Catherine W. Striley

Organizational Context and Provider Perception as Determinants of Mental Health Service Use

This study refines and tests an individual client model of service use and contrasts it with a model of service provision based on gateway provider perspectives. Structural equation models demonstrate that provider variables account for more service use variation than client variables. The client model accounts for 24% of the variance in service use, while the provider model accounts for 55% of the variance. Youth self-reported mental health was not positively associated with increased services or with provider perception of youth mental health. The provider model demonstrates the critical role played by provider perceptions, which are influenced more by work environment than by client problems.

Effects of major depression on crack use and arrests among women in drug court.

AIMS We examined whether a current major depressive episode (MDE) at baseline predicted crack use and arrests at follow-up among women enrolled in drug court. DESIGN Primary analyses used zero-inflated Poisson (ZIP) and zero-inflated negative binomial (ZINB) regression analyses to predict both yes/no and number of (i) days of crack use and (ii) arrests at 4-month follow-up from current (30-day) MDE at baseline. Secondary analyses addressed risk conferred by current versus past MDE at baseline. SETTING/PARTICIPANTS Participants were 261 women in drug court. MEASUREMENTS MDE was assessed using the Diagnostic Interview Schedule. Days using crack and number of arrests were assessed using the Washington University Risk Behavior Assessment for Women. FINDINGS Having a current MDE at baseline predicted likelihood of crack use at follow-up, but not days of crack use among those who used. Current MDE at baseline did not predict presence or number of arrests at the 4-month follow-up. Women with current MDE at baseline were more likely to be using crack at follow-up than were those with recent (31+ days to 12 months) but not current MDE (odds ratio = 5.71); past MDE at baseline did not increase risk of crack use. CONCLUSIONS Predictors of any versus no crack use or arrests appear to differ from predictors of frequency of these behaviors. Current major depression, but not past major depression, appears to be associated with increased risk of crack use among women attending drug court.

Review of the energy drink literature from 2013: findings continue to support most risk from mixing with alcohol.

Purpose of review In the field of caffeine research, interest in and concern for energy drink consumption have grown. Most caffeine-related research studies published in 2013 focused on energy drink consumption. This article reviews this literature. Recent findings Prevalence of energy drink consumption varies by measure and age group. Lack of a standardized definition of use inhibits comparison across studies. Studies reviewed show that energy drink consumption is generally low, but the minority who drink the most may be consuming at unsafe levels. Energy drinks are popular among adolescents and young adults. They boost energy and alertness in some conditions, but may have adverse hemodynamic effects. Harmful consequences, including involvement in risky driving, riding with an intoxicated driver and being taken advantage of sexually, were reported significantly more often by adolescents and young adults who combined energy drinks with alcohol compared with those who did not. Summary This review of recent literature focused on prevalence, motivation, and consequences of energy drink use. Clear findings emerged only on the dangers of mixing alcohol and energy drinks. The lack of a standardized measure made the comparison across studies difficult. Future research should extend and clarify these findings using standardized measures of use.

Assessing prescription stimulant use, misuse, and diversion among youth 10-18 years of age.

Purpose of review Assessing the medical and nonmedical use (NMU) of stimulants and diversion is a challenge, especially among youth, with different methods for recruitment and definitions of NMU. The field needs inexpensive, yet effective and reliable, methods of data collection to understand the prescription drug use problem. Most studies of youth are school or web-based, and conducted with teens. Recent findings The National Monitoring of Adolescent Prescription Stimulants Study recruited 11 048 youth 10–18 years of age from urban, rural, and suburban areas in 10 US cities using an entertainment venue intercept study. This review discusses the effectiveness of the method and results from four cross-sections as well as the representativeness of the sample. Lifetime prevalence of any stimulant use was 14.8%, with rates highest among rural 16–18 year olds. The rate of last 30-day use was 7.3%, with over half (3.9%) NMU. Nearly 12% of all youth (whether a user or not) reported lifetime incoming/outgoing diversion of prescription stimulants. Summary Because no study has focused on stimulant use among youth as young as 10 and 11, this study is a landmark for future comparisons and offers a unique strategy for sampling and data collection.

Enrolling, Retaining, and Benefiting Out-of-Treatment Drug Users in Intervention Research

Longitudinal research on street-recruited out-of-treatment drug users involves ethical issues concerning enrollment and retention of participants, remuneration and benefits. In contrast to practices of excluding such high-risk populations from research and assuming that they would not comply with a protocol requiring repeated measures over a 12-month period, this report presents examples from 15 years of community-based studies that have enrolled drug-using participants and achieved a 96% retention rate. We also examine ethical issues connected with cash remuneration, and describe methods to elucidate the kinds of benefits that are most meaningful to this population. Findings suggest that the research community must reconsider the ethics of blanket exclusions of such high-risk subjects, and make evidence-based decisions about recruitment, retention, remuneration, and benefits.

