Personal Social Networks in Later-Life Alcohol and Cigarette Use.

OBJECTIVES: This study examines the social network factors that influence health risk behaviors - specifically cigarette use and alcohol consumption - over time in a sample of older adults in the United States. Methods: Data are from Waves 1 (2005-2006) and 2 (2010-2011) of the National Social Life, Health, and Aging Project (NSHAP), a longitudinal study on health and social factors of older adults. The final analytic sample used for this study included 1,922 respondents who responded to both waves and who responded to questions concerning drinking and smoking behavior. Results: Using lagged dependent variable models, findings show that personal networks can have protective effects on smoking or drinking; more contact-days with alters lower odds of drinking (OR = 0.935, p < .01), and more alters in the same household lower odds of smoking (OR = 0.679, p < .05). Being able to discuss issues of health with others serves to reduce the adoption of smoking (OR = 0.555, p < .05). However, for current smokers and drinkers, personal networks are not necessarily protective from heavy smoking or drinking; more close ties increase odds of heavy drinking (OR = 1.531, p < .01), while networks have no significant associations with the odds of heavy smoking for current smokers. Conclusion: Context is important when evaluating the influence of social networks on health-compromising behaviors, as social networks can be protective from engaging in smoking/drinking behavior, but for those who currently smoke or drink, it has no relationship or can even be enabling for those who currently drink, making them more likely to be heavy drinkers.

The relationship between social network characteristics and depressive symptoms among older adults in the United States: differentiating between network structure and network function.

BACKGROUND: Social networks and social support can influence older adults' depressive symptoms, but depressive symptoms can also influence network maintenance. This study examined longitudinal relationships between social network structure, social support, and depressive symptoms. METHODS: Data are from Waves 1 (2005-2006) and 2 (2010-2011) of the National Social Life, Health, and Aging Project, a longitudinal study on health and social factors of older adults. Models examining: (i) the influence of T1 network structure and T1 social support on T2 depressive symptoms; (ii) the influence of T1 depressive symptoms and T1 network structure on T2 social support; and (iii) the influence of T1 depressive symptoms and T1 social support on T2 network structure, were estimated using ordinary least squares lagged dependent variable regression models. RESULTS: Evidence of reciprocal associations between social support and depressive symptoms were found, as well as social support and the number of close ties and frequency of contact. No clear reciprocal associations between social network structure and depressive symptoms were found, although density was associated with later depressive symptoms, and depressive symptoms were associated with later number of close ties. CONCLUSION: The reciprocal relationship between network structure and depressive symptoms is weak, whereas social support is strongly related to both depression and network structure, suggesting the importance of having supportive ties in an older adult's personal network for positive mental health.

An Exploratory Study of Physician Decision-Making When Treating Uncontrolled COPD.

Purpose: Current guidelines recommend triple therapy maintenance inhalers for patients with recurrent exacerbations of chronic obstructive pulmonary disease (COPD); however, these maintenance therapies are underutilized. This study aimed to understand how physicians make COPD treatment decisions, and how combination maintenance therapies are utilized in a real-world setting. Patients and Methods: This exploratory, hypothesis-generating, non-interventional study used a cross-sectional online survey that was administered to a sample of practicing physicians in the United States. The survey included five fictitious vignettes detailing common symptoms experienced by patients with COPD. Survey questions included factors physicians consider in their decisions, and perceived barriers to prescribing treatments. Repeated measures multivariable analyses were conducted to evaluate how likely physicians were to switch to triple therapy versus no change to patient's current maintenance therapy or change to another maintenance therapy. Results: In total, 200 physicians completed the survey. Cost of treatment and patient access to treatment were reported as the most common barriers physicians consider in their prescribing decisions. Physicians were more likely to switch a patient's maintenance inhaler to triple therapy versus no change to maintenance inhaler if they considered the patient's history of new symptoms, insurance status, and clinical guidelines in their decision. Physicians with more experience treating patients with COPD, and those who treat more patients with COPD per week, were more likely to switch to triple therapy versus no change to maintenance inhaler. Conclusion: This study demonstrates the complexity of factors that can influence physicians' decisions when prescribing treatments for patients with COPD, including considerations of treatment cost, patient access and adherence, patient comorbidities, efficacy of current treatment, clinical guidelines, and provider's level of experience treating COPD. Further research may help elucidate the relative importance of the factors influencing physicians' decisions and inform what types of decision-support tools would be most beneficial.

