Cyleste C. Collins

To smoke or not to smoke: Impact on disability, quality of life, and illicit drug use in baseline polydrug users

Abstract Does tobacco use in polydrug users relate to future daily functioning (SF-36) and disability? To answer this question, community-living polydrug users (n = 254) were interviewed at baseline, 1-year and 2-year follow-up. Measures included: smoking status and self-reported disability at each assessment, and SF-36 measures collected at the final assessment. Urine samples permitted validation of reported drug use status. Results revealed that baseline disability rates were high but fell nearly 50% over two years. Disabilities named were similar to those reported in the general population. Change in smoking status was associated with decreased disability and improvements in general health and vitality. Respondents reporting disability reported lower daily functioning (SF-36). Stable everyday smoking was strongly associated with increased probability of positive urine tests for illicit drug use. Illicit drug use did not affect SF-36 ratings. Findings suggest that tobacco use by polydrug users is related to disability rates, to illicit drug use and to variations in daily functioning.

Drug-Use Initiation and Conduct Disorder among Adolescents in Drug Treatment.

This study investigated effects of drug-use initiation and conduct disorder (CD) among 1031 adolescents who participated in the Drug Abuse Treatment Outcomes Studies for Adolescents (DATOS-A) sponsored by the National Institute on Drug Abuse (NIDA). The mean age of first drug use was 12.7 (S.D.=2.2), 57% met DSM-III-R criteria for CD, and earlier initiators were more likely to have CD. About 78% of the adolescents with CD reported that their first CD symptom occurred prior to drug-use initiation. The proportions of adolescents who had prior treatment were similar (about 28%) across all groups, but earlier initiators reported a greater number of treatment episodes and younger ages at their first treatment. Conduct disordered adolescents revealed greater problems prior to DATOS-A treatment, but they appeared to be more motivated and ready for treatment. Although adolescents with CD still showed worse outcomes after treatment, the impact of CD appeared to lessen when pretreatment differences were controlled. To a lesser extent, adolescents who began using drugs at earlier ages had greater alcohol and drug use and other problems at intake, but their treatment outcomes appeared to be similar to later initiators. There were few significant interaction effects of initiation and CD. Findings from this study highlight the importance of better understanding the progression of drug use, treatment utilization, and psychiatric comorbidity among adolescents with substance abuse problems.

Does Cigarette Smoking Affect Drug Abuse Treatment

Does quitting cigarette smoking help or hurt the polydrug user in treatment for drug use? Data were obtained from 407 polydrug users in 15 treatment centers in Los Angeles at baseline and one-year follow-up. Measures: Smoking status, reported drug use, urine test results, SF-36 scores, Hopkins SCL, ASI-alcohol use, -drug use, -psychiatric problems, and ad hoc employment-related problems. Results: Most respondents (95%) reported some lifetime smoking. Over one-year follow-up, 29% reported a change in smoking status. At follow-up, stable former smokers reported fewer psychiatric problems than stable current smokers. Change in smoking status was associated with reduced heroin use, but with increased psychiatric problems and employment-related problems. Stable former smokers consistently reported healthier outcomes than either stable regular smokers or status changers, as reflected in somatization, obsessive/compulsive behavior, depression, and anxiety scores. Conclusions: Long-term but not short-term abstinence from tobacco use in polydrug users undergoing treatment is associated with consistently more favorable health outcomes.

Paid sick leave and preventive health care service use among U.S. working adults

Managing work and health care can be a struggle for many American workers. This paper explored the relationship between having paid sick leave and receiving preventive health care services, and hypothesized that those without paid sick leave would be less likely to obtain a range of preventive care services. In 2016, cross-sectional data from a sample of 13,545 adults aged 18-64 with current paid employment from the 2015 National Health Interview Survey (NHIS) were examined to determine the relationship between having paid sick leave and obtaining eight preventive care services including: (1) blood pressure check; (2) cholesterol check; (3) fasting blood sugar check; (4) having a flu shot; (5) having seen a doctor for a medical visit; (6) getting a Pap test; (7) getting a mammogram; (8) getting tested for colon cancer. Findings from multivariable logistic regressions, holding 10 demographic, work, income, and medical related variables stable, found respondents without paid sick leave were significantly less likely to report having used six of eight preventive health services in the last 12months. The significant findings remained robust even for workers who had reported having been previously told they had risk factors related to the preventive services. These findings support the idea that without access to paid sick leave, American workers risk foregoing preventive health care which could lead to the need for medical care at later stages of disease progression and at a higher cost for workers and the American health care system as a whole.

Partnership Among Peers: Lessons Learned From the Development of a Community Organization–Academic Research Training Program

Abstract: Background: Community engagement and rigorous science are necessary to address health issues. Increasingly, community health organizations are asked to partner in research. To strengthen such community organization–academic partnerships, increase research capacity in community organizations, and facilitate equitable partnered research, the Partners in Education Evaluation and Research (PEER) program was developed. The program implements an 18-month structured research curriculum for one mid-level employee of a health-focused community-based organization with an organizational mentor and a Case Western Reserve University faculty member as partners. Methods: The PEER program was developed and guided by a community–academic advisory committee and was designed to impact the research capacity of organizations through didactic modules and partnered research in the experiential phase. Active participation of community organizations and faculty during all phases of the program provided for bidirectional learning and understanding of the challenges of community-engaged health research. The pilot program evaluation used qualitative and quantitative data collection techniques, including experiences of the participants assessed through surveys, formal group and individual interviews, phone calls, and discussions. Statistical analysis of the change in fellows’ pre-test and post-test survey scores were conducted using paired sample t tests. The small sample size is recognized by the authors as a limitation of the evaluation methods and would potentially be resolved by including more cohort data as the program progresses. Qualitative data were reviewed by two program staff using content and narrative analysis to identify themes, describe and assess group phenomena and determine program improvements. Objectives: The objective of PEER is to create equitable partnerships between community organizations and academic partners to further research capacity in said organizations and develop mutually beneficial research partnerships between academia and community organizations. Conclusion: PEER demonstrates a commitment to successfully developing sustainable research capacity growth in community organizations, and improved partnered research with academic institutions.

