Racial/ethnic differences in the bullying victimization-suicidality link among LGBQ high school students in the United States.

Although the relationship between bullying victimization and suicidal behaviors of lesbian, gay, bisexual, transgender, and questioning (i.e., unsure of their sexual orientation) students has been well documented in research, few studies have focused on how bullying victimization might be related to suicidal behaviors among youth with intersectional identities. This study examines associations between bullying victimization and suicidal behaviors across racial/ethnic groups in a sample of lesbian, gay, bisexual, and questioning (LGBQ) students. Data for this cross-sectional study were derived from the Center for Disease Control and Prevention's Youth Risk Behavior Survey combined data set (2003-2019), with a sample of 95,603 students who identified as LGBQ. Analyses included descriptive statistics and logistic regression. We found that homophobic bullying victimization was associated with higher odds of suicidal ideation and plans among the total sample and Black and Hispanic students. School-based bullying victimization was associated with higher odds of suicidal ideation, plans, and attempts among white and Hispanic students and higher suicidal ideation among multiracial-non-Hispanic students. Cyberbullying victimization was not associated with suicidal behavior among Asian students, but it was associated with all forms of suicidal behavior among youth of other racial/ethnic identities. Addressing bullying victimization and suicidality with culturally relevant, evidence-based violence prevention strategies is critical.

Racial and ethnic disparities in cervical and breast cancer screenings by nativity and length of U.S. residence.

OBJECTIVE: Previous studies of disparities in breast and cervical cancer screenings have focused on broad racial/ethnic groups or nativity status without accounting for immigration histories. Recent theoretical work argues for using intersectional approaches and examining within-group inequalities. Utilizing multiple years of National Health Interview Survey (NHIS) data, we examined between- and within-group Papanicolaou (Pap) test and mammogram screening based on nativity and length of U.S. residence for Asian and Hispanic women, along with non-Hispanic Black and White women. DESIGN: The study samples consist of 54,900 women ages 21-64 without a hysterectomy who responded to questions about Pap test screening and 36,300 women ages 40-64 who responded to questions about mammogram screening. Asian and Hispanic women were further stratified by nativity and, for immigrants, length of time in the United States. Logistic regression analysis was used to identify significant associations with Pap test and mammogram screenings. RESULTS: Recent Asian and Hispanic immigrants had the lowest Pap test and mammogram rates among all other groups, while Black (and White women for mammograms) women had the highest rates. After accounting for age, marital status, health insurance, education, employment status, and income, both Asian groups had lower odds, and Black and all Hispanic groups had higher odds of Pap test screening compared with White women. Similar results were observed for mammogram screening, except that long-term immigrant/U.S.-born Asian and U.S.-born Hispanic women did not have significantly different odds compared with White women. In general, the strength and direction of most sociodemographic variables were similar across groups for Pap test screening but differed for mammogram screening. CONCLUSIONS: The between-group differences identified emphasize the disparities in screening between racial/ethnic groups while the within-group differences suggest the need to examine whether more targeted outreach efforts and prevention messages can increase screening for specific groups.

Management site and level of health care for cannabis- and synthetic cannabinoid-related poison control center cases involving older adults, 2016-2019.

Increasing numbers of older adults use cannabis and cannabis-derived products that can have adverse effects. This study examined management site and level of healthcare services for older adult poison control center cases involving cannabis products. Using the American Association of Poison Control Centers' (PCC) National Poison Data System, 2016-2019, we extracted the 3109 cases aged 50+ for which cannabis was the only or primary substance. Multinomial logistic regression models were fit to examine associations between specific cannabis forms and management/care site (on site [mostly at home], at a healthcare facility [HCF], or no follow-up due to referral refusal or leaving against medical advice) and level of healthcare services for cases managed at a HCF. The results show that between 2016 and 2019, PCC cannabis cases involving older adults increased twofold, largely due to cases of cannabidiol, edibles, and concentrated extracts. Plant form and synthetic cannabinoid cases declined substantially. Compared to plant forms, synthetic cannabinoid cases had 4.22 (95% CI = 2.59-6.89) greater odds of being managed at, rather than outside, a HCF and 2.17 (1.42-3.31) greater odds of critical care unit admission. Although e-cigarette cases, compared to plant form cases, had lower odds of being managed at a HCF, HCF-managed e-cigarette cases had 3.43 greater odds (95% CI = 1.08-10.88) of critical care unit admission. Synthetic cannabinoid cases also had 1.86 (95% CI = 1.03-3.35) greater odds of no follow-up, and the presence of a secondary substance was also a significant factor. Stricter regulations for listing chemical ingredients and providing safety guidelines are needed for cannabis-derived products.

