Adam E. Barry

Web 2.0 Chronic Disease Self-Management for Older Adults: A Systematic Review

Background Participatory Web 2.0 interventions promote collaboration to support chronic disease self-management. Growth in Web 2.0 interventions has led to the emergence of e-patient communication tools that enable older adults to (1) locate and share disease management information and (2) receive interactive healthcare advice. The evolution of older e-patients contributing to Web 2.0 health and medical forums has led to greater opportunities for achieving better chronic disease outcomes. To date, there are no review articles investigating the planning, implementation, and evaluation of Web 2.0 chronic disease self-management interventions for older adults. Objective To review the planning, implementation, and overall effectiveness of Web 2.0 self-management interventions for older adults (mean age ≥ 50) with one or more chronic disease(s). Methods A systematic literature search was conducted using six popular health science databases. The RE-AIM (Reach, Efficacy, Adoption, Implementation and Maintenance) model was used to organize findings and compute a study quality score (SQS) for 15 reviewed articles. Results Most interventions were adopted for delivery by multidisciplinary healthcare teams and tested among small samples of white females with diabetes. Studies indicated that Web 2.0 participants felt greater self-efficacy for managing their disease(s) and benefitted from communicating with health care providers and/or website moderators to receive feedback and social support. Participants noted asynchronous communication tools (eg, email, discussion boards) and progress tracking features (eg, graphical displays of uploaded personal data) as being particularly useful for self-management support. Despite high attrition being noted as problematic, this review suggests that greater Web 2.0 engagement may be associated with improvements in health behaviors (eg, physical activity) and health status (eg, HRQoL). However, few studies indicated statistically significant improvements in medication adherence, biological outcomes, or health care utilization. Mean SQS scores were notably low (mean=63%, SD 18%). Studies were judged to be weakest on the Maintenance dimension of RE-AIM; 13 reviewed studies (87%) did not describe any measures taken to sustain Web 2.0 effects past designated study time periods. Detailed process and impact evaluation frameworks were also missing in almost half (n=7) of the reviewed interventions. Conclusions There is need for a greater understanding of the costs and benefits associated with using patient-centered Web 2.0 technologies for chronic disease self-management. More research is needed to determine whether the long-term effectiveness of these programs is sustainable among larger, more diverse samples of chronically ill patients. The effective translation of new knowledge, social technologies, and engagement techniques will likely result in novel approaches for empowering, engaging, and educating older adults with chronic disease.

Drunkorexia: Understanding the Co-Occurrence of Alcohol Consumption and Eating/Exercise Weight Management Behaviors.

Abstract Objective: Examine the co-occurrence of alcohol consumption, physical activity, and disordered eating behaviors via a drunkorexia perspective. Participants: Nationally representative sample (n = 22,488) of college students completing the Fall 2008 National College Health Assessment. Methods: Hierarchical logistic regression was employed to determine if physical activity and disordered eating behaviors uniquely predicted binge drinking, while controlling for age, race, gender, year in college, Greek membership, and place of residence. Results: Physical activity and disordered eating made unique, statistically significant contributions. Moreover, including physical activity and disordered eating behaviors allowed for the correct classification of an additional 431 cases (ie, binge drinkers) over and above the predictive ability of the covariate-only model. Conclusions: Findings corroborate prior research indicating highly active college students are more likely to binge drink than their nonactive peers, and highlight the potential of a drunkorexia perspective in explaining the counterintuitive alcohol–activity association among college students.

