Larissa I. Zakletskaia

Abbreviated Mindfulness Intervention for Job Satisfaction, Quality of Life, and Compassion in Primary Care Clinicians: A Pilot Study

PURPOSE Burnout, attrition, and low work satisfaction of primary care physicians are growing concerns and can have a negative influence on health care. Interventions for clinicians that improve work-life balance are few and poorly understood. We undertook this study as a first step in investigating whether an abbreviated mindfulness intervention could increase job satisfaction, quality of life, and compassion among primary care clinicians. METHODS A total of 30 primary care clinicians participated in an abbreviated mindfulness course. We used a single-sample, pre-post design. At 4 points in time (baseline, and 1 day, 8 weeks, and 9 months postintervention), participants completed a set of online measures assessing burnout, anxiety, stress, resilience, and compassion. We used a linear mixed-effects model analysis to assess changes in outcome measures. RESULTS Participants had improvements compared with baseline at all 3 follow-up time points. At 9 months postintervention, they had significantly better scores (1) on all Maslach Burnout Inventory burnout subscales—Emotional Exhaustion (P =.009), Depersonalization (P = .005), and Personal Accomplishment (P <.001); (2) on the Depression (P =.001), Anxiety (P =.006), and Stress (P = .002) subscales of the Depression Anxiety Stress Scales-21; and (3) for perceived stress (P = .002) assessed with the Perceived Stress Scale. There were no significant changes on the 14-item Resilience Scale and the Santa Clara Brief Compassion Scale. CONCLUSIONS In this uncontrolled pilot study, participating in an abbreviated mindfulness training course adapted for primary care clinicians was associated with reductions in indicators of job burnout, depression, anxiety, and stress. Modified mindfulness training may be a time-efficient tool to help support clinician health and well-being, which may have implications for patient care.

Extreme College Drinking and Alcohol-Related Injury Risk

BACKGROUND Despite the enormous burden of alcohol-related injuries, the direct connection between college drinking and physical injury has not been well understood. The goal of this study was to assess the connection between alcohol consumption levels and college alcohol-related injury risk. METHODS A total of 12,900 college students seeking routine care in 5 college health clinics completed a general Health Screening Survey. Of these, 2,090 students exceeded at-risk alcohol use levels and participated in a face-to-face interview to determine eligibility for a brief alcohol intervention trial. The eligibility interview assessed past 28-day alcohol use and alcohol-related injuries in the past 6 months. Risk of alcohol-related injury was compared across daily drinking quantities and frequencies. Logistic regression analysis and the Bayesian Information Criterion were applied to compute the odds of alcohol-related injury based on daily drinking totals after adjusting for age, race, site, body weight, and sensation seeking. RESULTS Male college students in the study were 19% more likely (95% CI: 1.12-1.26) to suffer an alcohol-related injury with each additional day of consuming 8 or more drinks. Injury risks among males increased marginally with each day of consuming 5 to 7 drinks (odds ratio = 1.03, 95% CI: 0.94-1.13). Female participants were 10% more likely (95% CI: 1.04-1.16) to suffer an alcohol-related injury with each additional day of drinking 5 or more drinks. Males (OR = 1.69, 95% CI: 1.14-2.50) and females (OR = 1.81, 95% CI: 1.27-2.57) with higher sensation-seeking scores were more likely to suffer alcohol-related injuries. CONCLUSIONS College health clinics may want to focus limited alcohol injury prevention resources on students who frequently engage in extreme drinking, defined in this study as 8+M/5+F drinks per day, and score high on sensation-seeking disposition.

Peer selection and influence effects on adolescent alcohol use: a stochastic actor-based model

BackgroundEarly adolescent alcohol use is a major public health challenge. Without clear guidance on the causal pathways between peers and alcohol use, adolescent alcohol interventions may be incomplete. The objective of this study is to disentangle selection and influence effects associated with the dynamic interplay of adolescent friendships and alcohol use.MethodsThe study analyzes data from Add Health, a longitudinal survey of seventh through eleventh grade U.S. students enrolled between 1995 and 1996. A stochastic actor-based model is used to model the co-evolution of alcohol use and friendship connections.ResultsSelection effects play a significant role in the creation of peer clusters with similar alcohol use. Friendship nominations between two students who shared the same alcohol use frequency were 3.60 (95% CI: 2.01-9.62) times more likely than between otherwise identical students with differing alcohol use frequency. The model controlled for alternative pathways to friendship nomination including reciprocity, transitivity, and similarities in age, gender, and race/ethnicity. The simulation model did not support a significant friends’ influence effect on alcohol behavior.ConclusionsThe findings suggest that peer selection plays a major role in alcohol use behavior among adolescent friends. Our simulation results would lend themselves to adolescent alcohol abuse interventions that leverage adolescent social network characteristics.

