Persistence of racial disparities in prescription of first-generation antipsychotics in the USA.

PURPOSE: The aim of this study was to estimate the prevalence of first-generation antipsychotics (FGA) prescribed for treatment of psychiatric and neurological conditions and use of benztropine to reduce extrapyramidal side effects (EPS) by patient race/ethnicity in a nationally representative sample of adult outpatient visits. METHODS: The study sample included all outpatient visits (N = 8154) among patients aged 18-69 years where a prescription for one or more antipsychotics was recorded across 6 years of the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (2005-2010). Use of FGA was compared by race/ethnicity using multiple logistic regression models accounting for patient and clinical characteristics stratified by neighborhood poverty rate. Frequency of EPS was determined by use of benztropine to reduce or prevent EPS. RESULTS: Black patients were significantly more likely than White patients to use FGA (odds ratio = 1.48, p = 0.040) accounting for psychiatric and neurological diagnoses, treatment setting, metabolic factors, neighborhood poverty, and payer source. Black patients were more than twice as likely as White patients to receive higher-potency FGA (haloperidol or fluphenazine), particularly in higher-poverty areas (odds ratio = 2.50, p < 0.001). Use of FGA, higher among Black than White patients, was positively associated with use of benztropine to reduce EPS. CONCLUSIONS: Racial disparities in the pharmacological treatment of severe mental disorders persist 30 years after the introduction of second-generation antipsychotics. The relatively high frequency of FGA of use among Black patients compared with White patients despite more Food and Drug Administration-approved indications and lower EPS risk for second-generation antipsychotics requires additional research.

Do caregivers benefit more from educational and volunteer activities than their noncaregiving peers?

Informal caregivers are a critical component of the US long-term care system, but caregivers often experience poor physical and mental health as a result of strain from the caregiving role. Engagement in community-based educational and volunteer activities contributes to older adult well-being, but previous studies have not assessed whether the effects of these types of engagement are different for older adults who are also caregivers. Using a sample of participants in educational and volunteer activities sponsored by a national nonprofit organization, we find that participants who are caregivers report more benefit from these community-based activities than their noncaregiving counterparts. Connecting caregivers to existing community-based activities may be an efficient strategy for improving caregiver well-being.

Active generations: an intergenerational approach to preventing childhood obesity.

BACKGROUND: Over the last 3 decades, US obesity rates have increased dramatically as more children and more adults become obese. This study explores an innovative program, Active Generations, an intergenerational nutrition education and activity program implemented in out-of-school environments (after school and summer camps). It utilizes older adult volunteers to implement a version of the evidence-based childhood obesity prevention program, Coordinated Approach to Child Health, in 8 US cities. METHODS: Approximately 760 children in third- to fifth-grade participated in Active Generations, a 10-lesson, intergenerational, childhood obesity prevention program. Children completed an age-appropriate survey instrument, the Active Generations survey (AGS). The AGS is a valid and reliable, self-administered, self-report, paper-and-pencil survey designed to assess knowledge, attitudes, and behaviors. It was administered by trained volunteers on the first day and last day of the program. Constructs assessed included physical activity, nutrition, and media use. RESULTS: Students significantly increased their reported fruit and vegetable consumption post-program. For example, the percentage of students reporting eating 3 or more servings of vegetables per day was 16% greater post-program. Students were more likely to report reading food labels and greater confidence that they could participate in physical activity. They also significantly decreased their daily screen time. CONCLUSIONS: Active Generations is a promising childhood obesity prevention program.

Rural medical-legal partnership and advocacy: a three-year follow-up study.

INTRODUCTION: Medical-legal partnerships perform advocacy services for vulnerable and underserved populations, who are burdened disproportionately by legal and medical problems. This study aimed to examine the effectiveness and projected sustainability of a rural medical-legal partnership (MLP). METHODS: Five years of baseline data and three years of follow-up data were analyzed using descriptive and inferential statistics as well as logic modeling. RESULTS: The benefit relative to cost of the MLP increased between the years of 2002-2006 and 2007-2009. The number of people served increased across the two time periods, and the proportion of cases won remained the same. Overall, the population served remained similar across time. The MLP continued to show social and financial impacts, such as health care recovery dollars (319% return on investment between 2007 and 2009), Social Security benefits, family law services, and end-of-life guidance. CONCLUSION: A rural MLP can maintain its impact and efficiency across time and have opportunities for expansion.

Are kids too busy?: early adolescents' perceptions of discretionary activities, overscheduling, and stress.

BACKGROUND: The activity patterns of children, especially after-school patterns, are receiving more professional attention. However, evidence regarding the value of various activities in children's lives is contradictory. The purpose of this study was to assess perceptions of discretionary activities, overscheduling, and levels of stress from adolescents' perspective. METHODS: A sample of 882 children, ages 9 to 13, recruited at 9 health education centers in the United States was selected for this study. Children answered questionnaires using remote, handheld devices. Data were analyzed using descriptive statistics and multivariate logistic regression. The outcomes of interest were activity-based stress and desire for more free time. RESULTS: The primary predictor for the desire for more free time was hours of screen time (television, computer, video games): those who reported 3 or more hours were nearly 3 times more likely to desire more free time. Further, children who chose their own activities experienced more activity-related stress than those who shared decisions with parents. The single greatest predictor of activity-related stress was the reported number of hours spent on homework. Students who averaged at least 2 hours on homework per night were nearly twice as likely to report frequent activity-related stress. CONCLUSION: Parents of school-aged children should assess activity-related stress and the degree to which children perceive they are busy. Teachers, school counselors, and school administrators should be aware of these perceptions as they are making decisions regarding school schedules and should teach personal skills such as time management and stress control.

