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1.
Child Youth Serv Rev ; 1192020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33311826

RESUMO

Many schools and school districts have put significant effort into improving school climate and the social emotional learning (SEL) of students, as they have been shown to be related to improved academic success. Yet, little is known about whether these efforts will contribute to or ameliorate racial differences in academic outcomes. In a series of structural equation models adjusting for school clustering, this study examined mediating and moderating effects of student perceptions of school climate and their own SEL on race differences in self-reported grades. Asian and Latinx students reported slightly more positive perceived school climate while Multiracial students reported significantly less positive perceived school climate compared to White students. Compared to their White peers, all racial groups reported lower levels of SEL. Significant but small indirect standardized effects of race on grades through social emotional competence but not school climate suggest that SEL partially mediates the relationship of race with grades. The association of SEL with grades was significantly stronger for White students compared to other racial groups; the standardized effect size of the association was nearly twice as large for White students as for Black and Native students.

2.
Prev Sci ; 20(5): 705-714, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30535622

RESUMO

The current study examines the continuity in comorbidity between substance use and internalizing mental health problems from adolescence to adulthood and investigates the general and specific predictors of comorbidity across development. Participants were drawn from the Seattle Social Development Project (N = 808), a gender-balanced, ethnically diverse longitudinal panel. Structural equation modeling was used to examine risk factors for comorbid substance use and internalizing problems in family and peer social environments; substance use- and mental health-specific social environments (family tobacco, alcohol, and marijuana use; family history of depression); and individual risk factors (behavioral disinhibition). Latent factors were created for comorbid substance use and mental health problems at ages 13-14 and comorbidity of substance abuse and dependence symptoms and mental health disorder symptoms at ages 30-33 and included indicators of anxiety, depression, alcohol, tobacco, and marijuana problems. Comorbid problems in adolescence predicted later comorbidity of disorders in adulthood. In addition, family tobacco environment and behavioral disinhibition predicted adolescent comorbidity, while family history of depression was associated with adult comorbidity. Finally, family and peer substance use in adolescence predicted substance use (alcohol, tobacco, and marijuana) both in adolescence and adulthood. The pattern of results suggests that comorbidity in adolescence continues into adulthood and is predicted by both general and behavior-specific environmental experiences during adolescence. Findings clarify the etiology of comorbid internalizing and substance use problems and suggest potential preventive intervention targets in adolescence to curb the development of comorbidity in adulthood.


Assuntos
Transtornos Mentais/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Transtornos Mentais/complicações , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto Jovem
3.
Am J Community Psychol ; 64(3-4): 333-347, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31449678

RESUMO

Although arts-based programming is shown to positively influence the development of youth exposed to adversity, little is known about the influence these programs have on formerly incarcerated emerging adult Black men enrolled in an alternative school. With educational resilience as a guiding framework, this qualitative case study explored the ways in which an arts-based program in the context of an alternative school designed for formerly incarcerated young people facilitates emerging adult Black men's academic and social-emotional development. Data collection consisted of observations and interviews with school personnel and formerly incarcerated Black male students. Analysis and interpretation included a range of inductive techniques (coding, constant comparisons, and memoing). Results indicate that offering arts-based activities fostered an environment where students could build caring and supportive relationships with peers and school personnel. Instructional practices that integrated music and poetry provided meaningful opportunities for the young men to participate, which appeared to enhance their motivation and attitudes (self, others, learning, and school) and academic self-efficacy, and lessen their psychological and emotional distress. Study findings provide insights into how an arts-based program in an alternative school can improve healthy development and academic achievement among formerly incarcerated young Black men transitioning into adulthood.


