the military. These findings support routine screening for sleep problems among soldiers and predischarge education around substance use risks related to unaddressed sleep problems.
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Affiliation(s)
- Bonnie M. Vest
- Department of Family Medicine, University at Buffalo, The State University of New York, Buffalo, New York,Correspondence may be sent to Bonnie M. Vest at the Department of Family Medicine, University at Buffalo, 77 Goodell Street, Suite 220, Buffalo, NY 14203, or via email at:
| | - Rachel A. Hoopsick
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, Illinois
| | - Jennifer Fillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina
| | - D. Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, New York
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, New York
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17
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Vest BM, Brimmer MJ, Brady LA, Homish GG. "I just wanna be another person at school": Disclosing veteran identity on campus and effects on campus engagement. J Am Coll Health 2022:1-8. [PMID: 35623047 PMCID: PMC9701239 DOI: 10.1080/07448481.2022.2076106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 04/08/2022] [Accepted: 05/06/2022] [Indexed: 06/15/2023]
Abstract
Objective: To describe how veterans feel about disclosing their military status on campus and impacts on engagement with social and health-related services. Participants: Thirty-one university student veterans who participated in a student veterans' health study. Participants self-identified as White and male (90%) with an average age of 29.5 years and 6.7 years of military service. Methods: Qualitative interviews explored veterans' perceptions of belonging on campus and the impact of veteran identity on educational experiences. Data analysis used an inductive, content-based approach. Results: Themes included: (1) varied feelings around disclosing military service history, with many preferring not to disclose; (2) visibility of resources on campus; and (3) use of resources on campus for social engagement, mental, and physical health. Conclusions: Findings illustrate student veterans' complex experiences, and how feelings about disclosing veteran identity on campus relate to resource use. Campuses should acknowledge and explore this complexity with student veterans' input to ensure that supports meet their needs.
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Affiliation(s)
- Bonnie M. Vest
- Primary Care Research Institute, Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Maximilian J. Brimmer
- Primary Care Research Institute, Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Laura A. Brady
- Primary Care Research Institute, Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Gregory G. Homish
- Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY
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18
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Mahajan SD, Homish GG, Quisenberry A. Multifactorial Etiology of Adolescent Nicotine Addiction: A Review of the Neurobiology of Nicotine Addiction and Its Implications for Smoking Cessation Pharmacotherapy. Front Public Health 2021; 9:664748. [PMID: 34291026 PMCID: PMC8287334 DOI: 10.3389/fpubh.2021.664748] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/24/2021] [Indexed: 12/14/2022] Open
Abstract
Nicotine is the primary pharmacologic component of tobacco, and its highly addictive nature is responsible for its widespread use and significant withdrawal effects that result in challenges to smoking cessation therapeutics. Nicotine addiction often begins in adolescence and this is at least partially attributed to the fact that adolescent brain is most susceptible to the neuro-inflammatory effects of nicotine. There is increasing evidence for the involvement of microglial cells, which are the brain's primary homeostatic sensor, in drug dependence and its associated behavioral manifestations particularly in the adolescent brain. A hallmark of neuro-inflammation is microglial activation and activation of microglia by nicotine during adolescent development, which may result in long-term addiction to nicotine. This non-systematic review examines multifactorial etiology of adolescent nicotine addiction, neurobiology of nicotine addiction and the potential mechanisms that underlie the effects of nicotine on inflammatory signaling in the microglia, understanding how nicotine affects the adolescent brain. We speculate, that modulating homeostatic balance in microglia, could have promising therapeutic potential in withdrawal, tolerance, and abstinence-related neural adaptations in nicotine addiction, in the adolescent brain. Further, we discuss nicotine addiction in the context of the sensitization-homeostasis model which provides a theoretical framework for addressing the potential role of microglial homeostasis in neural adaptations underlying nicotine abuse.
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Affiliation(s)
- Supriya D. Mahajan
- Department of Community Health and Health Behavior, School of Public Health, University at Buffalo, Buffalo, NY, United States
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, School of Public Health, University at Buffalo, Buffalo, NY, United States
| | - Amanda Quisenberry
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
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19
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Zhu K, Niu Z, Freudenheim JL, Zhang ZF, Lei L, Homish GG, Cao Y, Zorich SC, Yue Y, Liu R, Mu L. COVID-19 Related Symptoms of Anxiety, Depression, and PTSD among US Adults. Psychiatry Res 2021; 301:113959. [PMID: 33964602 PMCID: PMC8064819 DOI: 10.1016/j.psychres.2021.113959] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/18/2021] [Indexed: 01/18/2023]
Abstract
During the COVID-19 pandemic, social distancing measures often result in individual isolation, which can lead to adverse mental outcomes. We collected online questionnaires from 3,952 US adults to examine the impact of "shelter-in-place" guidelines on mental health, and to explore potential disparities and modifiable factors. Self-reported anxiety, depression, and PTSD symptoms were associated with more restrictive quarantine. Younger adults, women, those with lower income, more insecurity, more media exposure, reduced physical activity, or worsened family relationships were particularly affected. Targeted prevention on susceptible subpopulations, including young adults and lower SES groups, might help mitigate disparities in COVID-19-related mental health problems.
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Affiliation(s)
- Kexin Zhu
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Zhongzheng Niu
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Jo L. Freudenheim
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Zuo-Feng Zhang
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Lijian Lei
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Ying Cao
- Department of Population Health Sciences, University of Wisconsin-Madison, WI, USA
| | - Shauna C. Zorich
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Yihua Yue
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Rujie Liu
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Lina Mu
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA.
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20
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Hoopsick RA, Homish DL, Vest BM, Bartone PT, Homish GG. Resilience to Hazardous Drinking Among Never-Deployed Male United States Army Reserve and National Guard Soldiers. Alcohol Clin Exp Res 2021; 45:566-576. [PMID: 33503277 DOI: 10.1111/acer.14561] [Citation(s) in RCA: 2] [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] [Received: 10/05/2020] [Accepted: 01/19/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Negative emotions related to never having been deployed to active duty are associated with an increased risk of hazardous drinking among United States Army Reserve/National Guard (USAR/NG) soldiers. Resiliency factors are known to buffer the effects of combat on hazardous drinking among service members who have been deployed, but it is not known whether these factors are protective for never-deployed service members, or which domains of hazardous drinking might be affected. Therefore, we examined the effects of a range of resiliency factors (i.e., marital satisfaction, psychological hardiness, intrinsic religiosity) on the relation between nondeployment emotions (NDE) and domains of hazardous drinking. METHODS We drew a subset of data from Operation: Soldiers and Families Excelling Through the Years (N = 112 never-deployed male soldiers), an ongoing study of USAR/NG soldiers. Regression models examined the main effects of NDE on each of the domains of hazardous drinking (i.e., total Alcohol Use Disorders Identification Test [AUDIT] score, consumption subscale, dependence subscale, alcohol-related problems subscale) and effect modification of each of the resiliency factors on the relations between NDE and the domains of hazardous drinking, separately. Final models controlled for years of military service, rank (enlisted vs. officer), number of military friends in the social network, and depression. RESULTS Greater NDE were associated with a higher total AUDIT score, alcohol consumption, and alcohol dependence (ps < 0.05), but not alcohol-related problems (p > 0.05). Marital satisfaction and psychological hardiness buffered the effects of NDE on total AUDIT score and alcohol dependence (p < 0.05). Intrinsic religiosity only modified the effect of NDE on total AUDIT score. None of the resiliency factors modified the effects of NDE on alcohol consumption or alcohol-related problems. CONCLUSIONS Soldiers with greater NDE had a greater risk of hazardous drinking in the presence of low resilience. Interventions to promote resiliency are an important consideration for protecting USAR/NG soldiers from hazardous drinking, regardless of their deployment history.
