Addressing Barriers to Primary Care Screening and Referral to Prevention for Youth Risky Health Behaviors: Evidence Regarding Potential Cost-Savings and Provider Concerns.

Despite growing evidence and support for co-locating behavioral services in primary care to prevent risky health behaviors, implementation of these services has been limited due to a lack of reimbursement for services and negative perceptions among providers. We investigated potential to overcome these barriers based on new developments in healthcare funding and screening and referral to prevention (SRP) in primary care based on the Consolidated Framework for Implementation Research (CFIR), which could guide future SRP implementation strategies. To investigate the economic need for healthcare-based SRP, we quantified hospital charges to healthcare payors for services arising from adolescent risky behaviors (e.g., substance use, risky sex). Annual North Carolina (NC) hospital charges for these services exceeded $327 M (2019 dollars), suggesting high potential for cost savings if SRP can curb hospital services associated with risky behaviors. To investigate provider barriers and facilitators, we surveyed 151 NC pediatricians and 230 NC family therapists about their attitudes regarding a recently developed well-child visit SRP with family-based prevention. Both sets of professionals reported widespread need for and interest in the SRP but cited barriers of lack of reimbursement, training, and referrals to/from each other. Physicians, but not family therapists, reported concerns with poor patient or parent compliance. Many barriers could be resolved by co-locating family therapists in pediatric clinics to conduct well-child SRP. Our results support further research to develop business models for payor-funded SRP and CFIR-guided research to develop implementation strategies for primary care SRP to prevent adolescent risky health behaviors.

Residential Transience Among Adults: Prevalence, Characteristics, and Association with Mental Illness and Mental Health Service Use.

This study examined the association between frequent residential mobility (i.e., residential transience) and mental illness, mental health service use, and unmet need for services. Data are from the 2010 to 2014 National Surveys on Drug Use and Health (n = ~ 229,600). Logistic regression models examined the relationship between proximal (past year) and distal (past 2-5 years) residential transience and past year any mental illness (AMI), serious mental illness (SMI), mental health service use among adults with mental illness, and unmet need for services. Adults with transience had greater odds of AMI and SMI than those without transience. Proximal and distal transience were unrelated to past year mental health service use among adults with mental illness, but the odds of unmet need for services were greater among adults with transience compared with those without, suggesting a level of unmet service need among those with transience.

KAT2B polymorphism identified for drug abuse in African Americans with regulatory links to drug abuse pathways in human prefrontal cortex.

Drug abuse is a common and heritable set of disorders, but the underlying genetic factors are largely unknown. We conducted genome-wide association studies of drug abuse using 7 million imputed single nucleotide polymorphisms (SNPs) and insertions/deletions in African Americans (AAs; n = 3742) and European Americans (EAs; n = 6845). Cases were drawn from the Urban Health Study of street-recruited people, who injected drugs and reported abusing opioids, cocaine, marijuana, stimulants and/or other drugs 10 or more times in the past 30 days, and were compared with population controls. Independent replication testing was conducted in 755 AAs and 1131 EAs from the Genetic Association Information Network. An intronic SNP (rs9829896) in the K(lysine) acetyltransferase 2B (KAT2B) gene was significantly associated with drug abuse in AAs (P = 4.63 × 10-8 ) and independently replicated in AAs (P = 0.0019). The rs9829896-C allele (frequency = 12%) had odds ratios of 0.68 and 0.53 across the AA cohorts: meta-analysis P = 3.93 × 10-10 . Rs9829896-C was not associated with drug abuse across the EA cohorts: frequency = 36% and meta-analysis P = 0.12. Using dorsolateral prefrontal cortex data from the BrainCloud cohort, we found that rs9829896-C was associated with reduced KAT2B expression in AAs (n = 113, P = 0.050) but not EAs (n = 110, P = 0.39). KAT2B encodes a transcriptional regulator in the cyclic adenosine monophosphate and dopamine signaling pathways, and rs9829896-C was associated with expression of genes in these pathways: reduced CREBBP expression (P = 0.011) and increased OPRM1 expression (P = 0.016), both in AAs only. Our study identified the KAT2B SNP rs9829896 as having novel and biologically plausible associations with drug abuse and gene expression in AAs but not EAs, suggesting ancestry-specific effects.