Assuntos
Arte , Negro ou Afro-Americano/educação , Emoções , Mudança Social , Adolescente , Adulto , Grupos Focais , Humanos , Entrevistas como Assunto , Masculino , Observação , Pesquisa Qualitativa , Instituições Acadêmicas , Ensino , Adulto Jovem
4.
J Youth Adolesc ; 48(1): 30-42, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30478821

RESUMO

Young adulthood represents a developmental period with disproportionately heightened risk of losing a job. Young adult unemployment has been linked to increased mental health problems, at least in the short term. However, their possible long-term impacts, often referred as "scarring effects," have been understudied, possibly underestimating the magnitude of mental health burden that young adult unemployment generates. This longitudinal study examined whether duration of unemployment during young adulthood is associated with later mental health disorders, after accounting for mental and behavioral health problems in childhood. Furthermore, the current study investigated whether childhood neighborhood characteristics affect this association and if so, in what specific functional ways. Data were drawn from a longitudinal study of developmental outcomes in a community sample in Seattle. Data collection began in 1985 when study participants were elementary students and involved yearly assessments in childhood and adolescence (ages 10-16) and then biennial or triennial assessments (ages 18-39; N = 677 at age 39; 47% European American, 26% African American, 22% Asian American, and 5% Native American; 49% female). The current study findings suggest that duration of unemployment across young adulthood increased mental health problems at age 39, regardless of gender. Childhood neighborhood characteristics, particularly their positive aspect, exerted independent impacts on adult mental health problems beyond unemployment experiences across young adulthood. The current findings indicate a needed shift in service profiles for unemployed young adults-a comprehensive approach that not only facilitates reemployment but also addresses mental health needs to help them to cope with job loss. Further, the present study findings suggest that childhood neighborhoods, particularly positive features such as positive neighborhood involvement, may represent concrete and malleable prevention targets that can curb mental health problems early in life.


Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Etnicidade/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Desemprego/estatística & dados numéricos , Adolescente , Adulto , Criança , Feminino , Humanos , Estudos Longitudinais , Masculino , Saúde Mental/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Desemprego/psicologia , Adulto Jovem
5.
Prev Sci ; 18(4): 428-438, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28349235

RESUMO

Longitudinal analyses investigated (a) the co-occurrence of marijuana use and conventional cigarette smoking within time and (b) bidirectional associations between marijuana and conventional cigarette use in three developmental periods: adolescence, young adulthood, and adulthood. A cross-lag model was used to examine the bidirectional model of marijuana and conventional cigarette smoking frequency from ages 13 to 33 years. The bidirectional model accounted for gender, school-age economic disadvantage, childhood attention problems, and race. Marijuana use and conventional cigarette smoking were associated within time in decreasing magnitude and increased cigarette smoking predicted increased marijuana use during adolescence. A reciprocal relationship was found in the transition from young adulthood to adulthood, such that increased conventional cigarette smoking at age 24 years uniquely predicted increased marijuana use at age 27 years, and increased marijuana use at age 24 years uniquely predicted more frequent conventional cigarette smoking at age 27 years, even after accounting for other factors. The association between marijuana and cigarette smoking was found to developmentally vary in the current study. Results suggest that conventional cigarette smoking prevention efforts in adolescence and young adulthood could potentially lower the public health impact of both conventional cigarette smoking and marijuana use. Findings point to the importance of universal conventional cigarette smoking prevention efforts among adolescents as a way to decrease later marijuana use and suggest that a prevention effort focused on young adults as they transition to adulthood would lower the use of both cigarette and marijuana use.


Assuntos
Fumar Cigarros , Fumar Maconha , Adolescente , Adulto , Feminino , Humanos , Masculino
6.
Am J Public Health ; 106(5): 889-92, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26985600

RESUMO

OBJECTIVES: To evaluate 3 single-item screening measures for limited health literacy in a community-based population of English and Spanish speakers. METHODS: We recruited 324 English and 314 Spanish speakers from a community research registry in Dallas, Texas, enrolled between 2009 and 2012. We used 3 screening measures: (1) How would you rate your ability to read?; (2) How confident are you filling out medical forms by yourself?; and (3) How often do you have someone help you read hospital materials? In analyses stratified by language, we used area under the receiver operating characteristic (AUROC) curves to compare each item with the validated 40-item Short Test of Functional Health Literacy in Adults. RESULTS: For English speakers, no difference was seen among the items. For Spanish speakers, "ability to read" identified inadequate literacy better than "help reading hospital materials" (AUROC curve = 0.76 vs 0.65; P = .019). CONCLUSIONS: The "ability to read" item performed the best, supporting use as a screening tool in safety-net systems caring for diverse populations. Future studies should investigate how to implement brief measures in safety-net settings and whether highlighting health literacy level influences providers' communication practices and patient outcomes.


