Michael D. Moorhouse

Is there a misplaced focus on AmED? Associations between caffeine mixers and bar patron intoxication

BACKGROUND Previous research on alcohol mixed with energy drinks (AmED) suffers from measurement problems. Missing from the research literature are studies that assess caffeine-alcohol co-ingestion in natural drinking environments. METHODS This field study collected data in a U.S. college bar district from 328 randomly selected patrons. Anonymous data were obtained from face-to-face interviews and self-administered surveys, and from breath tests. RESULTS Cola-caffeinated alcoholic beverage consumers left bars in a more highly intoxicated state than those who consumed alcohol only. There was no significant difference between the intoxication level of the AmED group and the cola-caffeinated alcoholic beverage group. Results from a multivariate regression model indicated that quantity of caffeinated alcoholic beverage consumption had a significant, positive association with bar patron intoxication after adjusting for potential confounders. CONCLUSIONS Findings indicate that caffeine may have a dose-dependent relationship with alcohol intoxication in the bar/nightclub setting. In addition, results revealed that cola-caffeinated alcoholic drinks may pose similar levels of risk to bar patrons as those associated with AmED beverage consumption. Product labeling requirements about alcohol risks may need to be extended not only to energy drinks, but to caffeinated soft drinks as well.

Barriers to cancer screening for people with disabilities: A literature review

BACKGROUND Over 50 million Americans are currently living with some form of disability. Studies have shown that people with disabilities are underinsured, have less access to health care, and are more likely to engage in risky health behavior. Routine preventive screenings for breast, cervical and colorectal cancer are recommended for all adults to improve early detection and treatment of cancer. Although early detection of cancer offers the best chances for treatment and survival, cancer screening has been limited for many people with disabilities. OBJECTIVE To present results of a scoping review of studies focused on barriers to cancer screening for people with disabilities. METHODS Online databases were searched for research articles on barriers to cancer screening (breast, cervical, prostate, and colorectal) in people with disabilities. RESULTS Thirty-five peer-reviewed articles met inclusion criteria. Existing research on cancer screenings, particularly prostate cancer, among people with disabilities is limited. Current studies suggest that those with advanced disabilities are not being screened for cancer as often as the able-bodied population with the exception of military veterans. Education, income, age, employment, screening history, tobacco use, activity level, disability level, and geography affected screening rates. CONCLUSIONS Barriers include cost, access, health care provider discomfort, and physical and cognitive restraints. Future interventions to improve routine preventive cancer screenings rates could include specialized health care provider training, community interventions, emphasis on the value of health promotion and the specific health care needs of people with disabilities.

Rasch Analysis as a Technique to Examine the Psychometric Properties of a Career Ability Placement Survey Subtest

Rasch analysis offers researchers an innovative method for developing and validating rehabilitation instruments. Despite the increased use of Rasch analysis by allied health researchers, this method continues to be underutilized by rehabilitation counseling professionals. In the rehabilitation counseling profession, vocational evaluators use various instruments, such as the Career Ability Placement Survey (CAPS), to determine client aptitudes and justify job placement recommendations. The purpose of this article is to introduce Rasch analysis as a method for analyzing vocational assessments by examining the psychometric properties of the Word Knowledge (WK) subtest of the CAPS. University undergraduate and graduate students (n = 227) completed the WK subtest as part of a classroom exercise. The analysis determined item hierarchy, item gaps and redundancies, item-fit statistics (unidimensionality), and person reliability and separation statistics. Although the WK construct demonstrates good psychometric characteristics relating to unidimensionality and to person reliability and separation statistics, several items deviated from the expected ordering pattern. The reordering of items revealed potential item gaps and redundancies as well as poor person—instrument match. Adding and removing items will improve the validity and reliability of the WK subtest psychometrics.

Validity of the Neuromuscular Recovery Scale: A Measurement Model Approach

OBJECTIVE To determine how well the Neuromuscular Recovery Scale (NRS) items fit the Rasch, 1-parameter, partial-credit measurement model. DESIGN Confirmatory factor analysis (CFA) and principal components analysis (PCA) of residuals were used to determine dimensionality. The Rasch, 1-parameter, partial-credit rating scale model was used to determine rating scale structure, person/item fit, point-measure item correlations, item discrimination, and measurement precision. SETTING Seven NeuroRecovery Network clinical sites. PARTICIPANTS Outpatients (N=188) with spinal cord injury. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE NRS. RESULTS While the NRS met 1 of 3 CFA criteria, the PCA revealed that the Rasch measurement dimension explained 76.9% of the variance. Ten of 11 items and 91% of the patients fit the Rasch model, with 9 of 11 items showing high discrimination. Sixty-nine percent of the ratings met criteria. The items showed a logical item-difficulty order, with Stand retraining as the easiest item and Walking as the most challenging item. The NRS showed no ceiling or floor effects and separated the sample into almost 5 statistically distinct strata; individuals with an American Spinal Injury Association Impairment Scale (AIS) D classification showed the most ability, and those with an AIS A classification showed the least ability. Items not meeting the rating scale criteria appear to be related to the low frequency counts. CONCLUSIONS The NRS met many of the Rasch model criteria for construct validity.

