Michael Stephen Dunbar

Mental Health Service Utilization Among Lesbian, Gay, Bisexual, and Questioning or Queer College Students

PURPOSE College students are at high risk for mental health problems, yet many do not receive treatment even when services are available. Treatment needs may be even higher among sexual minority students, but little is known about how these students differ from heterosexual peers in terms of mental health needs and service utilization. METHODS A total of 33,220 California college students completed an online survey on mental health needs (e.g., current serious psychological distress and mental health-related academic impairment) and service utilization. Using logistic regressions, we examined differences in student characteristics, mental health service use, and perceived barriers to using on-campus services by sexual minority status. RESULTS Approximately 7% of students self-identified as sexual minorities. Compared with heterosexual students, sexual minority students endorsed higher rates of psychological distress (18% vs. 26%, p < .001) and mental health-related academic impairment (11% vs. 17%, p < .001) but were 1.87 (95% confidence interval: 1.50-2.34) times more likely to use any mental health services. Sexual minority students were also more likely to report using off-campus services and to endorse barriers to on-campus service use (e.g., embarrassed to use services and uncertainty over eligibility for services). CONCLUSIONS Sexual minority individuals represent a sizeable minority of college students; these students use mental health services at higher rates than heterosexual peers but have high rates of unmet treatment need. Efforts to address commonly reported barriers to on-campus service use, foster sexual minority-affirmative campus environments, and promote awareness of campus services may help reduce unmet treatment need in this population.

How Do Tobacco Power Walls Influence Adolescents? A Study of Mediating Mechanisms.

Objectives: Tobacco power walls display hundreds of tobacco products and are known to be a key part of the impact of point-of-sale tobacco advertising on risk for smoking in adolescents. The current study examined factors that are hypothesized to mediate the effect of tobacco power wall exposure on adolescents’ susceptibility for smoking in the future. Method: Participants (N = 148) aged 11–17 years were invited to shop in the RAND StoreLab, a life-sized replica of a convenience store. They were randomized to 1 of 2 conditions: one in which the power wall was located in its typical position behind the cashier and the other in which it was hidden behind an opaque wall. Participants shopped in the RAND StoreLab and then completed measures of susceptibility for smoking in the future, perceived smoking norms, and perceived accessibility of cigarettes. Participants’ movements in the store were electronically tracked. Results: Having the tobacco power wall behind the cashier increased adolescents’ susceptibility for smoking in the future by 14.3% (total effect) compared with when the power wall was hidden (p = .01), and 14% of this effect was mediated by participants’ perceived smoking norms. Time spent in front of the cashier and perceived accessibility of cigarettes did not play a role in the association between study condition and susceptibility for smoking in the future. Conclusions: The tobacco power wall increases adolescents’ smoking risk, and this effect is partly explained by the effect of the power wall on adolescents’ perceptions of how normative smoking is.

Effects of Antismoking Media on College Students' Smoking-Related Beliefs and Intentions

Ecological momentary assessment was used to examine immediate changes in 87 college students’ smoking-related attitudes, beliefs, and intentions as a joint function of their exposure to antismoking media and smoking status. Students (37 never smokers, 41 experimental smokers, and 9 current intermittent smokers) carried handheld data-collection devices for 3 weeks to record naturally occurring exposures to antismoking media and respond to investigator-initiated control prompts. At each reported exposure to antismoking media and each control prompt, participants reported their smoking-related attitudes, perceptions of the prevalence of smoking among their peers, resistance self-efficacy, and intentions to smoke. Mixed-effects regression was used to compare responses between encounters with antismoking media and control prompts. Experimental smokers reported weaker intentions to smoke and greater resistance self-efficacy at moments of exposure to antismoking media than at control prompts. Regardless of smoking experience, participants reported higher perceived prevalence of smoking at times of exposure to antismoking media than at control prompts. These findings generally support the value of antismoking media messages for shifting the beliefs and intentions of experimental smokers, who are at high risk for becoming committed regular smokers.

