Care Retention Among Veterans with Serious Mental Illness who were once lost-to-Veterans Health Administration care.

OBJECTIVE: To evaluate care retention among Veterans with serious mental illness (SMI) who were lost to Veterans Health Administration (VHA) care for at least one year and subsequently returned to VHA care via the SMI Re-Engagement program, an outreach program for Veterans with SMI who are lost-to-care. METHODS: For the 410 Veterans with SMI who returned to care via SMI Re-Engagement between April 4th, 2016 and January 31, 2018, we assessed VHA in-person and telehealth utilization (overall, primary care, mental health care) for two years following the date of return to care. RESULTS: Care retention was common: 70.2% of Veterans had at least one encounter in each year of the two-year follow-up period and an additional 22.7% had at least one encounter during one of the two years. During the two-year follow-up period, 72.4% of Veterans had at least one primary care encounter and 70.7% of Veterans had at least one mental health care encounter. Adjusted binomial logistic regression analyses found a return-to-care encounter in primary care (OR = 2.70; 95% CI: 1.34, 5.42) predicted primary care retention, and a return-to-care encounter in mental health care (OR = 4.01; 95% CI: 2.38, 6.75) predicted mental health care retention. CONCLUSION: Most Veterans who return to care via the SMI Re-Engagement program remain in VHA care for the subsequent two years.

Findings from a Peer-Facilitated, Social Isolation Intervention in the Veterans Health Administration Healthcare System: A Mixed-Methods, Pilot Feasibility Study.

BACKGROUND: Social isolation is a global public health threat. Veterans are particularly at risk for social isolation due to high rates of comorbid physical and mental health problems. Yet, effective interventions are limited. OBJECTIVES: Our primary objective was to assess the feasibility and acceptability of CONNECTED, a novel, transdiagnostic intervention to reduce social isolation that includes individual and group components and is delivered by peers via telehealth. Secondary objectives were to identify appropriate outcome measures and explore preliminary intervention effects. METHODS: This was a two-phase study. In Phase 1, to evaluate study feasibility, we surveyed 200 veterans to assess prevalence of social isolation and their interest in social connectedness interventions. In Phase 2, we employed a mixed-methods, pre-post study design in which we piloted CONNECTED with 19 veterans through 2 successive cohorts to further assess feasibility, to evaluate acceptability, and to explore preliminary effectiveness. Quantitative analyses involved descriptive and bivariate analyses as well as multivariate modeling. Qualitative interviews were analyzed using thematic analysis. RESULTS: For Phase 1, 39% of veterans surveyed were socially isolated. Participants who were ≤ 55 years old, caregivers, and those who experienced unmet social needs were more likely to report social isolation. Over 61% expressed interest in VA programs to reduce social isolation. For Phase 2, the pilot intervention, recruitment rate was 88% and the enrollment rate was 86%. Retention rates for the two cohorts were 80% and 50%, respectively, and satisfaction rates among intervention completers were 100%. Results also showed statistically significant improvements in social isolation (+ 5.91, SD = 4.99; p = .0028), social support (+ 0.74, SD = 1.09; p = .03), anxiety (-3.92, SD = 3.73; p = .003), and depression (-3.83, SD = 3.13; p = .001). Results for the other measures were not statistically significant. CONCLUSION: CONNECTED is a feasible and acceptable intervention and is likely to be an effective tool to intervene on social isolation among veterans.

College student smokers' cognitive appraisal of high-risk activities.

OBJECTIVE: Students who smoke are more likely to engage in risky behaviors such as binge drinking and unprotected sex (Schnieder and Morris, Environ Behav. 1999; 23:575-591). The goals of the present study were to determine whether smokers assess these behaviors as lower risk than nonsmokers, and if smoking rate influences risk perceptions. METHODS: Participants were 303 college students. Cognitive Appraisal of Risky Activities (Fromme et al., Cognit Ther Res. 1997; 21:421-442) and smoking were assessed August-November, 2006. RESULTS: Smokers reported significantly less risk, more benefit, and more involvement in risky behaviors than nonsmokers (p < .01). In hierarchical linear regression, risk perceptions moderated the association between smoking and (a) expected benefit from risky sexual behaviors (beta = -1.121, p < .05); and (b) expected involvement with illicit drugs (beta = -.313, p < .01). CONCLUSIONS: College smokers' assessment of high-risk behaviors influenced their intended involvement. Risk perception change may therefore alter their involvement in high-risk behaviors.

Heavy smokers perform more poorly than nonsmokers on a simulated task of gambling.

The Gambling Task (GT) has demonstrated sensitivity to a type of decision-making that differentiates individuals manifesting substance use disorders from those without such disorders. However, studies have not yet compared the GT performance of "heavy smokers" to the performance of never-smokers. In the present study, the GT performance of "heavy smokers" (n = 39) and never-smokers (n = 32) recruited from the community was compared in an experimental design. Analysis of covariance showed that "heavy smokers" performance on the GT was significantly worse than that of never-smokers (p < .01). Implications, the study's limitations and future directions are discussed.

Measurement of smoking outcome expectancies in children: the Smoking Consequences Questionnaire-Child.

A measure of smoking outcome expectancies was developed for children ages 7-12 years. Confirmatory factor analysis (CFA) was used to determine whether a 1-, 2-, 3-, or 4-factor solution was most appropriate for the data set. CFA revealed that the 3-factor model produced the most adequate fit (Positive Reinforcement, Negative Consequences, and Weight Control). The resulting 15-item measure was named the Smoking Consequences Questionnaire-Child (SCQ-C). The fit of the 3-dimensional structure was then examined separately for 3 age groups representing young (7- to 8-year-old), middle (9- to 10-year-old), and old (11- to 13-year-old) children. Overall, the 3-factor structure fit the data well for the 3 groups. As such, we examined the relations of the 3 scales with antecedent variables for the entire sample. The Positive Reinforcement scale was associated with children's smoking behavior and having a family member or peers who smoked. The Negative Consequences scale was inversely related to having a family member or peer who smoked.