Opioid poisoning cases aged 50+ in the 2015-2020 National Poisoning Data System: suspected suicides versus unintentional poisoning and other intentional misuse/abuse.

High rates of opioid overdose and suicide among the 50+ age group call for an examination of suicidal intent in overdose incidents. Using 2015-2020 National Poison Data System opioid poisoning cases aged 50+ (n = 83 153), we examined the types of opioids and other substances associated with suspected suicides compared to intentional misuse/abuse without suicidal intent. During the six years, prescription opioid cases decreased, while illicit opioid cases increased. Among both types of opioid poisoning cases, the proportions of suspected suicides decreased and those of intentional misuse/abuse without suicidal intent increased. However, due to the large increase in illicit opioid cases, the number of suspected suicide cases involving illicit opioids increased. Multivariable analyses showed that among prescription opioids, acetaminophen with opioid (IRR = 1.17, 95% CI = 1.11-1.24) and tramadol (IRR = 1.12, 95% CI = 1.06-1.47) were associated with higher risk of suspected suicides than intentional misuse/abuse without suicidal intent. Among illicit opioid cases, fentanyl poisoning cases were associated with lower risk of suspected suicides (IRR = 0.40, 95% CI = 0.17-0.94). Of other medications, use of benzodiazepines and antipsychotics was consistently associated with higher risk of suspected suicides in both prescription and illicit opioid cases. Alcohol and cocaine were also associated with higher risk of suspected suicide. Along with continued reductions in opioid prescribing, more effective monitoring of individual patient misuse/abuse behaviors and suicide risk assessment are needed. Healthcare professionals should also review other prescription medications frequently co-prescribed with opioids that may have additive effects on suicidal behaviors among older adults.

Cannabis and binge alcohol use among older individuals with major depressive episode.

Background: Research shows significant associations of major depression with cannabis and binge alcohol use. However, despite increasing cannabis and binge alcohol use rates among the 50+ age group, research on this age group is scant. Methods: We used the 2015-2019 National Survey on Drug Use and Health data (n = 44,007 age 50+) and multinomial logistic regression models to examine associations of a major depressive episode (MDE) with cannabis and binge alcohol use and co-use and associations of binge alcohol use with nonmedical and medical cannabis use. Results: Of individuals age 50+, 89.6% had no history of MDE, 5.7% had prior-to-past-year MDE, and 4.7% had past-year MDE. The rates of past-month cannabis use were 4.3%, 7.7%, and 11.6% and binge alcohol use were 17.3%, 18.7%, and 19.9% among those with no MDE history, prior-to-past-year MDE, and past-year MDE, respectively. Compared to no MDE history, prior-to-past-year MDE (RRR = 1.70, 95% CI = 1.30-2.23) and past-year MDE (RRR = 1.80, 95% CI = 1.27-2.55) were significantly associated with past-month cannabis use (with or without binge alcohol use). However, MDE status was not associated with past-month binge alcohol use. Among cannabis users, binge alcohol use was significantly associated with nonmedical cannabis use only (RRR = 2.50, 95% CI = 1.95-3.21). Users of cannabis and/or binge alcohol also had a higher likelihood of using tobacco products and illicit drugs. Conclusions: Healthcare professionals treating individuals age 50+ with depression should screen for substance use, provide education on the potential adverse effects of polysubstance use, and help them access treatment for co-occurring depression and substance use problems.

Who benefits from Two Way Prayer Meditation? Treatment effect moderators in a pilot randomized controlled trial of a spiritual intervention for people with substance use disorders.