Stakeholder Perspectives on Creating and Maintaining Trust in Community–Academic Research Partnerships

Community–academic research partnerships aim to build stakeholder trust in order to improve the reach and translation of health research, but there is limited empirical research regarding effective ways to build trust. This multisite study was launched to identify similarities and differences among stakeholders’ perspectives of antecedents to trust in research partnerships. In 2013-2014, we conducted a mixed-methods concept mapping study with participants from three major stakeholder groups who identified and rated the importance of different antecedents of trust on a 5-point Likert-type scale. Study participants were community members (n = 66), health care providers (n = 38), and academic researchers (n = 44). All stakeholder groups rated “authentic communication” and “reciprocal relationships” the highest in importance. Community members rated “communication/methodology to resolve problems” (M = 4.23, SD = 0.58) significantly higher than academic researchers (M = 3.87, SD = 0.67) and health care providers (M = 3.89, SD = 0.62; p < .01) and had different perspectives regarding the importance of issues related to “sustainability.” The importance of communication and relationships across stakeholders indicates the importance of colearning processes that involve the exchange of knowledge and skills. The differences uncovered suggest specific areas where attention and skill building may be needed to improve trust within partnerships. More research on how partnerships can improve communication specific to problem solving and sustainability is merited.

Utilizing spatial statistics to identify cancer hot spots: a surveillance strategy to inform community-engaged outreach efforts

BackgroundUtilization of spatial statistics and Geographic Information Systems (GIS) technologies remain underrepresented in the community-engagement literature, despite its potential role in informing community outreach efforts and in identifying populations enthusiastic to participate in biomedical and health research. Such techniques are capable not only of examining the epidemiological relationship between the environment and a disease, but can also focus limited resources and strategically inform where on the landscape outreach efforts may be optimized.MethodsThese analyses present several spatial statistical techniques among the HealthStreet population, a community-engaged organization with aims to link underrepresented populations to medical and social care as well as opportunities to participate in University-sponsored research. Local Indicators of Spatial Association (LISA) and Getis-Ord Gi*(d) statistics are utilized to examine where cancer-related “hot spots” exist among minority and non-minority HealthStreet respondents within Alachua County, Florida, United States (US). Interest in research is also reported, by minority status and lifetime history of cancer.ResultsOverall, spatial clustering of cancer was observed to vary by minority status, suggesting disparities may exist among minorities and non-minorities in regards to where cancer is occurring. Specifically, significant hot spots of cancer were observed among non-minorities in more urban areas throughout Alachua County, Florida, US while more rural clusters were observed among minority members, specifically west and southwest of urban city limits.ConclusionsThese results may help focus future outreach efforts to include underrepresented populations in health research, as well as focus preventative and palliative oncological care. Further, global community engaged studies and community outreach efforts outside of the United States may use similar methods to focus limited resources and recruit underrepresented populations into health research.

Cultural and Ethical Issues Concerning Research on American Indian Youth

A study of American Indian youths illustrates competing pressures between research and ethics. A stakeholder-researcher team developed three plans to protect participants. The first allowed participants to skip potentially upsetting interview sections. The second called for participants flagged for abuse or suicidality to receive referrals, emergency 24-hr clinical backup, or both. The third, based on the communitys desire to promote service access, included giving participants a list of service resources. Interviewers gave referrals to participants flagged as having mild problems, and reported participants with serious problems to supervisors for clinical backup. Participants seldom chose to skip sections, so data integrity was not compromised. However, participants did have more problems than expected (e.g., 1 in 3 had thought about suicide, 1 in 5 had attempted suicide, and 1 in 4 reported abuse), so service agencies were not equipped to respond. Researchers must accept the competing pressures and find ethically appropriate compromises that will not undermine research integrity.

Correlates of use of alcohol mixed with energy drinks among youth across 10 US metropolitan areas

BACKGROUND Predictors of use of alcohol mixed with energy drinks (AmED) among youth have been understudied. The current analyses investigated the prevalence of and correlates for use of AmED among alcohol users from a national study of stimulant use among youth. METHODS The National Monitoring of Adolescent Prescription Stimulants Study (N-MAPSS) assessed behaviors and risk factors for stimulant use from 11,048 youth, 10-18 years of age recruited from entertainment venues across 10 US cities. Of the four cross sections, two had questions on having alcohol mixed with energy drinks (AmED) in the past 30 days along with sociodemographic characteristics, current tobacco and marijuana use and current nonmedical use of prescription opioids, anxiolytics, and stimulants. Only 13 to18 year olds and those who reported alcohol use were included in the analyses. RESULTS Overall, 28.4% (1392 out of 4905) of the 13 to18 year olds reported past 30-day alcohol use. Among alcohol users, 27% reported having alcohol mixed with energy drinks in the past 30 days. Multivariate logistic regression indicated that use of AmED was significantly associated with tobacco and marijuana use and nonmedical use of prescription stimulants. CONCLUSIONS Underage drinking is common among youth and more than a quarter of these drinkers use AmED. Use of AmED is significantly associated with tobacco and marijuana use and nonmedical use of prescription stimulants. Drug and alcohol intervention programs should educate on the risks of AmED, as the same population is at high-risk for use of AmED and alcohol/drug use.

A review of current ethical concerns and challenges in substance use disorder research.

Purpose of review To consider and summarize provocative and important publications from 2009 and 2010 related to the ethics of international substance use disorder research. Recent findings This review highlights publications related to the interconnected areas of responsible conduct of research, human participant protections and the increasingly important area of community concerns in research, all within the larger realm of ethical concerns. Ongoing concerns highlighted include standards for conflict of interest, recruitment and remuneration practices. Other literature discussed expands the ethical dialogue to consider the community perspective on research, stigmatization of drug users from research and the absence of the ‘moral voice’ of drug users in ethical decision-making. Summary Ethical dilemmas are inherent in the pursuit of any research; in substance use disorder research, often situated in a community with at-risk populations, questions such as who sets the research agenda and what norms are followed are critically important. Responsible research that protects participants and their communities internationally requires ongoing vigilance.