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Affiliation(s)
- Rachel A Hoopsick
- Department of Family Medicine, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - D Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Bonnie M Vest
- Department of Family Medicine, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Paul T Bartone
- Institute for National Strategic Studies, National Defense University, Washington, DC, USA
| | - Gregory G Homish
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
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21
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Abstract
Epidemiological data identify risk factors related to substance use among military service members to inform prevention and treatment. Less is known about how motivations and risks for substance use vary over a military service career. The study goal was to explore substance use patterns and motivations among a sample of United States undergraduate student veterans in order to identify periods of risk. Methods: Qualitative interviews were conducted (n = 31) between December 2018 and April 2019. Transcripts were coded in ATLAS.ti using thematic content analysis. Results: Interviews revealed complex motivations around substance use and identified key periods of risk. 1) Pre-service: Participants reported using alcohol and marijuana, primarily during social activities. 2) During service: Participants described a culture of heavy alcohol and tobacco use in social contexts, but little use of other substances. Post-deployment was a notable exception, when some reported heavier alcohol use and use of other drugs, including opiates, cocaine, and ecstasy. 3) Post-service: Transitioning out of the military was described as difficult; some participants reported heavier use of substances during this period. Some participants quit smoking after military service, or switched to vaping. Others reported use of alcohol and/or marijuana to calm themselves, relieve stress, and enable sleep. Conclusions: These data indicate that the periods immediately following deployment and transition out of the military may be especially high-risk for heavy substance use and use of a broader range of substances. This highlights the need for tailored interventions and messaging at different points of military service, particularly during periods of greatest risk.
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Affiliation(s)
- Bonnie M Vest
- Primary Care Research Institute, Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Laura A Brady
- Primary Care Research Institute, Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Maximilian J Brimmer
- Primary Care Research Institute, Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Gregory G Homish
- Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
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22
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Hoopsick RA, Homish GG, Leonard KE. Differences in Opioid Overdose Mortality Rates Among Middle-Aged Adults by Race/Ethnicity and Sex, 1999-2018. Public Health Rep 2020; 136:192-200. [PMID: 33211981 DOI: 10.1177/0033354920968806] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [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: 11/15/2022] Open
Abstract
OBJECTIVES The types of opioids abused in the United States have changed from prescription opioids to heroin to fentanyl. However, the types of opioids abused may differ by demographic factors, especially among middle-aged adults. We examined national trends in opioid overdose mortality rates among middle-aged adults by race/ethnicity and sex. METHODS Using 1999-2018 data from the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research database, we examined overdose mortality rates per 100 000 population in 2018 among adults aged 45-64 that involved natural and semisynthetic opioids, heroin, synthetic opioids (excluding methadone), and methadone. We tested for significant differences in mortality rates by race/ethnicity and sex. We plotted drug-specific trends by race/ethnicity and sex from 1999 to 2018. RESULTS In 2018, non-Hispanic White adults had the highest rates per 100 000 population of natural and semisynthetic overdose mortality (men: 8.7; women: 7.9; P < .001), and non-Hispanic Black adults had the highest rates of heroin (men: 17.7; women: 5.4; P < .001) and synthetic opioid (men: 36.0; women: 11.2; P < .001) overdose mortality. Men had significantly higher overdose mortality rates than women did for deaths involving natural and semisynthetic opioids, heroin, and synthetic opioids, but not methadone. From 1999 to 2018, mortality rates increased sharply for heroin and synthetic opioids, increased modestly for natural and semisynthetic opioids, and decreased for methadone. The greatest increases were among non-Hispanic Black men for heroin overdose (3.3 in 1999 to 17.7 in 2018) and synthetic opioid overdose (0.1 in 1999 to 36.0 in 2018). CONCLUSIONS Policy making should consider unique subgroup risks and alternative trajectories of opioid use other than people being prescribed opioids, developing opioid use disorder, subsequently moving to heroin, and then to fentanyl.
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Affiliation(s)
- Rachel A Hoopsick
- 12292 Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Gregory G Homish
- 12292 Department of Community Health and Health Behavior, School of Public Health and Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Kenneth E Leonard
- Clinical and Research Institute on Addictions, University at Buffalo, The State University of New York, Buffalo, NY, USA.,12292 Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
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23
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Hoopsick RA, Homish DL, Collins RL, Nochajski TH, Read JP, Homish GG. Is deployment status the critical determinant of psychosocial problems among reserve/guard soldiers? Psychol Serv 2020; 17:461-471. [PMID: 30762411 PMCID: PMC6693987 DOI: 10.1037/ser0000331] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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] [Indexed: 02/03/2023]
Abstract
A general assumption that deployment is the primary catalyst for psychological and social difficulties may contribute to underrecognition and undertreatment of problems among never-deployed service members (i.e., having no history of ever being deployed). We aimed to determine if ever-deployed (i.e., having a history of at least one deployment) and never-deployed United States Army Reserve and National Guard (USAR/NG) soldiers differed in mental health, substance use, and resiliency factors, and to determine the relative influence of deployment status and each of these factors on poor psychosocial outcomes. We analyzed a subset of data from Operation: SAFETY (Soldiers and Families Excelling Through the Years) (N = 404), an ongoing study examining the health and well-being of USAR/NG soldiers. Bivariate analyses demonstrated that soldiers did not significantly differ across a range of measures on the basis of deployment status (ps > 0.05). In fact, Factor Analyses and Discriminant Function Analysis revealed that deployment status was the least salient factor to psychosocial problems among the measured variables and that the observed variables could not accurately discriminate between ever-deployed and never-deployed soldiers, F(8, 374) = 1.34, p > .05. Measures of mental health and substance use were more salient to psychosocial problems (ps < .05). Measures of resiliency loaded negatively onto psychosocial problems (ps < .05), indicating that they contribute to better well-being. Targeting screening and intervention efforts only on soldiers who have been deployed will miss opportunities to intervene on an equally affected group. Resiliency factors should be considered as intervention targets. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Rachel A. Hoopsick
- Department of Community Health and Health Behavior, School
of Public Health and Health Professions, University at Buffalo, The State University
of New York, Buffalo, NY 14215, USA
| | - D. Lynn Homish
- Department of Community Health and Health Behavior, School
of Public Health and Health Professions, University at Buffalo, The State University
of New York, Buffalo, NY 14215, USA
| | - R. Lorraine Collins
- Department of Community Health and Health Behavior, School
of Public Health and Health Professions, University at Buffalo, The State University
of New York, Buffalo, NY 14215, USA
| | - Thomas H. Nochajski
- School of Social Work, University at Buffalo, The State
University of New York, Buffalo, NY 14260, USA
| | - Jennifer P. Read
- Department of Psychology, College of Arts and Sciences,
University at Buffalo, The State University of New York, Buffalo, NY 14260,
USA
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, School
of Public Health and Health Professions, University at Buffalo, The State University
of New York, Buffalo, NY 14215, USA
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Vest BM, Kulak JA, Homish DL, Hoopsick RA, Homish GG. Mental and physical health factors related to dual use of veterans affairs and non-veterans affairs healthcare among U.S. reserve soldiers. PSYCHOL HEALTH MED 2020; 27:976-986. [PMID: 32997548 DOI: 10.1080/13548506.2020.1828945] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study examined the association between mental and physical health factors and dual use of Veterans' Affairs (VA) and non-VA healthcare among previously deployed male Reserve/National Guard (R/NG) soldiers (N = 214). Participants completed online annual surveys on a range of topics, including validated measures of mental and physical health, as well as questions about past-year healthcare utilization. Multinomial logistic regression models separately examined the association between mental health symptoms (PTSD, anxiety, depression, emotional role limitations), physical health symptoms (bodily pain, physical role limitations), and healthcare use (single use and dual use compared to no use), controlling for geography, trust in the VA, age, and race. Anxiety (aRR: 1.13; 95% Confidence Interval (CI): 1.02, 1.26; p<.05), depression (aRR: 1.23; 95% CI: 1.06, 1.43; p<.01), and PTSD (aRR: 1.05; 95% CI: 1.01, 1.10; p<.05) symptoms were all related to past year dual use of VA and non-VA healthcare, even after controlling for known demographic factors. Bodily pain and emotional and physical role limitations were not related to healthcare outcomes. This suggests that mental health symptoms themselves may be a primary factor driving healthcare use. Further study is needed to examine whether dual use of VA and non-VA healthcare is duplicative or complementary.
