Effectiveness of A-CRA/ACC in treating adolescents with cannabis-use disorders.

An evidence-based treatment for adolescent cannabis users, Adolescent Community Reinforcement Approach with Assertive Continuing Care, was implemented in a rural county and small city in the USA. A total of 147 adolescents, ages 12-18, were enrolled and assessed at baseline and three time points: 3, 6, and 12 months using the Global Appraisal of Individual Needs and related measures. Program effectiveness was confirmed. The treatment was equally effective for youth from the city versus the county. More than two-thirds (68.7%) of the adolescents reported quitting use of cannabis by 12 months. The days of cannabis use in the last 90 days decreased significantly from the first follow-up, controlling for age (p value < .01), and shows consistent decline until the end of the treatment. In addition to reduction in substance use, the average number of days missing school and expelled from school decreased significantly from baseline to the end of the treatment.

Attachment style and coping in relation to posttraumatic stress disorder symptoms among adults living with HIV/AIDS.

Research indicates that a significant proportion of people living with HIV/AIDS report symptoms of posttraumatic stress disorder (PTSD). Moreover, attachment style has been associated with psychological and behavioral outcomes among persons living with HIV/AIDS. Attachment style may influence the ability to cope with traumatic stress and affect PTSD symptoms. To examine the association between attachment style and coping with PTSD symptoms, we assessed 94 HIV-positive adults on self-report measures of posttraumatic stress, coping, and attachment style. In multiple regression analysis, avoidant attachment and emotion-focused coping were positively and significantly associated with greater PTSD symptomatology. Support was also found for the moderating effects of avoidant and insecure attachment styles on emotion-focused coping in relation to greater PTSD symptoms. Taken altogether, these results suggest that interventions that develop adaptive coping skills and focus on the underlying construct of attachment may be particularly effective in reducing trauma-related symptoms in adults living with HIV/AIDS.

Health disparities between Appalachian and non-Appalachian counties in Virginia USA.

UNLABELLED: The examination of health disparities among people within Appalachian counties compared to people living in other counties is needed to find ways to strategically target improvements in community health in the United States of America (USA). METHODS: A telephone survey of a random sample of adults living in households within communities of all counties of the state of Virginia (VA) in the USA was conducted. FINDINGS: Health status was poorer among those in communities within Appalachian counties in VA and health insurance did not make a difference. Health perception was significantly worse in residents within communities in Appalachian counties compared to non-Appalachian community residents (30.5 vs. 17.4% rated their health status as poor/fair), and was worse even among those with no chronic diseases. Within communities in Appalachian counties, black residents report significantly better health perception than do white residents. CONCLUSION: Residents living in communities in Appalachian counties in VA are not receiving adequate health care, even among those with health insurance. More research with a larger ethnic minority sample is needed to investigate the racial/ethnic disparities in self-reported health and health care utilization within communities.

An evaluation of a computer-imaging program to prepare women for chemotherapy-related alopecia.

OBJECTIVE: This study was conducted to evaluate a computer program named Help with Adjustment to Alopecia by Image Recovery (HAAIR) that was developed to provide educational support and reduce distress in women with hair loss following chemotherapy. METHODS: Forty-five women who had been diagnosed with cancer and anticipated alopecia following treatment were randomly assigned to either the Imagining group (IG) or Standardized Care group (SCG). Patients in the IG used a computer-imaging program that created the patient's image on a screen to simulate baldness and use of wigs whereas patients in the SCG were directed to a resource room at the Cancer Center established for women with chemotherapy-related alopecia. Assessment data using the Brief Symptom Inventory, Importance of Hair Questionnaire, and the Brief Cope were completed at baseline (T1), before chemotherapy and hair loss, following hair loss (T2), and 3 months follow-up (T3). RESULTS: All women were able to successfully use the touch screen computerized-imaging program and reported that using the computer was a positive, helpful experience, thus establishing acceptability and usability. Women in both the IG and the SCG group showed significantly lower hair loss distress scores at T2 after hair loss than at T1 with T3 distress scores increasing in the SCG and decreasing in the IG. Those with avoidance coping reported more distress. CONCLUSIONS: This evaluation demonstrates that the HAAIR program is a patient-endorsed educational and supportive complement to care for women facing chemotherapy-related alopecia.

