Carla A Green

Gender Differences in the Relationships Between Multiple Measures of Alcohol Consumption and Physical and Mental Health

BACKGROUNDnEpidemiological research examining health consequences of alcohol consumption generally relies on average volume consumed, yet examinations of drinking patterns show different dimensions of use associated with different health outcomes. Gender differences in metabolism and body composition may lead to gender-specific consequences of drinking frequency, quantity consumed per occasion, average amount consumed, and drinking pattern. Inconsistent results suggest gender differences are not well understood.nnnMETHODSnParticipants were 3069 male and 2600 female health maintenance organization survey respondents. Gender differences in relationships between alcohol consumption and health were examined using analyses of covariance adjusting for age alone and for age, ethnicity, marital status, body water index, and smoking. Past-year alcohol consumption (frequency, quantity per occasion, average drinks per month, and drinking pattern) and health measures (Short Form-36 general health, physical functioning, mental health subscales) were examined.nnnRESULTSnGender x drinking frequency and drinking quantity interactions were significant in age-adjusted and fully adjusted models of general health and physical functioning. Gender interactions for drinking pattern were significant in the age-adjusted model and marginally significant in the fully adjusted model. No gender x drinking measure interactions were found for mental health. Fully adjusted models attenuated but did not eliminate gender differences for health and magnified relationships for functioning, the latter after adjusting for body water. For both genders, light to moderate consumption and more frequent drinking were associated with better health and functioning; relationships were stronger among women than men.nnnCONCLUSIONSnGender x drinking measure interactions in health outcomes suggest analyses should include such interactions except, possibly, for mental health. Adjusting for potential confounders can attenuate (general health) or magnify (physical functioning) gender differences. Functional status appears a sensitive measure for evaluating gender differences in alcohols health effects, adjusting for body water. Womens health may benefit proportionally more from moderate drinking than mens.

Training rural practitioners to use buprenorphine: Using The Change Book to facilitate technology transfer

The Opiate Medication Initiative for Rural Oregon Residents trained physicians and counselors in Central and Southwestern Oregon to use buprenorphine and develop service models that supported patient participation in drug abuse counseling. The Change Book from Addiction Technology Transfer Centers was used to structure the change process. Fifty-one individuals (17 physicians, 4 pharmacists, 2 nurse practitioners, and 28 drug abuse counselors and administrators) from seven counties completed the training and contributed to the development of community treatment protocols. A pre-post measure of attitudes and beliefs toward the use of buprenorphine suggested significant improvements in attitude after training, especially among counselors. Eight months after training, 10 of 17 physicians trained had received waivers to use buprenorphine and 29 patients were in treatment with six of the physicians. The Change Book facilitated development of county change teams and structured the planning efforts. The initiative also demonstrated the potential to concurrently train physicians, pharmacists, and counselors on the use of buprenorphine.

Gender differences in outcomes in an HMO-based substance abuse treatment program

Abstract This study examined gender differences in treatment outcomes and outcomes predictors among 155 men and 81 women attending a gendersensitive substance abuse treatment program. Bivariate analyses indicated women improved more than men in social/family and daily functioning domains, but differences disappeared after controlling for baseline characteristics. Multivariate models predicting treatment outcomes revealed that, across Addiction Severity Index domains, outcomes for men were predicted primarily by mental health and medical conditions, severity of the substance abuse problem, and treatment completion. For women, in addition to treatment completion, outcomes were more likely to be predicted by social, sociodemographic, and life history characteristics. For abstinence outcomes, women who completed treatment were 9 times as likely to be abstinent at 7-month followup as other women; men who completed were 3 times more likely to be abstinent than other men. Women with more severe psychiatric status and those who felt their life was out of control were less likely to be abstinent, as were men who lived alone. Clinicians targeting such factors differentially for men and women may enhance the effectiveness of treatment.

