Beth Han

Depressive symptoms and self-rated health in community-dwelling older adults: a longitudinal study

OBJECTIVES: To test whether baseline depressive symptoms in older adults increase the risk of subsequent decline in self‐rated health and decrease the likelihood of subsequent improvement in self‐rated health.

Associations Between Duration of Illicit Drug Use and Health Conditions: Results from the 2005–2007 National Surveys on Drug Use and Health

PURPOSEnTo estimate and compare prevalence rates of lifetime health conditions by inferred duration of illicit drug use among the general U.S. adult population and to investigate associations between duration of use of each specific illicit drug (marijuana, cocaine, heroin, hallucinogens, or inhalant) and each lifetime health condition after controlling for potential confounding factors.nnnMETHODSnData from respondents aged 35 to 49 (N = 29,195) from the 2005-2007 National Surveys on Drug Use and Health (NSDUH) were analyzed.nnnRESULTSnThe prevalence rates of a broad range of health conditions by duration of use of specific illicit drug among persons 35 to 49 years of age in the United States were estimated and compared. After adjustment for potential confounding factors, the results of 20 multivariate logistic regression models indicated positive associations between duration of marijuana use and anxiety, depression, sexually transmitted disease (STD), bronchitis, and lung cancer; between duration of cocaine use and anxiety and pancreatitis; between duration of heroin use and anxiety, hepatitis, and tuberculosis; between duration of hallucinogen use and tinnitus and STD; and between duration of inhalant use and anxiety, depression, HIV/AIDS, STD, tuberculosis, bronchitis, asthma, sinusitis, and tinnitus.nnnCONCLUSIONSnThis study provides initial analyses on the relationships between illicit drug use and health conditions based on a large nationally representative sample. These results can help prepare for treating health problems among former and continuing illicit drug users.

The National Nursing Assistant Survey: Improving the Evidence Base for Policy Initiatives to Strengthen the Certified Nursing Assistant Workforce

PURPOSEnThis study introduces the first National Nursing Assistant Survey (NNAS), a major advance in the data available about certified nursing assistants (CNAs) and a rich resource for evidence-based policy, practice, and applied research initiatives. We highlight potential uses of this new survey using select population estimates as examples of how the NNAS can be used to inform new policy directions.nnnDESIGN AND METHODSnThe NNAS is a nationally representative survey of 3,017 CNAs working in nursing homes, who were interviewed by phone in 2004-2005. Key survey components are recruitment; education; training and licensure; job history; family life; management and supervision; client relations; organizational commitment and job satisfaction; workplace environment; work-related injuries; and demographics.nnnRESULTSnOne in three CNAs received some kind of means-tested public assistance. More than half of CNAs incurred at least 1 work-related injury within the past year and almost one quarter were unable to work for at least 1 day due to the injury. Forty-two percent of uninsured CNAs cite not participating in their employer-sponsored insurance plan because they could not afford the plan. Years of experience do not translate into higher wages; CNAs with 10 or more years of experience averaged just

Inappropriate emergency department visits and use of the Health Care for the Homeless Program services by Homeless adults in the northeastern United States.

2/hr more than aides who started working in the field less than 1 year ago.nnnIMPLICATIONSnThis survey can be used to understand CNA workforce issues and challenges and to plan for sustainable solutions to stabilize this workforce. The NNAS can be linked to other existing data sets to examine more comprehensive and complex relationships among CNA, facility, resident, and community characteristics, thereby expanding its usefulness.

Serious Psychological Distress and Mental Health Service Use Among Community-Dwelling Older U.S. Adults

This study tested whether the use of the Health Care for the Homeless Program (HCHP) by homeless adults was associated with reduced risk of inappropriate emergency department (ED) use. Researchers interviewed 941 homeless adults at 52 soup kitchens. Of those interviewed, 508 reported having at least 1 ED visit during the last 6 months. Then, 243 subjects 688 ED records were retrieved. Inappropriateness of each ED use was evaluated based on clinical criteria. Logistic regressions were applied. Having two or more HCHP visits [odds ratio (OR) = 0.43, 95% confidence interval (CI) 0.19, 0.90] by homeless adults was associated with decreased odds of having inappropriate ED visits.

Anticoagulation for Patients with Atrial Fibrillation in Ambulatory Care Settings

OBJECTIVESnThis study examined the prevalence and predictors of past-year serious psychological distress and receipt of mental health services among community-dwelling older adults in the United States.nnnMETHODSnThe sample included 9,957 adults aged 65 or older from the 2004-2007 National Survey on Drug Use and Health. Serious psychological distress was defined as having a score of 13 or higher on the K6 scale of nonspecific psychological distress. Descriptive analyses and logistic regression modeling were applied.nnnRESULTSnAmong community-dwelling older adults, 4.7% had serious psychological distress in the past year. Among those with past-year serious psychological distress, 37.7% received mental health services in the past year (4.8% received inpatient services, 15.8% received outpatient services, and 32.1% received prescription medications) (weighted percentages). Logistic regression results suggested that among older adults with serious psychological distress, receipt of mental health services was more likely among women, non-Hispanic whites, those who were married, those who were highly educated, Medicare-Medicaid dual beneficiaries, those with a major depressive episode, and those with more general medical conditions.nnnCONCLUSIONSnThese results suggest the need to screen for mental health problems among older adults and to improve the use and the quality of their mental health services. Since 2008 significant changes have revolutionized payment for mental health care and may promote access to mental health care in this population. Further studies are needed to assess trends in mental health service utilization among older adults and in the quality of their mental health care over time.