Alcohol use and sexual risk behavior among college students: understanding gender and ethnic differences.

OBJECTIVES: The purpose of the current study was to assess the role of gender and ethnicity in the relationship between alcohol use and risky sexual behavior. METHOD: Sexually active college students (n = 425) reported on alcohol expectancies, perceived risk of HIV, and drinking and sexual behavior in the context of a larger health behavior survey. RESULTS: Approximately one-third of participants reported binge drinking 3 or more times in the past two weeks. African-American women reported less drinking and less positive alcohol expectancies than other women. Older men engaged more often than younger men in binge drinking and reported more sexual partners in the past year. Younger age and greater perceived risk for HIV were positively associated with condom use for both women and men. CONCLUSION: Collectively, these findings suggest that alcohol abuse and HIV prevention efforts among young adults need to consider gender, ethnicity, and age.

Physician attitudes regarding hypoactive sexual desire disorder in a primary care clinic: a pilot study.

INTRODUCTION: Female sexual dysfunction (FSD), in particular, complaints of low desire, affects many American women. Despite the impact FSD may have on these women, many do not present their symptoms to their physicians. AIM: To determine physician attitudes and practices regarding hypoactive sexual desire disorder (HSDD) in the primary care setting. MAIN OUTCOME MEASURES: A 10-item questionnaire regarding HSDD. METHODS: All residents and faculty in an academic primary care clinic were invited to participate in a web-based survey regarding HSDD. Return of the questionnaire was considered consent. Responses were downloaded into Excel and converted into an spss database. RESULTS: In total, 53 of 155 physicians responded (46% response rate-41.5% women, 58.5% men). Of respondents, 90% reported little confidence in making the diagnosis of HSDD, 90% of physicians had not screened a patient for HSDD, and 98% of the physicians had not prescribed medication for patients with HSDD. No significant gender differences among physicians were identified, but faculty providers had more confidence in diagnosing and treating HSDD than resident physicians. CONCLUSIONS: These results indicate there is an opportunity to improve patient care and life satisfaction by offering physicians training on diagnosis and management of HSDD.

Salivary cortisol, dehydroepiandrosterone, and testosterone interrelationships in healthy young males: a pilot study with implications for studies of aggressive behavior.

The present small pilot study was designed to demonstrate the feasibility and relevance of using salivary assessments of biological markers to model a complex biological substrate of aggressive behavior. Five college-aged males completed the State-Trait Anger Expression Inventory on enrollment and provided saliva samples at 2000, 0200 and 0800 h during one mid-week 24-h period for three consecutive weeks. Saliva samples were assayed for cortisol (C), dehydroepiandrosterone (DHEA), and testosterone (T). All three biological measures showed stable circadian rhythms for each individual across the weeks of the study. Circadian variations indicate the importance, for C in particular, of including collection at 0200 h. Examination of the relationship among C, DHEA and T and the scales of the State-Trait Anger Expression Inventory provides preliminary evidence of an acceptable methodology to study complex interrelationships based on both levels and circadian variations of all three biological measures. This study demonstrates the feasibility of using salivary collection and assays to assess the level and stability of circadian variation in biological markers, and the necessity of formulating complex models to investigate the relationship between biology and behavior.

Relationships of depression to child and adult abuse and bodily pain among women who have experienced intimate partner violence.

This study investigates whether depression in women who experienced intimate partner violence is associated with having also experienced childhood sexual and physical abuse, psychological abuse by an intimate partner, recent involvement with the abusive partner, and bodily pain. Fifty-seven women who had left a violent relationship with an intimate partner completed measures assessing their demographic characteristics, experiences of abuse in childhood and in their relationship with their intimate partner, and depressive symptoms. Multiple regression analysis showed that women's depression was significantly greater among those who had experienced childhood physical and sexual abuse, more severe psychological abuse, and greater bodily pain (p<.001), adjusted R(2)=.32. These results suggest characteristics that can help to identify abused women who are most at risk for depression, and they suggest specific issues that may need to be addressed in this population.