Prevalence of serious psychological distress and mental health treatment in a national sample of pregnant and postpartum women.

This study examines the prevalence and correlates of past month serious psychological distress (SPD) and past year mental health treatment (MHT) across pregnancy and the postpartum. Data are from the 2008 to 2012 National Surveys on Drug Use and Health. Prevalence estimates of SPD as well as MHT among women with SPD were generated for each trimester and across the postpartum period. Correlates of SPD and MHT were examined among pregnant and postpartum women. The prevalence of past month SPD was 6.4 % in first trimester women and 3.9 % in third trimester women. In postpartum women, SPD prevalence ranged from 4.6 % (0-2 months) to 6.9 % (3-5 months). Correlates of SPD among pregnant and postpartum women included being younger; non-Hispanic black; unmarried; making under $20,000 annually; having past month cigarette use; or having a past year alcohol or illicit drug use disorder. Only 38.5 % of pregnant and 49.5 % of postpartum women with past month SPD reported past year MHT. Those who received MHT were more likely to be white; widowed, divorced, or separated; have insurance; and have a history of depression or anxiety than their counterparts with no MHT. Pregnant women with SPD were less likely to report past year MHT than postpartum women, even after adjusting for potential confounders. Over half of pregnant and postpartum women with past month SPD are not receiving MHT. Increased contact with health care professionals during this time may be an opportunity for screening, identification, and referral to MHT.

Exposure to maternal pre- and postnatal depression and anxiety symptoms: risk for major depression, anxiety disorders, and conduct disorder in adolescent offspring.

This study evaluated whether exposure to maternal pre- or postnatal depression or anxiety symptoms predicted psychopathology in adolescent offspring. Growth mixture modeling was used to identify trajectories of pre- and postnatal depression and anxiety symptoms in 577 women of low socioeconomic status selected from a prenatal clinic. Logistic regression models indicated that maternal pre- and postnatal depression trajectory exposure was not associated with offspring major depression, anxiety, or conduct disorder, but exposure to the high depression trajectory was associated with lower anxiety symptoms in males. Exposure to medium and high pre- and postnatal anxiety was associated with the risk of conduct disorder among offspring. Male offspring exposed to medium and high pre- and postnatal anxiety had higher odds of conduct disorder than did males with low exposure levels. Females exposed to medium or high pre- and postnatal anxiety were less likely to meet conduct disorder criteria than were females with lower exposure. To the best of our knowledge, this is the first study to examine the effect of pre- and postnatal anxiety trajectories on the risk of conduct disorder in offspring. These results suggest new directions for investigating the etiology of conduct disorder with a novel target for intervention.

A systematic review of the effects of postnatal maternal anxiety on children.

Several decades of research have focused on the impact of exposure to postnatal depression on children, while anxiety has been largely overlooked. Estimates of the prevalence of postnatal maternal anxiety (PMA) range from 3% to 43%, suggesting PMA may be an important risk factor for adverse outcomes in children. This review summarizes what is known about the effects of PMA exposure on children and makes recommendations for future research. A systematic search of Ovid MEDLINE and PsychINFO through 2008 identified 18 studies that evaluated child outcomes associated with PMA exposure. Identified studies covered three domains: somatic, developmental, and psychological outcomes. The strongest evidence for an adverse effect of PMA exposure is in somatic and psychological outcomes; the evidence for an effect of PMA on child development is inconclusive. Methodological differences among the studies make comparisons difficult and there are a number of common limitations that challenge the validity of these studies.

Correlates of exposure to potentially traumatic experiences: Results from a national household survey.

OBJECTIVE: Prior studies have indicated that exposure to potentially traumatic events (PTEs) may increase the risk of poor mental and physical health outcomes. This study's main goal is to examine the association between PTE exposures and having any past year mental disorder, substance use disorder (SUD), or functional impairment and to explore the moderating effects of age and gender on these associations in a nationally representative sample of civilian adults living in U.S. households. METHOD: The sample included adults aged 18 or older (n = 5,653) from the 2008-2012 Mental Health Surveillance Study. RESULTS: PTE exposure was significantly associated with having any past year mental disorder and any past year SUD (odds ratio [OR] = 1.85, 95% CI [1.48, 2.32] and OR = 1.59, 95% CI [1.16, 2.18], respectively), as well as lower functioning scores as measured by the abbreviated World Health Organization Disability Assessment Schedule (WHODAS) and the Global Assessment of Functioning scale in models adjusted for sociodemographic characteristics. A single significant interaction (p = .002) indicated that the magnitude of the PTE exposure-WHODAS-measured functional impairment association was stronger among females than males. CONCLUSIONS: These findings from a nationally representative study of civilian adults living in U.S. households suggest that PTE exposure may have significant public health implications beyond those associated with the development of posttraumatic stress disorder. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Psychosocial determinants of intention to screen for Alzheimer's disease.