Self-efficacy to drive while intoxicated: insights into the persistence of alcohol-impaired driving

BACKGROUND Scant research has examined event-level risk factors for impaired driving in natural drinking settings. This study assessed driving self-efficacy among intoxicated individuals to better understand decision-making about alcohol-impaired driving at night after exiting on-premise drinking establishments. METHODS Interview and breath test data were collected from bar patrons (n = 512) exiting 2 college bar districts in Florida and Texas. RESULTS Results from a multivariable linear regression model indicated that self-efficacy to drive while intoxicated was more strongly associated with situational variables, that is, perceived drunkenness and self-estimated blood alcohol concentration than patron traits, that is, past-year history of drinking, risk proneness, and sex. A large proportion of bar patrons, particularly men, expressed confidence in their ability to drive, despite being highly intoxicated. Moreover, the majority of legally intoxicated patrons who were confident in their ability to drive were aware of their high level of intoxication. CONCLUSIONS Emphasis should be placed on the enactment and enforcement of policies and laws to prevent alcohol-impaired driving.

Tobacco Cessation Intervention for People With Disabilities: Survey of Center for Independent Living Directors

People with disabilities (PWD) are 50% more likely to smoke compared with the general population, yet interventions tailored to the needs of PWD remain limited. The authors surveyed directors from a leading disability service organization to assess their delivery of tobacco cessation interventions. Although tobacco cessation was identified as a high priority, directors reported that they are ill-equipped to deliver tobacco cessation interventions. To properly address the unique challenges that PWD face when quitting tobacco, disability sensitive cessation interventions are needed.

Protective behavioral strategies and negative alcohol-related consequences among US college fraternity and sorority members

Abstract Objectives: Students affiliated with Greek fraternities/sororities are at greater risk for experiencing negative alcohol-related consequences. Protective behavioral strategies (PBS) appear to decrease these consequences; however, these strategies have yet to be examined specifically with US college fraternity/sorority populations. Therefore, the purpose of this study was to examine the relationship between PBS and negative alcohol-related outcomes among fraternity/sorority members. Methods: We conducted a secondary data analysis of 18 354 US college students (65.3% female) between the ages of 18 and 25 who participated in the Fall 2010 National College Health Assessment-II survey. Using adjusted logistic regression models, we predicted the odds of drinking behaviors, 11 PBS, and 9 negative alcohol-related consequences based on fraternity/sorority membership status. Results: Compared to non-fraternity/sorority members, fraternity/sorority members were more likely to report using all but two PBS examined in the study. Additionally, fraternity/sorority members were more likely to report binge drinking, driving after drinking, and experiencing negative consequences of alcohol use. Conclusions: These findings indicate PBS alone may be insufficient for preventing negative outcomes associated with drinking in high-risk groups. Future research should examine if PBS combined with other alcohol use intervention strategies among fraternity/sorority members are more effective at preventing negative outcomes.

Evaluation of a newly developed tobacco cessation program for people with disabilities

BACKGROUND Tobacco use is the single most preventable cause of morbidity and mortality, accounting for at least 480,000 deaths in the United States annually. People with disabilities smoke at a rate 1.5 times greater than the able-bodied population. Higher incidence of tobacco use among people with disabilities has been directly related to both unique and universal cessation barriers. Despite increased prevalence of tobacco use and cessation obstacles, evidence is lacking on the development of successful interventions targeting people with disabilities. OBJECTIVE We aimed to assess the feasibility, acceptability, and potential effectiveness of a cessation intervention tailored to people with disabilities. METHODS Eighteen tobacco users with disabilities (56% African American, 64% male) participated in a 4-week, 8-session tobacco cessation program consisting of group sessions on managing addiction, relapse, and lifestyle changes specific to people with disabilities. Semi-structured interviews were conducted at the conclusion of the program. A follow-up measure of smoking status, triggers, and nicotine replacement therapy usage was completed at 4 weeks and 6 months. RESULTS Sixteen participants completed the intervention (89%), with participants on average attending 86% of sessions. Most participants rated the program as excellent (83%) or good (8%). Qualitative interviews revealed participants value social support, accessibility, and a tailored program. Four participants (22%) reported abstinence at six months, which is greater than the standard quit rate. CONCLUSION This study suggests tailoring a cessation program to the characteristics unique to people with disabilities may be critical in delivering meaningful and effective cessation interventions among this population.

Assessing alcohol use in college: is it time for a new approach to identify risky drinking behavior?

Abstract Objectives: The purpose of this study is to demonstrate how traditional risky drinking indicators, such as binge drinking, are inefficient when identifying college students who are in need of alcohol-related services. Methods: Using data collected from the 2010 National College Health Assessment II (NCHA-II), the sensitivity, specificity, positive predictive value and negative predictive value of binge drinking was analyzed relative to experiencing negative alcohol-related consequences in the previous 12 months. Results: Despite a considerable mathematical advantage, binge drinking demonstrated a sensitivity of 0.80 and a specificity of 0.69. Additionally, more than 56% of the sample who were identified as binge drinkers did not experience a major negative consequence in the previous 12 months. Conclusions: Risky drinking indicators constructed solely of frequency, quantity and duration items have a limited capacity to discriminate at-risk college drinkers from the general student body. New indicators comprised of novel drinking behaviors are necessary to properly identify students at high risk.

Creating a Tobacco Cessation Program for People with Disabilities: LIFT to ELIFT

In 1964, the Surgeon General released the first report linking smoking to the increased risk of lung and laryngeal cancer, as well as chronic bronchitis [1]. Over the years research has shown smoking not only causes lung and laryngeal cancer, but a variety of cancers and an increased risk of stroke, respiratory diseases, diabetes and a decrease in fertility and immune function [2]. Despite the serious health consequences, health warnings on cigarettes packages, and the banning of cigarette advertisements on television, 42.1 million U.S. adults currently smoke, and approximately 480,000 U.S. deaths are attributed to cigarette smoking each year [1-3]. While the overall rate of cigarette use in the US continues to decline, 25.4 percent of people with disabilities (PWD) smoke compared to 17.3 percent of the able-bodied population [4].