C. Raymond Bingham

Pharmacy data identify poorly adherent patients with schizophrenia at increased risk for admission.

Background. Health care organizations may be able to use pharmacy data to identify patients with schizophrenia and poor antipsychotic adherence. Objective. To determine whether a pharmacy-based measure of outpatient adherence, the medication possession ratio (MPR), is associated with adverse outcomes among patients with schizophrenia, as evidenced by increased psychiatric admission. Research Design. Cohort study linking pharmacy and utilization data for veterans with schizophrenia. MPRs were calculated by dividing the number of days’ supply of antipsychotic medication the veteran had received by the number of days’ supply they needed to receive to take their antipsychotic continuously. Using multivariate regression, the relationship between MPRs and psychiatric admission was examined. Subjects. Sixty-seven thousand seventy-nine veterans who received a diagnosis of schizophrenia and had outpatient antipsychotic medication fills between October 1, 1998 and September 30, 1999. Results. Patients with MPRs close to 1.0 had the lowest rates of admission. As patients secured progressively smaller proportions of required antipsychotic medication (and had smaller MPRs), rates of admission climbed. Among patients on one antipsychotic (n = 49,003), patients with poor adherence (MPRs < 0.8) were 2.4 times as likely to be admitted as patients with good adherence (MPRs from 0.8–1.1). 23% of poorly adherent patients but only 10% of adherent patients were admitted. Once admitted, poorly adherent patients had more hospital days. Patients who received excess medication also had higher admission rates. Conclusions. Many health care systems may be able to use pharmacy data to identify poorly adherent patients with schizophrenia. These patients are at-risk for admission and may benefit from intervention.

Effects of a brief intervention for reducing violence and alcohol misuse among adolescents: a randomized controlled trial.

CONTEXT Emergency department (ED) visits present an opportunity to deliver brief interventions to reduce violence and alcohol misuse among urban adolescents at risk of future injury. OBJECTIVE To determine the efficacy of brief interventions addressing violence and alcohol use among adolescents presenting to an urban ED. DESIGN, SETTING, AND PARTICIPANTS Between September 2006 and September 2009, 3338 patients aged 14 to 18 years presenting to a level I ED in Flint, Michigan, between 12 pm and 11 pm 7 days a week completed a computerized survey (43.5% male; 55.9% African American). Adolescents reporting past-year alcohol use and aggression were enrolled in a randomized controlled trial (SafERteens). INTERVENTION All patients underwent a computerized baseline assessment and were randomized to a control group that received a brochure (n = 235) or a 35-minute brief intervention delivered by either a computer (n = 237) or therapist (n = 254) in the ED, with follow-up assessments at 3 and 6 months. Combining motivational interviewing with skills training, the brief intervention for violence and alcohol included review of goals, tailored feedback, decisional balance exercise, role plays, and referrals. MAIN OUTCOME MEASURES Self-report measures included peer aggression and violence, violence consequences, alcohol use, binge drinking, and alcohol consequences. RESULTS About 25% (n = 829) of screened patients had positive results for both alcohol and violence; 726 were randomized. Compared with controls, participants in the therapist intervention showed self-reported reductions in the occurrence of peer aggression (therapist, -34.3%; control, -16.4%; relative risk [RR], 0.74; 95% confidence interval [CI], 0.61-0.90), experience of peer violence (therapist, -10.4%; control, +4.7%; RR, 0.70; 95% CI, 0.52-0.95), and violence consequences (therapist, -30.4%; control, -13.0%; RR, 0.76; 95% CI, 0.64-0.90) at 3 months. At 6 months, participants in the therapist intervention showed self-reported reductions in alcohol consequences (therapist, -32.2%; control, -17.7%; odds ratio, 0.56; 95% CI, 0.34-0.91) compared with controls; participants in the computer intervention also showed self-reported reductions in alcohol consequences (computer, -29.1%; control, -17.7%; odds ratio, 0.57; 95% CI, 0.34-0.95). CONCLUSION Among adolescents identified in the ED with self-reported alcohol use and aggression, a brief intervention resulted in a decrease in the prevalence of self-reported aggression and alcohol consequences. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00251212.

Timing of first sexual intercourse: The role of social control, social learning, and problem behavior

Prior research has pointed to several distinct processes that may affect the timing of first intercourse among adolescents. In the present study, the role of six hypothesized processes was assessed in a sample of 289 rural adolescent boys and girls. Results support the importance of family socialization and problem-behavior for both sexes, the role of biological factors for boys, and the role of social control processes for girls. Two other hypothesized influences—social class and poor psychosocial adjustment—were not supported in either gender. These results indicate that multiple processes influence the timing of first intercourse; thus, they underscore the need for eclectic predictive models that incorporate the multiplicity of influences.