BACKGROUND: There is little information about how receptive older adults are to discuss memory problems with healthcare providers. Here we test the psychosocial factors explaining older adults' intention to undergo screening for Alzheimer disease (AD). METHODS: A population-based, random-digit dialing strategy surveyed 1,039 older adults. The Behavioral Model of Health Services Use was used as a conceptual framework for a questionnaire testing constructs from several behavioral theories. Structural equation modeling assessed the relationship of latent variables to each construct with goodness-of-fit indices. RESULTS: The study had an 82% response rate and 72% completer rate. The respondents' mean age was 62.7 +/- 10.2 years (range, 50 to 97 years). The sample was 67% women, 86% were white, and less than 40% had personal experience with AD. Respondents were nondemented (Short Blessed scores, 1.7 +/- 2.2). Predictors of intention to screen included perceived benefits (gamma = .35), knowledge of dementia (gamma = .26), self-efficacy (gamma = .23), preventive health behaviors (gamma = .17), and perceived susceptibility (gamma = .14). Knowledge was positively correlated with perceived benefits (phi = .29) and susceptibility (phi = .20). Preventive behaviors (phi = .20) were positively correlated with perceived benefits. Self-efficacy correlated positively with preventive behaviors (phi = .24) and perceived benefits (phi = .37) and negatively with perceived susceptibility (phi = -.11). Goodness-of-fit indices suggested a good fit of this model (root mean square error of approximation, .037; comparative fit index, 0.98; relative fit index; .96). DISCUSSION: Older adults who have knowledge of dementia and perceive benefit from diagnosis and treatment are more likely to exhibit willingness and confidence to be tested for cognitive problems. Individuals with high self-efficacy, perceived susceptibility, and positive preventive health behaviors are also more likely to exhibit intention. These constructs can now be used to develop interventions to evaluate cognitive health in the elderly.

Translation of an evidence-based tailored childhood injury prevention program.

This article describes the process of translating Safe n' Sound, a computer-based program for parents of young children, for a general clinic environment. Safe n' Sound is designed to reduce the risk of unintentional childhood injuries, the leading cause of death among children older than 1 year in the United States. The evidence-based program produces tailored information for parents and their healthcare provider about burns, falls, poisoning, drowning, suffocations, choking prevention, and car safety. To offer Safe n' Sound to a broader audience, we translated the program from the form used for efficacy testing to a stand-alone application. Notable steps in this translation included (1) conducting an organizational assessment to determine the needs of the clinic staff and feasibility of implementation, (2) modifying the program to reduce length, prioritize risk areas, and update content, (3) repackaging the program to minimize cost and space requirements, and (4) developing promotional and instructional materials. Factors contributing to the success of this effort include strong collaborative partnerships, the relative advantage of Safe n' Sound over traditional materials, the modifiable design of the program, and the support of the clinic staff and providers. Challenges and areas for future work are discussed.

Residential Transience and Substance Use Disorder Are Independently Associated with Suicidal Thoughts, Plans, and Attempts in a Nationally Representative Sample of U.S. Adults.

This study tests the association between past-year residential transience (RT), substance use disorder (SUD), major depressive episode (MDE), and suicidal outcomes in a nationally representative sample of noninstitutionalized, civilian, community-dwelling adults who participated in the 2008-2013 National Surveys on Drug Use and Health. RT, SUD, and MDE were each significantly associated with suicidal thoughts, plans, and attempts in models adjusted for each other and sociodemographic covariates. Because RT is independently associated with each suicidal outcome, even when there is no co-occurring SUD or MDE, assessment of RT should occur when screening for suicide.

