Rani A. Desai

Video-Gaming Among High School Students: Health Correlates, Gender Differences, and Problematic Gaming

OBJECTIVE: Video game playing may negatively impact youth. However, the existing literature on gaming is inconsistent and often has focused on aggression rather than the health correlates of gaming and the prevalence and correlates of problematic gaming. METHODS: We anonymously surveyed 4028 adolescents about gaming and reported problems with gaming and other health behaviors. A total of 51.2% of the sample reported gaming (76.3% of boys and 29.2% of girls). RESULTS: There were no negative health correlates of gaming in boys and lower odds of smoking regularly; however, girls who reported gaming were less likely to report depression and more likely to report getting into serious fights and carrying a weapon to school. Among gamers, 4.9% reported problematic gaming, defined as reporting trying to cut back, experiencing an irresistible urge to play, and experiencing a growing tension that could only be relieved by playing. Boys were more likely to report these problems (5.8%) than girls (3.0%). Correlates of problematic gaming included regular cigarette smoking, drug use, depression, and serious fights. Results suggest that gaming is largely normative in boys and not associated with many health factors. In girls, however, gaming seems to be associated with more externalizing behaviors and fewer internalizing symptoms. CONCLUSIONS: The prevalence of problematic gaming is low but not insignificant, and problematic gaming may be contained within a larger spectrum of externalizing behaviors. More research is needed to define safe levels of gaming, refine the definition of problematic gaming, and evaluate effective prevention and intervention strategies.

Gender differences in the associations between past-year gambling problems and psychiatric disorders

Psychiatric disorders frequently co-occur with pathological gambling. The extent to which co-occurence extends to subsyndromal levels of gambling or differs between women and men is incompletely understood. To examine whether the association between psychiatric disorders and past-year gambling problems is stronger in women than men. Data from the national epidemiological survey of alcoholism and related disorders (NESARC) (n = 43,093) were analyzed. Increasing severity of past-year gambling problems was associated with increasing odds of most past-year Axis I and lifetime Axis II disorders, regardless of gender. Associations between gambling problems and major depression, dysthymia, panic disorder, and nicotine dependence were statistically stronger in women than in men. A severity-related association exists between past-year gambling problems and psychiatric disorders. The stronger associations in women suggest that gambling research, prevention and treatment efforts consider gender differences.

Nondaily smoking and alcohol use, hazardous drinking, and alcohol diagnoses among young adults: findings from the NESARC.

BACKGROUND Nondaily smoking and heavy alcohol use are prevalent behaviors among young adults, with nondaily smoking occurring primarily in the context of alcohol use. Although the relationship between drinking and daily smoking has been well characterized in young adults, few epidemiological investigations have investigated the association between nondaily smoking and drinking behavior. METHODS We examined Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; Grant et al., 2003b; n = 43,093). Young adults (aged 18 to 25 years; n = 5,838) were stratified on current smoking behavior (daily, nondaily, and nonsmokers in the past 12 months) and differences in weekly quantity of alcohol use, frequency of alcohol use, frequency of binge drinking behavior, rates of NIAAA-defined hazardous drinking, and rates of DSM-IV alcohol diagnoses were investigated. College student status was examined. RESULTS Twenty-five percent were current smokers and 7% were smoking on a nondaily basis. Seventy-one percent were current drinkers, 39% reported binge drinking at least once a month, 41% met criteria for hazardous drinking, and 18% had alcohol use disorders. Across all measures of alcohol use, there was a significant effect of smoking status, with daily smokers having greater alcohol use patterns, compared with nondaily smokers, with nonsmokers consuming the least. Nondaily smokers were more likely to report any binge drinking in the past 12 months. However, daily smokers were more likely to report daily binge drinking. With regard to hazardous drinking and alcohol use disorders, nondaily smoking conferred the greatest risk, followed by daily smoking with nonsmoking as the reference group. Multinomial logistic regression demonstrated that the odds of being a hazardous drinker were 16 times greater (95% CI 9.46-26.48) in a nondaily smoker compared with a nonsmoker, whereas the odds for a daily smoker were increased by 7-fold (95% CI 5.54-9.36). A similar pattern of results was demonstrated for DSM-IV alcohol diagnoses. No differences across college student status were observed. CONCLUSIONS The increased risk of hazardous drinking and alcohol use disorders conferred by nondaily smoking supports the findings that nondaily smoking and drinking are highly concomitant behaviors. Results such as these suggest that interventions disengaging alcohol and cigarette use patterns (e.g., smoking bans in alcohol venues) might serve to limit the occurrence of hazardous drinking among young adults at heightened risk for this behavior.