Assuntos
Letramento em Saúde/estatística & dados numéricos , Hispânico ou Latino , Idioma , Inquéritos e Questionários/normas , Adolescente , Adulto , Idoso , Feminino , Humanos , Alfabetização , Masculino , Pessoa de Meia-Idade , Curva ROC , Reprodutibilidade dos Testes , Texas , Adulto Jovem
7.
Dev Psychopathol ; 28(3): 721-41, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27427802

RESUMO

This study examines the interplay between individual and social-developmental factors in the development of positive functioning, substance use problems, and mental health problems. This interplay is nested within positive and negative developmental cascades that span childhood, adolescence, the transition to adulthood, and adulthood. Data are drawn from the Seattle Social Development Project, a gender-balanced, ethnically diverse community sample of 808 participants interviewed 12 times from ages 10 to 33. Path modeling showed short- and long-term cascading effects of positive social environments, family history of depression, and substance-using social environments throughout development. Positive family social environments set a template for future partner social environment interaction and had positive influences on proximal individual functioning, both in the next developmental period and long term. Family history of depression adversely affected mental health functioning throughout adulthood. Family substance use began a cascade of substance-specific social environments across development, which was the pathway through which increasing severity of substance use problems flowed. The model also indicated that adolescent, but not adult, individual functioning influenced selection into positive social environments, and significant cross-domain effects were found in which substance-using social environments affected subsequent mental health.


Assuntos
Transtornos Mentais/psicologia , Saúde Mental , Meio Social , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adolescente , Adulto , Criança , Progressão da Doença , Feminino , Humanos , Masculino , Transtornos Mentais/diagnóstico , Índice de Gravidade de Doença , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Adulto Jovem
8.
J Soc Work Pract Addict ; 16(1-2): 132-159, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28243179

RESUMO

The current study examined relationships between interpersonal violence victimization and smoking from childhood to adulthood. Data were from a community-based longitudinal study (N = 808) spanning ages 10 - 33. Cross-lag path analysis was used to model concurrent, directional, and reciprocal effects. Results indicate that childhood physical abuse predicted smoking and partner violence in young adulthood; partner violence and smoking were reciprocally related in the transition from young-adulthood to adulthood. Gender differences in this relationship were not detected. Social work prevention efforts focused on interpersonal violence and interventions targeting smoking cessation may be critical factors for reducing both issues.

9.
J Prev (2022) ; 45(2): 287-302, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38300438

RESUMO

Comorbidity of depression and substance abuse is common and a major public health burden. Studies of this form of comorbidity in racial and ethnic minoritized (REM) populations are minimal and have mixed findings. The present study examined the effect of general risk factors (family bonding, supervision, involvement, peer delinquency), depression risk factors (caregiver depression), and substance use risk factors (adult family members, sibling, and peer substance use) in early adolescence (~ ages 13-14) on comorbid depression and substance use in later adolescence (~ ages 15-17) and adulthood (~ ages 29-31) and continuity in comorbidity from adolescence to adulthood. Longitudinal data on 1000 Black (n = 680) Hispanic (n = 170) and White (n = 150) individuals came from the Rochester Youth Development Study. Participants were interviewed 14 times over 17 years beginning in 1988. General risk factors predicted comorbidity across racial/ethnic groups. Substance specific risk predicted comorbidity among Black and Hispanic individuals whereas depression specific risk was predictive among White individuals. Adolescent comorbidity predicted comorbidity in adulthood across race. These findings highlight the importance of substance use intervention for racial and ethnic minoritized individuals and mental health risk factors in Whites. The continuity of comorbidity from adolescence to adulthood highlights the importance of targeting adolescents for intervention to prevent long-term manifestation of this form of comorbidity and its associated consequences.


Assuntos
Depressão , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Adulto , Humanos , Comorbidade , Depressão/epidemiologia , Hispânico ou Latino , Saúde Mental , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Negro ou Afro-Americano , Brancos
10.
J Prev (2022) ; 45(2): 303-321, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38353805

RESUMO

Prevention Science seeks to advance the prevention research and to translate scientific advances into the promotion of healthy development for all youth. Despite tremendous progress creating a robust evidence-base and set of translational tools, elaborations and expansions for equity are required. Our collective errors of omission as prevention researchers have left prevention practitioners and policy-makers without sufficient information to identify strategies that have been demonstrated to prevent behavioral health problems in young people who identify as Black, Indigenous, or other People of Color (BIPOC). We first describe the current shortcomings of available evidence, and then we call for individual and collective action to conceptualize equity-enhancing prevention, sample more inclusively, and improve analytic approaches such that we can truly promote the healthy development of all youth.


