Factors associated with adolescent utilization of alcohol treatment services

Objective: This study examined factors associated with adolescents' use of alcohol treatment services.

Method: Data on adolescents (aged 12–17) from the 1994 National Household Survey on Drug Abuse (NHSDA, N=4698), a large representative sample of the U.S. population, were used in this study. Information obtained from the survey included adolescent alcohol use, drinking patterns, alcohol abuse/dependent problems, and service use for alcohol-related problems. In addition, socio-demographics, health insurance, mental and behavioral problems, and other drug use were also included in the analysis.

Results: The findings indicate that many adolescents with alcohol problems did not receive treatment. White adolescents were more likely to receive alcohol treatment services than nonwhites. Among alcohol-related problems, alcohol causing problems at home, school, or other settings predicted entry into alcohol treatment. Drug use and poor health status were also associated with receiving alcohol treatment services.

Conclusions: This study calls for an improved service delivery system to meet service needs of adolescents with alcohol-related problems, especially among minorities, and those with alcohol-related problems but without yet experiencing significant negative social consequences.     

Risk domains associated with an adolescent alcohol dependence diagnosis

Aims. To determine the contribution of familial, interpersonal, academic and early substance use factors to relative risk for an alcohol dependence (AD) diagnosis in adolescents. Methods. Information on 619 adolescents and their 390 sets of biological parents was obtained using the adolescent version of the Child Semi-Structured Assessment for the Genetics of Alcoholism (C-SSAGA) and the adult counterpart of this instrument, the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA). The C-SSAGA elicits a wide range of environmental, social, and psychiatric diagnostic information. Specific domain scale scores associated with an adolescent AD were computed, and generalized estimating equations (GEE) modeling was used to determine the odds ratio (relative risk) of the specified risk domains for an alcohol dependence diagnosis. Findings. Risk factors for a DSM-III-R AD diagnosis included being at least 16 years of age, as well as negative parent-child interactions, school and personal-related difficulties (including the presence of an externalizing or internalizing DSM-III-R non-alcohol-related diagnosis), and early experimentations with a variety of substances. Conclusions. An array of familial, interpersonal, academic and early substance use factors were strongly associated with adolescent AD. Given the findings of this study, further research to determine temporal relationships that might influence the onset of adolescent alcohol dependence is warranted.     

Factors associated with probation officers' use of criminal justice coercion to mandate alcohol treatment

Alcohol problems are widespread among individuals in county criminal justice probation systems. However, it is unclear why only a small fraction of these problem drinkers receive treatment. In this study, self-administered questionnaires were mailed to 145 probation officers in nine California counties to identify factors that predicted probation officers' use of coercion to mandate alcohol treatment. The questionnaire measured characteristics of probation officers, characteristics of their caseloads, and perceptions about their departments. Principle components analysis combined some of the items into six factor-based scales. Multiple regression analyses identified two significant predictors of use of coercion into treatment: a belief that treatment was effective and a belief that one's peers in the department were using coercion frequently. Implications for increasing treatment entry of probationers with drinking problems include educating probation officers about the effectiveness of substance abuse treatment in general and about coerced treatment in particular. Probation departments are encouraged to develop management styles that facilitate shared normative beliefs about assessing and managing alcohol problems among probationers.     

Factors associated with increased healthcare utilization among adults with asthma

Objective. To evaluate determinants of increased emergency room (ER) visit and hospitalization among adults with asthma, with emphasis on the role of psychological distress, self-efficacy, and obesity. Methods: For analysis 2009, 2011/2012 California Health Interview Survey was used. Adults who reported lifetime asthma were selected. Association between ER and overnight hospital stay with population characteristics were conducted using chi-square analysis. Multivariable binary logistic regression models, taking into account control variables, were utilized to assess the relationship between ER visit or overnight hospital stay with that of psychological distress, self-efficacy, and obesity. Results: Odds of ER visits were higher among those with mild-to-moderate psychological distress (adjusted odds ratio [aOR] = 1.94, 95% CI: 1.28, 2.94), and among those with serious psychological distress (aOR = 2.62, 95% CI: 1.65, 4.16). Mild-to-moderate distress was associated with two-fold increase in hospital overnight stay (aOR = 2.05, 95% CI: 1.29, 3.25). Adults with asthma who reported low self-efficacy had increased ER visits (aOR = 6.21, 95% CI: 3.63, 10.65) and hospitalization (aOR = 4.13, 95% CI: 2.63, 6.49). Finally, adults who had asthma and were obese had higher odds of ER visits (aOR = 1.60, 95% CI: 1.20, 2.13). Conclusions: Healthcare utilization is higher among asthma patients with psychological distress, low self-efficacy, and obesity. Interventions, such as incorporation of integrated care models, are critical to ensure early screening of mental health status among such patients. In addition, there is a need for patient education and improved weight management among adults with asthma.     