Background: Two Way Prayer Meditation (TWPM) is a spiritual intervention that holds promise for improving the psychospiritual well-being of individuals in recovery from substance use disorders (SUD). This study aimed to identify moderators of TWPM's treatment effects. Moderators tested included gender, race/ethnicity, age, education, religious/spiritual affiliation, and most often used substance. Methods: This study employed a randomized controlled trial design with pretest and posttest. In total, 134 adults in four residential recovery programs participated in the study and were randomly assigned to the TWPM group or the treatment as usual control group. Linear mixed modeling was used to assess the moderating effect of each hypothesized moderator in the form of interaction tests. Sensitivity analyses were conducted by excluding cases with more than a minimum number of missing items. Results: There were no significant moderators for psychological distress, self-esteem, and most of the spiritual well-being outcomes. Both the primary and sensitivity analyses showed education significantly moderated TWPM's effect on overall spirituality self-ranking. Specifically, TWPM's positive effect on overall spirituality self-ranking was greater in the master's degree subgroup than in the less than high school subgroup. Conclusion: TWPM's treatment effects on most outcomes were not found to vary by the tested participant characteristics. The only statistically significant finding suggests clinicians may need to adjust TWPM workshop/teaching content, delivery style, or language used to reach clients with lower levels of education. Future better-powered studies are recommended to continue exploring the potential moderating effects of race/ethnicity, education, spiritual/religious affiliation, and most often used substance.

Public mental health service use among U.S. adults age 50+ compared to younger age groups.

Despite increasing numbers of older-adult mental health service users, few studies have examined their use of public mental health services. Using the 2018 and 2019 Mental Health-Client Level data for clients age 18+ (N = 4,291,737 in 2018 and N = 4,513,946 in 2019), we examined whether those age 50+ who received outpatient-only, both outpatient and inpatient, or inpatient-only services had greater odds of certain types of mental disorders, especially schizophrenia, than younger adults. Of all users, 25.3% were age 50-64 and 6.7% were age 65 + . Multivariable logistic regression results, controlling for gender, race/ethnicity, census region, and alcohol/substance use disorder, showed that compared to the 30-49 age group, the 50-64 and 65+ age groups had higher odds of having depressive disorder in outpatient-only settings; however, they had consistently higher odds of a diagnosis of schizophrenia or other psychotic disorder in all three service settings. Along with advocating for increased funding for publicly-financed mental health services, social workers in public mental health service systems should ensure that they utilize effective intervention skills for older adults with serious mental illness.

Characteristics of Mental Health and Substance Use Service Facilities for Older Adults: Findings from U.S. National Surveys.

OBJECTIVES: To describe the characteristics of U.S. mental health and substance use service programs dedicated/tailored for older adults (age 65+). METHODS: Data came from the 2012 and 2019 National Mental Health Services Survey (N-MHSS) and the National Survey of Substance Abuse Treatment Services (N-SSATS). Using Pearson χ2 and Fisher's exact tests, we compared the numbers/proportions of older-adult programs in 2012 and 2019 and examined differences between facilities with or without an older-adult program in 2019. RESULTS: From 2012 to 2019, the percent of all mental health and substance use service facilities for adults that had a dedicated/tailored program for older adults increased significantly, from 20.7% to 28.9% for mental health facilities and from 7.1% to 24.8% for substance use facilities, with 101 mental health facilities and 53 substance use facilities serving older adults exclusively in 2019. Compared to facilities without an older-adult program, higher percentages of facilities with such a program offered treatment for co-occurring mental and substance use disorders and supplemental health and social care services. CONCLUSIONS: Given the rapidly aging society, more accessible and affordable programs dedicated/tailored for older adults are needed. To achieve this goal and better meet older adults' needs, more detailed data on facility characteristics are needed to build the knowledge base on improving the treatment environment. CLINICAL IMPLICATIONS: Programs for older adults should be designed to meet the complex needs of those with mental health and/or substance use problems and incorporate innovative service delivery models that can improve older adults' access.

COVID-19 and Loneliness among Older Adults: Associations with Mode of Family/Friend Contacts and Social Participation.