Measures of human immunodeficiency virus (HIV) community viral load and HIV incidence among people who inject drugs.

PURPOSE: To evaluate the measures of community human immunodeficiency virus (HIV) viral load (VL) and the association with HIV incidence among people who inject drugs (PWID). METHODS: Data were from 1986 to 1999 Urban Health Study conducted among PWID in the San Francisco Bay Area. Extant measures of community VL use mean VL among HIV + study participants, not accounting for the proportion of HIV- individuals. We compared the strength of the associations between HIV incidence and the traditionally measured mean community VL and a new prevalence-adjusted community VL, calculated by dividing the sum of VL among HIV + participants by the total participants irrespective of HIV status. RESULTS: Mean community VL was not correlated with HIV incidence in this sample of PWID (rs = 0.32, P = .28). However, prevalence-adjusted community VL was strongly correlated with HIV incidence (rs = 0.69, P = .009). Nested complimentary log-log linear models indicated that increases in community VL and prevalence-adjusted community VL were both associated with HIV incidence, but prevalence-adjusted community VL was a more sensitive measure (hazard ratio = 1.28, P = .038 and hazard ratio = 3.29, P < .001, respectively). CONCLUSIONS: The effect of community VL on HIV incidence may be stronger than previously reported. Future studies of community VL surveillance should consider accounting for the prevalence of HIV using a prevalence-adjusted community VL measure.

Is the Fagerström test for nicotine dependence invariant across secular trends in smoking? A question for cross-birth cohort analysis of nicotine dependence.

BACKGROUND: The Fagerström Test for Nicotine Dependence (FTND), a derivation of the Fagerström Tolerance Questionnaire, was first published in 1991. The FTND remains one of the most widely used measures of nicotine dependence for studying genetic and epidemiological risk factors and the likelihood of smoking cessation. However, it is unclear whether secular trends in patterns of smoking alter the psychometric properties of the FTND and its interpretation. METHODS: We examined measurement invariance in the lifetime and current FTND scores across birth cohorts using participants drawn from six study samples (N = 13,775). RESULTS: We found significant (p < 0.05) measurement non-invariance in means and factor loadings of most FTND items by birth cohort, but effect sizes, ranging from r2 = 0.0001 to r2 = 0.0035, indicated that less than 0.5% of the model variance was explained by the measurement non-invariance for each factor loading. To assess its impact, we regressed the lifetime FTND latent variable on well-established factors associated with nicotine dependence (quitting smoking and the nicotinic acetylcholine receptor gene [CHRNA5] variant rs16969968, separately), and we observed that the regression coefficients were unchanged between models with and without adjustment for measurement non-invariance. CONCLUSIONS: These findings suggest that possible FTND non-invariance that occurs across study samples of various birth years has a negligible impact on study results.

Residential Mobility, Transience, Depression, and Marijuana Use Initiation Among Adolescents and Young Adults.

Marijuana use initiation is associated with numerous health and behavioral consequences, particularly among young adolescents. Finding easily identifiable risk markers for marijuana initiation is an important step for targeting primary and secondary prevention efforts. This study used data from the 2010-2014 National Survey on Drug Use and Health to evaluate the association between residential mobility (no mobility, low mobility, high mobility [ie, transience]), and major depressive episode(s) (MDE) on marijuana initiation among adolescents (12-17) and young adults (18-20). Age-stratified logistic regression models indicated that among 12- to 13-year-old adolescents, mobility in the past 5 years and past year MDE have a multiplicative effect on the odds of past year marijuana initiation. Among adolescents aged 14 to 15 years, both mobility and MDE were independently associated with marijuana initiation, but there was no interaction. Among older adolescents (aged 16-17 years), only transience (⩾3 moves in the past 5 years) was associated with marijuana use initiation, and although MDE was significantly associated with marijuana initiation, there was no interaction with mobility. Among young adults, mobility was not associated with marijuana initiation. Residential mobility among young adolescents is an easily identifiable risk marker that may serve as an indicator for physical and mental health professionals, school personnel, and parents to use in targeting both depression and marijuana prevention efforts.

Marijuana Use, Recent Marijuana Initiation, and Progression to Marijuana Use Disorder Among Young Male and Female Adolescents Aged 12-14 Living in US Households.