Individual and social/environmental predictors of alcohol and drug use 2 years following substance abuse treatment.

The purpose of this study was to identify individual and social/environmental predictors of alcohol and drug use 2 years following substance abuse treatment. Participants (n=180) self-administered questionnaires within their first month of substance abuse treatment and completed a 2-year follow-up interview. Individual factors (coping, self-efficacy, resource needs, and expectations for sober fun), social/environmental factors (craving, exposure, negative social influences, and involvement in substance-using leisure activities), and background characteristics measured during treatment were used to predict alcohol and drug use during a 2-year follow-up using manifest variable regression analysis. Results suggest that poorer self-efficacy, greater involvement in substance-using leisure activities, being single, and less income predicted alcohol use directly, whereas greater resource needs and involvement in substance-using leisure activities, being of minority status, and being single predicted drug use directly. Income, gender, problem severity, marital status, and race also predicted alcohol and drug use indirectly. Findings highlight differential predictors of posttreatment substance use that may be useful in developing alternative approaches to prevent relapse.

Longitudinal adjustment patterns of boys and girls experiencing early, middle, and late sexual intercourse

This study examined the association between psychosocial development and the timing offirst sexual intercourse in a sample of White, rural adolescents. Two theoretical models were tested. The first model, derived from problem behavior theory, proposed that earlier timing of first sexual intercourse is associated with longitudinal patterns of transition proneness and poor psychosocial adjustment. The second model, the stage termination model, proposed that early first sexual intercourse interferes with subsequent development, thereby resulting in negative developmental outcomes. Problem behavior theory was supported. For both boys and girls, earlier timing of first sexual intercourse was associated with longitudinal patterns of greater transition proneness and poorer psychosocial adjustment. The stage termination model was not supported. No evidence was found suggesting that early timing of first sexual intercourse results in negative psychosocial outcomes.

Behavioral Outcomes among Children of Alcoholics During the Early and Middle Childhood Years: Familial Subtype Variations

This study examined early behavioral outcomes among young children of alcoholics (COAs) as a function of differences in subtype of paternal alcoholism. Participants were 212 children (106 girls and 106 boys, ages 3 through 8) and both of their biological parents. Families were characterized as antisocial alcoholics, nonantisocial alcoholics, and nonalcoholic controls. There were significant familial subtype group differences on parent report measures of childrens total behavior problems, externalizing behavior, and internalizing behavior, and on measures of childrens intellectual functioning and academic achievement. In all instances, COAs had poorer functioning than controls. In the behavior problem domain, but not for the domain of intellectual functioning, children from antisocial alcoholic families had greater problems than children from nonantisocial alcoholic families. In addition to the subtype effects, boys had higher levels of behavior problems than girls in all three areas, and older children had more internalizing problems than younger children. Maternal functioning pertaining to lifetime alcohol problem involvement and antisocial behavior also contributed to child subtype differences in internalizing behavior. Results indicate that, even at very early ages, male and female COAs are heterogeneous populations that are distinguishable by way of familial subtype membership, as well as distinguishable from their non-COA peers. Thus, findings underscore the need to consider the heterogeneity of alcoholism when looking at its effects on child development.

Brief motivational interviewing intervention for peer violence and alcohol use in teens: one-year follow-up.

BACKGROUND AND OBJECTIVES: Emergency department (ED) visits present an opportunity to deliver brief interventions (BIs) to reduce violence and alcohol misuse among urban adolescents at risk for future injury. Previous analyses demonstrated that a BI resulted in reductions in violence and alcohol consequences up to 6 months. This article describes findings examining the efficacy of BIs on peer violence and alcohol misuse at 12 months. METHODS: Patients (14–18 years of age) at an ED reporting past year alcohol use and aggression were enrolled in the randomized control trial, which included computerized assessment, random assignment to control group or BI delivered by a computer or therapist assisted by a computer. The main outcome measures (at baseline and 12 months) included violence (peer aggression, peer victimization, violence-related consequences) and alcohol (alcohol misuse, binge drinking, alcohol-related consequences). RESULTS: A total of 3338 adolescents were screened (88% participation). Of those, 726 screened positive for violence and alcohol use and were randomly selected; 84% completed 12-month follow-up. In comparison with the control group, the therapist assisted by a computer group showed significant reductions in peer aggression (P < .01) and peer victimization (P < .05) at 12 months. BI and control groups did not differ on alcohol-related variables at 12 months. CONCLUSIONS: Evaluation of the SafERteens intervention 1 year after an ED visit provides support for the efficacy of computer-assisted therapist brief intervention for reducing peer violence.

