If mothers had their say: research-informed intervention design for empowering mothers to establish smoke-free homes.

The Empowering Mothers to Establish Smoke-free Homes (EMESH) project developed in response to an interdisciplinary health team seeking effective interventions for reducing/eliminating the environmental tobacco smoke exposure of infants with compromised respiratory status. Two study phases that informed the EMESH intervention design are described. Phase I involved semi-structured interviews with 20 caretakers of infants diagnosed with Bronchopulmonary Dysplasia (BPD). In Phase II, 75 randomly selected medical records of infants with BPD were reviewed to explore the family demographics and staff behavior regarding environmental tobacco smoke (ETS) interventions. Interview results suggest that families are open to partnering with social workers and interdisciplinary team members in addressing infants' ETS exposure, families' unique circumstances indicate a need for tailored interventions, and the use of self-efficacy and decisional balance tools are feasible options. Results from the medical records review indicate that many families are economically vulnerable and reside in regions where smoking is common. There is a paucity of staff documentation regarding ETS conversations and interventions, indicating that these conversations may not take place. Together these results suggest a two-pronged approach in the next phases of EMESH: staff training in hosting and documenting ETS conversations and a tailored, parent-driven set of intervention options.

The relationship of legal coercion to readiness to change among adults with alcohol and other drug problems.

Prior research on legally coerced treatment for substance abuse tends to find no difference between coerced and non-coerced clients with respect to treatment retention and treatment outcomes. There is less known about the relationship between coercion and a client's motivation to change. We considered the relationship of legal coercion and readiness to change among 295 consecutive admissions to five publicly funded outpatient treatment programs. A logistic regression analysis indicated that legal coercion was associated with greater readiness to change after controlling for addiction severity, prior treatment history, and gender. Persons entering treatment due to legal coercion were over three times more likely to have engaged in recovery-oriented behavior in the month preceding admission. Entering treatment more prepared to benefit from the experience could contribute to outcomes that are more positive.

Substance abuse treatment outcomes for coerced and noncoerced clients.

This study provides new evidence regarding the relation of coerced care to posttreatment substance use and addiction severity while controlling for two important factors: readiness to change and addiction severity at admission to treatment. The initial study sample consisted of 289 people who agreed to participate in a prospective study of substance abuse treatment outcomes in five large outpatient programs in Ohio. The findings reported here are based on analyses for the 141 (48.8 percent of the original sample) individuals who completed a six-month follow-up interview using the short form of the Addiction Severity Index. These data indicate that legally coerced participants were more likely than noncoerced participants to report abstaining from alcohol and other drugs in the 30 days before their follow-up interview. They were also more likely to demonstrate reduced addiction severity at follow-up. Readiness to change at admission showed no relation to treatment outcomes.

The validity of a social indicator approach to substance misuse needs assessment.

Factors other than the magnitude of a community's drug- or alcohol-use-related problems may play a large role in resource allocation. Needs assessment approaches such as key informant interviews and household surveys can contribute to a more informed process. An additional approach to needs assessment, social indicator modeling, addresses the high cost of surveys and the potential subjectivity of key informant interviews. This paper discusses the history of social indicator approaches to needs assessment and reviews recent equitable distribution approaches. An equitable distribution model of alcohol- and other drug-use-related problems was created and validated. The drug model accounted for close to 50% of the variation in estimates of lifetime diagnosis of drug dependence or misuse. The alcohol model performed less successfully, accounting for 21% of the variation in lifetime diagnosis of alcohol-use-related problems.

Gender and racial inequities in retirement resources.

Two waves of a Social Security Beneficiary survey were analyzed to consider differences in the retirement resources of women and men based on marital status and race/ethnicity. Despite increased workforce participation the economic situation of single women, including white women, worsened over time. A bifurcation in retirement resources was found, with men relying more on private income sources and women depending more on Social Security. Current retirement policies based on privatization will continue to adversely impact women who work at low-paying jobs, receive lower wages, and live longer than men.