Marijuana initiation during adolescence, and early adolescence in particular, is associated with adverse health consequences. Our study used 2005-2014 data from the annual, cross-sectional National Survey on Drug Use and Health to study the prevalence and correlates of marijuana initiation, use, and marijuana use disorder (MUD; abuse or dependence) among 12- to 14-year olds living in civilian US households (n = 84 954). Examined correlates included age, sex, race/ethnicity, poverty status, metropolitan status, year of survey, depression, tobacco use, alcohol use, and fighting at school. Sex differences in the correlates of lifetime use and past year marijuana initiation were tested via interaction. Lifetime prevalence of marijuana use was 5.5%; 3.2% reported past year initiation. About 1 in 6 (16.8%) past year initiates progressed to MUD within 12 months of first use. Although men had higher prevalence of lifetime use than women, past year initiation did not differ by sex. On examining the sex*race/ethnicity interaction effects, findings determined that non-Hispanic black and Hispanic men had higher prevalence estimates of ever using marijuana and incidence of past year initiation as compared with non-Hispanic white men; these race/ethnicity differences were not found among women. Identifying correlates of initiation and progression to MUD among young adolescents is critical to improve prevention and treatment program targets.

Alcohol Initiation and Progression to Use, Heavy Episodic Use, and Alcohol Use Disorder Among Young Adolescents Ages 12-14 Living in U.S. Households.

OBJECTIVE: This study examined the prevalence and correlates of past-year alcohol initiation among young adolescents ages 12-14 and, among recent initiates, progression to current use, heavy episodic use, and alcohol use disorder (AUD). METHOD: The 2004-2013 data from the annual cross-sectional National Survey of Drug Use and Health among 12- to 14-year-olds living in civilian U.S. households (n = 87,470) were used to estimate the prevalence and correlates of alcohol initiation. RESULTS: Lifetime prevalence of alcohol use was 19.9%; 14.1% reported past-year initiation. Among those with past-year initiation, 39.7% reported past-month use, 17.9% reported past-month heavy episodic use, and 10.4% met criteria for past-year AUD. Each alcohol estimate was higher among females than among males. Alcohol initiation increased with age; however, among past-year initiates, age was not associated with past-month use, heavy episodic use, or past-year AUD. In adjusted models, tobacco and illicit drug use were associated with each alcohol indicator tested; depression was associated with alcohol initiation and AUD among recent initiates. CONCLUSIONS: Progression from initiation to heavy episodic use and development of AUD happened rapidly for some young adolescents, including those who used other substances. Our results suggest the need for targeted clinical and public health efforts to prevent and reduce the burden of drinking and harmful drinking among this age group, especially among females, whose use and prevalence of use and misuse exceeded those of males.

Prescription pain reliever misuse and levels of pain impairment: 3-year course in a nationally representative outpatient sample of US adults.

BACKGROUND: The primary aim of this work was to present the prevalence data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a representative 3-year longitudinal survey (ages 18+ years) that captured information on patterns of self-reported pain interference and prescription pain reliever misuse. A second aim was to assess the degree to which the risk of various types of opioid misuse (onset, desistance, and incidence of dependence) was related to the longitudinal course of self-reported pain interference over the 3-year period. METHODS: We used a two-wave, nationally representative sample of adults (aged 18+ years) in which the baseline data were collected during 2001-2002 and a single follow-up was obtained ~3 years later (2004-2005 with 34,332 respondents with complete data on study variables for both waves). RESULTS: Our findings indicated that ~10% reported high pain interference in the past month at each wave. There was tremendous stability in levels of pain, with ~5% reporting consistent levels of high impairment over the 3-year study, a proxy for chronic pain. Levels of pain were more strongly associated with prescription pain reliever misuse concurrently rather than prospectively, and the association was largely linear, with the likelihood of misuse increasing with levels of pain. Finally, health service factors were also prominent predictors of onset, but not the outcomes, of desistance or transitions to problem use. CONCLUSION: This study is the first to use a nationally representative sample with measures of pain and drug use history collected over an extended period. These results may help provide clinicians with an understanding that the risk of misuse is greatest when pain is active and may help guide the selection of appropriate intervention materials and monitor strategies for those at greatest risk.

The role of mental illness on cigarette dependence and successful quitting in a nationally representative, household-based sample of U.S. adults.