OBJECTIVES: Given physical/social distancing due to COVID-19, we examined associations between self-reported loneliness and changes in contact with family/friends and mode of social participation among older adults. METHODS: Data came from the 2020 National Health and Aging Trend Study (NHATS) and its supplemental mail COVID-19 survey (N = 2,910 respondents who reported changes in loneliness during the COVID-19 outbreak). We fit a generalized linear model (GLM) with Poisson and log link using increased versus the same/decreased loneliness as the dependent variable and changes in frequencies of four modalities of contact with family/friends and social participation mode during COVID-19 as the independent variables. RESULTS: Approximately 19% of respondents reported feeling lonely on more days during COVID-19. GLM results showed that decreased in-person contact (AOR = 1.42, 95% CI = 1.17-1.73) and increased video call contact (AOR = 1.30, 95% CI = 1.01-1.66) with family/friends and on-line participation in clubs, classes, and other organized activities (AOR = 1.36, 95% CI = 1.04-1.77) were associated with higher odds of increased loneliness. CONCLUSIONS: Virtual interaction is not an effective substitute for in-person interaction for older adults and is associated with increased loneliness. CLINICAL IMPLICATIONS: : Innovative means of making virtual contacts more similar to in-person contacts are needed to decrease older adults' loneliness during COVID-19.

Associations of cannabis use frequency and cannabis use disorder with receiving a substance use screen and healthcare professional discussion of substance use.

BACKGROUND AND OBJECTIVES: Screening, brief intervention, and referral to treatment (SBIRT) can reduce substance use, but receipt of these services by those who use cannabis frequently and have cannabis use disorder (CUD) remains unexplored. We examined cannabis use frequency and CUD's associations with the odds of receiving a substance use screening and a healthcare professional discussion among those who used healthcare services. METHODS: Data came from the 2015-2019 National Survey on Drug Use and Health (N = 214,505 aged 18+). Among adults who used cannabis and attended healthcare settings in the past year (N = 36,374), multivariable logistic regression analysis was used to examine associations of cannabis use frequency and CUD with receiving a substance use screen and substance use discussion by a healthcare professional. RESULTS: Cannabis use frequency was associated with higher odds of receiving a screen (adjusted odds ratio [AOR] = 1.27, 95% confidence interval [CI] = 1.14-1.41 for 300+ days of use) and a discussion among those screened (AOR = 1.83, 95% CI = 1.60-2.09 for 300+ days of use). CUD was not associated with receiving a screen, but it was positively associated with receiving a discussion among those screened (AOR = 1.22, 95% CI = 1.08-1.39). Nonmedical users were less likely to have a discussion among those screened and not screened. DISCUSSION AND CONCLUSIONS: Findings indicate disparities in screening and discussion of substance use with patients, especially between medical and nonmedical users. SCIENTIFIC SIGNIFICANCE: Study findings provide novel insight into differences in the reach of SBIRT services among adult cannabis users.

Marijuana use/nonuse among those aged 50+: comparisons of use-to-nonuse, initiation/reinitiation, and continued use over 24 months.

OBJECTIVES: To examine: (1) correlates of use-to-nonuse (use 13-24 months ago, but no past-year use), initiation/reinitiation (no use 13-24 months ago, but past-year use), and continued use over a 24-month period; and (2) associations of past-year marijuana use disorder with use/nonuse among older adults. METHOD: The 2015-2017 National Survey on Drug Use and Health provided data (N = 26,322 aged 50+). We used multinomial and binary logistic regression analyses to compare users-to-nonusers and initiators/reinitiators to continued users (N = 2304). RESULTS: In the 50-64 age group, 2.1% were users-to-nonusers, 2.2% initiators/reinitiators, and 7.2% continued users. In the 65+ age group, the corresponding percentages were 0.7%, 0.7%, and 2.4%. Residence in states with medical marijuana laws, nicotine dependence, and other illicit drug use were associated with a lower likelihood of use-to-nonuse than continued use. Alcohol use disorder was associated with a higher likelihood of initiation/reinitiation. Parole/probation status was associated with higher likelihood of use-to-nonuse. Moderate/great marijuana risk perceptions were associated with a higher likelihood of both use-to-nonuse and initiation/reinitiation. The odds of marijuana use disorder did not differ between continued users and initiators/reinitiators or between medical and recreational users. CONCLUSION: Most older users continued using over 24 months. Substantial numbers had marijuana and other substance use problems that require treatment.

Comparing older nonmedical and medical cannabis users: health-related characteristics, cannabis use patterns, and cannabis sources.