Evolution of the Surgeon Volume / Patient Outcome Relationship

Objective:Higher surgeon volume is associated with improved patient outcomes. This finding has prompted recommendations for increasing specialization and referrals to high-volume surgeons, yet their implementation in clinical practice has not been measured. Methods:We performed cross-sectional analyses using 1999 and 2005 discharge information from the Health Care Utilization Project National Inpatient Sample to measure whether the number of procedures performed by high-volume surgeons increased over time. Procedures included those demonstrated to have strong surgeon volume-outcome associations in the literature. International Classification of Diseases, Ninth Revision codes were employed for colorectal procedures, esophagectomy, gastrectomy, pancreatectomy, thyroidectomy, coronary artery bypass graft surgery, and carotid endarterectomy. Bivariate analyses and hierarchical generalized linear models were employed to measure association between surgeon volume and length of stay (LOS) and mortality or complications. Results:There was a significant increase in the proportion of procedures performed by high-volume surgeons over time, with the most dramatic increases seen for gastrectomy (54%), pancreatectomy (31%), and thyroidectomy (23%). Having a procedure performed by a high-volume surgeon was associated with patient race and insurance status. Overall, unadjusted mortality and LOS were significantly lower for high-volume surgeons compared with low-volume surgeons in 1999 and 2005. In multivariable hierarchical generalized linear models, only differences in LOS by surgeon volume remained significant in both years. Conclusions:The proportion of procedures performed by high-volume surgeons increased over a 6-year period, as evidence mounted in support of a surgeon volume-outcome association. Efforts are still needed to improve access among underserved subsets of the population and eliminate apparent disparities based on patient race and insurance status.

Gender Differences in Adolescent Gambling

BACKGROUND Although adolescent gambling has been linked to a wide array of risk behaviors, little is known regarding the correlates of gambling in adolescent girls as compared with adolescent boys. METHODS We examined by logistic regression a nationally representative U.S. sample (n = 534) of 16- and 17-year-olds from the 1998 Gambling Impact and Behavior Study (GIBS) (1) to investigate the influence of gender on: 1) the association between gambling and psychiatric symptomatology; and, 2) gambling attitudes and behaviors. RESULTS Gambling was associated with elevated rates of alcohol use and abuse/dependence in both boys and girls, and dysphoria/depression in girls only. Boy gamblers reported heavier gambling and higher rates of gambling problems than did girl gamblers. CONCLUSIONS Adolescent gambling may be associated with more severe psychiatric symptoms in girls than in boys, though future research will be needed to replicate and extend these findings. Gender considerations are important in understanding youth gambling and the relationship between gambling and psychiatric disorders in adolescents.

Nicotine withdrawal in U.S. smokers with current mood, anxiety, alcohol use, and substance use disorders

BACKGROUND The current study examined tobacco withdrawal symptoms and withdrawal-related discomfort and relapse in smokers with and without current mood disorders, anxiety disorders, alcohol use disorders (AUD), and substance use disorders (SUD). METHODS The subsample of current daily smokers (n=8213) from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, Wave 1, 2001-2002, full sample n=43,093) were included in these analyses. Cross-sectional data compared smokers with and without current psychiatric disorders on withdrawal symptoms using logistic regression models. The effects of having a co-morbid psychiatric disorder and AUD/SUD compared to a psychiatric disorder alone on nicotine withdrawal were also examined. RESULTS Participants with a current mood disorder, anxiety disorder, AUD, or SUD were more likely to report withdrawal symptoms and reported more withdrawal symptoms than those without current disorders. Having a current mood disorder, anxiety disorder, or SUD was also associated with increased likelihood of withdrawal-related discomfort and relapse. There were no significant interactions between psychiatric disorders and AUDs/SUDs on withdrawal symptoms or behavior. CONCLUSIONS Participants with a current Axis I disorder were more likely to experience tobacco withdrawal symptoms and withdrawal-related discomfort and relapse. Having a co-morbid psychiatric disorder and AUD/SUD did not synergistically increase the experience of withdrawal-related symptoms or relapse. It is important to identify Axis I disorders in smokers and provide these smokers with more intensive and/or longer treatments to help them cope with withdrawal symptoms and prevent relapse.