Ethnic Differences in Cigarette Use Trajectories and Health, Psychosocial, and Academic Outcomes

PURPOSE Cigarette smoking among youth is associated with poorer health and psychosocial outcomes. However, few studies address how smoking may differentially relate to the emergence of disparities in functioning across races/ethnicities over adolescence. METHODS Youth (n = 2,509) were surveyed eight times from ages 11 to 18. We measured cigarette use, academic and social functioning, mental and physical health, and delinquency. Sequelae of change models controlled for sociodemographic factors, and tested whether intercept and slope for smoking trajectories were associated with outcomes at the end of high school, and examined racial/ethnic differences in outcomes assuming similar smoking trajectories across groups. RESULTS Youth were 45% Hispanic, 20% Asian, 20% white, 10% multiethnic, 2% black, and 1% other ethnicities. Higher average probability of smoking and steeper slopes of smoking trajectories were associated with poorer outcomes in multiple domains. Controlling for smoking trajectories, we observed the following disparities (vs. white youth; all ps < .05): black, Hispanic, and multiethnic youth reported lower academic performance; Asian, black, and multiethnic youth reported higher academic unpreparedness; Asian and multiethnic youth reported poorer mental health; Asian, Hispanic, and multiethnic youth reported poorer physical health; and Asian youth reported higher delinquency and poorer social functioning. CONCLUSIONS Statistically adjusting for similar smoking trajectories, racial/ethnic minority youth demonstrated poorer outcomes in multiple domains compared with white peers. Smoking may be a particularly robust marker for risk of negative outcomes in racial/ethnic minority youth. Screening for cigarette use and intervening on smoking and associated risk behaviors among minority youth may help reduce disparities in functioning.

Increased attention to the tobacco power wall predicts increased smoking risk among adolescents

The purpose of this correlational study was to evaluate the association between attention paid by adolescents to the tobacco power wall and their susceptibility to future smoking. The study was conducted in the RAND Store Lab (RSL), a life-sized replica of a convenience store designed to investigate how tobacco advertising displays in retail point-of-sale environments relate to tobacco use risk and behaviors. In this study, middle and high school students (N = 80) shopped in the RSL while their attention to the tobacco power wall was measured covertly. Before and after shopping in the RSL, participants completed a measure of susceptibility to smoking in the future. Controlling for baseline cigarette smoking susceptibility and other potential confounders, attention toward the tobacco power wall was found to be significantly associated with future smoking susceptibility, p = .046. This finding suggests that policies aimed at decreasing the prominence of power walls in retail outlets should be given careful consideration as ways to reduce the impact of point-of-sale tobacco advertising and promotion on youth smoking susceptibility.

Unmet Mental Health Treatment Need and Attitudes Toward Online Mental Health Services Among Community College Students

OBJECTIVE A survey assessed use of and attitudes toward online mental health services among community college students to inform how such services may contribute to reducing unmet treatment need. METHODS A total of 6,034 students completed a Web-based survey on mental health and use of and attitudes toward mental health services. Logistic regression assessed the relationship between prior mental health treatment and attitudes among students with current serious psychological distress. RESULTS Among students with psychological distress (N=1,557), 28% reported prior in-person service use and 3% reported online mental health services use; most (60%) reported willingness to use online services. Students with no prior in-person treatment were less likely than those with history of in-person treatment to endorse preferences for in-person services (adjusted odds ratio=.54). CONCLUSIONS Students reported being open to using online mental health services, but utilization was low. Targeted outreach efforts may be required if these services are to reduce unmet treatment need.

Online Methods for Locating Medical Marijuana Dispensaries: Practical Considerations for Future Research

Knowing the names, locations, and signage of medical marijuana dispensaries is critical for assessing how marijuana availability affects neighborhood quality and marijuana use, yet no detailed methods for locating and coding dispensaries are published. Limitations regarding accuracy of official records, unregulated businesses, and the size of areas where dispensaries are located make it difficult to accurately capture all open dispensaries in any area. In this study, we test a practical and feasible method to collect a point-in-time portrayal of medical marijuana dispensaries in a large urban area lacking an official record of these businesses. Using publicly-available Internet sources alone, we collected the name, address, phone number, signage, and open/closed status of medical marijuana dispensaries in Los Angeles County between October 2016 and February 2017. Data were verified by calling a subset of dispensaries and comparing data against a list of licensed dispensaries. Our methods yielded 872 unique dispensaries in Los Angeles County, of which 470 were open. Most open stores were discernable by a green cross sign; however, few had names that clearly indicated the store sold marijuana. Data verification procedures showed that Internet sources were able to locate nearly all dispensaries in the county that were then verified with non-Internet methods, such as calling the businesses to confirm information. This study is significant as it provides methodology that can be replicated in other metropolitan areas, facilitating comparisons across databases in different locations and regulatory environments. However, caution should be taken when solely using Internet sources. Accurate information on dispensary names, locations, and signage can advance research and provide important information for policy decisions. Methods for enhancing the online methods described in this study are discussed.

