Kipling M. Bohnert

The impact of early behavior disturbances on academic achievement in high school

BACKGROUND. Previous research has indicated that childhood behavioral disturbances predict lower scores on academic tests and curtail educational attainment. It is unknown which types of childhood behavioral problems are most likely to predict these outcomes. METHODS. An ethnically diverse cohort was assessed at 6 years of age for behavioral problems and IQ and at 17 years of age for academic achievement in math and reading. Of the original cohort of 823 children, 693 (84%) had complete data. Multiple regressions were used to estimate associations of attention and internalizing and externalizing problems at age 6 and with math and reading achievement at age 17, adjusting for IQ and indicators of family socioeconomic status. RESULTS. Adjusting for IQ, inner-city community, and maternal education and marital status, teacher ratings of attention, internalizing behavior, and externalizing problems at age 6 significantly predict math and reading achievement at age 17. When types of problems are examined simultaneously, attention problems predict math and reading achievement with little attenuation, whereas the influence of externalizing and internalizing problems is materially reduced and not significant. CONCLUSIONS. Interventions that target attention problems at school entry should be tested as a potential avenue for improving educational achievement.

Characteristics of adults seeking medical marijuana certification

BACKGROUND Very little is known about medical marijuana users. The present study provides descriptive information on adults seeking medical marijuana and compares individuals seeking medical marijuana for the first time with those renewing their medical marijuana card on measures of substance use, pain and functioning. METHODS Research staff approached patients (n=348) in the waiting area of a medical marijuana certification clinic. Chi-square and Wilcoxon signed rank tests were used to compare participants who reported that they were seeking medical marijuana for the first time (n=195) and those who were seeking to renew their access to medical marijuana (n=153). RESULTS Returning medical marijuana patients reported a higher prevalence of lifetime cocaine, amphetamine, inhalant and hallucinogen use than first time patients. Rates of recent alcohol misuse and drug use were relatively similar between first time patients and returning patients with the exception of nonmedical use of prescription sedatives and marijuana use. Nonmedical prescription sedative use was more common among first time visitors compared to those seeking renewal (p<0.05). The frequency of recent marijuana use was higher in returning patients than first time patients (p<0.0001). Compared to first time patients, returning patients reported somewhat lower current pain level and slightly higher mental health and physical functioning. CONCLUSIONS Study results indicate that differences exist between first time and returning medical marijuana patients. Longitudinal data are needed to characterize trajectories of substance use and functioning in these two groups.

Stability of psychiatric outcomes of low birth weight: A longitudinal investigation

CONTEXT Research on psychiatric disturbances in low-birth-weight (LBW) children (<or=2500 g), which has focused primarily on the extreme low end of the LBW distribution, has suggested an increased risk of attention, externalizing, and internalizing problems. OBJECTIVE To examine the long-term effects of LBW on psychiatric problems in socially disadvantaged children and in middle-class children. DESIGN A stratified random sample assessed at ages 6, 11, and 17 years. SETTING Random samples of LBW and normal-birth-weight children from newborn discharge lists (1983 through 1985) of 2 major hospitals in southeast Michigan, one serving an inner city and the other serving middle-class suburbs. PARTICIPANTS Cohort members with 1 or more assessments (n = 823). MAIN OUTCOME MEASURES Attention, internalizing, and externalizing problems rated by mothers and teachers (Child Behavior Checklist and Teachers Report Form, respectively) at ages 6, 11, and 17 years, using standard cutoffs that identify children with disturbances above the normal range. RESULTS Low-birth-weight children had modest excesses of externalizing and internalizing disturbances (adjusted odds ratios = 1.53 and 1.28, respectively) (P = .001 and .02, respectively). An increased risk of attention problems was associated with LBW only in the urban community (adjusted odds ratio = 2.78) (P = .001) and was greater among very LBW children (<or=1500 g) than heavier LBW children (1501-2500 g). In the suburban community, there was no increased risk for attention problems associated with LBW. Psychiatric outcomes of LBW did not vary across ages of assessments. CONCLUSIONS Effects of LBW on psychiatric disturbance appear to be stable through the period of school attendance. The differential effect of LBW on attention problems between the 2 communities suggests the possibility of interplay between prenatal adversity and social environment.

Computer and therapist based brief interventions among cannabis-using adolescents presenting to primary care: one year outcomes.