PURPOSE: To begin to explore whether the association between mental illness (MI), cigarette dependence, and unsuccessful quit attempts differs across particular demographic subgroups. METHODS: This study examines data from adults aged 18 years or older participating in the 2008-2012 National Surveys on Drug Use and Health. Analyses explored the moderating effects of age, gender, and race and/or ethnicity on associations between three levels of MI: (serious mental illness [SMI], any mental illness but no SMI, and no MI) and two smoking-related outcomes (cigarette dependence among current smokers and successful quitting among ever daily smokers). RESULTS: After confirming that adults with MI were more likely to be dependent on cigarettes and less likely to successfully quit smoking, particularly among those with SMI, adjusted analyses indicated that age (but not gender or race/ethnicity) moderated the associations between MI and cigarette dependence and between MI. CONCLUSIONS: The magnitude of the association between MI and cigarette dependence and between MI and successful quitting appears to be stronger among older adults than among younger adults. Identifying subgroups at particular high risk of cigarette dependence is paramount to targeting smoking prevention, cessation, and treatment services appropriately.

Variation in the Relationship Between Mental Illness and Residential Transience by Race-Ethnicity.

OBJECTIVE: This study examined the relationship between residential transience (moving frequently) and mental illness. METHODS: The analyses used data for approximately 154,400 adults from the 2008-2011 National Survey on Drug Use and Health. Logistic regression was used to evaluate the odds of transience among all adults and by race-ethnicity. RESULTS: Residential transience was more prevalent among adults with mental illness versus adults without mental illness (5.7% versus 1.9%, p<.001). In adjusted models, the odds of transience were twice as high among adults with mental illness (odds ratio=1.99, 95% confidence interval=1.81-2.19) versus those without mental illness. This association differed by race-ethnicity. Among adults reporting multiple races, having a mental illness was associated with a fourfold increase in odds of transience. CONCLUSIONS: Residential transience may be a concern for adults with mental illness, particularly those of multiple races. Further studies should examine whether transience is associated with difficulties in accessing care.

Residential Transience, Major Depressive Episodes, and the Risk of Suicidal Thoughts, Plans, and Attempts.

The association between past-year residential transience (frequent moving) and suicidal ideation among a nationally representative sample of over 190,000 U.S. adults was evaluated. Suicidal thoughts, plans, and attempts were more prevalent among transient adults. Among adults without major depressive episodes (MDE), transience was associated with 70% to 90% greater odds of suicidal ideation compared to nontransient adults. Among adults with MDE, transience was associated with a 60% to 80% increased odds of suicidal ideation compared to nontransient adults. Residential transience may be an indicator for increased suicide risk even in the absence of depression.

Binge drinking and the risk of suicidal thoughts, plans, and attempts.

BACKGROUND: Major depression is one of the strongest known risk factors for suicide. However, of the estimated 8.5 million adults with serious thoughts of suicide in the past year, only half had a major depressive episode (MDE). Identifying risk factors for suicide in the absence of depression may provide additional targets for prevention and intervention. This study uses nationally representative data to evaluate the association of binge drinking with suicidal thoughts, plans, and attempts in adults with and without MDE. METHODS: Combined 2008-2012 National Survey on Drug Use and Health data were analyzed. Sex-stratified prevalence estimates of past year suicide indicators were generated by past month binge drinking and past year MDE status. Logistic regression was used to evaluate the association of binge drinking with suicide indicators by sex with and without MDE. RESULTS: Unadjusted prevalence estimates for suicide indicators in males and females were higher among binge drinkers than among nonbinge drinkers, regardless of MDE status. Regression analyses indicated that binge drinking was associated with suicidal thoughts (adjusted odds ratio [aOR]=1.51, 95% confidence interval [CI]=1.28-1.79), plans (aOR=1.75, CI=1.23-2.48), and attempts (aOR=2.57, CI=1.74-3.79) in females without MDE and with suicidal thoughts in males without MDE (aOR=1.25, CI=1.04-1.49). Among males and females with MDE, binge drinking was not associated with any of the suicide indicators (p>.05). CONCLUSIONS: Binge drinking in females without MDE may be an indicator for identifying at risk individuals for targeting suicide prevention activities.