Background: US epidemiologic data show that nearly one in 10 individuals aged 50+ report past-year cannabis use, and nearly one in five users report medical use. However, research on older cannabis users, especially medical cannabis users, is scant.Objectives: We examined medical and nonmedical cannabis users aged 50+ on health-related characteristics, cannabis use patterns, and cannabis sources. Hypotheses were that compared to nonmedical users, medical users are more likely to have physical and mental health problems, use healthcare services, discuss their drug use with a healthcare professional, use cannabis more frequently, and purchase cannabis from a medical dispensary and other sources rather than obtain it as a gift, share someone else's, or use other means.Methods: We used 2018 and 2019 National Survey on Drug Use and Health data (N = 17,685 aged 50+; male = 8,030; female = 9,655). Hypotheses were tested using logistic regression analysis.Results: The past-year cannabis use rate was 8.9%. Of past-year users, 18.5% reported medical use. Compared to nonmedical use, medical use was associated with lower odds of alcohol use disorder but higher odds of discussing drug use with a healthcare professional (AOR = 4.18, 95% CI = 2.53-6.89), high-frequency use (e.g., AOR = 2.56, 95% CI = 1.35-4.86 for 200-365 days), and purchase at a medical cannabis dispensary (AOR = 4.38, 95% CI = 2.47-7.76).Conclusion: Medical and nonmedical users did not differ on physical and most behavioral health indicators. Most obtained cannabis from private/informal sources. Some medical users are likely to self-treat without healthcare professional consultation. Healthcare professionals should engage older adults in discussions of cannabis use and behavioral health needs.

Efficacy of two-way prayer meditation in improving the psychospiritual well-being of people with substance use disorders: A pilot randomized controlled trial.

Background: The study goal was to conduct a preliminary evaluation of a spiritual intervention called Two Way Prayer Meditation's (TWPM) effectiveness on the psychological distress, self-esteem, and spiritual well-being of people with substance use disorders. Methods: This study employed a randomized controlled trial design with pretest and posttest. In total, 134 adults in four residential recovery programs participated in the study and were randomly assigned to either the TWPM group or the treatment as usual group. Primary and sensitivity analyses were conducted using linear mixed modeling. Hedges's g was used to estimate treatment effect sizes. Results: Both primary and sensitivity analyses found significant treatment effects on daily spiritual experiences (Hedges's g = 0.62), reliance on God (g = 0.49), private religious practice (g = 0.36), and positive religious/spiritual coping (g = 0.68). Treatment effects on psychological distress (g = 0.33), self-esteem (g = 0.41), and overall spirituality self-ranking (g = 0.32) reached significance in the primary analysis but not in the sensitivity analysis. Conclusions: This study found evidence of TWPM's effectiveness in improving some aspects of the spiritual well-being of adults with substance use disorders. TWPM was also found to be promising in decreasing psychological distress and increasing self-esteem.

Prescription Pain Reliever Use and Misuse among Cannabis Users Aged 50+ Years.

Objectives: To examine rates and correlates of dual cannabis and prescription pain reliever (PPNR) use and misuse among U.S. individuals aged 50+ who reported past-year cannabis use. Methods: Using the 2015-2018 National Survey of Drug Use and Health, we examined cannabis nonuse/use and PPNR nonuse/use/misuse among all 35,229 respondents, and then focused on 2,632 past-year cannabis users to examine the risk of PPNR use but no misuse and the risk of PPNR misuse, compared to PPNR nonuse. Results: More than one-half of older cannabis users used PPNR in the past year. Multinomial logistic regression results show that the risks of PPNR use/no misuse and PPNR misuse were higher among those who had more chronic medical conditions and a major depressive episode. The risk of PPNR use/no misuse was also associated with high frequency and medical cannabis use. The risk of PPNR misuse was also associated with younger cannabis initiation age and cannabis and other illicit drug use disorders. Conclusions: Correlates of dual cannabis and PPNR use/misuse among older adults are poor physical and mental health problems and problematic cannabis use. Clinical Implications: Older adults with cannabis and PPNR misuse need access to evidence-based treatment, including medication-assisted treatment when needed.

Spillover Effects of Job Skills Training on Substance Misuse Among Low-Income Youths With Employment Barriers: A Longitudinal Cohort Study.