AIMS This paper describes outcomes from a randomized controlled trial examining the efficacy of brief interventions delivered by a computer (CBI) or therapist (TBI) among adolescents in urban primary care clinics. METHODS Patients (ages 12-18) self-administered a computer survey. Adolescents reporting past year cannabis use completed a baseline survey and were randomized to control, CBI or TBI, with primary (cannabis use, cannabis related consequences - CC) and secondary outcomes [alcohol use, other drug use (illicit and non-medical prescription drugs), and driving under the influence of cannabis (DUI)] assessed at 3, 6, and 12 months. RESULTS 1416 adolescents were surveyed; 328 reported past year cannabis use and were randomized. Comparisons of the CBI relative to control showed that at 3 months the group by time interaction (G × T) was significant for other drug use and CC, but not for cannabis use, alcohol use, or DUI; at 6 months, the G × T interaction was significant for other drug use but not for cannabis use, alcohol use, or CC. For analyses comparing the TBI to control, at 3 months the G×T interaction was significant for DUI, but not significant for cannabis use, alcohol use, or CC; at 6 months, the G×T interaction was not significant for any variable. No significant intervention effects were observed at 12 months. CONCLUSION Among adolescent cannabis users presenting to primary care, a CBI decreased cannabis related problems and other drug use and a TBI decreased cannabis DUI in the short-term. Additional boosters may be necessary to enhance these reductions over time.

Comparing adults who use cannabis medically with those who use recreationally: Results from a national sample

OBJECTIVES Cannabis has been legalized for medical use in almost half of the states in the U.S. Although laws in these states make the distinction between medical and recreational use of cannabis, the prevalence of people using medical cannabis and how distinct this group is from individuals using cannabis recreationally is unknown at a national level. METHODS Data came from the 2013 National Survey on Drug Use and Health (NSDUH). All adults endorsing past year cannabis use who reported living in a state that had legalized medical cannabis were divided into recreational cannabis use only and medical cannabis use. Demographic and clinical characteristics were compared across these two groups. RESULTS 17% of adults who used cannabis in the past year used cannabis medically. There were no significant differences between those who used medically versus recreationally in race, education, past year depression and prevalence of cannabis use disorders. In adjusted analyses, those with medical cannabis use were more likely to have poorer health and lower levels of alcohol use disorders and non-cannabis drug use. A third of those who reported medical cannabis use endorsed daily cannabis use compared to 11% in those who reported recreational use exclusively. CONCLUSIONS Adults who use medical and recreational cannabis shared some characteristics, but those who used medical cannabis had higher prevalence of poor health and daily cannabis use. As more states legalize cannabis for medical use, it is important to better understand similarities and differences between people who use cannabis medically and recreationally.

Ethnic identity, acculturation and the prevalence of lifetime psychiatric disorders among Black, Hispanic, and Asian adults in the U.S

BACKGROUND Past research has asserted that racial/ethnic minorities are more likely to develop psychiatric disorders due to their increased exposure to stressors; however most large epidemiologic studies have found that individuals who are Black or Hispanic are less likely to have most psychiatric disorders than those who are White. This study examines the associations between ethnic identity, acculturation, and major psychiatric disorders among Black, Hispanic, and Asian adults in the U.S. METHODS The sample included Wave 2 respondents to the National Epidemiologic Survey on Alcohol Related Conditions (NESARC), a large population-based survey, who self-identified as Black (N = 6219), Asian/Native Hawaiian/Other pacific islander (N = 880), and Hispanic (N = 5963). Multivariable regression analyses were conducted examining the relationships between ethnic identity, acculturation, and the prevalence of psychiatric disorders. RESULTS Higher scores on the ethnic identity measure were associated with decreased odds of having any lifetime psychiatric diagnoses for those who were Black (AOR = 0.978; CI = 0.967-0.989), Hispanic (AOR = 0.974; CI = 0.963-0.985), or Asian (AOR = 0.96; CI = 0.936-0.984). Higher levels of acculturation were associated with an increased odds of having any lifetime psychiatric diagnosis for those who were Black (AOR = 1.027; CI = 1.009-1.046), Hispanic (AOR = 1.033; CI = 1.024-1.042), and Asian (AOR = 1.029; CI = 1.011-1.048). CONCLUSION These findings suggest that a sense of pride, belonging, and attachment to ones racial/ethnic group and participating in ethnic behaviors may protect against psychopathology; alternatively, losing important aspects of ones ethnic background through fewer opportunities to use ones native language and socialize with people of their ethnic group other may be a risk factor for psychopathology.