Factors associated with referral to outpatient cardiac rehabilitation services

BACKGROUND: Although practice guidelines and policy statements for cardiac rehabilitation recommend that it be offered to all patients with cardiovascular disease, the participation rates in most Western countries are low. PURPOSE: This study aimed to determine the factors associated with referral to outpatient cardiac rehabilitation in the Hunter region of New South Wales, Australia. METHODS: The study sample comprised 1933 patients discharged from public hospitals in the Hunter region between March 1, 1998 and February 28, 1999 who were eligible for cardiac rehabilitation, and for inclusion on the Hunter Area Heart and Stroke Register (the Register). Data were obtained from the Register database (gender, age, clinical information) and via a self-completed questionnaire eliciting referral, sociodemographic, and cardiovascular disease risk factor information. Multiple logistic regression analysis was conducted to determine the factors independently associated with referral. RESULTS:: Of the respondents (1202/1933), 41% (493/1202; 95% confidence interval, 38-44%) reported that they had been referred to outpatient cardiac rehabilitation. The factors independently associated with referral were age younger than 65 years, previous participation in an outpatient cardiac rehabilitation program, admission to a hospital that provides outpatient cardiac rehabilitation, a discharge diagnosis of acute myocardial infarction, and coronary artery bypass surgery. CONCLUSIONS: Younger age, previous participation in outpatient cardiac rehabilitation, admission to a hospital that provides outpatient cardiac rehabilitation, a discharge diagnosis of acute myocardial infarction, and coronary artery bypass surgery were associated with referral to cardiac rehabilitation. Research testing strategies designed to increase cardiac rehabilitation referral rates are needed and could include testing the potential role of modern quality management methods.     

Factors associated with joint mobility in an adolescent population.

Fixed torque devices were used to measure joint mobility at three sites in 364 adolescents including 39 families with at least two siblings. Increasing age and being male were associated with reduced laxity, and a strong effect of family was observed in the 39 sibling sets studies. The population included 47 Asians whose mobility was similar to that of the non-Asians, though the female/male difference was apparently greater in the former group. None of the above conclusions apply to index finger hyperextension, and it is apparent that genetic and constitutional factors only affect mobility at some sites. Such observations could lead to a review of current scoring systems for clinical hypermobility.     

Factors associated with readiness to stop smoking among patients in treatment for alcohol use disorder

The Timing of Alcohol and Smoking Cessation (TASC) Study is a randomized controlled trial that examines the optimal timing of intervention for nicotine dependence in patients with alcohol use disorders. A cross-sectional analysis of baseline characteristics of study participants was used to identify characteristics associated with readiness of patients in intensive treatment for alcohol abuse or dependence to quit smoking. Baseline characteristics of 499 subjects enrolled in the TASC trial were analyzed. Readiness to quit was assessed by two self-rated measures: being in the preparation/action stages of change and scoring at least an 8 on the Contemplation Ladder. Univariate analyses showed a higher prevalence of African-Americans and other minorities than Caucasian, among participants planning to quit in the next month (p = 0.005). There were no other differences between groups. Participants in the preparation/action stages of change experienced significantly lower rates of current (p = 0.011) and past (p = 0.014) major depressive disorder and displayed significantly less current depressive symptoms on the Beck Depression Inventory (p = 0.008). Patients with Contemplation Ladder ratings between 8 and 10 showed similar results. Logistic regression models consistently confirmed that the degree of depression was negatively associated with the intention to quit, but different models suggested that increasing age, shorter duration of smoking history, race other than white, and a greater number of past quit attempts were positively associated with readiness to quit. Among patients in intensive treatment for alcohol use disorders who smoke, a history of depressive disorder and depressive symptoms predict less interest in quitting smoking.     