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Affiliation(s)
- Bonnie M Vest
- Department of Family Medicine, University at Buffalo, Buffalo, NY, USA
| | - Jessica A Kulak
- Department of Health, Nutrition, & Dietetics, Buffalo State College, Buffalo, NY, USA
| | - D Lynn Homish
- Department of Community Health & Health Behavior, University at Buffalo, Buffalo, NY, USA
| | - Rachel A Hoopsick
- Department of Family Medicine, University at Buffalo, Buffalo, NY, USA.,Department of Community Health & Health Behavior, University at Buffalo, Buffalo, NY, USA
| | - Gregory G Homish
- Department of Community Health & Health Behavior, University at Buffalo, Buffalo, NY, USA
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Vest BM, Hoopsick RA, Homish DL, Homish GG. Lower levels of bodily pain increase risk for non-medical use of prescription drugs among current US reserve soldiers. Addict Behav 2020; 108:106443. [PMID: 32315933 DOI: 10.1016/j.addbeh.2020.106443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/22/2020] [Revised: 03/09/2020] [Accepted: 04/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Military populations have a higher prevalence of pain compared to their civilian counterparts and are also at increased risk for substance use. The link between clinically significant pain and substance use has been established, but it is unclear if lower levels of pain relate to risk. The goal of this inquiry was to determine if level of bodily pain was associated with increased risk of current substance use over time among a community sample of U.S. Army Reserve/National Guard (USAR/NG) soldiers. METHODS Data were drawn from an ongoing study of USAR/NG soldiers. We used generalized estimating equations to examine the longitudinal impact of baseline bodily pain level (modeled in standard deviations from the mean pain score) on current drug use (illicit and non-medical use of prescription drugs [NMUPD]) among soldiers (n = 387) over two-years. Final models controlled for baseline post-traumatic stress disorder (PTSD), anxiety, and depression symptomatology, history of deployment (yes/no), years of military service, and substance use norms. RESULTS Bodily pain was longitudinally associated with increased odds of current NMUPD (AOR: 1.49, p < .05), but not with the current use of illicit drugs (AOR: 1.18, p > .05), controlling for symptoms of PTSD, anxiety, depression, deployment, years of service, and substance use norms. CONCLUSIONS Overall, our findings indicate that bodily pain is longitudinally associated with NMUPD among male soldiers, but not with illicit drugs. Significantly, our results stem from a non-clinical sample of soldiers with overall lower levels of pain. This indicates that pain may be important, even at lower levels, and underscores the importance of early non-pharmacologic interventions for pain.
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Affiliation(s)
- Bonnie M Vest
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA.
| | - Rachel A Hoopsick
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA; Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - D Lynn Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Gregory G Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
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Hoopsick RA, Vest BM, Homish DL, Homish GG. Problems with Social Acceptance and Social Victimization Predict Substance Use among US Reserve/Guard Soldiers. Stress Health 2020; 36:311-321. [PMID: 31999055 PMCID: PMC7390694 DOI: 10.1002/smi.2934] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/14/2020] [Accepted: 01/17/2020] [Indexed: 12/30/2022]
Abstract
The effects of negative social interactions/experiences on substance use have largely been studied in civilian populations, but less is known about United States Army Reserve/National Guard (USAR/NG) soldiers-a high-risk group. We examined the associations between problems with social acceptance, social victimization, and substance use among USAR/NG soldiers, and examined potential differences by deployment history. The sample consisted of soldiers who completed baseline and 1-year follow-up assessments (N = 445) of Operation: SAFETY, an ongoing study of USAR/NG soldiers. We examined the effects of baseline problems with social acceptance/social victimization on nonmedical use of prescription drugs (NMUPD), illicit drug use, frequent heavy drinking (FHD), and alcohol problems at follow-up. Significant effects were small in magnitude but consistent in direction. Greater problems with social acceptance were associated with higher odds of NMUPD and illicit drug use. Greater social victimization was associated with higher odds of NMUPD and illicit drug use. There were no differences by deployment history. Problems with social acceptance/social victimization were not associated with FHD or alcohol problems. Problems with social acceptance/social victimization may contribute to drug use among USAR/NG soldiers. Intervention programs should address social issues, regardless of deployment history.
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Affiliation(s)
- Rachel A. Hoopsick
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA,Corresponding Author: Rachel A. Hoopsick, Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 3435 Main Street, 335 Kimball Tower, Buffalo, NY 14214, USA. Phone: 716-829-5704,
| | - Bonnie M. Vest
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - D. Lynn Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
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Anderson Goodell EM, Johnson RM, Latkin CA, Homish DL, Homish GG. Risk and protective effects of social networks on alcohol use problems among Army Reserve and National Guard soldiers. Addict Behav 2020; 103:106244. [PMID: 31838442 DOI: 10.1016/j.addbeh.2019.106244] [Citation(s) in RCA: 5] [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: 06/07/2019] [Revised: 11/18/2019] [Accepted: 11/20/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Military personnel engage in alcohol-related behaviors for a variety of reasons, some of which may be socially-motivated. Although civilian-based research has established that peers' drinking behaviors are correlated with individuals' own drinking behaviors, military work has not yet examined the influence of social network characteristics on soldier drinking behaviors. This study describes characteristics of soldiers' social networks in association with soldier alcohol use problems. METHODS This study includes data on 353 U.S. Reserve and National Guard (R/NG) soldiers and their 2154 past-year social ties. Descriptive analyses examined social tie characteristics (e.g., military affiliation, substance misuse, and drinking influence). Negative binomial regression models examined relationships between social network characteristics and soldier alcohol use problems. RESULTS On average, 14% of a R/NG soldier's social network was comprised of military-affiliated ties. Further, an average of 14% of ties in a soldier's network were considered drinking buddies, and 8% of ties were heavy-drinkers. More drinking buddies and heavy-drinking ties in a soldier's social network and greater average number of past-month days drinking with ties were associated with increases in soldier alcohol problems. For deployed soldiers, larger military-affiliated social networks were protective against alcohol problems. CONCLUSIONS Drinking-related social network characteristics are associated with increased alcohol problems among soldiers, while military-affiliated ties are protective specifically for deployed soldiers. Interventions to reduce alcohol use problems may focus on enhancing social connections between R/NG soldiers and providing opportunities to connect deployed R/NG soldiers with one another during and after reintegration.
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Vest BM, Hoopsick RA, Homish DL, Homish GG. Mental health and educational outcomes among current and former National Guard and Reserve soldiers. J Am Coll Health 2020; 68:110-114. [PMID: 30570455 PMCID: PMC6586523 DOI: 10.1080/07448481.2018.1536056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 05/07/2018] [Revised: 07/06/2018] [Accepted: 09/25/2018] [Indexed: 06/09/2023]
Abstract
Objective: This study examined the relationships between mental health and educational outcomes among student service members and veterans (SSM/Vs). Participants: Current/former Reserve and National Guard (R/NG) soldiers who were enrolled in school, college, or university in the past year (n = 130). Data were collected in 2014-2016. Methods: Exact logistic regression models separately examined the impact of anxiety, depression, anger, and PTSD on quitting/flunking in the past year. Final models controlled for sex and deployment status. Results: In final models, anxiety [OR: 1.14; 95% confidence interval (CI): 1.05, 1.23; p<.01], anger (OR: 1.12; 95% CI: 1.04, 1.21; p<.01), and PTSD (OR: 1.06; 95% CI: 1.02, 1.10; p<.01) were associated with a higher odds of quitting/flunking school, college or university. Depression was not associated with quitting/flunking. Conclusion: Anxiety, anger, and PTSD are associated with quitting/flunking among SSM/Vs. Interventions tailored to this population that address mental health needs may improve the likelihood of academic success.
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Affiliation(s)
- Bonnie M. Vest
- Department of Family Medicine, University at Buffalo, 77 Goodell Street, Suite 220, Buffalo NY 14203
| | - Rachel A. Hoopsick
- Department of Community Health & Health Behavior, University at Buffalo, 325 Kimball Tower, 3435 Main Street, Buffalo NY 14214
| | - D. Lynn Homish
- Department of Community Health & Health Behavior, University at Buffalo, 325 Kimball Tower, 3435 Main Street, Buffalo NY 14214
| | - Gregory G. Homish
- Department of Community Health & Health Behavior, University at Buffalo, 325 Kimball Tower, 3435 Main Street, Buffalo NY 14214
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Kulak JA, Homish DL, Hoopsick RA, Fillo J, Bartone PT, Homish GG. Hardiness protects against problematic alcohol use in male, but not female, soldiers. Psychol Serv 2020; 18:426-432. [PMID: 31971440 DOI: 10.1037/ser0000409] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Indexed: 11/08/2022]
Abstract
Military service members are at high risk for problematic substance use compared with the general population; deployment and combat exposure further increases this risk. It is thus critical to identify resiliency factors that can buffer the negative effects of military experiences and potentially prevent problematic alcohol use. The current research examines the extent to which psychological hardiness predicts lower risk of problematic alcohol use and explores potential sex differences in this association. Data are from Operation: SAFETY, an ongoing study of U.S. Army Reserve/National Guard soldiers. Negative binomial regression models examined the relation between baseline hardiness, assessed by the 15-item Dispositional Resiliency Scale, and problematic alcohol use at the 1-year follow-up, assessed by the Alcohol Use Disorders Identification Test (N = 260), controlling for baseline combat exposure (Combat Exposure subscale, Deployment Risk and Resilience Inventory-2) and baseline quantity and frequency of alcohol use. To examine the impact of hardiness on men and women, models were stratified by sex. In final, adjusted models, hardiness predicted lower risk of problematic alcohol use (adjusted risk ratio = 0.98; p < .05) for male soldiers and was unrelated to alcohol use for female soldiers (adjusted risk ratio = 1.01; p > .05). Post hoc analyses explored the impact of each dimension of hardiness (i.e., commitment, control, and challenge) on problematic alcohol use. Hardiness assessment may complement existing screening tools to identify high-risk populations; interventions to promote hardiness may help in preventing problematic alcohol use, particularly among male soldiers. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Abstract
Research on the behavioral health of military spouses/partners is essential, yet lacking. Data on 344 civilian spouses were drawn from a study of U.S. Army Reserve/National Guard soldier couples. This project characterizes civilian spouses' behavioral health symptoms. Regression analyses assessed the relationship between substance use and mental health symptoms. Overall, findings indicate civilian spouses had behavioral health impairments. Mental health, alcohol use, and tobacco use did not differ by soldiers' deployment history; illicit drug use and non-medical use of prescription drugs did at trend level. Support initiatives focusing on all military spouses, not just those of deployed soldiers, are needed.