Objectives. To examine spillover effects of job skills training (vs basic services only [e.g., adult basic education, job readiness training]) on substance misuse among low-income youths with employment barriers.Methods. Data came from the National Longitudinal Survey of Youth 1997, a longitudinal cohort study of youths born between 1980 and 1984 in the United States. Based on respondents' reports of substance misuse (past-month binge drinking and past-year marijuana and other illicit drug use) from 2000 to 2016, we estimated substance misuse trajectories of job skills training (n = 317) and basic services (n = 264) groups. We accounted for potential selection bias by using inverse probability of treatment weighting.Results. Compared with the basic services group, the job skills training group showed notable long-term reductions in its illicit drug misuse trajectory, translating to a 56.9% decrease in prevalence rates from 6.5% in year 0 to 2.8% in year 16.Conclusions. Job skills training can be an important service component for reducing substance misuse and improving employment outcomes among youths with economic disadvantages and employment barriers.

Depression and activity-limiting fall worry among older adults: longitudinal reciprocal relationships.

OBJECTIVES: Late-life depression, falls, and fall worry are public health problems. While previous research confirms the cross-sectional relationship between depression and fall worry, few longitudinal studies have examined whether changes in fall worry are associated with changes in depressive illness and vice versa. This study examined longitudinal relationships between probable major depression (PMD) and activity-limiting fall worry (ALW). DESIGN, SETTING, PARTICIPANTS, MEASUREMENTS: This longitudinal panel observational study used data from the National Health and Aging Trends Study (NHATS) waves 5 (referred to as T1 in this study) and 6 (T2), conducted in 2015 and 2016, respectively (N = 6,299, aged 65 and older). We examined associations of new and continued ALW between T1 and T2 with T2 PMD, controlling for T1 PMD; and associations of new and continued PMD between T1 and T2 with T2 ALW, controlling for T1 ALW. We used χ2 and t tests for descriptive statistics and logistic regression for multivariable analysis. RESULTS: Those with new ALW at T2 had significantly greater odds of T2 PMD compared to those without ALW at both time points (AOR = 2.64, 95% CI = 1.98-3.51), and those with new PMD at T2 had significantly greater odds of T2 ALW (AOR = 2.42, 95% CI = 1.66-3.52). Those with continued PMD also had greater odds of T2 ALW compared to those without PMD at either time point (AOR = 2.31, 95% CI = 1.62-3.29). CONCLUSIONS: The findings add to knowledge about bidirectional (mutually reinforcing) relationships between depression and activity-limiting fall worry. Innovative interventions are needed to reduce both late-life depression and activity-limiting fall worry.

Internet and Health Information Technology Use and Psychological Distress Among Older Adults With Self-Reported Vision Impairment: Case-Control Study.

BACKGROUND: The number of older adults with vision impairment (VI) is growing. As health care services increasingly call for patients to use technology, it is important to examine internet/health information technology (HIT) use among older adults with VI. OBJECTIVE: This study aimed to examine (1) the rates of internet/HIT use among older adults with VI compared with a matched sample of their peers without VI, (2) associations of VI with internet/HIT use, and (3) association of HIT use with psychological distress, assessed with the Kessler-6 screen. METHODS: Data were obtained from the 2013 to 2018 US National Health Interview Survey. Older adults (aged ≥65 years) with self-reported VI were matched with older adults without VI, in a 1:1 ratio, based on age, sex, number of chronic medical conditions, and functional limitations (N=2866). Descriptive statistics and multivariable logistic regression models, with sociodemographic factors, health conditions, health insurance type, and health care service use as covariates, were used to examine the research questions. RESULTS: In total, 3.28% of older adults (compared with 0.84% of those aged 18-64 years) reported VI, and 25.7% of them were aged ≥85 years. Those with VI were significantly more socioeconomically disadvantaged than those without VI and less likely to use the internet (adjusted odds ratio [aOR] 0.64, 95% CI0.49-0.83) and HIT (aOR 0.74, 95% CI 0.56-0.97). However, among internet users, VI was not associated with HIT use. HIT use was associated with lower odds of mild/moderate or serious psychological distress (aOR 0.62, 95% CI 0.43-0.90), whereas VI was associated with greater odds of mild/moderate or serious distress (aOR 1.84, 95% CI 1.36-2.49). Health care provider contacts were also associated with higher odds of internet or HIT use. CONCLUSIONS: Compared with their matched age peers without VI, older adults with VI are less likely to use HIT because they are less likely to use the internet. Socioeconomically disadvantaged older adults experiencing a digital divide need help to access information and communication technologies through a fee waiver or subsidy to cover internet equipment and subscription and ensure continuous connectivity. Older adults with VI who do not know how to use the internet/HIT but want to learn should be provided instruction, with special attention to accessibility features and adaptive devices. Older adults with a low income also need better access to preventive eye care and treatment of VI as well as other health care services.