Burden of phase-specific sexual dysfunction with SSRIs.

OBJECTIVE: This study examines phase-specific sexual dysfunction among patients who are being treated for major depression and who do not meet criteria for global sexual dysfunction. METHODS: 6297 adult outpatients receiving antidepressant monotherapy completed the Changes in Sexual Functioning Questionnaire (CSFQ). The sub-sample for this study (n = 3114) comprises participants who were receiving treatment with a SSRI or SNRI and did not meet the gender-specific criterion for global sexual dysfunction on the CSFQ. RESULTS: Among this sub-sample, 95.6% of women and 97.9% of men exhibited impairment in at least one phase of sexual functioning. Men were significantly more likely than women to experience dysfunction in the desire phase (91.2% vs. 79.0%; OR = 2.76; 95% C.I. = 2.14 to 3.5) and the orgasmic phase (85.1% vs. 45.4%; OR = 6.9; 95% C.I. = 5.6 to 8.4) but were significantly less likely than women to experience dysfunction in the arousal phase (71.9% vs. 83.3%; OR = .51; 95% C.I. = .43 to .62). The prevalence of phase-specific dysfunction did not vary significantly by SSRI/SNRI for males or females. CONCLUSION: Among patients who do not experience clinically significant global sexual dysfunction on SSRI/SNRI monotherapy, dysfunction in at least one phase of the sexual response cycle is very common and may reduce sexual health-related quality of life.

Fit WIC: attitudes, perceptions and practices of WIC staff toward addressing childhood overweight.

OBJECTIVE: To assess the attitudes, perceptions, and practices of staff of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in providing nutrition education on childhood overweight topics with WIC participants. DESIGN: Descriptive and correlational study. SETTING: WIC clinics in Virginia. PARTICIPANTS: 106 employees working in direct contact with WIC participants. MEAN OUTCOME MEASURE(S): Demographic information; comfort level and frequency of discussing childhood overweight-related topics with participants; perception of WIC's ability to prevent and help address overweight among children and adults; body mass index (BMI); and attitudes toward personal weight. ANALYSIS: Descriptive statistics, regression, and analysis of variance. RESULTS: WIC staff in this study reported a lack of comfort, practice, and confidence in addressing and/or preventing childhood overweight with WIC participants, with differences existing based on job title (P < .05). Barriers to implementing programs included perceived attitudes of participants, transportation, time, cultural issues, and childcare. Staff BMIs were significantly correlated to ethnicity, age, feeling overweight, unhappiness with current weight, and comfort level discussing fruit and vegetable intake and physical activity (P < .05). CONCLUSIONS AND IMPLICATIONS: Staff training, health promotion programs, and culturally relevant educational materials are warranted for WIC staff to build a strong knowledge base and promote self-efficacy about childhood overweight-related topics.

A placebo-controlled trial of bupropion SR as an antidote for selective serotonin reuptake inhibitor-induced sexual dysfunction.

OBJECTIVE: This study reports the results of a placebo-controlled, double-blind comparison of bupropion sustained release (SR) as an antidote for sexual dysfunction versus placebo in 42 patients with selective serotonin reuptake inhibitor (SSRI)-induced sexual dysfunction. Exploratory analyses of the association of testosterone and sexual functioning in women in the study were also performed. METHOD: Patients with DSM-IV major depression who experienced a therapeutic response to any SSRI and were experiencing medication-induced global or phase-specific sexual dysfunction, as measured by the Changes in Sexual Functioning Questionnaire (CSFQ), were randomly assigned to receive either bupropion SR 150 mg b.i.d. or placebo for 4 weeks in addition to the SSRI. Total testosterone levels were assessed at baseline and week 4. RESULTS: The difference in global sexual functioning, based on the total CSFQ score, was not statistically significant between the 2 groups at week 4, nor were differences in orgasm, desire/ interest as measured by sexual thoughts, or self-reported arousal. There was a statistically significant difference between the 2 groups at week 4 in desire as measured by self-report feelings of desire and frequency of sexual activity. Desire/ frequency showed a significantly greater improvement among those patients receiving bupropion SR compared with placebo (Wilk's F = 5.47, df = 1, p =.024). Frequency was significantly correlated to total testosterone level at baseline (r = 0.36, p =.027) and at week 4 (r = 0.41, p =.025). CONCLUSIONS: Bupropion SR, as an effective antidote to SSRI-induced sexual dysfunction, produced an increase in desire to engage in sexual activity and frequency of engaging in sexual activity compared with placebo. A larger study is needed to further investigate this finding.