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Affiliation(s)
- Jessica A Kulak
- University at Buffalo - The State University of New York, Family Medicine, Buffalo, New York.,Buffalo State College - The State University of New York, Health, Nutrition, and Dietetics, Buffalo, New York
| | - Jennifer Fillo
- University at Buffalo - The State University of New York, Clinical and Research Institute on Addictions, Buffalo, New York
| | - D Lynn Homish
- University at Buffalo - The State University of New York, Community Health and Health Behavior, Buffalo, New York
| | - Linda Kahn
- University at Buffalo - The State University of New York, Family Medicine, Buffalo, New York
| | - Gregory G Homish
- University at Buffalo - The State University of New York, Community Health and Health Behavior, Buffalo, New York
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Neumann AM, Blondell RD, Hoopsick RA, Homish GG. Randomized clinical trial comparing buprenorphine/naloxone and methadone for the treatment of patients with failed back surgery syndrome and opioid addiction. J Addict Dis 2019; 38:33-41. [PMID: 31774028 DOI: 10.1080/10550887.2019.1690929] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 10/25/2022]
Abstract
Opioid analgesic consumption has led to an unprecedented epidemic of overdose death and opioid addiction in the US history. The treatment of chronic pain in patients with opioid addiction who receive prescriptions for opioid medications presents a clinical dilemma. Continuing opioid medication could result in hyperalgesia rendering opioids ineffective and results in iatrogenic therapeutic damage as evidenced by the worsening of addiction. Discontinuing opioid medications could result in severe pain and cravings that often leads the patient to the illicit market. This study compared methadone and buprenorphine/naloxone in patients with failed back surgery syndrome and opioid addiction. Nineteen participants were randomly assigned to methadone or buprenorphine/naloxone and were followed for 6 months. In an intent-to-treat analysis analgesia, craving, functioning, drug use, depression, and treatment retention were assessed monthly. It was planned to enroll 66 patients with failed back surgery syndrome and opioid addiction; however, enrollment was closed early due to suspected abuse of medications. Patients in both treatment conditions exhibited significantly improved 24-hour pain severity with up to 20% reduction of pain severity at the last follow-up (p < .05). However, patients receiving methadone reported significantly reduced current pain severity, whereas patients receiving buprenorphine/naloxone did not. Patients reported significantly improved functioning, fewer cravings, less opioid use, and depression (p < .05) across the treatment conditions. When given a choice between methadone and buprenorphine/naloxone, buprenorphine/naloxone is recommended due to its superior safety profile. Treatment with either needs to be monitored closely.
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Affiliation(s)
- Anne M Neumann
- Primary Care Research Institute, Department of Family Medicine, The State University of New York at Buffalo, Buffalo, NY, USA
| | - Richard D Blondell
- Primary Care Research Institute, Department of Family Medicine, The State University of New York at Buffalo, Buffalo, NY, USA
| | - Rachel A Hoopsick
- Primary Care Research Institute, Department of Family Medicine, The State University of New York at Buffalo, Buffalo, NY, USA
| | - Gregory G Homish
- Department of Community Health and Health Behavior, The State University of New York at Buffalo, Buffalo, NY, USA
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Hoopsick RA, Homish DL, Bartone PT, Homish GG. Developing a Measure to Assess Emotions Associated with Never Being Deployed. Mil Med 2019; 183:e509-e517. [PMID: 29547934 DOI: 10.1093/milmed/usy005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 12/06/2017] [Accepted: 01/05/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Much research has focused on stress related to deployments; however, a substantial proportion of soldiers never deploy. In a study of 1.3 million veterans, suicide risk was higher among veterans who had never deployed. Thus, not being deployed may have an impact on soldiers' well-being; however, no measures exist to assess emotions regarding non-deployment. We aimed to develop and test an original measure of non-deployment emotions. METHODS We examined the Non-Deployment Emotions (NDE) questionnaire, a novel four-item measure of guilt, unit value, unit camaraderie, and unit connectedness in a sample of never-deployed male and female US Army Reserve/National Guard (USAR/NG) soldiers (N = 174). Data are from Operation: SAFETY (Soldiers and Families Excelling Through the Years), an ongoing survey-based study examining the health of USAR/NG soldiers and their partners. The protocol was approved by the Institutional Review Board at the State University of New York at Buffalo. The relationship between each of the items was examined by calculating correlation and alpha coefficients. Latent class analyses tested for the existence of distinct levels of negative emotions related to non-deployment. Negative binomial regression models examined the cross-sectional associations between NDE summary score and each of the following outcomes, separately: anger, anxiety, depression, and post-traumatic stress. FINDINGS More than half of never-deployed USAR/NG soldiers expressed negative emotions for having not been deployed. "Guilt," "value," "camaraderie," and "connectedness" were each positively correlated with each other (p < 0.001) and the internal consistency reliability was high (male soldier α = 0.90, female soldier α = 0.93). Latent class analyses revealed a superior three-class model with well-delineated class membership (entropy = 0.93): "Class 1" (low NDE; 47.6%), "Class 2" (moderate NDE; 33.8%), and "Class 3" (high NDE; 18.6%). Regression models demonstrated that greater non-deployment emotions were independently associated with more severe anger (RR = 1.02, 95% CI: 1.01, 1.03, p < 0.001), anxiety (RR = 1.06, 95% CI: 1.01, 1.11, p < 0.05), depression (RR = 1.06, 95% CI: 1.01, 1.11, p < 0.05), and PTSD (RR = 1.10, 95% CI: 1.04, 1.16, p < 0.01). DISCUSSION Findings demonstrate that negative emotions regarding non-deployment are prevalent among never-deployed USAR/NG soldiers and that these emotions are related to a mental health. The NDE provides a measure of "guilt," "value," "camaraderie," and "connectedness" specific to non-deployed soldiers and is able to well discriminate between soldiers that have low, moderately, and highly negative non-deployment emotions. These findings suggest that all military personnel, regardless of deployment status, could be at risk for negative outcomes. As with any survey-based study, there is a potential for response bias; however, given the range of responses collected with the NDE, social desirability is unlikely. Further work is needed to confirm our findings in other components of the military and to examine soldiers in the rear detachment.
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Affiliation(s)
- Rachel A Hoopsick
- Department of Community Health and Health Behavior, State University of New York at Buffalo, 3435 Main Street, Buffalo, NY
| | - D Lynn Homish
- Department of Community Health and Health Behavior, State University of New York at Buffalo, 3435 Main Street, Buffalo, NY
| | - Paul T Bartone
- Center for Technology & National Security Policy, Institute for National Strategic Studies, National Defense University, 300 5th Avenue SW, Building 62, Fort Lesley J. McNair, Washington, DC
| | - Gregory G Homish
- Department of Community Health and Health Behavior, State University of New York at Buffalo, 3435 Main Street, Buffalo, NY
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Abstract
Introduction Use of 2 or more types of tobacco products is common among youth and young adults, highlighting the need for monitoring and intervention activities to encompass products beyond combustible cigarettes. This study documented patterns and trends of ever, current, and frequent hookah use among high school students in New Jersey by other tobacco product use status. Methods We analyzed data from the 2008, 2010, 2012, 2014, 2016 waves of the New Jersey Youth Tobacco Survey. Point estimates and 95% confidence intervals described hookah use stratified by use of other tobacco products. Multivariable logistic regression models assessed trends and correlates of hookah use, controlling for the use of other tobacco products and users’ sociodemographic characteristics. Negative binomial regression models examined the association between total number of tobacco products used and hookah use while controlling for sociodemographic variables and survey year. Results The adjusted odds of current and frequent hookah use among New Jersey high school students were significantly higher in 2014, but not in 2016, compared to 2008. In recent years, hookah use among students who had ever smoked hookah, currently smoked hookah, or frequently smoked hookah was more common among students who had ever or currently smoked cigarettes or e-cigarettes. Hookah users consumed a wider variety of other tobacco products than those who did not use hookah. Conclusion Hookah use remains a public health concern for adolescents; it is more common among users of other tobacco products, especially cigarette and e-cigarette smokers. Questions remain as to whether users of multiple tobacco products are being adequately reached by existing policies and regulations.