Comparison of mammography use by older black and white women.

Background: In the context of recently published guidelines, we studied anticoagulation for atrial fibrillation as part of stroke prevention. Methods: The National Center for Health Statistics ambulatory care surveys use a multistage random sampling design consisting of 112 US geographic primary sampling units, nonfederal physician offices and hospital outpatient departments within those units, and patient visits to those offices and outpatient departments. Patient and visit characteristics were abstracted from 1771 medical records of patients with atrial fibrillation aged 20 years or older from 2001 to 2006, representing a national estimate of 6.1 million annual visits. The dependent variable was the prescription of warfarin. Independent variables included embolic risk factors, age, sex, race, payment source, region, urban-rural location, year, primary care provider status, number of visits during the past year, and documentation of aspirin. χ2 and logistic regression measured associations with the prescription of warfarin. Analysis was performed in SUDAAN version 9.0 (RTI International, Research Triangle Park, NC). Results: Among patients with atrial fibrillation, warfarin was prescribed during 52.2% of visits. Warfarin use was more likely in 2005 to 2006 than in 2001 and at visits covered by Medicare than by those covered by private insurance. Women and non-white patients were less likely to receive warfarin than their counterparts. Patients taking aspirin were less likely to get warfarin, but there were no significant differences because of age or the presence of risk factors. Warfarin use was more likely in the Northeast as compared with all other regions of the country. Conclusions: Accepted guidelines for warfarin have been implemented during more than half of visits of patients with atrial fibrillation. Disparities exist among race, sex, and region. More attention is needed to appropriate prescribing of warfarin.

Differences in the prevalence rates and correlates of alcohol use and binge alcohol use among five Asian American subpopulations

OBJECTIVES: To identify differences in the prevalence of ever having had a mammogram and having had a recent mammogram between older black and white women and to compare factors associated with mammography use in older black and white women.

Use of the Health Care for the Homeless Program services and other health care services by homeless adults.

BACKGROUNDnThis study (1) estimated the prevalence of alcohol and binge alcohol use among adult Asian Americans by sub-ethnicity; (2) examined alcohol drinking patterns among these subpopulations; and (3) investigated sub-ethnic differences in characteristics associated with alcohol and binge alcohol use.nnnMETHODnData from 8900 Asian Americans aged 18 or older who participated in the 2002-2008 National Surveys on Drug Use and Health (NSDUHs) were analyzed. Descriptive analyses and multivariate logistic regression modeling were applied.nnnRESULTSnKorean Americans (51.8%) and Japanese Americans (49.7%) reported higher rates of past-month alcohol use than Chinese Americans (42.0%), Filipino Americans (37.9%), and Asian Indian Americans (34.0%). Korean Americans (24.6%) reported the highest rate of past-month binge alcohol use, followed by Filipino Americans (14.5%), Japanese Americans (14.2%), Asian Indian Americans (10.1%), and Chinese Americans (8.1%). Among these examined Asian Americans, foreign-born Chinese, Filipino, and Asian Indian Americans were less likely to have past-month alcohol use than their corresponding U.S. born counterparts; and only foreign-born Asian Indian Americans were less likely to have past-month binge alcohol use than their U.S. born counterparts. Males were 3-5 times more likely to have binge alcohol use than females among examined Asian American subpopulations except for Korean Americans. Korean Americans were more likely to have binge alcohol use than the other examined sub-ethnic Asian Americans.nnnCONCLUSIONSnAdult Asian Americans are heterogeneous in sociodemographic characteristics and alcohol and binge alcohol use. These differences suggest the need for sub-ethnically specific prevention and treatment programs for alcohol use problems among Asian American subpopulations.

Characteristics of patients receiving hospice care at home versus in nursing homes: results from the National Home and Hospice Care Survey and the National Nursing Home Survey.

This study examined factors associated with the use of the Health Care for the Homeless Program and other health care services by homeless adults. A total of 941 homeless adults were identified in 52 soup kitchens in U.S. communities. Descriptive statistics and logistic regression models were applied. Among homeless adults, having dental problems was the most robust factor associated with their use of Health Care for the Homeless Program services (odds ratio [OR] = 2.50, 95 percent confidence interval [CI] = 1.44-4.32). Among homeless adults who did not visit Health Care for the Homeless Program services during last six months, the number of emergency room visits was the most powerful factor associated with their use of other health care services (OR = 1.15, 95 percent CI = 1.05-1.26). The results of the study can help health care providers better serve homeless adults to meet their health needs.