John Capitman

Depressive symptoms and cigarette smoking among teens

Context. Although several risk factors for tobacco use have been implicated in the development of depression, smoking progression has typically been viewed as a consequence of depression. The results of limited longitudinal studies are controversial. Objective. To assess the nature and direction of the relationship between cigarette smoking and depression among teens. Design. Prospective analysis of baseline and 1-year follow-up data from the National Longitudinal Study of Adolescent Health. Setting. In-home teen and parent interviews. Participants. Two samples were identified. For the first sample, 8704 adolescents who were not depressed at baseline based on CES-D scores were identified for analyses of the effects of cigarette smoking on development of high depressive symptomatology. Baseline smoking status, which could vary in this group, was the predictor of interest in these analyses. For the second sample, 6947 teens who had not smoked cigarettes in the 30 days before the baseline survey (noncurrent smokers) were identified for analyses on the effect of high depressive symptoms on subsequent moderate to heavy cigarette use at 1 year of follow-up. Baseline high depressive symptomatology based on CES-D score was the predictor of interest in this sample. Main Outcome Measures. Among the nondepressed, developing high depressive symptoms at 1 year of follow-up. Among noncurrent smokers, smoking at least 1 pack per week at 1 year of follow-up. Results. For the nondepressed, multivariate modeling revealed that current cigarette smoking was the strongest predictor of developing high depressive symptoms in all models (final model odds ratio [OR]: 3.90; 95% confidence interval [CI]: 1.85,8.20). For noncurrent smokers, although in bivariate analyses, baseline high depressive symptoms increased the risk of heavy smoking nearly threefold, multivariate modeling revealed that baseline high depressive symptoms were not predictive of heavy smoking when controlling for other determinants of smoking in teens. Previous experimentation with smoking was the strongest predictor of becoming a heavy smoker (OR: 3.04; 95% CI: 1.93,4.88). Conclusions. In contrast to common dictum, depression does not seem to be an antecedent to heavy cigarette use among teens. However, current cigarette use is a powerful determinant of developing high depressive symptoms.

Finding Satisfaction in Adult Day Care: Analysis of a National Demonstration of Dementia Care and Respite Services

The effects of adult day care (ADC) operational choices on the satisfaction of informal caregivers were examined for 312 pairs of caregivers and care receivers from 10 case study sites that participated in the Robert Wood Johnson Foundations national demonstration of Dementia Care and Respite Services. Cognitive, behavioral, and affective components of satisfaction were examined. Satisfaction was represented by measures of perceived affordability, length of stay, intensity of use, and caregiver well-being. Multivariate analyses indicated that controlling for other factors, program operational choices about nursing approaches, respite services, and activities programming had direct and interactive effects on satisfaction. The study concluded that dementia status is not a strong predictor of satisfaction with ADC, and the operational choices made by ADC programs can influence consumer outcomes, but no single choice accounts for all aspects of consumer satisfaction.

Effective Coordination of Medical and Supportive Services

For at least the past quarter century, tension between “medical/allied health” and “social” models of care have characterized much of the home-care policy debate. There has also emerged a growing body of research and boundary-bending care models based on a holistic view of care recipients and caregiving. Such models coordinate between medical care and expanded supportive community services (SCS) that range from assistance with lifestyle modification, self-care, and informal care to adult-day services and home-health care. This article presents a new rationale for these models based on disablement theory and recent accounts of fairness in health policy. This approach is contrasted with the efficiency and efficacy policy perspectives that have received the most attention. The implications of an equal-opportunity approach to home-care policy for performance indicators are explored. Six basic models of coordination and current evidence on their impacts are described from this new perspective. Using qualitative data from two recent projects, five dimensions of care recipient and caregiver experiences that may be relevant to performance measurement are described. Suggestions for further service innovations and research are offered.

The Central California Regional Obesity Prevention Program: Changing Nutrition and Physical Activity Environments in California's Heartland

The goals of the Central California Regional Obesity Prevention Program (CCROPP) are to promote safe places for physical activity, increase access to fresh fruits and vegetables, and support community and youth engagement in local and regional efforts to change nutrition and physical activity environments for obesity prevention. CCROPP has created a community-driven policy and environmental change model for obesity prevention with local and regional elements in low-income, disadvantaged ethnic and rural communities in a climate of poor resources and inadequate infrastructure. Evaluation data collected from 2005-2009 demonstrate that CCROPP has made progress in changing nutrition and physical activity environments by mobilizing community members, engaging and influencing policymakers, and forming organizational partnerships.