Physical Activity Frequency Among Older Adults With Diabetes or Prediabetes: Associations With Sociodemographics, Comorbidity, and Medical Advice.

To examine the differences in physical activity (PA) between older adults with and without diabetes/prediabetes and the correlates of PA frequency and associations between medical advice on PA and/or diet/weight loss and increasing PA among those with diabetes/prediabetes. Multinomial and binary logistic regression models using 2016-2017 National Health Interview Survey data (N = 4,860 aged 65+ years with diabetes/prediabetes). About 44.2% of those with diabetes/prediabetes, compared with 48.1% of a matched sample without, engaged in any PA three plus times a week. The low PA group (PA frequency was zero to two times a week) was more socioeconomically disadvantaged and had more chronic illnesses than the medium (three to four times a week) or high (five plus times a week) PA groups. Any PA and/or diet/weight loss medical advice was associated with two to three times higher odds of increasing PA. Health care providers should consider prescribing PA and/or diet/weight loss for patients with diabetes/prediabetes.

Associations between psychological distress and health-related behaviors among adults with chronic kidney disease.

Chronic kidney disease (CKD) affects 15% of the US general population, and this rate is projected to increase. A healthy lifestyle is important for individuals with CKD to reduce risk for CKD progression and adverse heath events. Adults with CKD also have high rates of psychological distress, which may be associated with unhealthy behaviors. Using the 2013-2017 public use data files of the US National Health Interview Survey, we compared health behaviors (smoking, alcohol use, and physical activity [PA]) and psychological distress (assessed with the Kessler-6 scale) between adults with a CKD diagnosis in the preceding year and a matched sample of adults without a CKD diagnosis. We then examined the association between psychological distress and health behaviors among adults with CKD (n = 3923) using multinomial logistic regression models. Compared to those without CKD, those with CKD had lower rates of smoking, heavy alcohol use, and engagement in any type of PA 3+ times a week and higher rates of psychological distress. In addition to the health concerns posed by the high smoking rate (17%) and low physical activity rate (34%) among those with CKD, smoking and lack of PA were associated with greater risk of mild-moderate and/or serious psychological distress. Compared to no unhealthy behaviors, 2-3 unhealthy behaviors were associated with 4.72 (95% CI = 2.97-7.48) times greater risk of serious psychological distress. Adults with CKD and unhealthy behaviors need help with lifestyle modifications and assessment and treatment of psychological distress to reduce CKD progression and prevent other health complications.

Poisoning deaths among late-middle aged and older adults: comparison between suicides and deaths of undetermined intent.

BACKGROUND: Given the rapid increase in prescription and illicit drug poisoning deaths in the 50+ age group, we examined precipitating/risk factors and toxicology results associated with poisoning deaths classified as suicides compared to intent-undetermined death (UnD) among decedents aged 50+. METHODS: Data were from the 2005-2015 US National Violent Death Reporting System (N = 15,453). χ2 tests and multinomial logistic regression models were used to compare three groups of decedents: suicide decedent who left a suicide note, suicide decedent who did not leave a note, and UnD cases. RESULTS: Compared to suicide decedents without a note (37.7% of the sample), those with a note (29.4%) were more likely to have been depressed and had physical health problems and other life stressors, while UnD cases (32.9%) were less likely to have had mental health problems and other life stressors but more likely to have had substance use and health problems. UnD cases were also more likely to be opioid (RRR = 2.65, 95% CI = 2.42-2.90) and cocaine (RRR = 2.59, 95% CI = 2.09-3.21) positive but less likely to be antidepressant positive. Blacks were more than twice as likely as non-Hispanic Whites to be UnDs. Results from separate regression models in the highest UnD states (Maryland and Utah) and in states other than Maryland/Utah were similar. CONCLUSIONS: Many UnDs may be more correctly classified as unintentional overdose deaths. Along with more accurate determination processes for intent/manner of death, substance use treatment and approaches to curbing opioid and other drug use problems are needed to prevent intentional and unintentional poisoning deaths.