The Community Research Scholars Initiative: A Mid‐Project Assessment

Community organizations addressing health and human service needs generally have minimal capacity for research and evaluation. As a result, they are often inadequately equipped to independently carry out activities that can be critical for their own success, such as conducting needs assessments, identifying best practices, and evaluating outcomes. Moreover, they are unable to develop equitable partnerships with academic researchers to conduct community‐based research. This paper reports on the progress of the Community Research Scholar Initiative (CRSI), a program that aims to enhance community research and evaluation capacity through training of selected employees from Greater Cleveland community organizations. The intensive 2‐year CRSI program includes didactic instruction, fieldwork, multiple levels of community and academic engagement, leadership training, and a mentored research project. The first cohort of CRSI Scholars, their community organizations, and other community stakeholders have incorporated program lessons into their practices and operations. The CRSI program evaluation indicates: the importance of careful Scholar selection; the need to engage executive leadership from Scholar organizations; the value of a curriculum integrating classwork, fieldwork, and community engagement; and the need for continual scholar skill and knowledge assessment. These findings and lessons learned guide other efforts to enhance community organization research and evaluation capacity.

Working U.S. Adults without Paid Sick Leave Report more Worries about Finances

Abstract Using the National Health Interview Survey 2015 data release, an analytic sample of 17,897 working U.S. adults in current paid employment were examined to determine if there was a relationship between not having paid sick leave and worry about finances. A series of nine indicators of financial worry were regressed on paid sick leave status with ten control variables. U.S. workers who lack paid sick leave are more likely to report worry about: medical bills from a potential future sickness or accident, retirement, current medical costs from an illness or accident, maintenance of standard of living, medical costs for normal health care, normal monthly bills, rent, mortgage, or other housing costs, and credit card payments. Based on this set of nine multinomial multivariable regressions equations, findings indicate a positive association between not having paid sick leave and reporting financial worry after controlling for gender, age, marital status, education level, race and ethnicity, personal health status, full time work status, insurance coverage, family size, and annual family income. Implications for policy, practice, and future research are set forth.

Understanding Intimate Partner Sexual Assaults: Findings from Sexual Assault Kits

ABSTRACT In 2013, Cuyahoga County, Ohio, began DNA testing and investigating nearly 5000 previously unsubmitted sexual assault kits (SAKs) from 1993 through 2009. We examined case files from a sample of SAKs that were tested but not previously adjudicated (n = 429). More than 10% (n = 45) involved victims who reported to police that a former or current intimate partner sexually assaulted them. This article integrates the available data on the offenders, the victims, the initial investigation, and the specifics of the assaults to provide a more complete understanding of intimate partner sexual assault (IPSA). More than one-third of the IPSA offenders were serial sex offenders; that is, the offenders sexually assaulted an intimate partner and another person(s). Comparing IPSAs to all other sexual assaults, IPSAs more frequently involved bodily force, less frequently involved a weapon, and IPSA investigations were more frequently closed because (1) the victims stated they lied or the police doubted the victims and (2) the victims declined to prosecute. The most common sequencing of events was a demand for sex by the offender followed by a verbal refusal by the victim and the use of bodily force in the sexual assault. The findings, however, indicate a great deal of variation in the sequencing of events surrounding the sexual assault, with over 25% involving no physical confrontation before or after the sexual assault and no demands for sex. Unsubmitted SAK data provide a unique window into understanding the understudied and underreported issue of IPSA.

Family, Identity, and the American Dream: Service Providers’ Perspectives on Families’ Experiences With Foreclosure

This article reports the findings from in-depth qualitative interviews with 18 service providers who worked with families facing foreclosure. The interviews’ purpose was to better understand a broad range of families’ experiences and inductive coding focused on quotes that reflected the meaning of those experiences. The analysis extracted three main themes related to foreclosure representing threat: (a) foreclosure threatened children’s education, (b) foreclosure threatened family memories, and (c) foreclosure threatened clients’ sense of self and attaining the American Dream. Providers reported that families fought to keep their homes and hoped to buy again after foreclosure. The findings suggest that social work services could be beneficial in helping families navigate the emotional and financial impact of the foreclosure experience.

Cultural models of popularity, stress, social support, and violence among African American U.S. teens living in a high-poverty community

ABSTRACT The ways in which teenagers understand their social environments can be important for social service providers to understand. A cognitive anthropological approach grounded in cultural consensus theory was used to investigate teenagers and social and health service providers in a pilot study in East Cleveland, Ohio (N = 28). The qualitative method of free listing was used to determine the cultural models of popularity, stress, social support, and causes of violence. Teens were also surveyed to examine their levels of stress, anxiety, and depression. Consensus was tested and not found in the domains. Teens were found to have above-average rates of stress and anxiety. A greater understanding of the sources of stress and causes of violence is described, along with the clinical, policy, and research implications of this study.