Preventing illegal tobacco and alcohol sales to minors through electronic age-verification devices: a field effectiveness study

Efforts to prohibit the sales of tobacco and alcohol products to minors are widespread. Electronic Age Verification (EAV) devices are one possible means to improve compliance with sales to minors laws. The purpose of this study was to evaluate the implementation and effectiveness of EAV devices in terms of the frequency and accuracy of age verification, as well as to examine the impact of EAVs on the retailer environment. Two study locations were selected: Tallahassee, Florida and Iowa City, Iowa. Retail stores were invited to participate in the study, producing a self-selected experimental group. Stores that did not elect to test the EAVs comprised the comparison group. The data sources included: 1) mystery shopper inspections: two pre- and five post-EAV installation mystery shopper inspections of tobacco and alcohol retailers; 2) retail clerk and manager interviews; and 3) customer interviews. The study found that installing EAV devices with minimal training and encouragement did not increase age verification and underage sales refusal. Surveyed clerks reported positive experiences using the electronic ID readers and customers reported almost no discomfort about being asked to swipe their IDs. Observations from this study support the need for a more comprehensive system for responsible retailing.

Health Care Access, Health Promotion, and Older Women of Color

The U.S population is becoming increasingly older due to steady increases in longevity, especially among women. Statistics show that older women, those 65 and over, outnumber older men by three to two. It is likely that as this trend in longevity continues, older women will continue to outnumber older men. The health care system must respond to these changes in the population by incorporating appropriate modifications into every aspect of the system, including financing mechanisms, service organization and delivery, consumer-centered care approaches, quality assurance mechanisms, and health promotion efforts. This article discusses the longevity advantage of women (particularly women of color) and its implications for economic insecurity, underinsurance of health care, health status, functional disability, access to care, and service use. The article concludes with a discussion of the challenges and opportunities presented as health care reform and the devolution of federal roles continue to unfold.

Caregiver Education and Support: Results of a Multi-Site Pilot in an HMO

ABSTRACT Caregiver workshops were offered to members by a group practice HMO as part of a larger demonstration of adding community care to HMO services. Of 1,200 members indicating interest at four sites, 532 participated in workshops and 320 completed pre- and post-questionnaires on effectiveness. Analyses showed improvements in caregiving preparedness and reductions in sadness and depression. Engagement in the workshops (completing 3 or more sessions) and improvements were more likely for individuals with more independent lives and social capital. Alternative helping strategies are recommended for caregivers who are less likely to engage in classes due to burden or lack of respite or transportation.

Policy and Program Options in Community-Oriented Long-Term Care

Proposals for major reforms in the organization, delivery, and financing of long-term care for the aged and disabled increasingly dominate federal and state health-policy debates. Innovative programs and large-scale demonstration and research efforts have focused attention on expanding community-oriented long-term care (CLTC). This review examines findings from national surveys, evaluations of CLTC demonstrations, and early returns from emergent comprehensive models with a focus on the lessons and challenges presented by CLTC for health-care practitioners and clinical research. The first section summarizes the major criticisms of the current delivery system for long-term care and defines two sets of conclusions derived from studies of programs intended to improve this system.

Achieving excellence in community health centers: implications for health reform

Background. Existing studies tell us little about care quality variation within the community health center (CHC) delivery system. They also tell us little about the organizational conditions associated with CHCs that deliver especially high quality care. The purpose of this study was to examine the operational practices associated with a sample of high performing CHCs. Methods. Qualitative case studies of eight CHCs identified as delivering high-quality care relative to other CHCs were used to examine operational practices, including systems to facilitate care access, manage patient care, and monitor performance. Results Four common themes emerged that may contribute to high performance. At the same time, important differences across health centers were observed, reflecting differences in local environments and CHC capacity. Conclusions. In the development of effective, community-based models of care, adapting care standards to meet the needs of local conditions may be important.

Hopeful care for people with dementia

This study explores the notion of hopeful care and suggests that adult day care can support hope in people with dementia and their families. It evaluates how program services might contribute to the delivery of hopeful care. Data were analyzedfrom a sample of 175 pairs of people with dementia and theirfamily caregiversfrom 10 adult day centers who participated in the Robert Wood Johnson Foundations Dementia Care and Respite Services program. Results of multivariate regressions indicate that variations in the way adult day services are operationalized appear to influence care receiver and caregiver outcomes theoretically linked to hopeful care.