Factors associated with adolescent use of doping agents: anabolic-androgenic steroids

Aims. The purpose was to assess the importance of risk factors such as socio-demographics, sports activities, tobacco use, alcohol consumption, use of certain psychotropic substances and violence in the use of doping agents in adolescents. Design. Cross-sectional survey using anonymous closed response questionnaire. Setting. Eight senior high schools in Uppsala, Sweden. Participants. A total of 2742 senior high school students; 1592 were in their first year (aged 16-17 years) and 1150 in their third (aged 18-19 years). Findings. Multiple logistic regression analyses revealed that strength training, tobacco use, heavy alcohol consumption, truancy at least once a week and living alone were significantly independently associated in the use of doping agents. Further, the study showed that use of cannabis oil, LSD, amphetamine and opioids were related specifically to anabolic-androgenic steroid use. Conclusions. Use of doping agents probably involves more than a desire to enhance appearance or sports performance and appears to have much in common with use of alcohol, tobacco and psychotropic drugs.     

Factors associated with adolescent abortion in a rural area of Bangladesh

This study examines levels and trends in abortion among adolescent girls in 1982-98 and identifies groups of adolescents who are at high risk for having an abortion. The study used data sets collected in Matlab in Bangladesh where the Center for Health and Population Research at ICDDR,B, has maintained a demographic surveillance system, since 1966. Both bivariate and multivariate techniques of analysis were employed. We also used qualitative information derived from in-depth interviews with adolescents. The incidence of abortion was 35 times higher for unmarried than for married adolescents. Abortion ratios were also higher for adolescents who were <18 years old and for those with more than primary education. A little less than half of the abortions were induced by biomedical health workers (by means of menstrual regulation) which means that traditional providers fulfilled an important function in this rural area. The findings suggest that high-quality abortion services provided to adolescents in the framework of comprehensive reproductive health services will help to lower abortions in general and of unsafe abortions provided by traditional providers in particular.     

Factors associated with use of gastric cancer screening services in Korea

AIM： To identify the factors associated with participation in gastric cancer screening programs. METHODS： Using data from the Korea National Health and Nutrition Examination Survey 2005 （KNHANES Ⅲ）, a nationwide health-related survey in Korea, a cross-sectional study was performed to investigate the multiple factors associated with gastric cancer screening attendance among persons aged at least 40 years. The study population included 4593 individuals who completed a gastric cancer screening questionnaire and had no previous cancer history. Four groups of individual-level or environmental level covariates were considered as potential associated factors. RESULTS： Using KNHANES Ⅲ data, an estimated 31.71% of Korean individuals aged at least 40 years adhered to gastric cancer screening recommendations. Subjects who graduated from elementary school [adjusted odds ratio （aOR）, 1.66; 95% CI： 1.21-2.26], middle/high school （aOR, 1.38; 95% CI： 1.01-1.89）, and university or higher （aOR, 1.64; 95% CI： 1.13-2.37） were more likely to undergo gastric cancer screening than those who received no formal education at all. The population with the highest income tertile had more attendance at gastric screening compared to those with the lowest income tertile （aOR, 1.36; 95% CI： 1.06-1.73）. Gastric screening was also negatively associated with excessive alcohol consumption （aOR, 0.71; 95% CI： 0.53-0.96）. A positive attitude to preventive medical evaluation was significantly associated with better participation in gastric cancer screening programs （aOR, 5.26; 95% CI： 4.35-6.35）. CONCLUSION： Targeted interventions for vulnerable populations and public campaigns about preventive medical evaluation are needed to increase gastric cancer screening participation and reduce gastric cancer mortality.     

Acute myocardial infarction associated with heavy alcohol intake in an adolescent with normal coronary arteries

Acute ingestion of large quantities of alcohol is known to be able to trigger acute myocardial infarction. A 19-year-old boy presented at the emergency department of our hospital with complaints of severe retrosternal chest pain. One night before this event, he had drunk large amounts of alcohol. The level of alcohol in his blood was measured at 0.59 grams per litre. A 12-lead electrocardiogram showed elevations of the ST segment, averaging from 2 to 10 millimetres, in leads V1-6, DI and aVL. Since consumption of alcohol is very common in the community, the triggering effect of binge-drinking and consumption of large amounts of alcohol on acute myocardial infarction should be considered as a crucial subject for public health so as to raise the consciousness of the population, especially young persons.     