Understanding the service needs of assault-injured, drug-using youth presenting for care in an urban Emergency Department

BACKGROUND Violence is a leading cause of injury among youth 15-24years and is frequently associated with drug use. To inform optimal violence interventions, it is critical to understand the baseline characteristics and intent to retaliate of drug-using, assault-injured (AI) youth in the Emergency Department (ED) setting, where care for violent injury commonly occurs. METHODS At an urban ED, AI youth ages 14-24 endorsing any past six-month substance use (n=350), and a proportionally-sampled substance-using comparison group (CG) presenting for non-assault-related care (n=250), were recruited and completed a baseline assessment (82% participation). Medical chart review was also conducted. Conditional logistic regression was performed to examine correlates associated with AI. RESULTS Over half (57%) of all youth met the criteria for drug and/or alcohol use disorder, with only 9% receiving prior treatment. Among the AI group, 1 in 4 intended to retaliate, of which 49% had firearm access. From bivariate analyses, AI youth had poorer mental health, greater substance use, and were more likely to report prior ED visits for assault or psychiatric evaluation. Based on multivariable modeling, AI youth had greater odds of being on probation/parole (AOR=2.26; CI=1.28, 3.90) and having PTSD (AOR=1.88; CI=1.01, 3.50) than the CG. CONCLUSIONS AI youth may have unmet needs for substance use and mental health treatment, including PTSD. These characteristics along with the risk of retaliation, increased ED service utilization, low utilization of other health care venues, and firearm access highlight the need for interventions that initiate at the time of ED visit.

Latent class analysis of substance use among adolescents presenting to urban primary care clinics

Abstract Background: Polysubstance use during adolescence is a significant public health concern. However, few studies have investigated patterns of substance use during this developmental window within the primary care setting. Objectives: This study used an empirical method to classify adolescents into substance use groups, and examines correlates of the empirically defined groups. Methods: Data came from patients, ages 12–18 years, presenting to an urban, primary care community health clinics (Federally Qualified Health Centers) in two cities in the Midwestern United States (n = 1664). Latent class analysis (LCA) was used to identify classes of substance users. Multinomial logistic regression was used to examine variables associated with class membership. Results: LCA identified three classes: class 1 (64.5%) exhibited low probabilities of all types of substance use; class 2 (24.6%) was characterized by high probabilities of cannabis use and consequences; and class 3 (10.9%) had the highest probabilities of substance use, including heavy episodic drinking and misuse of prescription drugs. Those in class 2 and class 3 were more likely to be older and have poorer grades, poorer health, higher levels of psychological distress and more sexual partners than those in class 1. Individuals in class 3 were also less likely to be African-American than those in class 1. Conclusion: Findings provide novel insight into the patterns of substance use among adolescents presenting to low-income urban primary care clinics. Future research should examine the efficacy of interventions that address the complex patterns of substance use and concomitant health concerns among adolescents.

Tobacco use disorder and the risk of suicide mortality

BACKGROUND AND AIMS Tobacco use may be a risk factor for suicide mortality; however, prior research has produced equivocal findings and has been limited by relatively small sample sizes to study the rare event of suicide, as well as a lack of adjustment for other important factors, including psychiatric illness. We estimate the predictive association between tobacco use disorder and the risk of suicide mortality, adjusting for other important variables. DESIGN A prospective cohort study. SETTING The United States Veterans Health Administration (VHA). PARTICIPANTS All individuals who received VHA services in fiscal year (FY) 2005 and were alive at the start of FY 2006 (n = 4 863 086). MEASUREMENTS Tobacco use disorder was assessed via FYs 2004-05 VHA National Patient Care Database records. The outcome of suicide mortality was assessed during the follow-up interval from the beginning of FY 2006 to the end of FY 2008 using National Death Index records. FINDINGS Of the 4 863 086 individuals in the study, 4823 died by suicide during the follow-up interval. In the unadjusted model, tobacco use disorder was associated with an increased risk of suicide [hazard ratio (HR) = 1.88; 95% confidence interval (CI) = 1.76, 2.02]. After adjustment for model covariates, the association remained statistically significant, although attenuated (HR = 1.36, 95% CI = 1.27, 1.46). CONCLUSIONS Tobacco use disorder may confer a modest excess risk of death by suicide. Psychiatric disorders may partially explain the relationship between tobacco use disorder and suicide.

The 9/11 terrorist attack and posttraumatic stress disorder revisited

Research published in the aftermath of the 9/11 terrorist attack reported elevated rates of posttraumatic stress disorder (PTSD) in the US population (4.3%–17.0%), attributable to indirect exposure through the media. We use data from a national survey conducted in 2004 to 2005 (National Epidemiologic Survey on Alcohol and Related Conditions Wave 2) (n = 34,653). The list of traumatic events covered in the survey included indirect exposure to 9/11 through media coverage. Respondents who endorsed more than 1 traumatic event were asked to single out “the worst event” they had ever experienced. The worst event (or the only event) was the index event for diagnosing PTSD. Indirect experience of 9/11 had the lowest PTSD risk of all the traumatic events in the list, 1.3%. In the subset that endorsed only 9/11 indirect exposure (n = 3981), the PTSD risk was 0.3%. Of the total sample, 0.7% experienced PTSD in relation to indirect 9/11. Explanations for the lower estimates are discussed.