Gender Differences in Violence Exposure Among University Students Attending Campus Health Clinics in the United States and Canada

PURPOSE To explore gender differences in prevalence, types, perpetrators, and correlates of recent violence experiences among university students at campus clinics at five universities in the Midwest and Pacific Northwest U.S. and Canada. METHODS Systematic survey of students presenting for routine primary care visits (N=2,091), pencil-and-paper screen for recent emotional and physical violence exposure (past 6 months), demographics, plus sensation-seeking, at-risk alcohol use, and depression. Chi-square tests compared prevalence by gender; correlates for types of violence were analyzed separately for men and women using chi-square with adjusted standardized residuals comparing no violence, intimate partner violence (IPV) and other violence (Other). RESULTS Similar rates of men (17%) and women (16%) reported any violence in the past 6 months; women were more likely to report emotional and men to report physical violence. Of those reporting emotional violence, 45.5% women and 50% men indicated it was IPV, and 23.7% women and 20.9% men reported physical IPV. Correlates differed by gender; demographics were not linked to IPV. At-risk drinking was associated with both IPV and Other violence for women, but only Other violence for men. Depression was the only correlate significantly linked to IPV for men. CONCLUSIONS Recent violence exposure among university students affects nearly one in five attending campus clinics. Screening for violence exposure should include both men and women, especially students who indicate heavy drinking patterns or depressive symptoms. Campus health promotion interventions should address healthy dating relationships. Further research on IPV among college men is needed.

Alcohol-Induced Memory Blackouts as an Indicator of Injury Risk among College Drinkers

Background An alcohol-induced memory blackout represents an amnesia to recall events but does not involve a loss of consciousness. Memory blackouts are a common occurrence among college drinkers, but it is not clear if a history of memory blackouts is predictive of future alcohol-related injury above and beyond the risk associated with heavy drinking episodes. Objective To determine whether baseline memory blackouts can prospectively identify college students with alcohol-related injury in the next 24 months after controlling for heavy drinking days. Methods Data were analysed from the College Health Intervention Project Study (CHIPS), a randomised controlled trial of screening and brief physician intervention for problem alcohol use among 796 undergraduate and 158 graduate students at four university sites in the USA and one in Canada, conducted from 2004 to 2009. Multivariate analyses used generalised estimating equations with the logit link. Results The overall 24-month alcohol-related injury rate was 25.6%, with no significant difference between men and women (p=0.51). Alcohol-induced memory blackouts at baseline exhibited a significant dose–response on odds of alcohol-related injury during follow-up, increasing from 1.57 (95% CI 1.13 to 2.19) for subjects reporting 1–2 memory blackouts at baseline to 2.64 (95% CI 1.65 to 4.21) for students acknowledging 6+ memory blackouts at baseline. The link between memory blackouts and injury was mediated by younger age, prior alcohol-related injury, heavy drinking, and sensation-seeking disposition. Conclusions Memory blackouts are a significant predictor of future alcohol-related injury among college drinkers after adjusting for heavy drinking episodes.

Prevention For College Students Who Suffer Alcohol-Induced Blackouts Could Deter High-Cost Emergency Department Visits

Fifty percent of college students who drink report alcohol-induced blackouts, and alcohol abusers in general put a heavy burden on the medical care system. Using data drawn from a randomized, controlled alcohol intervention trial at five university sites, our study quantified the costs of visits to emergency departments by college students who experienced blackouts from drinking alcohol. Of 954 students in the study, 52 percent of males and 50 percent of females at the outset of the study had experienced an alcohol-induced blackout in the past year. Of 404 emergency department visits among the study participants over a two-year observation period, about one in eight were associated with blackout drinking. Injuries ranged from broken bones to head and brain injuries requiring computed tomography. We calculate that on a large university campus having more than 40,000 students, blackout-associated emergency department visit costs would range from

Alcohol Use in Students Seeking Primary Care Treatment at University Health Services

469,000 to

Effects of Primary Care Team Social Networks on Quality of Care and Costs for Patients With Cardiovascular Disease

546,000 per year. We conclude that blackouts are a strong predictor of emergency department visits for college drinkers and that prevention efforts aimed at students with a history of blackouts might reduce injuries and emergency department costs.

Primary care team communication networks, team climate, quality of care, and medical costs for patients with diabetes: A cross-sectional study

Abstract Objective: Given the high rate of at-risk drinking in college students, the authors examined drinking behaviors and associated factors in students being seen in student health services for primary care visits from October 30, 2004, to February 15, 2007. Methods: Analyses were based on a Health Screening Survey completed by 10,234 college students seeking general medical treatment. Results: Alcohol use was similar to other studies with 57% (n = 5,840) meeting the National Institute on Alcohol Abuse and Alcoholism criteria for at-risk drinking. Twenty-six percent of the students reported smoking at least once in the last 3 months. Risk factors for at-risk drinking included young age, white males, drinking at a fraternity/sorority house, and use of tobacco. Conclusions: These findings support the widespread implementation of alcohol screening and intervention in university health services.

The Role of Adolescent Friendship Group Integration and Cohesion in Weapon-Related Violent Crime as a Young Adult

PURPOSE Cardiovascular disease is the leading cause of mortality and morbidity in the United States. Primary care teams can be best suited to improve quality of care and lower costs for patients with cardiovascular disease. This study evaluates the associations between primary care team communication, interaction, and coordination (ie, social networks); quality of care; and costs for patients with cardiovascular disease. METHODS Using a sociometric survey, 155 health professionals from 31 teams at 6 primary care clinics identified with whom they interact daily about patient care. Social network analysis calculated variables of density and centralization representing team interaction structures. Three-level hierarchical modeling evaluated the link between team network density, centralization, and number of patients with a diagnosis of cardiovascular disease for controlled blood pressure and cholesterol, counts of urgent care visits, emergency department visits, hospital days, and medical care costs in the previous 12 months. RESULTS Teams with dense interactions among all team members were associated with fewer hospital days (rate ratio [RR] = 0.62; 95% CI, 0.50–0.77) and lower medical care costs (−