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Affiliation(s)
- Jessica A Kulak
- Department of Health, Nutrition, and Dietetics, Buffalo State College, 1300 Elmwood Avenue, Buffalo, NY 14222.
| | - Michelle T Bover Manderski
- Center for Tobacco Studies, School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Cristine D Delnevo
- Center for Tobacco Studies, School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Mary Hrywna
- Center for Tobacco Studies, School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Gregory G Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Gary A Giovino
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
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Biddle C, Fallavollita JA, Homish GG, Giovino GA, Orom H. Gender differences in symptom misattribution for coronary heart disease symptoms and intentions to seek health care. Women Health 2019; 60:367-381. [PMID: 31370742 DOI: 10.1080/03630242.2019.1643817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 10/26/2022]
Abstract
Women are more likely to delay seeking care for coronary heart disease (CHD) symptoms than men. We tested whether this was because they are more likely to misattribute CHD symptoms. Data were collected in December 2016. Participants were 714 Amazon's Mechanical Turk (crowdsourcing marketplace) workers with US Internet Protocol (IP) addresses; 52% female (ages 35-77 years) made judgments about patients of their same gender described in vignettes. We used adjusted multivariable logistic, ordinal, and linear regression to test our hypotheses. Women had a higher odds of misattributing the symptoms of the target in the vignettes to non-cardiac causes than men (adjusted odds ratio [AOR] = 2.08, p < .001), despite having higher mean knowledge scores about CHD (4.49 vs. 4.03, p < .001) and rating their CHD risk as higher (25% more likely to get CHD vs. 19%, p = .025) than men. Women were also less likely than men to intend to seek care at an emergency department (b = -0.33, p = .024), and if they did intend to seek care, they were more likely to intend to wait to seek care (AOR = 2.37, p = .003). Symptom misattribution may partially account for women's lower likelihood of intending to seek care from an emergency department, which would be especially critical in emergency situations.
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Affiliation(s)
- Caitlin Biddle
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, New York, USA
| | | | - Gregory G Homish
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, New York, USA
| | - Gary A Giovino
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, New York, USA
| | - Heather Orom
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, New York, USA
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Hoopsick RA, Benson KR, Homish DL, Homish GG. Resiliency factors that protect against post-deployment drug use among male US Army Reserve and National Guard soldiers. Drug Alcohol Depend 2019; 199:42-49. [PMID: 30981048 PMCID: PMC7370314 DOI: 10.1016/j.drugalcdep.2019.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 07/31/2018] [Revised: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Service members who have been deployed are at risk for substance use, especially Reserve/Guard troops. However, it is unclear what modifiable factors protect against substance use in this at-risk population. Our objective was to examine the effects of pre-, peri-, and post-deployment resiliency factors on post-deployment drug use. METHODS Data were drawn from Operation: SAFETY (Soldiers and Families Excelling Through the Years), an ongoing study examining the health of US Army Reserve/National Guard (USAR/NG) soldiers. This sample consisted of male USAR/NG soldiers with at least one combat deployment (N = 228). At baseline, we assessed the following as potential protective factors: deployment preparation, unit support and support from family/friends during soldiers' most recent deployment, and marital satisfaction. We examined the relations between each of these resiliency factors with drug use at the first follow-up assessment using the NIDA modified ASSIST 2.0. RESULTS Greater unit support (AOR = 0.56, 95% CI: 0.34, 0.92; p < 0.05) and support from family/friends during deployment (AOR = 0.64, 95% CI: 0.43, 0.96; p < 0.05) were associated with lower odds of drug use, controlling for age, rank, years of military service, combat exposure, traumatic brain injury, time since last deployment, and baseline drug use. Deployment preparation and marital satisfaction were not associated with drug use (ps > 0.05). CONCLUSIONS Social support provided to soldiers during deployment, either by his unit or his family/friends, showed evidence of protection against post-deployment drug use. In addition to existing post-deployment efforts, we recommend interventions that facilitate stronger interpersonal relationships during deployment.
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Affiliation(s)
- Rachel A. Hoopsick
- Department of Community Health & Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA,Corresponding Author: Rachel A. Hoopsick, MS, MPH, CHES, Department of Community Health & Health Behavior, University at Buffalo, The State University of New York, 3435 Main Street, 335 Kimball Tower, Buffalo, NY 14214, USA. Phone: 716-829-4731,
| | - Katelyn R. Benson
- Department of Community Health & Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - D. Lynn Homish
- Department of Community Health & Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Gregory G. Homish
- Department of Community Health & Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
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Abstract
BACKGROUND Non-VA health care providers in the USA have been called upon to screen patients for veteran status as a means to better identify military-related health sequelae. Despite this recognized need, many service members are still not being asked about veteran status. OBJECTIVE The purpose of this research was to qualitatively assess, from non-VA primary care providers' point-of-view, barriers to providing care to veterans, the training providers perceive as most useful and the tools and translational processes they think would be most valuable in increasing military cultural competency. METHODS Semi-structured qualitative interviews, with non-VA primary care providers (N = 10) as part of a larger quantitative study of primary care providers' attitudes around veteran care. Interviews asked about providers' approach to addressing veteran status in their practice and their thoughts on how to address the needs of this population. Qualitative data were analyzed using a thematic content analysis approach. RESULTS Three major themes were identified: (i) barriers to caring for patients who are identified as veterans, (ii) thoughts on tools that might help better identify and screen veteran patients and (iii) thoughts on translating and implementing new care processes for veteran patients into everyday practice. CONCLUSIONS Our study identified barriers related to non-VA providers' ability to care for veterans among their patients and possible mechanisms for improving recognition of veterans in civilian health care settings. There is a need for further research to understand how assessment, screening and follow up care for veteran patients is best implemented into civilian primary care settings.
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Affiliation(s)
- Bonnie M Vest
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York- University at Buffalo, Buffalo, USA
| | - Jessica A Kulak
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York- University at Buffalo, Buffalo, USA
| | - Gregory G Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, State University of New York- University at Buffalo, Buffalo, USA
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Abstract
BACKGROUND AND OBJECTIVES The military population is frequently overlooked in civilian primary care due to an assumption that they are treated at the Veterans Health Administration (VA). However, less than 50% of eligible veterans receive VA treatment. Primary care providers (PCPs) may need support in addressing veterans' needs. This regional pilot study explored the current state of practice among primary care providers as it pertains to assessing patients' veteran status and their knowledge of and comfort with treating common conditions in this population. METHODS An electronic survey was administered to PCPs (N=102) in Western New York. Survey questions asked about assessing military status, understanding of military-related health problems, and thoughts on the priority of addressing these issues in practice. Data were analyzed using descriptive summary statistics. RESULTS The majority (56%; n=54) of respondents indicated they never or rarely ask their patients about military service, and only 19% (n=18) said they often or always ask. Seventy-one percent (n=68) of providers agreed or strongly agreed it was important to know if their patient was a veteran. Participants indicated limited knowledge about military stressors, resources available for military populations, and common medical conditions impacting veterans. CONCLUSIONS Our pilot results demonstrate that in a regional sample of primary care providers, providers rarely ask patients about their military history; however, they feel it is important information for patient care. While further study is needed, it may be necessary to provide education, specifically pertaining to military culture and health-related sequelae, to address barriers that may be limiting PCPs' provision of care for this population.