Willingness and competence of depressed and schizophrenic inpatients to consent to research.

In this study, the willingness of psychiatric inpatients to volunteer for research and their capacity to consent to and distinguish between protocols offering different levels of risk and benefit were assessed. Twenty-two inpatients with major depressive disorder, 21 inpatients with schizophrenia, and 21 community control subjects were asked to consider participation in a lower-risk study offering the potential for direct medical benefit and a higher-risk study offering no direct medical benefit. Consent-related capacities were assessed with the MacArthur Competence Assessment Tool-Clinical Research. Depressed inpatients, while having a greater degree of impairment than control subjects, still demonstrated relatively high decision-making capacity and were able to distinguish levels of risk between studies. Their pattern of preferences did not differ from control subjects. However, they were more likely to decline to participate in the research, being six times more likely to decline the lower-risk study and 1.4 times more likely to decline the higher-risk study. Schizophrenic subjects demonstrated greater impairments in decision-making capacity and were even more likely than depressed subjects to decline to participate.

Decisions to initiate involuntary commitment: the role of intensive community services and other factors.

OBJECTIVE: This study examined the predictors of actions to initiate involuntary commitment of individuals experiencing a mental health crisis. METHODS: Emergency services clinicians throughout Virginia completed a questionnaire following each face-to-face evaluation of individuals experiencing a mental health crisis. Over a one-month period in 2007, a total of 2,624 adults were evaluated. Logistic hierarchical multiple regression was used to analyze the relationship between demographic, clinical, and service-related variables and outcomes of the emergency evaluations. RESULTS: Several factors predicted 84% of the actions taken to initiate involuntary commitment. These included unavailability of alternatives to hospitalization, such as temporary housing or residential crisis stabilization; evaluation of the client in a hospital emergency room or police station or while in police custody; current enrollment in treatment; and clinical factors related to the commitment criteria, including risk of self-harm or harm to others, acuity and severity of the crisis, and current drug abuse or dependence. CONCLUSIONS: A lack of intensive community-based treatment and support in lieu of hospitalization accounted for a significant portion of variance in actions to initiate involuntary commitment. Comprehensive community services and supports for individuals experiencing mental health crises may reduce the rate of involuntary hospitalization. There is a need to enrich intensive community mental health services and supports and to evaluate the impact of these enhancements on the frequency of involuntary mental health interventions.

The effect of community mental health services on hospitalization rates in Virginia.

OBJECTIVE: This study examined the relationship between the availability of mental health outpatient services provided by 40 publicly funded community service boards (CSBs) and the use of inpatient mental health treatment among Medicaid recipients. METHODS: Three-year data were obtained for Medicaid recipients aged 18-64 from the Medicaid claims database for the Commonwealth of Virginia. Medicaid recipients who had a mental disorder diagnosis and who had received at least one community mental health service were included in the sample. A multivariate regression model was used for the analyses. RESULTS: Of the 11,107 individuals included, 27% had schizophrenia-related disorders and 32% had affective psychoses; 60% were white and 37% were black; and the average age was 40.1±13.1 years. In this sample, greater use of outpatient mental health services, but not greater variety of services available, was correlated with fewer inpatient hospital days for mental health treatment (-1.0±.2 days of hospitalization). CONCLUSIONS: Virginia's CSBs provide a range of outpatient mental health services that are designed to enable individuals to remain in their community. The availability of community-based mental health services was correlated with lower rates of inpatient hospitalization for mental illness. More research, however, is needed to establish causality and to determine which services are most effective at reducing the need for inpatient care.