Process and impact evaluation of a legal assistance and health care community partnership.

Community health partnerships have increased in popularity, but their effectiveness is often not evaluated. Through secondary data analysis, this study evaluates a program that offered access to legal services to address health-related issues, such as Medicaid reimbursement, Social Security benefits, medication coverage, and divorce. Based on the analysis reimbursements to expenditures, the health and law program appears to be cost-effective and thereby economically sustainable. The cost-effectiveness of this program increases the likelihood that it will be institutionalized and/or expanded. This program evaluation is used to exemplify how community stakeholders could partner to leverage resources to establish a sustainable community health and law program to address the needs of people living in medically underserved areas.

Effects of a single-lesson tobacco prevention curriculum on knowledge, skill identification and smoking intention.

One in five students report experimenting with tobacco before the age of 13 and most prevention efforts take place in the school setting. This study measures the effect of a single-lesson tobacco prevention curriculum, conducted by a health education center, focusing on knowledge of tobacco, ability to identify refusal techniques, and intent not to smoke. Data were collected, via electronic keypads, from students visiting a non-school, health education center in Michigan (n = 704 intervention and 85 comparison). Contingency table Chi-squared tests and t-tests demonstrated that a single lesson can improve general knowledge and ability to identify appropriate refusal techniques. Improvement in intent not to smoke was not significant because both groups had very high intent prior to implementation. Similar to results from other programs, multivariate logistic regression of gender, general knowledge, and skill identification revealed that only the skill variable was associated with intent not to smoke at pretest. Recommendations are given for further research and for designing more effective curricula or programs.

Early adolescents perceptions of health and health literacy.

BACKGROUND: Health illiteracy is a societal issue that, if addressed successfully, may help to reduce health disparities. It has been associated with increased rates of hospital admission, health care expenditures, and poor health outcomes. Because of this, much of the research in the United States has focused on adults in the health care system. This study investigated the effect of aspects of health literacy on the motivation to practice health-enhancing behaviors among early adolescents. METHODS: Measures were generally based on 3 National Health Education Standards for grades 5-8. Data were obtained from 1178 9- to 13-year-old students visiting 11 health education centers in 7 states. Students responded via individual electronic keypads. RESULTS: Multivariate logistic regression revealed that, in addition to age, difficulty understanding health information and belief that kids can do little to affect their future health, decreased the likelihood for interest in and desire to follow what they were taught about health. Further, low interest independently decreased motivation to follow what was taught. Girls were more likely to turn to school, parents, and medical personnel for health information. Older students were more likely to turn to school and to the Internet. CONCLUSIONS: Programs and curricula should be designed to increase student interest in health issues and their self-efficacy in controlling their own health destinies. Educators should also teach students to more effectively use nonconventional health information sources such as the Internet, parents, and medical professionals.

Gender, age, and behavior differences in early adolescent worry.

Early adolescents in the United States are increasingly exposed to a culture of worrisome messages. A degree of adolescent worry is normal, but the likelihood of a young person being anxious or depressed increases with the perceived number of worries. This study examined the effect of age, gender, and worry behavior on frequency of 8 adolescent worries. Data were obtained from 1,004 9- to 13-year-old students visiting 10 health education centers in 7 states. Students responded via individual, electronic keypads. Multivariate logistic regression revealed that boys worry more about the future, whereas girls worry more about being liked or being overweight. The oldest adolescents worry most about their appearance, being overweight, their friends, and problems at home. Adolescents who prefer talking to parents when worried are less likely to worry about being liked, while those who keep worries to themselves have more worries about grades. Those who turn to parents for information are less likely to worry about being liked, failure, their future, and their friends than those who turn to other sources (teachers, Internet, and friends). Recommendations are given to assist health educators and other school staff to recognize frequent worriers and plan school-based approaches to address their needs.

Perceptions of tobacco use in early adolescents.

In an effort to strengthen tobacco use prevention programs, this study explores early (9- to 13-year-old) adolescent motivations for and perceptions of use. Data were collected, via electronic keypads, from students visiting 12 health education centers in the U.S. (N=1433). Multivariate logistic regression showed that perceptions of frequent peer tobacco use and popularity of adolescent smoking, in addition to absence of family discussion of tobacco use, were associated with greater likelihood for smoking and of reporting past smoking. Even though most participants thought adolescents who smoke are very unpopular, more than 60% said the primary reason for adolescent smoking was that smokers believe it will make them popular. Participants thought the best way to prevent use was to give kids "other fun things to do instead." Recommendations are given for customizing curricula or programs.