Zonnic®: a new player in an old field.

The tobacco industry is continually evolving to adapt to increasing tobacco control pressure and regulation, and to cater to consumer preferences. Recently, RJ Reynolds rolled-out a nicotine-containing gum, Zonnic®, which is marketed as a smoking cessation and reduction product and is sold at convenience stores at a lower price and in a smaller quantity than existing brands sold at pharmacies. The introduction of Zonnic® products is a critical first step in tobacco industry’s involvement in the NRT market and a serious indication of the evolving tobacco and nicotine-delivery industry and environment. It is likely that this trend will continue and spread, and as such, have a significant impact at multiple dimensions, including consumer perceptions and behavior, tobacco and NRT industry business strategy, and regulation and policy. In this special communication, we present an overview of the current marketing strategy for Zonnic®, discuss its potential impacts at the market level and at the level of the individual consumer, and suggest research and policy priorities based on the magnitude and urgency of the impacts.

Development and Maintenance of Standardized Cross Setting Patient Assessment Data for Post-Acute Care: Summary Report of Findings from Alpha 1 Pilot Testing

The Centers for Medicare & Medicaid Services (CMS) contracted with the RAND Corporation to identify and/or develop standardized items to include in the post-acute care patient assessment instruments. RAND was tasked by CMS with developing and testing items to measure seven areas of health status for Medicare beneficiaries: (1) vision and hearing; (2) cognitive status; (3) depressed mood; (4) pain; (5) care preferences; (6) medication reconciliation; and (7) bladder and bowel continence. This article presents results of the first Alpha 1 feasibility test of a proposed set of items for measuring each of these health status areas. Conducted between August and October 2016, the test is one of two Alpha tests that will be completed by mid-2017 to assess the feasibility of proposed items. The results of these small-scale feasibility tests will inform a national Beta test designed to determine how well the measures perform when implemented in post-acute care settings. The Alpha 1 testing phase was successfully completed, in that all items were pilot tested among 133 patients. Items from all content areas were assessed on interrater reliability and feasibility; items from some content areas were assessed on other metrics. Items have now been revised, when necessary, based on the findings of the Alpha 1 test. Alpha 2 testing is under way with the updated, revised items.

A Collaborative Approach to Behavioral Health Care for Veterans and Their Families

M any veterans and their families struggle with behavioral health problems, yet they often face barriers to receiving adequate treatment. Notably, while many veterans are eligible to receive care at Department of Veterans Affairs (VA) facilities, family members are not and must seek care elsewhere. In seeking care in the community, veteran family members may face obstacles in ensuring that the care is sensitive to the issues that veteran families face and coordinated across providers. Can a model of care that colocates and coordinates behavioral health services for veterans and their families address these barriers? The experiences in a new health center may shed light on this question. The Unified Behavioral Health Center (UBHC) for Military Veterans and Their Families is a public-private partnership between a VA medical center and a private-sector health care provider, both located in New York state. The center offers coordinated care for veterans and their families by locating VA and private providers side by side at the same facility. RAND researchers evaluated the center’s activities. The evaluation was intended to assess the viability of this new approach to behavioral health care, identify implementation challenges and successes, and assess the impact on patient health. The broader goal was to draw lessons to facilitate the center’s replication elsewhere, should it prove successful. The evaluation had two components. The first documented the center’s capacity for delivering services (facilities, staff, technology, infrastructure) and the actual services delivered. The second assessed patient outcomes. For the first component, the evaluation used data from site visits and focus groups, as well as administrative data. For the second, it used patient-reported outcome data collected by UBHC staff.