Mental health system transformation after the Virginia Tech tragedy.

On 16 April 2007, a deeply disturbed Virginia Tech student murdered thirty-two fellow students and faculty and then shot himself. Less than one year later, the Virginia legislature improved the emergency evaluation process, modified the criteria for involuntary commitment, tightened procedures for mandatory outpatient treatment, and increased state funding for community mental health services. The unanswered question, however, is whether the necessary political momentum can be sustained for the long-term investment in community services and the fundamental legal changes needed to transform a system focused on managing access to scarce hospital beds to a community-based system of accessible voluntary services.

Reliability and construct validity of the Changes in Sexual Functioning Questionnaire short-form (CSFQ-14).

The Changes in Sexual Functioning Questionnaire (CSFQ) is a 36-item clinical and research instrument identifying five scales of sexual functioning. This study documents the internal consistency and factor structure of a 14-item version of the CSFQ (CSFQ-14), which yields scores for three scales corresponding to the phases of the sexual response cycle (i.e., desire, arousal, and orgasm) as well as the five scales of the original CSFQ. Factor analysis confirms the construct validity of the CSFQ-14 as a global measure of sexual dysfunction. The CSFQ-14 and the individual scales exhibit strong internal reliability.

Using focus group results to inform preschool childhood obesity prevention programming.

OBJECTIVE: This study about maternal feeding practices and beliefs was conducted as background for the development of a childhood obesity prevention program for multi-ethnic parents in the USA receiving services from a federal government supplemental nutrition program for low-income mothers. DESIGN: Using a grounded theory approach, focus groups were conducted with low-income African American, white non-Hispanic (i.e. the majority Caucasian American population), Hispanic and Vietnamese parents to collect cross-cultural perspectives on: (a) infant and child feeding practices, (b) childhood overweight, (c) healthy dietary intake, (d) physical activity and inactivity, and (e) infant feeding information sources. RESULTS: A content analysis of the data yielded three main themes common to all four groups: (a) lack of awareness of the relationship between increased physical activity and health, (b) the use of food to influence behavior, and (c) the loss of parental control over feeding when a child starts child care or school, and revealed perspectives on age-appropriate food, infant satiety, overweight and information sources that were specific to each group. CONCLUSION: Interventions that enhance parent self-efficacy that build on themes that are specific to ethnic groups toward preventing childhood obesity are needed. There is also a need for culturally appropriate information for governmental nutrition programs that is in the client's own language and takes into account ethnic differences in beliefs and traditions.

Juvenile sex offender re-arrest rates for sexual, violent nonsexual and property crimes: a 10-year follow-up.

We report the results of a 10-year follow-up recidivism study of two sex offender treatment programs for incarcerated juvenile sex offenders (JSOs) in Virginia. The programs vary in environment and intensity. The more intense JSO program ("self-contained") operates in specialized living units that are separate from those of the general juvenile incarcerated population. In the less intense program ("prescriptive"), JSOs remain housed with the general population of juvenile offenders. Arrest and incarceration data through January 2003 were obtained for 261 male JSOs released between 1992 and 2001. The inclusion of adult incarceration data allowed for a more accurate assessment of the actual time at risk for sexual re-offending. Outcomes are re-arrest rates, length of time to re-arrest and type of offense (property, nonsexual assault, sexual) on re-arrest, with analyses using survival curve functions. For both groups, actual re-arrest is most likely to be for a nonsexual person offense (31 and 47%, respectively) and least likely to be for a sexual offense (<5% for both groups). Comparing the nonequivalent groups, the self-contained treatment group has a lower predicted re-arrest rate and a longer mean time to re-arrest, for all types of offenses, than the prescriptive treatment group. In addition, juveniles who indicate high levels of impulsive/antisocial behaviors are significantly more likely to recidivate compared to juveniles with low-levels of impulsive/antisocial behaviors, regardless of treatment type. This is the first 10-year follow-up study of treatment outcomes for a relatively large sample of males who were incarcerated for sexual offenses as juveniles.