Chronic obstructive pulmonary disease (COPD) symptoms can be effectively managed with maintenance therapies, which are treatments that are taken routinely to help improve symptoms. A combination of three different therapies (triple therapy maintenance) has been shown to be more effective than a combination of two different therapies (dual therapy maintenance) in patients with moderate-to-severe COPD. However, maintenance therapies, including triple therapy, are underutilized. This study aimed to explore how physicians make their treatment decisions for patients with COPD, and how combination maintenance therapies are utilized. To do so, we administered a survey to a sample of practicing physicians in the United States. The survey included five clinically based, fictitious profiles, or vignettes, of patients with COPD, with common symptoms and patient characteristics being described. Physicians were then asked to answer questions about what treatment they would prescribe for each patient, and any factors they considered when deciding on a treatment for a patient. We found that cost of treatment and patient access to treatment were the most common barriers that physicians considered when choosing a treatment. Physicians were also more likely to switch a patient's maintenance inhaler to a triple therapy maintenance inhaler if they considered the patient's history of new symptoms, patient's insurance status, and clinical guidelines when making their decisions. Our study shows that there are many complex factors that influence physicians' decisions when deciding on a treatment for patients with COPD.

Validation of an Algorithm to Identify Venous Thromboembolism in Health Insurance Claims Data Among Patients with Rheumatoid Arthritis.

Purpose: Health insurance claims databases provide an opportunity to study uncommon events, such as venous thromboembolism (VTE), in large patient populations. This study evaluated case definitions for identifying VTE among patients treated for rheumatoid arthritis (RA) using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes in claims data. Patients and Methods: Study participants were insured adults who received treatment for and had a diagnosis of RA between 2016 and 2020. After a 6-month covariate assessment window, patients were observed for ≥1 month until health plan disenrollment, occurrence of a presumptive VTE, or end of the study (12/31/2020). Presumptive VTEs were identified using predefined algorithms based on ICD-10-CM diagnosis codes, anticoagulant use, and care setting. Medical charts were abstracted to confirm the VTE diagnosis. Performance of primary and secondary (less stringent) algorithms was assessed by calculating the positive predictive value (PPV; primary and secondary objectives). Additionally, a linked electronic health record (EHR) claims database and abstracted provider notes were used as a novel alternative source to validate claims-based outcome definitions (exploratory objective). Results: A total of 155 charts identified with the primary VTE algorithm were abstracted. The majority of patients were female (73.5%), with mean (standard deviation) age 66.4 (10.7) years and Medicare insurance (80.6%). Obesity (46.8%), ever smoking (55.8%), and prior evidence of VTE (28.4%) were commonly reported in medical charts. The PPV for the primary VTE algorithm was 75.5% (117/155; 95% confidence interval [CI], 68.7%, 82.3%). A less stringent secondary algorithm had a PPV of 52.6% (40/76; 95% CI, 41.4%, 63.9%). Using an alternative EHR-linked claims database, the primary VTE algorithm PPV was lower, potentially due to the unavailability of relevant records for validation. Conclusion: Administrative claims data can be used to identify VTE among patients with RA in observational studies.

The impact of early social support on subsequent health recovery after a major disaster: A longitudinal analysis.

Social support may facilitate disaster recovery. Prior analyses are hampered by the limits of cross-sectional approaches. We use longitudinal data from the KATIVA-NOLA survey to explore whether social support soon after Hurricane Katrina facilitated recovery of health status for a representative sample of 82 Vietnamese New Orleanians. Health and social support were assessed just before Hurricane Katrina (2005), soon afterwards (2006, 2007), and at longer durations post-disaster (2010, 2018). We use random effects regression to examine how social support measured in 2006 influences mental and physical health measured in 2006, 2007, 2010, and 2018. Social support soon after Katrina was positively associated with physical health and mental health years later in 2010, even after controlling for potential confounders such as Katrina-related housing damage and pre-Katrina health and support and modeling an interaction between year and social support in 2006. Other immigrants who are highly impacted by a major disaster could benefit from programs that seek to rapidly reconstruct systems of social support.