Assuntos
Pesquisa sobre Serviços de Saúde , Nível de Saúde , Humanos , Adolescente , Estados Unidos , Grupos Raciais
11.
J Homosex ; : 1-15, 2024 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-38377333

RESUMO

The aims of this study were to identify Australian mental health practitioners' knowledge of what LGBTQA+ conversion practices are and their perceptions of impacts on survivors. We interviewed 18 mental health workers from a range of clinical modalities who were practicing in Australia. We used reflexive thematic analytic techniques to identify themes that characterized Australian mental health practitioners' knowledge of LGBTQA+ conversion practices and perceptions of the impacts of such practices on survivors. Practitioners' understandings of what constitutes LGBTQA+ conversion practices were varied and derived from a range of sources, and practitioners' perceptions of the impacts that conversion practices had on survivors ranged from undeveloped to nuanced. Generalist and specialist practitioners provided vastly different responses. We identified the following four themes: (1) inexperienced practitioners' understandings were limited and reliant on stereotypes about conversion practices; (2) specialist practitioners' understandings were refined and match experiences reported by survivors; (3) generalist practitioners emphasized specific and undeveloped negative impacts; (4) specialist practitioners were aware of deeper harms and the need for sustained support. These themes may be translated into strategies to facilitate improved services offered by practitioners, which may assist survivors in managing and coping with the trauma associated with exposure to these practices.

13.
Soc Sci Med ; 305: 115040, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35609469

RESUMO

Religion-based LGBTQA + conversion practices frame all people as potential heterosexuals whose gender aligns with their birth sex (in a cisgender binary model of male and female sexes). Deviation from this heterosexual cisgender social identity model is cast as curable 'sexual brokenness'. However, research shows conversion practices are harmful, and particularly associated with increased experiences of abuse, mental health diagnoses, and suicidality. This paper explores their contribution to the particular harms of moral injury and religious trauma, drawing firstly on the foundational moral injury literature to offer a unique conceptual framework of spiritual harm and moral injury, and secondly on a rare qualitative 2016-2021 study of the spiritual harms reported in semi-structured interviews of 42 survivors of LGBTQA + change and suppression practices in Australia. The paper examines the survivors' support needs around the nature and extent of religious trauma and moral injury, to inform services working towards supporting their recovery from such experiences and their resolution of conflicts deeply bound in their sense of self and belonging. It argues that impairment of conversion survivors' relationships with religious communities, and religious self-concepts, point to the need for additional improvements in pastoral practice.


Assuntos
Transtornos de Estresse Pós-Traumáticos , Feminino , Identidade de Gênero , Humanos , Masculino , Pesquisa Qualitativa , Religião , Comportamento Sexual , Sobreviventes/psicologia
14.
Psychol Sch ; 59(10): 2022-2041, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36247350

RESUMO

Although racial and ethnic equity-informed school-based strategies are important to addressing racialized structures and processes that create and sustain racial trauma, disadvantage and disparity, little is known about the process of embedding racial and ethnic equity in school-based strategies and how adults and young people perceive them to promote a positive school climate and youth development. Using a qualitative research approach that included focus groups, this study examined student of color and school and community partner staff perceptions of the role and influence racial and ethnic equity-informed school-based strategies in one middle school have on the school's climate and students of color experiences and development. Findings suggest that racial and ethnic equity-informed social and emotional learning strategies are important in facilitating positive student-teacher interactions and identity and social-emotional development among students of color. Participant's experiences in and perceptions of the impact these strategies have on school climate and youth development substantiate the need to understand racial and ethnic equity as a process-oriented approach that requires continuous improvement, rather than just an outcome-focused endeavor. Implications for research and practice are discussed.