Factors associated with discontinuation of antiretroviral therapy in HIV-infected patients with alcohol problems

Although mortality rates among HIV-infected populations have declined with the advent of combination antiretroviral therapy (ART), patients with substance use disorders have benefited less from these therapies. While adherence to ART has been well studied, less is known about factors associated with discontinuation of ART. The aim of this study is to investigate predictors of discontinuation of ART in HIV-infected patients with alcohol problems, focusing on their substance use and depressive symptoms. The study cohort (n=266) was prospectively assessed with biannual standardised interviews between 2001 and 2005. Four predictor variables (cocaine, heroin, heavy alcohol use and substantial depressive symptoms) were assessed six months prior to the outcome (ART discontinuation). Longitudinal logistic regression models examined the association between predictor variables and ART discontinuation adjusting for age, gender, race/ethnicity, homelessness, CD4, HIV RNA and HIV Symptom Index. Subjects were 77% male; 43% black; 22% homeless; 45% used cocaine; 20% used heroin; 29% had heavy alcohol use; and 40% had substantial depressive symptoms. Discontinuation occurred in 135 (17%) of the observations (n=743). In bivariate analyses, cocaine use, heroin use and depressive symptoms were significantly associated with ART discontinuation but heavy alcohol use was not. In the multivariable model, substantial depressive symptoms (adjusted odds ratio (AOR)=1.66; 95% confidence interval (CI): 1.04, 2.65) but not cocaine (AOR=1.28; 95%CI: 0.76, 2.16) or heroin use (AOR=1.27 95%CI: 0.66, 2.44), remained significantly associated with ART discontinuation. Among HIV-infected adults with alcohol problems, depressive symptoms, but not substance use, predicted subsequent ART discontinuation. Recognition and treatment of depressive symptoms in this population may result in better maintenance of ART and its associated clinical benefits.     

Factors affecting utilization of cervical cancer prevention services in low-resource settings

Strategies for introducing or strengthening cervical cancer prevention programs must focus on ensuring that appropriate, cost-effective services are available and that women who most need the services will, in fact, use them. This article summarizes the experiences of research projects in Bolivia, Peru, Kenya, South Africa, and Mexico. Factors that affect participation rates in cervical cancer prevention programs are categorized in three sections. The first section describes factors that arise from prevailing sociocultural norms that influence women's views on reproductive health, well being, and notions of illness. The second section discusses factors related to the clinical requirements and the type of service delivery system in which a woman is being asked to participate. The third section discusses factors related to quality of care. Examples of strategies that programs are using to encourage women's participation in cervical cancer prevention services are provided. This paper is available too at: http://www.insp.mx/salud/index.html.     

Factors associated with adolescent and caregiver reported problems in using asthma medications

Objectives: The purpose of this study was to: (a) describe the types of medication problems/concerns youth with asthma and their caregivers reported and (b) examine the association between sociodemographic characteristics and youth and caregiver reported medication problems/concerns. Methods: English- and Spanish-speaking youth ages 11–17 with persistent asthma were recruited at four pediatric clinics. Youth were interviewed and caregivers completed questionnaires about reported asthma medication concerns/problems. Multiple logistic regression was used to analyze the data. Results: Three hundred and fifty-nine youth were recruited. Eighty percent of youth and 70% of caregivers reported one or more problems in using asthma medications. The most commonly reported problems by youth were: (a) hard to remember when to take the asthma medication (54%) and (b) hard to use asthma medication at school (34%). Younger children were significantly more likely to report difficulty in understanding their asthma medication's directions and difficulty reading the print on the medication's package. Caregivers’ top-reported problem was that it is hard for their child to remember to take their asthma medications (49%). Caregivers without Medicaid were significantly more likely to express difficulty paying for their child's asthma medications. Conclusions: Difficulty remembering to take asthma medication was a significant problem for youth and their caregivers. Providers should work with youth and their caregivers to identify asthma medication problems and discuss strategies to address those problems.     