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Affiliation(s)
- Bonnie M Vest
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York-University at Buffalo, NY
| | - Jessica Kulak
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York-University at Buffalo, NY
| | - Victoria M Hall
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York-University at Buffalo, NY
| | - Gregory G Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, State University of New York-University at Buffalo, NY
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Cao YJ, Noyes K, Homish GG. Life Partner Influence on Uptake of Preventive Services: Evidence From Flu Vaccine Adoption Among the Aging Population. J Aging Health 2019; 32:441-452. [PMID: 30793640 DOI: 10.1177/0898264319829979] [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] [Indexed: 11/15/2022]
Abstract
Objectives: This study examines how the patterns of life partner concordance on preventive health service uptake vary by a partner's previous behavioral history and between genders. Method: This study uses 2008 and 2012 waves of Health and Retirement Study (HRS), a nationally representative sample of U.S. aging population, to examine one's decision to receive a preventive service as a function of the partner's decision changes over time (N = 2,680). Results: Life partner concordance on preventive service use is different by the partner's previous use history and gender. Positive partner preventive engagement showed greater association than negative ones. Women are more responsive to the positive health behaviors (of their partners), and men are more sensitive to the negative partner health behaviors. Conclusion: The asymmetric partner concordance by gender and the partner's previous usage experience provide implications to develop efficient and culturally acceptable interventions to increase the uptake of preventive health services.
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Biddle C, Fallavollita JA, Homish GG, Orom H. Gender bias in clinical decision making emerges when patients with coronary heart disease symptoms also have psychological symptoms. Heart Lung 2019; 48:331-338. [PMID: 30595342 DOI: 10.1016/j.hrtlng.2018.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 07/05/2018] [Revised: 11/18/2018] [Accepted: 11/19/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Delayed treatment may contribute to women's relatively higher morbidity and mortality from coronary heart disease (CHD). We tested whether disparities in treatment may be due to bias in diagnosis and treatment recommendations for women with psychological symptoms. METHODS Fourth year medical students (N = 225) from 13 U.S. medical schools were randomly assigned to make clinical decisions (CHD risk judgments, diagnosis, treatment recommendations) about one of four experimental vignette patients (male or female; with symptoms of depression and anxiety or without). Vignettes were presented as text via an online survey platform. RESULTS The female patient with psychological symptoms was perceived to be at lowest risk for CHD. Perceptions of risk partly mediated lower likelihood of recommending the female patient with psychological symptoms be seen in an emergency department, take medication, or receive nutrition or exercise advice relative to the male patient with psychological symptoms. CONCLUSIONS There was a gender bias in CHD clinical decision-making when patients had concurrent psychological symptoms.
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Affiliation(s)
- Caitlin Biddle
- Department of Community Health and Health Behavior, University at Buffalo, State University of New York, 304 Kimball Tower, 3435 Main St., Buffalo, NY 14222, USA
| | - James A Fallavollita
- Department of Medicine, University at Buffalo, State University of New York, Buffalo, NY 14222, USA
| | - Gregory G Homish
- Department of Community Health and Health Behavior, University at Buffalo, State University of New York, 304 Kimball Tower, 3435 Main St., Buffalo, NY 14222, USA
| | - Heather Orom
- Department of Community Health and Health Behavior, University at Buffalo, State University of New York, 304 Kimball Tower, 3435 Main St., Buffalo, NY 14222, USA.
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Abstract
Use of family readiness programs (FRPs) by military families is not well understood. This work uses the Gelberg-Andersen Behavioral Model to identify characteristics of Reserve and National Guard (R/NG) couples who access FRPs. Data are from Operation: SAFETY, a study of R/NG soldiers and partners. Logistic regression models examined odds of accessing FRPs based on predisposing, enabling, and need factors. Greater length of military service, greater presence of non-military social ties, and civilian partner reports of adequate support during deployment were associated with higher likelihood of accessing FRPs. Results provide information on FRP utilization and may help inform outreach efforts.
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Affiliation(s)
- Erin M Anderson Goodell
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - D Lynn Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo - The State University of New York, Buffalo, NY
| | - Gregory G Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo - The State University of New York, Buffalo, NY.,Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo - The State University of New York, Buffalo, NY
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Homish GG, Hoopsick RA, Heavey SC, Homish DL, Cornelius JR. Drug use and hazardous drinking are associated with PTSD symptoms and symptom clusters in US Army Reserve/National Guard Soldiers. Am J Addict 2018; 28:22-28. [PMID: 30548523 DOI: 10.1111/ajad.12829] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/27/2018] [Accepted: 11/17/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES There is strong evidence of the association between Posttraumatic Stress Disorder (PTSD) symptoms and substance use. Previous work has found sex differences in these associations. With revisions to the DSM, it is important to understand how overall PTSD symptoms and the new symptom clusters relate to substance use among Reserve/Guard soldiers-a high risk group. METHODS Data are from the baseline assessment of Operation: SAFETY (Soldiers and Families Excelling Through the Years), a longitudinal study of US Army Reserve/National Guard (USAR/NG) soldiers (N = 389 males, N = 84 females). We examined associations between current substance use (drug use, hazardous drinking, and smoking) and overall PTSD symptoms, and symptom clusters. Additionally, we examined PTSD by sex interactions. RESULTS Greater overall PTSD symptoms were associated with higher odds of drug use (OR = 1.08; 95%CI: 1.05, 1.12) and hazardous drinking (OR = 1.04; 95%CI: 1.02, 1.07). Greater individual symptom cluster scores were associated with higher odds of drug use (ps < .001) and hazardous drinking (ps < .01). Interaction models revealed no differences in these associations on the basis sex (ps > .05). There were no associations between PTSD symptoms or symptom clusters on smoking (ps > .05). DISCUSSION AND CONCLUSION Soldiers experiencing PTSD symptoms are reporting current drug and hazardous alcohol use, suggestive of self-medication. SCIENTIFIC SIGNIFICANCE It is imperative to consider the impact of PTSD on substance use broadly, as this work shows that overall symptoms and symptom clusters have an impact on male and female USAR/NG soldiers. (Am J Addict 2019;28:22-28).
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Affiliation(s)
- Gregory G Homish
- Department of Community Health and Health Behavior, State University of New York at Buffalo, 3435 Main Street, Buffalo 14214, New York.,Departments of Pediatrics and Family Medicine, State University of New York at Buffalo, 3435 Main Street, Buffalo 14214, New York
| | - Rachel A Hoopsick
- Department of Community Health and Health Behavior, State University of New York at Buffalo, 3435 Main Street, Buffalo 14214, New York
| | - Sarah Cercone Heavey
- Department of Community Health and Health Behavior, State University of New York at Buffalo, 3435 Main Street, Buffalo 14214, New York
| | - D Lynn Homish
- Department of Community Health and Health Behavior, State University of New York at Buffalo, 3435 Main Street, Buffalo 14214, New York
| | - Jack R Cornelius
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh 15213, Pennsylvania
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Hoopsick RA, Homish DL, Vest BM, Homish GG. Alcohol Use Among Never-Deployed U.S. Army Reserve and National Guard Soldiers: The Effects of Nondeployment Emotions and Sex. Alcohol Clin Exp Res 2018; 42:2413-2422. [PMID: 30381833 PMCID: PMC6286239 DOI: 10.1111/acer.13901] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/30/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Limited research shows that mental health problems are prevalent among never-deployed soldiers and many experience negative emotions related to their nondeployment. U.S. Army Reserve/National Guard (USAR/NG) soldiers are also at high risk for alcohol misuse. However, it is not known if nondeployment emotions contribute to an increased risk of alcohol misuse among never-deployed USAR/NG soldiers. METHODS Data are from Operation: SAFETY (Soldiers and Families Excelling Through the Years), an ongoing study of USAR/NG soldiers. We used regression models to examine the relations between nondeployment emotions, assessed by the Non-Deployment Emotions (NDE) Questionnaire, and a range of alcohol use outcomes, assessed by the Alcohol Use Disorders Identification Test and standard quantity and frequency questions, among a sample of never-deployed soldiers who were partnered at baseline (N = 174). Final models controlled for years of military service, current number of close military friends in the social network, marital satisfaction, and depression. We also tested for potential differences in these associations by sex. RESULTS Nondeployment emotions were associated with frequency of getting drunk (adjusted risk ratio [aRR] = 1.02, 95% CI: 1.01, 1.04; p < 0.05) and typical number of drinks consumed during a drinking episode (aRR = 1.03, 95% CI: 1.01, 1.04; p < 0.01). Nondeployment emotions had a trend-level association with percent of days drinking (adjusted odds ratio = 1.05, 95% CI: 1.00, 1.11; p = 0.055). Nondeployment emotions had a significant interaction with sex (p < 0.05) on the likelihood of alcohol problems, such that only male soldiers experienced a greater likelihood of alcohol problems when they had highly negative nondeployment emotions. There was no relation between nondeployment emotions and alcohol problems among female soldiers. CONCLUSIONS Findings demonstrate that greater nondeployment emotions are associated with increased alcohol use among never-deployed USAR/NG soldiers. The NDE Questionnaire may assist in identifying those at highest risk for alcohol problems.
