Brandi P. Cotton

Residential Instability Among Low-Income Families: A Concept Analysis

Residential instability is relatively common among low-income families and is associated with a host of negative outcomes, especially for children and adolescents. Psychiatric nurses, especially those in the advanced practice role, observe the consequences of residential instability within the clinical setting. Yet, to-date, the concept is somewhat vague and its essential meaning and definition remain unclear. The aim of this paper is to develop a definition of residential instability using Wilsons method of concept analysis. An overview of historical perspectives is included. The paper concludes with recommendations for future research and application within clinical practice.

Relationships between self-determination theory and theory of planned behavior applied to physical activity and exercise behavior in chronic pain

Abstract This study examined the relationships between self-determination theory (SDT) and theory of planned behavior (TpB) applied to physical activity and exercise behavior (PA&E) in people with chronic pain. Two hundred and eleven adults with chronic musculoskeletal pain (28 males and 183 females, age range 18 to 82 years, mean age 43 years) were recruited from online support groups and clinic networks in the United States. Participants completed SDT measures relevant to PA&E on perceived autonomy support, autonomy, competence, and relatedness, as well as TpB measures relevant to PA&E on intention, attitudes, subjective norms, and perceived behavioral control. Correlational techniques and canonical correlation analysis were performed to examine the relationships and variance within and between theoretical dimensions. Overall, the SDT set accounted for 37% of the TpB variance and the TpB set accounted for 32% of the SDT set variance. The results indicate there are statistical similarities and differences between concepts in SDT and TpB models for PA&E. Using both empirical guidance and clinical expertise, researchers and practitioners should attempt to select and integrate non-redundant and complementary components from SDT, TpB, and other related health behavior theories.

Characteristics of Medicaid recipients in Methadone Maintenance Treatment: A comparison across the lifespan

Methadone Maintenance Treatment (MMT) is utilized by an increasingly broad age-range of individuals with opioid use disorders. The present study aims to (1) describe health, behavioral, and psychosocial characteristics among adults aged 50 years and older compared with younger adults enrolled in MMT, (2) describe socioeconomic and clinical characteristics by age and time in MMT and (3) investigate whether age influences the associations between duration of MMT and health and psychosocial characteristics. Our sample consisted of 1364 recipients from four MMT programs (age ranged from 18 to 77 years; mean: 38 years: standard deviation: 11.1 years) in Southern New England Using descriptive analysis and logistic regression, we determined that one-third (33%) of adults 50 years of age and older had been admitted or readmitted into MMT within the previous 6 months, 27% had been in treatment for 7-47 months, while 40% had been in treatment for at least 4 years. Psychosocial problems and smoking were both common (>80%) at the time of MMT enrollment but declined with longer duration of MMT for all age groups. The prevalence of metabolic conditions was associated with increased duration of MMT for younger adults for both age (1.03; CI 1.02-1.05; p < 0.001) and time in treatment (1.29; 1.12-1.44; p < 0.001; interaction term 0.0996; CI 0.993-0.998). Tailored strategies to enhance engagement, retention, and prevention among MMT recipients should include considerations of age, health status upon enrollment, duration of treatment, and developmental context.

Methadone Maintenance Treatment for Older Adults: Cost and Logistical Considerations

In a demographic shift, older adults now comprise an increasing proportion of those receiving methadone maintenance treatment (MMT) for opioid use disorder. A study of MMT recipients in New York City suggests that 13% of the population is over 60 years of age. Adults ages 50-59 are among the largest age demographic, evidence that the number of older adults receiving MMT will continue to increase. Because medical comorbidities, cognitive impairment, and neurobehavioral changes often accumulate with age, older adults on MMT become increasingly vulnerable. The cost of MMT and logistical considerations also pose challenges to continued care. Together, these issues warrant a reconsideration of emerging concerns and health policies related to use of MMT in this growing and understudied population. Given the changing health care system and the opioid epidemic, the need for evidence-based guidelines and supportive policies that consider the unique treatment needs of older populations is especially relevant.

Mindfulness as a protective factor against depressive symptoms in people with fibromyalgia

Abstract Background: Depressive symptoms complicate pain management for people with FM, with adverse consequences such as a greater need for pain medications and limited pain coping strategies. Determining risks and protective factors associated with depressive symptoms in persons with FM could inform the development and implementation of mental health interventions. Aims: To formulate and test a behavioral activation model of depression with mindfulness as a protective factor for people with FM. Methods: We conducted an online cross-sectional survey with 117 adults with FM from community and clinic networks. Path analysis was used to assess the relationships of pain intensity, perceived stress, activity interference, pain catastrophizing and mindfulness with depressive symptoms. Results: Mindfulness has a negative direct association with depressive symptoms and a negative indirect association with depressive symptoms through perceived stress, activity interference and pain catastrophizing. Perceived stress, activity interference and pain catastrophizing had direct associations with depressive symptoms. Finally, perceived stress, activity interference and pain catastrophizing had indirect associations with depressive symptoms through pain intensity. Conclusions: Mindfulness seems to play an important role as a protective factor against the negative effects of stress and depression among people with FM and should be included in mental health interventions for chronic pain.

Residential Mobility and Social Behaviors of Adolescents: A Systematic Review of the Literature.

PROBLEM The association between residential mobility and negative behaviors in adolescence has attracted multidisciplinary attention. METHODS The purpose of this article is to conduct a systematic literature review in order to synthesize research that measured mobility and at least one social behavior among participants 11 thru 18 years of age. The systematic search yielded 22 studies. FINDINGS Residential mobility is associated with negative behaviors among adolescents, including social problems, delinquency, substance and nicotine use, and adolescent pregnancy. However, these effects are explained by neighborhood disadvantage and inherent differences between movers and nonmovers. CONCLUSION For youth from disadvantaged backgrounds, moving may be one indicator of problem behaviors. Attending to when and why youth move-and to where-contributes to an understanding of the etiology of risky behaviors.