15.
J Adolesc Health ; 70(4): 584-587, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35165028

RESUMO

PURPOSE: To examine the association between state laws protecting lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) students and school districts' recommendations or requirements for establishing gay-straight alliances (GSAs) in schools. Beginning in fall 2013, 19 state education agencies (SEAs) engaged in HIV/STI and pregnancy prevention activities in "priority" school districts. SEAs provided support to priority districts to require or recommend GSAs in their schools. METHODS: This study used semi-annually collected program evaluation data and state law data from the Gay, Lesbian, and Straight Education Network. We assessed whether increases in the percentage of priority districts recommending or requiring schools to provide GSAs varied by the presence of nondiscrimination or enumerated antibullying laws with a difference-in-difference design. RESULTS: States with nondiscrimination laws began with more priority districts recommending or requiring schools to provide GSAs (52.5%) compared to states without laws (47.5%). We found a significant interaction (p < .01) between increases in the percentage of priority districts recommending or requiring a GSA and having a state nondiscrimination law. Across the first 3 years of program implementation, there was a 30% increase (p < .01) in priority districts recommending or requiring schools to provide GSAs in states with nondiscrimination laws, compared to a 12% increase (p < .01) in states without laws. There was no significant interaction between states with enumerated antibullying laws and districts recommending or requiring a GSA. DISCUSSION: State LGBTQ nondiscrimination laws for students may facilitate school district support of GSAs, which may decrease health risks among LGBTQ youth.


Assuntos
Infecções por HIV , Homossexualidade Feminina , Minorias Sexuais e de Gênero , Infecções Sexualmente Transmissíveis , Adolescente , Feminino , Humanos , Instituições Acadêmicas , Estudantes
16.
Psychol Sch ; 58(5): 893-912, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33994583

RESUMO

This study examined the relationships between school-level school climate and race differences in student grades, accounting for school sociodemographic composition. We found that schools with more positive school climates had smaller race differences in student self-reported grades. The moderating effect of school climate remained after accounting for the sociodemographic composition of the school and students' own perceptions of climate at their school. This moderating effect was confounded by school grade band (i.e., elementary, middle, or high) since perception of positive school climate was lower in middle and high schools than in elementary schools. Despite the difficulty of disentangling school climate from grade band, the findings suggest school improvement strategies focused on school climate may promote racial equity in academic outcomes. School practitioners' efforts to improve the school climate may also contribute to racial equity in academics.

17.
Sch Psychol ; 36(6): 546-554, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34766816

RESUMO

As schools physically closed across the country to protect against the spread of the COVID-19 pandemic, it became clear early on that the burden on students will not be equally shared. Structural racism patterns the lives of people of color that, in turn, increases their exposure to the effects of the pandemic further impacting the quality of education the students of color have access to. It is critical to examine the ways in which racial disparities in social emotional and educational outcomes have the potential to increase as a result of the pandemic. To that end, using a content analysis of an open-ended survey, this study examines (a) how teachers and school staff experienced the pandemic, (b) their perception of student experiences during the transition to remote learning, and (c) school staff's perceptions of how racial inequities may be increased as a result of the pandemic. Our findings highlight the deep, but unequal impact of the pandemic on school staff, students, and their families. Teachers are overwhelmed and overworked, struggling to manage multiple roles while working at home. They also have tremendous empathy for the weight of the losses that students have experienced, and concern for the well-being of students in difficult living or family situations. However, most school staff maintained a colorblind analysis of the way the pandemic is affecting their students and did not recognize the role of systemic racism or potential for racial disparities to be increased. Implications and limitations are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
COVID-19 , Pandemias , Humanos , Percepção , SARS-CoV-2 , Instituições Acadêmicas
18.
Am J Orthopsychiatry ; 90(2): 283-287, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31789545