Benchmarking treatment of schizophrenia: A comparison of service delivery by the national government and by state and local providers

This study compared treatment of schizophrenia in two types of organization: a national, government-operated health care system, the Department of Veterans Affairs (VA), and in hospitals and clinics operated by state and local providers. Between 1994 and 1996, 746 male patients with a clinical diagnosis of schizophrenia residing in two states in the Southeast and Midwest were surveyed: 192 VA inpatients were compared with 96 non-VA inpatients, and 274 VA outpatients were compared with 184 non-VA outpatients. VA patients were older and had higher incomes than non-VA patients but did not differ significantly on measures of clinical status, satisfaction with providers, or community adjustment. VA outpatients were more likely to have been hospitalized during the previous year than non-VA outpatients and were less likely to have received services from a day hospital, from a case manager or social worker, or to have received crisis intervention services. On 5 of 26 Schizophrenic Patient Outcomes Research Team treatment recommendations, a smaller proportion of VA than non-VA patients adhered to standards. Four of these reflected reduced access among VA patients to psychosocial services such as work therapy, job training, or case management services. Cross-sectional surveys can be used to compare quality of care across service systems. VA care was associated with similar satisfaction and clinical outcomes but greater reliance on hospital treatment and less use of community-based psychosocial services.

Problematic Internet Use and Health in Adolescents: Data from a High School Survey in Connecticut

OBJECTIVE This study aims to explore the prevalence and health correlates of problematic Internet use among high school students in the United States. METHOD A cross-sectional survey with a sample size of 3,560 students was conducted among high schools in Connecticut. Demographic data, characteristics of Internet use, health measures, and risk behaviors were assessed. Chi-square and logistic regression analyses were used to study the relationship between problematic Internet use and risk behaviors as well as related gender differences. RESULTS When problematic Internet use was diagnosed with criteria modeled after the Minnesota Impulsive Disorder Inventory that address core features of impulse-control disorder (strong urge, growing tension, and attempts to cut back), the overall prevalence was about 4%, with no significant difference between genders. Problematic Internet use was more common among Asian (7.86%) and Hispanic (6.07%) students. Even though boys spent significantly more time on the Internet (16.52% of boys spent over 20 hours per week vs 12.62% of girls; P = .0001) and more frequently missed important school or social activities as a result (8.97% of boys vs 5.85% of girls; P = .0004), girls more frequently self-reported measures of excessive use of the Internet (11.81% of girls thought that they had a problem vs 8.90% of boys; P = .0048). After adjustment of sociodemographic factors, problematic Internet use was found to associate significantly with substance use (P = .0014), depression (P < .0001), and aggression (P < .0001), with largely similar patterns of associations between genders. CONCLUSIONS Problematic Internet use may be present in about 4% of high school students in the United States. It may be associated with depression, substance use, and aggressive behaviors. High school boys, though, may have heavier Internet use and may be less self-aware of the related problems.

Outcomes Following Thyroid and Parathyroid Surgery in Pregnant Women

OBJECTIVES To perform the first population-based measurement of clinical and economic outcomes after thyroid and parathyroid surgery in pregnant women and identify the characteristics of this population and the predictors of outcome. DESIGN Retrospective cross-sectional study. SETTING Health Care Utilization Project Nationwide Inpatient Sample (HCUP-NIS), a 20% sample of nonfederal US hospitals. PATIENTS All pregnant women, compared with age-matched nonpregnant women, who underwent thyroid and parathyroid procedures from 1999 to 2005. MAIN OUTCOME MEASURES Fetal, maternal, and surgical complications, in-hospital mortality, median length of stay, and hospital costs. RESULTS A total of 201 pregnant women underwent thyroid (n = 165) and parathyroid (n = 36) procedures and were examined together. The mean age was 29 years, 60% were white, 25% were emergent or urgent admissions, and 46% had thyroid cancer. Compared with nonpregnant women (n = 31 155), pregnant patients had a higher rate of endocrine (15.9 vs 8.1%; P < .001) and general complications (11.4 vs 3.6%; P < .001), longer unadjusted lengths of stay (2 days vs 1 day; P < .001), and higher unadjusted hospital costs (

GENDER DIFFERENCES IN ADOLESCENT MARIJUANA USE AND ASSOCIATED PSYCHOSOCIAL CHARACTERISTICS

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