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Affiliation(s)
- Rachel A. Hoopsick
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York
| | - D. Lynn Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York
| | - Bonnie M. Vest
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York
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Abstract
BACKGROUND Limited data exist on what young adults report as their first-ever nicotine product; some evidence suggests that they report hookah as their first product smoked. OBJECTIVES This study reports on the first nicotine product used among undergraduates who had ever tried tobacco, and explores correlates of hookah as that first product. METHODS Participants included a convenience sample of undergraduate students (n = 1538) at four universities in upstate New York during fall 2013. Descriptive statistics assessed first nicotine product used and prevalence of current use. Logistic regression was used to examine correlates of hookah as the first nicotine product used. RESULTS Among the 832 students who reported ever use of any nicotine product, 25.4% reported hookah as their first product smoked; only combustible cigarettes (39.5%) were reported more frequently. Among students who ever smoked cigarettes, most reported cigarettes as their introductory product. Among students who never smoked cigarettes, nearly half reported hookah as their introductory product. Among ever nicotine users, current hookah smoking was common (34.9%), and greater than current e-cigarette (25.9%) and current combustible cigarette (26.4%) use. Never users of cigarettes, females, and non-Hispanic African Americans, had higher adjusted odds of reporting hookah as their introductory product. CONCLUSIONS The results of this study have implications for the identification of risk factors for tobacco initiation, the assessment of tobacco use patterns and behaviors, and the tailoring of tobacco prevention initiatives among youth. Our findings suggest that broadening prevention efforts beyond a focus on combustible cigarettes may be warranted.
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Affiliation(s)
- Jessica A Kulak
- a Primary Care Research Institute, Department of Family Medicine , University at Buffalo , Buffalo , New York , USA
| | | | - Mark J Travers
- c Department of Health Behavior and Aerosol Pollution Exposure Research Laboratory , Roswell Park Cancer Institute , Buffalo , New York , USA
| | - Maansi Bansal-Travers
- c Department of Health Behavior and Aerosol Pollution Exposure Research Laboratory , Roswell Park Cancer Institute , Buffalo , New York , USA
| | - Gregory G Homish
- d Department of Community Health and Health Behavior, School of Public Health and Health Professions , University at Buffalo, The State University of New York , Buffalo , New York , USA
| | - Martin C Mahoney
- d Department of Community Health and Health Behavior, School of Public Health and Health Professions , University at Buffalo, The State University of New York , Buffalo , New York , USA.,e Division of Cancer Prevention and Population Sciences , Roswell Park Cancer Institute , Buffalo , New York , USA
| | - Gary A Giovino
- d Department of Community Health and Health Behavior, School of Public Health and Health Professions , University at Buffalo, The State University of New York , Buffalo , New York , USA
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Vest BM, Homish DL, Fillo J, Homish GG. Military status and alcohol problems: Former soldiers may be at greater risk. Addict Behav 2018; 84:139-143. [PMID: 29679924 PMCID: PMC5975126 DOI: 10.1016/j.addbeh.2018.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 01/02/2018] [Revised: 04/11/2018] [Accepted: 04/11/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The goal of this study was to explore differences in alcohol problems as a function of military status (current soldier, previous soldier and civilian spouses), and the possible interaction between sex and military status. We hypothesized that 1) soldiers would be at greater risk for alcohol problems than civilian spouses, and 2) former soldiers would be at greater risk compared to current soldiers. METHODS Data were drawn from Operation: SAFETY, a longitudinal study examining physical and mental health among U.S. Army Reserve and National Guard soldiers and their partners. The analytic sample included male and female participants who completed both the baseline and first follow-up assessments (N = 772). Negative binomial regression models were used to examine differences between military status group on alcohol problems at follow-up, controlling for sex and alcohol consumption at baseline. Interactions between military status and sex were also examined. RESULTS Among current soldiers, males experienced significantly more alcohol problems compared to women (4.47, 3.46; p = 0.005). Likewise, among previous soldiers, males experienced significantly more alcohol problems compared to women (6.69, 2.92; p = 0.002). Male previous soldiers had significantly more alcohol problems compared to both male current soldiers and male civilian spouses (6.69, 4.47, p = 0.04; 6.69, 3.96; p = 0.02). Among women, there were no significant differences by military status. CONCLUSIONS Our results indicate that male previous soldiers are at greater risk of alcohol problems than both current soldiers and civilian spouses. Health care and service providers should consider screening and monitoring soldiers who separate from the military, as alcohol use may increase.
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Affiliation(s)
- Bonnie M Vest
- Department of Family Medicine, University at Buffalo, 77 Goodell Street, Suite 220, Buffalo, NY 14203, United States.
| | - D Lynn Homish
- Department of Community Health & Health Behavior, University at Buffalo, 325 Kimball Tower, 3435 Main Street, Buffalo, NY 14214, United States
| | - Jennifer Fillo
- Research Institute on Addictions, 1021 Main Street, Buffalo, NY 14203, United States
| | - Gregory G Homish
- Department of Community Health & Health Behavior, University at Buffalo, 325 Kimball Tower, 3435 Main Street, Buffalo, NY 14214, United States
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Abstract
BACKGROUND The goal of this work was to examine associations among childhood trauma, combat trauma, and substance use (alcohol problems, frequent heavy drinking [FHD], current cigarette smoking, and current/lifetime drug use) and the interaction effects of childhood trauma and combat exposure on those associations among National Guard/reserve soldiers. METHODS Participants (N = 248) completed an electronic survey asking questions about their military experiences, physical and mental health, and substance use. Childhood trauma and combat exposure were examined jointly in regression models, controlling for age, marital satisfaction, and number of deployments. RESULTS Childhood trauma was associated with current drug use (trend level, odds ratio [OR] = 1.44, 95% confidence interval [CI]: 0.97, 2.14; P = .072) in the main effect model; however, there was not a significant interaction with combat. Combat exposure had a significant interaction with childhood trauma on alcohol problems (b = -0.56, 95% CI: -1.12, -0.01; P = .048), FHD (b = -0.27, 95% CI: -0.47, -0.08; P = .007), and lifetime drug use (OR = 1.78, 95% CI: 1.04, 3.04; P = .035). There were no associations with either of the trauma measures and current cigarette smoking. CONCLUSIONS These results demonstrate that childhood and combat trauma have differential effects on alcohol use, such that combat trauma may not add to the effect on alcohol use in those with greater child maltreatment but may contribute to greater alcohol use among those with low child maltreatment. As expected, childhood and combat trauma had synergistic effects on lifetime drug use. Screening for multiple types of trauma prior to enlistment and/or deployment may help to identify at-risk individuals and allow time for early intervention to prevent future adverse outcomes.
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Affiliation(s)
- Bonnie M Vest
- a Department of Family Medicine , University at Buffalo , Buffalo , New York , USA
| | - Rachel A Hoopsick
- b Department of Community Health and Health Behavior , University at Buffalo , Buffalo , New York , USA
| | - D Lynn Homish
- b Department of Community Health and Health Behavior , University at Buffalo , Buffalo , New York , USA
| | - Rachel C Daws
- b Department of Community Health and Health Behavior , University at Buffalo , Buffalo , New York , USA
| | - Gregory G Homish
- a Department of Family Medicine , University at Buffalo , Buffalo , New York , USA.,b Department of Community Health and Health Behavior , University at Buffalo , Buffalo , New York , USA
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Abstract
BACKGROUND Military deployment and combat are associated with worse outcomes, including alcohol misuse. Less is known about how these experiences affect soldiers' spouses. OBJECTIVE The study objective was to explore relationships between deployment, combat exposure, and alcohol misuse; especially cross-spouse effects (effect of one partner's experiences/behavior on the other partner), which has been under-examined in military samples. METHODS U.S. Army Reserve/National Guard soldiers and their partners completed a questionnaire covering physical and mental health, military service and substance use. Negative binomial regression models examined number of deployments and combat exposure individually for alcohol misuse and frequent heavy drinking (FHD). In additional models, we examined combat exposure's role on alcohol outcomes, controlling for the soldiers' number of deployments, PTSD symptoms, age, and in cross-spouse models, alcohol use and FHD. We considered individuals' deployment experiences related to their alcohol outcomes and to their spouses' alcohol outcomes. RESULTS The study sample included male soldiers with current/lifetime military service (n = 248) and their female partners. Combat exposure was related to FHD (RR: 1.01, p < .05, 95% CI: 1.01, 1.01) among male soldiers while controlling for PTSD symptoms, number of deployments, and age. Female partners of male soldiers were more likely to engage in FHD (RR: 1.01, p < .05, 95% CI: 1.01, 1.01) if their spouse experienced combat. CONCLUSIONS Our results demonstrate that male soldiers and their spouses are at increased risk of FHD if the soldier experienced combat. This points to the need for better screening, particularly of spouses of soldiers, whose alcohol misuse may be overlooked.