The Development and Implications of Peer Emotional Support for Student Service Members/Veterans and Civilian College Students

Student service members/veterans represent a growing population on college campuses. Despite this growth, scholarly investigations into their health- and adjustment-related issues are almost nonexistent. The limited research that is available suggests that student service members/veterans may have trouble connecting with their civilian counterparts and be at risk for social isolation. The present study compared the development and implications of emotional support from peers among 199 student service members/veterans and 181 civilian students through 3 distinct occasions over the course of 1 calendar year. Data were collected via electronic survey. Measured constructs included perceived emotional support from university friends, mental health, alcohol use, and academic functioning. A series of multilevel models revealed that student service members/veterans reported less emotional support from their peers compared with their civilian counterparts; yet, emotional support from peers increased similarly for both groups over time. Although, increasing peer emotional support was generally related to better academic and mental health outcomes for both groups, the links between emotional support and mental health were stronger for civilian students. Results suggest that mental health practitioners, particularly those on college campuses, should be prepared to deal with veteran-specific experiences that occur before and during college.

Student Service Members/Veterans in Higher Education: A Systematic Review

Abstract We systematically reviewed the data-based peer-reviewed research examining student service members/veterans (SSM/V) in higher education. Compared to civilian peers, SSM/V exhibit disproportionately higher rates of health risk behaviors and psychological symptoms, and personal and educational adjustment difficulties (i.e., inability to connect with peers and faculty on campus). Combat-related trauma is a contributing factor to these differences. The current evidence-base is scant, lacking nationally representative and/or longitudinal data to inform policies and programs for SSM/V.

The impact of alcohol on Alzheimer's disease: A systematic review

Currently, there is discrepancy regarding alcohols impact on Alzheimers disease (AD). Consequently, the purpose of this systematic review was to determine whether alcohol serves as a protective agent against the development of AD, as well as whether protective effects are influenced by quantity and/or frequency of drinking. Adapted versions of the Matrix Method and PRISMA guidelines were used in order to identify, organize, and synthesize relevant research. Overall, there is no consensus regarding alcohols impact on AD. Specifically, seven articles suggested drinking alcohol decreases the risk of AD, three studies found drinking led to an increased risk of AD, and yet another nine reported alcohol had no impact on AD. Validity and consistency of both alcohol and AD measures across studies represents a severe limitation. Prior to the development of standards and/or clinical recommendations, more investigations into the association between alcohol and AD are necessary. Considering the current evidence base, alcohol should not be used as a means to decrease risk of developing AD.

Examining Physical Activity Levels and Alcohol Consumption: Are People Who Drink More Active?:

Objective. Summarize/categorize current scientific literature examining the association between alcohol consumption (AC) and levels of physical activity (PA). Data Source. Electronic databases spanning education, psychology, sociology, medicine, and interdisciplinary reports. Study Inclusion and Exclusion Criteria. Included studies (n = 17) must be published in a peer-reviewed, English language journal; measure either AC or PA as an independent/dependent variable; and primarily examine the relationship between AC and PA. Data Extraction. Search terms/phrases included alcohol, alcohol consumption, drinking, physical activity, exercise, and physically active. Data Synthesis. The Matrix Method and PRISMA guidelines organized pertinent literature and identified/extracted salient findings. Results. Alcohol consumers of all ages were more physically active than nondrinking peers. Further, several studies suggest a dose-response relationship between AC and PA, indicating that as drinking increases, so does PA level. Conclusion. Reviewed studies support a positive association between AC and PA across all ages. Findings were contrary to the hypothesis of the investigators. Future research should place specific emphasis on identifying why alcohol consumers exercise at higher levels than non–alcohol consumers.

Use (and Misuse) of the Responsible Drinking Message in Public Health and Alcohol Advertising: A Review

The objective is to present a comparative analysis examining the alcohol industry’s and scholarly researchers’ use of the concept “responsible drinking.” Electronic databases associated with health, education, sociology, psychology, and medicine were the date sources. Results were limited to English, peer-reviewed articles and commentaries specifically addressing “responsible drinking.” Search descriptors included responsible, responsibility, drinking, alcohol, brewer, and campaign. Eighteen articles constituted the final sample. The matrix method was utilized to organize and abstract pertinent information. Misunderstanding stemming from the inconsistency and counterintuitive nature of brewer-sponsored “responsible drinking” campaigns is further compounded by researchers’ use of the term and concept of “responsible drinking” in their scholarly reports. In articulating the definition of “responsible drinking,” researchers employ subjective notions and personal ideas, thus not differentiating the construct’s meaning from the one acquired in brewer-sponsored campaigns. Researchers are consistently inconsistent when identifying specific health measures that promote and/or contradict responsible alcohol consumption. To evade the subjective notions of researchers and restrictive impressions attached by the alcohol industry, the manner in which individuals interpret, perceive, and practice responsible drinking must be systematically explored and examined using theoretically based constructs.