Factors associated with compliance in treatment of tuberculosis

The most important cause of failure of antituberculosis therapy is that the patient does not take the medication as prescribed. To assess this problem, a retrospective review was conducted, using medical and nursing records, of adult patients treated at the tuberculosis clinic of the Montreal Chest Hospital in 1987–1988. In all, 352 patients were identified, of whom 59% were judged to have completed therapy. Completion of therapy was recorded in 92% of those with culture-positive disease, 76% of those with active but culture-negative disease and 54% among the 300 prescribed preventive therapy (P < 0.001). Compliance with preventive therapy was highest among those who had been in contact with an active case, and lowest among those identified through a workforce screening survey (P < 0.01). At the time of the first follow-up visit, patients identified to have suboptimal compliance were more likely to fail to complete therapy (P < 0.001). Compliance was higher among those initially hospitalized, those assessed to have better understanding (P < 0.05), those prescribed 6–9 rather than 12 months of therapy (P < 0.01), and those who returned for follow-up within 4 weeks of initiation of therapy (P < 0.01). Compliance could be improved by enhancing patient understanding, closer follow-up, and shorter therapy, particularly for those at lower risk of reactivation. As well, additional compliance enhancing interventions can be targeted to those patients with suboptimal compliance who can be accurately identified early in the course of therapy.     

Antidepressant treatment and health services utilization among HIV-infected medicaid patients diagnosed with depression

OBJECTIVE: To characterize the prevalence and predictors of diagnosed depression among persons with HIV on Medicaid and antidepressant treatment among those diagnosed, and to compare utilization and costs between depressed HIV-infected individuals treated with and without antidepressant medications. DESIGN: Merged Medicaid and surveillance data were used to compare health services utilized by depressed individuals who were or were not treated with antidepressant medications, controlling for other characteristics. SETTING AND PARTICIPANTS: The study population comprised Medicaid recipients in New Jersey who were diagnosed with HIV or AIDS by March 1996 and received Medicaid services between 1991 and 1996. MEASUREMENTS AND MAIN RESULTS: Logistic regression and ordinary least squares regressions were employed. Women were more likely and African Americans were less likely to be diagnosed with depression. Women and drug users in treatment were more likely to receive antidepressant treatment. Depressed patients treated with antidepressants were more likely to receive antiretroviral treatment than those not treated with antidepressants. Monthly total expenditures were significantly lower for individuals diagnosed with depression and receiving antidepressant therapy than for those not treated with antidepressants. After controlling for socioeconomic and clinical characteristics, treatment with antidepressant medications was associated with a 24% reduction in monthly total health care costs. CONCLUSIONS: Depressed HIV-infected patients treated with antidepressants were more likely than untreated subjects to receive appropriate care for their HIV disease. Antidepressant therapy for treatment of depression is associated with a significantly lower monthly cost of medical care services. This research was supported by a grant from the National Institute on Drug Abuse, R01-DA11362-01. The findings and opinions reported here are those of the authors and do not necessarily represent the views of any other individuals or organizations.     

Prevalence of personality disorder in alcohol and drug services and associated comorbidity

AIMS: To compare the prevalence of personality disorder in alcohol and drug populations with special attention to its impact on psychopathology and service characteristics. DESIGN: Cross-sectional survey. SETTING: Three alcohol and four drug services in four urban UK centres. PARTICIPANTS: Two hundred and sixteen drug and 64 alcohol service patients randomly sampled from current treatment populations. MEASUREMENTS: A treatment population census recorded demographic and diagnostic data. Patient interviews assessed the presence, cluster type and severity of personality disorder using the Quick Personality Assessment Schedule (PAS-Q). Other psychopathology was measured using the Comprehensive Psychopathological Rating Scale (CPRS). A case-note audit recorded psychotic psychopathology using the OPCRIT schedule and data regarding social morbidity. FINDINGS: The overall prevalence of personality disorder was 37% in the drug service sample and 53% in the alcohol service sample. The distribution of severity and clusters differed markedly between the two samples. There was a significant association between the severity of personality disorder and psychopathology in both samples. Levels of morbidity associated with clusters B and C were similar. Clinical diagnosis of personality disorder showed high specificity but low sensitivity when compared to PAS-Q. CONCLUSIONS: In both alcohol and drug service populations, personality disorder is associated with significantly increased rates of psychopathology and social morbidity that worsens with increasing severity of the disorder. Despite this, personality disorder is poorly identified by clinical staff. The PAS-Q may be useful as a clinical assessment tool in the substance misuse population for the early identification and management of patients with personality disorder.