RESUMO

Weissberg, Durlak, Domitrovich, and Gullotta (2015) note that social and emotional learning (SEL) is increasingly recognized as a critical component of academic and life success. In many schools around the nation, SEL is becoming (or has become) part of a comprehensive strategy to strengthen students' academic performance, improve school and classroom climate, and lessen conduct problems. A recent benefit-cost analysis by Belfield et al. (2015) of six prominent SEL programs showed a positive return on the original investments in these programs at a ratio of about 11 to 1. SEL supports the development of skills in emotion regulation, social awareness, conflict resolution, and responsible decision making, all of which are essential to students' success within and outside the classroom. These so called noncognitive skills are associated not only with proximal gains in students' academic performance and reductions in conduct problems but also with their later choices related to education and employment, as discussed by the economist, James Heckman and his team (Heckman, Stixrud, & Urzua, 2006). Furthermore, according to a report by Nagaoka, Heath, Farrington, and Cureton Turner (2015) for the University of Chicago Consortium on Chicago School Research, evidence shows that not attending to fundamental SEL skills and competencies within and outside the context of formal schooling can actually undermine children's long-term development and keep them from succeeding in adult roles. (PsycINFO Database Record (c) 2020 APA, all rights reserved).


Assuntos
Desenvolvimento Infantil , Tomada de Decisões , Regulação Emocional , Aprendizagem , Modelos Educacionais , Instituições Acadêmicas , Habilidades Sociais , Criança , Humanos
19.
J Soc Social Work Res ; 11(1): 21-38, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33841719

RESUMO

OBJECTIVE: Parents in Washington State face new challenges related to the non-medical marijuana legislation that was passed in 2012. We asked parent focus group participants about changes they have observed in their environment, how their children are exposed to marijuana, and how this exposure might affect youth marijuana use. METHOD: We conducted 6 focus groups with parents of youth ages 8 to 15 (N = 54). Parents were recruited from the Seattle Social Development Project, a multi-ethnic, longitudinal panel study that originated in Seattle in 1985. Thematic content analysis was used to analyze qualitative data. RESULTS: Parents agreed that they did not want their children using marijuana, and were concerned that their children were exposed to marijuana more often and in many different contexts. Parents said they now need to monitor their children's environment more carefully, especially the other adults that spend time around their children. Edible marijuana products were particularly concerning for parents, as they offer a new set of challenges for parents in monitoring their children's exposure to and use of marijuana. Parents were concerned that marijuana exposure would increase risk of marijuana use in adolescents. CONCLUSIONS: Parents' experiences in Washington State provide valuable lessons for social work practitioners, policymakers and those developing preventive interventions. Prevention efforts and public health messaging should begin before legalization takes effect to support parents in preparing for changes in their social and physical environments, and should seek to incorporate parenting strategies to monitor and intervene when children are exposed to marijuana.

20.
Med Care ; 47(4): 440-7, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19238099

RESUMO

BACKGROUND: Prediction models that identify populations at risk for high health expenditures can guide the management and allocation of financial resources. OBJECTIVE: To compare the ability for identifying individuals at risk for high health expenditures between the single-item assessment of general self-rated health (GSRH), "In general, would you say your health is Excellent, Very Good, Good, Fair, or Poor?," and 3 more complex measures. STUDY DESIGN: We used data from a prospective cohort, representative of the US civilian noninstitutionalized population, to compare the predictive ability of GSRH to: (1) the Short Form-12, (2) the Seattle Index of Comorbidity, and (3) the Diagnostic Cost-Related Groups/Hierarchal Condition Categories Relative-Risk Score. The outcomes were total, pharmacy, and office-based annualized expenditures in the top quintile, decile, and fifth percentile and any inpatient expenditures. DATA SOURCE: Medical Expenditure Panel Survey panels 8 (2003-2004, n = 7948) and 9 (2004-2005, n = 7921). RESULTS: The GSRH model predicted the top quintile of expenditures, as well as the SF-12, Seattle Index of Comorbidity, though not as well as the Diagnostic Cost-Related Groups/Hierarchal Condition Categories Relative-Risk Score: total expenditures [area under the curve (AUC): 0.79, 0.80, 0.74, and 0.84, respectively], pharmacy expenditures (AUC: 0.83, 0.83, 0.76, and 0.87, respectively), and office-based expenditures (AUC: 0.73, 0.74, 0.68, and 0.78, respectively), as well as any hospital inpatient expenditures (AUC: 0.74, 0.76, 0.72, and 0.78, respectively). Results were similar for the decile and fifth percentile expenditure cut-points. CONCLUSIONS: A simple model of GSRH and age robustly stratifies populations and predicts future health expenditures generally as well as more complex models.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Nível de Saúde , Adulto , Estudos de Coortes , Feminino , Previsões , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco , Estados Unidos
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