Community-based care and risk of nursing home placement

Objective. To test the substitution hypothesis, that community-based care reduces the probability of institutional placement for at-risk elderly. Research Design. The closure of the Social Health Maintenance Organization (Social HMO) at HealthPartners (HP) in Minnesota in 1994 and the continuation of the Social HMO at Kaiser Permanente Northwest (KPNW) in Oregon/Washington comprised a “natural experiment.” Using multinomial logistic regression analyses, we followed cohorts of Social HMO enrollees for up to 5 years, 1995 to 1999. To adjust for site effects and secular trends, we also followed age- and gender-matched Medicare-Tax Equity and Fiscal Responsibility Act (TEFRA) cohorts, enrolled in the same HMOs but not in the Social HMOs. Subjects. All enrollees in the Social HMO for at least 4 months in 1993 and an age-gender matched sample of Medicare–TEFRA enrollees. To be included, individuals had to be alive and have a period out of an institution after January 1, 1995 (total n = 18,143). Measures. The primary data sources were the electronic databases at HP and KPNW. The main outcomes were long-term nursing home placement (90+ days) or mortality. Covariates were age, gender, a comorbidity index, and geographic site effect. Results. Adjusting for variations in the 2 sites, we found no difference in probability of mortality between the 2 cohorts, but approximately a 40% increase in long-term institutional placement associated with the termination of the Social HMO at HealthPartners (odds ratio, 1.43; 95% confidence interval, 1.15–1.79). Conclusions. The Social HMO appears to help at-risk elderly postpone long-term nursing home placement.

Structural Models of Gender, Alcohol Consumption, and Health

Background.u2002Gender differences exist in patterns of alcohol consumption and in the health and social effects of alcohol use, but little is known about gender differences in how alcohol use is affected by mental and physical health conditions. Methods.u2002We used structural equation modeling techniques to examine gender differences in the relationships among alcohol consumption, physical and mental health, functional status, and social and demographic characteristics. Data were obtained from a random sample of the adult membership of a health maintenance organization in the U.S. Pacific Northwest. Simultaneous models evaluated gender differences in predictors of drinking vs. nondrinking status and, among drinkers, amount of alcohol consumed. Results.u2002Physical health was twice as strong a predictor of drinker/nondrinker status among women compared with men, but among drinkers, there were no gender differences in predictors of amount of alcohol consumed. Mental health predicted drinking status and alcohol consumption among drinkers, but these relationships did not differ by gender. Overall, sociodemographic characteristics and physical health were stronger predictors of alcohol use among women than among men. Conclusions.u2002Women may be more amenable than men to alcohol-related preventive messages that target physical health concerns. Treating mental health conditions may be an important method for reducing alcohol consumption.

Talk about costs: Health care professionals' views about expenses related to substance abuse treatment

The organization, financing, and delivery of substance abuse treatment services have undergone rapid change in the U.S. In 1991, about 10% of Medicaid clients were in managed care systems, a figure that in 1998 had risen to 54% nationwide (Centers for Medicare and Medicaid Services, 1995; Centers for Medicare and Medicaid Services, 2000) and to nearly 85% in Oregon (Laws, Gabriel, and McFarland, 2002). Health plans, providers, and payers have become increasingly interested in understanding factors that affect costs of care and determine appropriate payment rates and methods, particularly for populations with special needs (Frank, McGuire, & Newhouse, 1995; McCarty, Dilonardo, & Argeriou, 2003; Swartz, 1995). To this end, various riskadjustment models have been developed to match capitation rates with the characteristics of the populations covered by those payments (Rice & Smith, 2001). Inadequate compensation for publicly funded clients can cause health plans and providers to leave programs that require acceptance of capitated payment rates (Ettner & Johnson, 2003; McFarland, Carla A. Green, Ph.D., M.P.H., is a Research Assistant Professor in the Department of Public Health and Preventive Medicine at Oregon Health and Science University, and an Affiliate Investigator at Kaiser Permanente Center for Health Research in Portland, OR. Frances L. Lynch, Ph.D., MSPH, is an Investigator, and Michael R. Polen, M.A., is a Senior Research Associate, both at the Kaiser Permanente Center for Health Research in Portland. Bentson H. McFarland, M.D., Ph.D., is a Professor in the Departments of Psychiatry and Public Health and Preventive Medicine at Oregon Health and Science University, and an Affiliate Investigator at Kaiser Permanente Center for Health Research in Portland. Daniel M. Dickinson, M.A., is a Clinical Manager in the Department of Addiction Medicine at Kaiser Permanente Northwest in Portland. Donald K. Freeborn, Ph.D., is a Clinical Professor in the Department of Public Health and Preventive Medicine at Oregon Health and Science University, and a Senior Investigator Emeritus at Kaiser Permanente Center for Health Research in Portland. The authors would like to thank the health care professionals who volunteered their time for this project. In addition, we would like to thank Shannon Fulmer for her help arranging and coordinating all the focus group interviews, and for helping with manuscript production. This work was supported by the National Institute on Drug Abuse, Grant R01 DA11646. Address for correspondence: Carla A. Green, Ph.D., M.P.H., Kaiser Permanente Center for Health Research, 3800 N. Interstate Avenue, Portland, OR. E-mail: carla.a.green@kpchr.org. Administration and Policy in Mental Health, Vol. 31, No. 6, July 2004 ( 2004)