Implications of Posttraumatic Stress Among Military-Affiliated and Civilian Students

Abstract Objectives: To determine whether posttraumatic stress (PTS) symptoms are associated with problem drinking and alcohol-related consequences, as well as academic correlates among military-affiliated and civilian students. Participants: The final sample (n = 248) included 78 combat-exposed student service members/veterans, 53 non–combat-exposed student service members/ veterans, 38 ROTC (Reserve Officers’ Training Corps) students, and 79 civilian students. Methods: Self-report data were collected spring 2011 via a Web-based survey measuring PTS, problem drinking, alcohol-related consequences, grade point average, educational self-efficacy, academic amotivation, and persistence. Results: Military students exposed to combat-related trauma reported significantly greater PTS symptoms than other military and civilian groups. PTS symptoms were associated with problem drinking and alcohol-related consequences for all groups, yet unrelated to academic correlates among those exposed to combat-related trauma. Conclusion: This study adds to the scant literature base exploring the unique characteristics of student service members/veterans in higher education.

A Comparison of the Combined-Use of Alcohol & Energy Drinks to Alcohol-Only on High-Risk Drinking and Driving Behaviors

Background: The combined-use of alcohol and energy drinks is an emerging public health issue. This investigation examined differences in drinking and driving behaviors among combined-users (CU) and participants who consumed alcohol-only (AO). Objectives: This study was specifically designed to investigate potential differences in drinkers perceptions of (a) what it means to them to drive over the .08 Blood Alcohol Content (BAC) driving limit and (b) what it means to drive after knowing they have had too much to drink to drive safely. Methods: College students (N = 355) were surveyed to assess differences in drinking and driving-related behaviors between the AO (n = 174) and CU (n = 107) groups. Results: CU were more likely than AO to drive over the .08 BAC driving limit (53% vs. 38%; p = .009) and after knowing they were too drunk to drive (57% vs. 44%; p = .025). CU were also more likely (56% vs. 35%; p = .000) to ride with an intoxicated driver while knowing it was unsafe. Conclusions/Importance: Combined-users are more likely to drive after drinking, drive while knowingly drunk, and participate in other high-risk behaviors such as heavy drinking that increase the potential for injury. Public policy makers and health professionals should focus prevention efforts to reduce high-risk combined-use behavior.

Perceived Discrimination and DSM-IV–Based Alcohol and Illicit Drug Use Disorders

OBJECTIVES We examined the relationship between everyday and major discrimination and alcohol and drug use disorders in a nationally representative sample of African Americans and Black Caribbeans. METHODS With data from the National Survey of American Life Study, we employed multivariable logistic regression analyses--while controlling for potential confounders--to examine the relationship between everyday and major discrimination and substance use disorders on the basis of Diagnostic and Statistical Manual of Mental Disorders criteria. RESULTS Every 1 unit increase in the everyday discrimination scale positively predicted alcohol (odds ratio [OR] = 1.02; P < .01) and drug use (OR = 1.02; P < .05) disorders. Similarly, each additional major discrimination event positively predicted alcohol (OR = 1.10; P < .05) and drug use (OR = 1.15; P < .01) disorders. CONCLUSIONS To our knowledge, this study is the first to examine problematic usage patterns rather than infrequent use of alcohol and drugs in a national sample of African American and Black Caribbean adults and the first to examine this particular relationship in a national sample of Black Caribbeans.