Rates and Correlates of Violent Behaviors Among Adolescents Treated in an Urban Emergency Department

PURPOSE Violence is a leading cause of death for adolescents in inner-city settings. This article describes violent behaviors in relation to other risk behaviors (e.g., substance use) among adolescents screened in an urban emergency department (ED). METHODS Patients aged 14-18 years were approached to self-administer a computerized survey assessing violent behaviors (i.e., physical aggression), substance use (cigarettes, alcohol, marijuana), and weapon carriage. RESULTS A total of 1128 adolescents (83.8% participation rate; 45.9% male; 58.0% African-American) were surveyed. In the past year, 75.3% of adolescents reported peer violence, 27.6% reported dating violence, and 23.5% reported carrying a weapon. In the past year, 28.0% drank alcohol, 14.4% binge drank, 5.7% reported alcohol-related fighting, and 36.9% smoked marijuana. Logistic regression analyses predicting violent behaviors were significant. Teens reporting peer violence were more likely to be younger, African-American, on public assistance, carry a weapon, binge drink, and smoke marijuana. Teens reporting dating violence were more likely to be female, African-American, carry a weapon, binge drink, screen positive for alcohol problems, and smoke marijuana. Teens reporting alcohol-related fighting were more likely to carry a weapon, binge drink, screen positive for alcohol problems, and smoke marijuana. CONCLUSIONS Adolescents presenting to an urban ED have elevated rates of violent behaviors. Substance use (i.e., binge drinking and smoking marijuana) is an important risk factor for violent behaviors among urban adolescents. Universal screening and intervention protocols to address multiple risk behaviors, including violent behaviors and substance use, may be useful to prevent injury among adolescents presenting to the urban ED.

Family Configuration in Relation to the Sexual Behavior of Female Adolescents.

Several recent studies have reported that aspects of family configuration including both sibling constellation and parents marital status are related to adolescent sexual intercourse experience. However these findings often have been based on relatively small community or regional samples and the analyses sometimes have not included adequate controls. The present study based on a national probability sample of 15-to-19-year-old women replicates only one of the earlier results. Teenage young women who have been raised by a single parent are more likely to have nonmarital sexual intercourse than young women from intact marriages. However this effect is diminished by controlling for age and race social class and religion. When all of these variables are entered first in a regression equation the effect of parents marital status on daughters sexual status is greatly reduced but remains marginally significant. Sibling constellation effects reported in some earlier studies are not evident in these data. (Authors)

Ethnicity and diagnostic patterns in veterans with psychoses

Abstract.Background:Differential diagnosis of schizophrenia and bipolar disorder is a challenging but important task. These conditions often exhibit overlapping clinical symptomatology, but have different prognoses and pharmacological management strategies. Factors other than clinical presentation may influence diagnosis. Past studies suggest that ethnicity is one such factor, with variations observed in diagnostic rates of serious mental illness (SMI). With increasing attention paid to provider cultural competency, we investigate current diagnostic practices within a veteran population.Method:Controlling for patient need characteristics and illness severity, we examine whether ethnic differences in diagnosis continue to exist. If so, race may adversely enter the evaluation process. A national database of all SMI veterans explores the relationship between ethnicity and diagnosis. The role of symptomatology is also examined. Given minimal variation in veteran socioeconomic status, the Department of Veterans Affairs (VA) provides a natural setting to address this confounding factor. The 1999 National Psychosis Registry provides a sample of 134,523 veterans diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder. Multinomial logistic regression yielded odds ratios (OR) for being diagnosed with schizophrenia versus bipolar disorder; the schizoaffective versus bipolar risk was likewise assessed, exploring theoretical aspects of a psychosis-affective ‘continuum’.Results:Small effects were observed for being male, single or rural resident. However, the demographic characteristic most strongly associated with a schizophrenia diagnosis was race. The OR for African Americans was 4.05, and 3.15 for Hispanics. Similar though less dramatic results were revealed for schizoaffective disorder.Conclusions:This study confirms continued ethnic disparities in diagnostic patterns, and highlights the importance of recognizing ethnic differences in symptom presentation while emphasizing greater cultural competency.