Assessment of Cardiovascular Health among Community-Dwelling Men with Incarceration History.

Returning to the community after incarceration is a particularly vulnerable time with significantly increased risk of death in the first 2 weeks. The elevated risk of death persists as long as 2 years, with cardiovascular disease (CVD) among the leading causes. African-Americans, especially African-American men, have higher rates of incarceration and community supervision (e.g., probation and parole) and an earlier onset of hypertension compared to Whites. Few studies have objectively assessed the cardiovascular health profile of criminal justice involved individuals. This study is designed to determine the cardiovascular health profile among men in community corrections and/or transitional housing, identify the prevalence of key CVD risk factors, and assess if risk varies by race/ethnicity. We recruited 100 adult men (mean age = 42.7, SD = 11.35, 60% White, 40% non-Hispanic White) with a history of incarceration in jail or prison of ≥ 6 months during their most recent incarceration and enrolled in a community corrections program. Using the American Heart Association's Life's Simple 7™ (LS-7), measures of each of the LS-7 components (body mass index, blood pressure, lipids, blood glucose, smoking, diet, and physical activity) were obtained, and LS-7 scores were generated for each measure using AHA-defined categories of poor (1 point), intermediate (2 points), and ideal (3 points) and summed to yield a total score ranging from poor for all (7 points) to ideal for all (21 points). Mann-Whitney U tests were performed to assess differences in LS-7 scores (poor, intermediate, ideal) by race/ethnicity. Additionally, an independent samples t test was conducted for race/ethnicity and LS-7 total score. Mann-Whitney U tests for LS-7 categories and race/ethnicity indicated a greater number of non-Whites had poor blood pressure (p < .01) and diet (p < .05) as compared to Whites. The independent samples t test demonstrated significantly lower LS-7 scores for non-Whites compared to Whites. To our knowledge, this is the first study to evaluate cardiovascular health among individuals with a history of incarceration using the LS-7 metric, which included objective measures for four of the seven LS-7 metrics. Non-Whites, which included African-Americans, Hispanics, and American Indians, were more likely than Whites to fall into the poor category for both diet and blood pressure and had significantly lower total LS-7 scores than Whites, indicating they have worse scores across all seven of the LS-7 measures. Similar to what is found among non-incarcerated samples, non-Whites with incarceration histories are at elevated risk for cardiovascular events relative to their White peers.

A pilot trial of In vivo NRT sampling to increase medication adherence in community corrections smokers.

BACKGROUND: Individuals in the criminal justice system demonstrate high rates of cigarette use (70-80%) and low adherence to smoking cessation medication. Educational approaches have not been shown to promote adherence or cessation, though medication sampling has boosted both use and cessation. The objective of the present study was to determine whether In vivo nicotine replacement therapy (NRT) sampling approach increases NRT adherence among criminal justice smokers during a subsequent quit attempt. METHODS: We conducted a pilot study with 43 community corrections smokers randomized to a 4-session (one 30-min session per week) precessation intervention of either In vivo NRT sampling (Session 1: patch; Session 2: gum; Session 3: combination NRT (cNRT); Session 4: review) vs. 4 time-matched sessions of standard smoking cessation with cNRT started after Session 1. Both groups received an additional 8weeks of cNRT following the four intervention sessions. RESULTS: During the in vivo administration of NRT, total withdrawal and craving severity significantly decreased from pre- to post-session compared to Control participants. In vivo participants evinced greater patch use at Session 4 and greater gum use through Week 8 relative to Controls. DISCUSSION: In vivo NRT sampling may increase NRT adherence relative to standard counseling sessions among criminal justice smokers. A larger trial of this novel intervention appears to be warranted.

Mixed-amphetamine salts expectancies among college students: Is stimulant induced cognitive enhancement a placebo effect?

INTRODUCTION: Non-medical use of prescription stimulants for cognitive enhancement in college students is increasing, despite evidence showing little benefit in non-clinical populations. The balanced placebo design (BPD) was used to independently evaluate the pharmacologic versus expectancy effects of mixed amphetamine salts on cognitive performance among a non-clinical sample of college-aged students. METHOD: Participants were screened and excluded for ADHD and other psychopathologies. A non-clinical sample (N=32) completed four two-hour laboratory sessions and were administered a neurocognitive battery in each session. Medication Assignment (10mg mixed-amphetamine salt (Adderall™) versus placebo) was crossed with Instructional Set (deception versus truth). A within-subjects design was used, such that all participants experienced each of the four conditions of the BPD during one of the four laboratory sessions. RESULTS: Participants performed no better than chance in identifying whether they received stimulant or placebo (Belief about Medication Assignment; 47% agreement; κ=-0.047, p=0.590). Participants showed improvement on only two of 31 subtests during active medication. Expecting and receiving stimulants was associated with improved cognitive performance. However, expecting placebo was associated with worse cognitive performance, regardless of the type of medication given. DISCUSSION: This study demonstrated that although non-medical use of stimulants does not enhance cognition, expectancies prominently influence cognitive performance. Participants who believed they received active medication both subjectively rated themselves as performing better and objectively performed better on a minority of subtests, independent of medication state.