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Affiliation(s)
- Bonnie M. Vest
- Department of Family Medicine, University at Buffalo, Buffalo NY
| | - Sarah Cercone Heavey
- Department of Community Health & Health Behavior, University at Buffalo, Buffalo NY
| | - D. Lynn Homish
- Department of Community Health & Health Behavior, University at Buffalo, Buffalo NY
| | - Gregory G. Homish
- Department of Family Medicine, University at Buffalo, Buffalo NY
- Department of Community Health & Health Behavior, University at Buffalo, Buffalo NY
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Murphy SL, Samuels EM, Kolb HR, Behar-Horenstein LS, Champagne E, Byks-Jazayeri C, Hahn J, Roth MT, Ennever F, Bajwa W, Singh M, Homish GG, Dubocovich ML. Best Practices in Social and Behavioral Research: A multisite pilot evaluation of the good clinical practice online training course. J Clin Transl Sci 2018; 2:95-102. [PMID: 31660222 PMCID: PMC6798520 DOI: 10.1017/cts.2018.27] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 03/14/2018] [Accepted: 03/30/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The Best Practices in Social and Behavioral Research Course was developed to provide instruction on good clinical practice for social and behavioral trials. This study evaluated the new course. METHODS Participants across 4 universities took the course (n=294) and were sent surveys following course completion and 2 months later. Outcomes included relevance, how engaging the course was, and working differently because of the course. Open-ended questions were posed to understand how work was impacted. RESULTS Participants rated the course as relevant and engaging (6.4 and 5.8/7 points) and reported working differently (4.7/7 points). Participants with less experience in social and behavioral trials were most likely to report working differently 2 months later. DISCUSSION The course was perceived as relevant and engaging. Participants described actions taken to improve rigor in implementing trials. Future studies with a larger sample and additional participating sites are recommended.
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Affiliation(s)
- Susan L. Murphy
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
- VA Ann Arbor HealthCare System, Geriatric Research, Education, and Clinical Center (GRECC), Ann Arbor, MI, USA
| | - Elias M. Samuels
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA
| | - H. Robert Kolb
- Clinical and Translational Science Institute, University of Florida, Gainesville, FL, USA
| | | | - Ellen Champagne
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA
| | - Christine Byks-Jazayeri
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA
| | - Jordan Hahn
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA
| | - Mary-Tara Roth
- Clinical Research Resources Office, Boston Medical Center and Boston University Medical Campus, Boston, MA, USA
| | - Fanny Ennever
- Compliance Department, Boston Medical Center, Boston, MA, USA
| | - Wajeeh Bajwa
- Clinical and Translational Science Institute, University of Florida, Gainesville, FL, USA
| | - Meher Singh
- Clinical and Translational Science Institute, University at Buffalo, Buffalo, NY, USA
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
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Heavey SC, Delmerico AM, Burstein G, Moore C, Wieczorek WF, Collins RL, Chang YP, Homish GG. Descriptive Epidemiology for Community-wide Naloxone Administration by Police Officers and Firefighters Responding to Opioid Overdose. J Community Health 2018; 43:304-311. [PMID: 28852906 PMCID: PMC5832501 DOI: 10.1007/s10900-017-0422-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 01/11/2023]
Abstract
Recently implemented New York State policy allows police and fire to administer intranasal naloxone when responding to opioid overdoses. This work describes the geographic distribution of naloxone administration (NlxnA) by police and fire when responding to opioid overdoses in Erie County, NY, an area of approximately 920,000 people including the City of Buffalo. Data are from opioid overdose reports (N = 800) filed with the Erie County Department of Health (July 2014-June 2016) by police/fire and include the overdose ZIP code, reported drug(s) used, and NlxnA. ZIP code data were geocoded and mapped to examine spatial patterns of NlxnA. The highest NlxnA rates (range: 0.01-84.3 per 10,000 population) were concentrated within the city and first-ring suburbs. Within 3 min 27.3% responded to NlxnA and 81.6% survived the overdose. The average individual was male (70.3%) and 31.4 years old (SD = 10.3). Further work is needed to better understand NlxnA and overdose, including exploring how the neighborhood environment creates a context for drug use, and how this context influences naloxone use and overdose experiences.
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Affiliation(s)
- Sarah Cercone Heavey
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd., Rochester, NY, 14642, USA.
| | - Alan M Delmerico
- Institute for Community Health Promotion, Center for Health and Social Research, Center for Development of Human Services, SUNY Buffalo State, Buffalo, NY, USA
| | - Gale Burstein
- Departments of Pediatrics and Family Medicine, Jacobs School of Medicine & Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
- Erie County, NY Department of Health, Buffalo, NY, USA
| | - Cheryll Moore
- Erie County, NY Department of Health, Buffalo, NY, USA
| | - William F Wieczorek
- Institute for Community Health Promotion, Center for Health and Social Research, Center for Development of Human Services, SUNY Buffalo State, Buffalo, NY, USA
| | - R Lorraine Collins
- Department of Community Health & Health Behavior, School of Public Health & Health Professions, State University of New York at Buffalo, Buffalo, NY, USA
| | - Yu-Ping Chang
- School of Nursing, State University of New York at Buffalo, Buffalo, NY, USA
| | - Gregory G Homish
- Departments of Pediatrics and Family Medicine, Jacobs School of Medicine & Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
- Department of Community Health & Health Behavior, School of Public Health & Health Professions, State University of New York at Buffalo, Buffalo, NY, USA
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Vest BM, Homish DL, Hoopsick RA, Homish GG. What drives the relationship between combat and alcohol problems in soldiers? The roles of perception and marriage. Soc Psychiatry Psychiatr Epidemiol 2018; 53:413-420. [PMID: 29282479 PMCID: PMC5864545 DOI: 10.1007/s00127-017-1477-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 07/05/2017] [Accepted: 12/18/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND While the relationship between combat exposure and alcohol problems is well-established, the role of perceptions of trauma is less understood. The goal of this study was to explore associations between National Guard (NG) and reserve soldiers' perceptions of combat experiences as traumatic and alcohol problems, and to examine marital satisfaction as a possible protective factor. METHODS The Operation: SAFETY study recruited US Army Reserve and NG soldiers and their partners to complete a questionnaire covering many physical and mental health, military service, and substance use topics. Negative binomial regression models examined the impact of perceived trauma of combat experiences on alcohol problems (N = 198). The potential role of marital satisfaction as a resiliency factor was also examined. RESULTS The perception of combat experiences as traumatic was associated with increased risk of alcohol problems (risk ratio [RR] = 1.06, 95% confidence interval [CI] 1.01, 1.12; p = 0.024). Combat exposure itself showed no relationship. Marital satisfaction had a significant interaction with perceived combat trauma on alcohol problems (RR = 0.90, 95% CI 0.81, 0.99, p = 0.046), such that soldiers who perceived combat exposure as moderately-highly traumatic were less likely to have alcohol problems when they rated their marital satisfaction highly. CONCLUSIONS Our results demonstrate that the perception of combat experiences as traumatic may be a greater contributor to adverse outcomes, such as alcohol problems, than mere combat exposure. They also demonstrate the importance of marital satisfaction as a resiliency factor, particularly at the highest levels of trauma.
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Affiliation(s)
- Bonnie M Vest
- Department of Family Medicine, University at Buffalo, 77 Goodell Street, Suite 220, Buffalo, NY, 14203, USA.
| | - D Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo, 325 Kimball Tower, 3435 Main Street, Buffalo, NY, 14214, USA
| | - Rachel A Hoopsick
- Department of Community Health and Health Behavior, University at Buffalo, 325 Kimball Tower, 3435 Main Street, Buffalo, NY, 14214, USA
| | - Gregory G Homish
- Department of Community Health and Health Behavior, University at Buffalo, 325 Kimball Tower, 3435 Main Street, Buffalo, NY, 14214, USA
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