Raul Caetano

Socioeconomic Predictors of Intimate Partner Violence Among White, Black, and Hispanic Couples in the United States

This study assesses the relative influence of various SES measures on the probability of intimate partner violence (IPV) among a national sample of White, Black, and Hispanic married and cohabiting couples. Participants were interviewed in conjunction with the 1995 National Alcohol Survey. Sociodemographic, psychosocial, and alcohol consumption data were obtained from both members of the couple. IPV was measured through the Conflict Tactics Scale, Form R. Bivariate tests were employed to investigate the association between SES and IPV. Deviance statistics, based on contrasting transformed likelihood measures obtained through multivariate logistic regression models, were computed to assess the relative influence of SES on the probability of IPV. Results indicate that annual household income had the greatest relative influence on the probability of partner violence. Future research is needed to explore the pathways by which SES contributes to the risk of partner violence.

THE MIXED EVIDENCE FOR BRIEF INTERVENTION IN EMERGENCY DEPARTMENTS, TRAUMA CARE CENTERS AND INPATIENT HOSPITAL SETTINGS: WHAT SHOULD WE DO?

BACKGROUND This qualitative review is based on a symposia presented at the 2009 annual conference of the Research Society on Alcoholism (Baird et al., 2009; Field et al., 2009; Monti et al., 2009; Saitz et al., 2009a). The purpose is to describe the mixed evidence supporting brief interventions in the emergency department, trauma care, and in-patient medical care settings; examine potential moderators of treatment outcome in light of the mixed evidence; and identify methods to move the research and practice of brief interventions beyond their current state. METHODS By drawing upon existing reviews and selected individual studies, we provide examples that reflect the current complexity of research in this area and propose steps for advancing the field. RESULTS Emergency departments, inpatient hospital settings, and trauma care settings represent three unique contexts within which brief interventions have been tested. While the general efficacy of brief alcohol interventions in these settings has been recognized, the evidence is increasingly mixed. Recent studies investigating potential moderators of treatment outcomes suggest that a more sophisticated approach to evaluating the effectiveness of brief interventions across varying patient populations is needed to further understand its effectiveness. CONCLUSIONS Current dissemination efforts represent a significant advance in broadening the base of treatment for alcohol problems by providing an evidence-based intervention in health care settings and should not be curtailed. However, additional research is required to enhance treatment outcomes, refine current practice guidelines, and continue to bridge the gap between science and practice. Given the current state of research, a multisetting clinical trial is recommended to account for potential contextual differences while controlling for study design.

Patterns of alcohol use among Brazilian adolescents

OBJECTIVE To describe patterns of alcohol consumption by adolescents in Brazil. METHOD From November 2005 to April 2006, a sample composed of 661 subjects aged between 14 to 17 years was rigorously selected in Brazil using a multistage probabilistic method to represent the profile of the adolescent Brazilian population. RESULTS 34% of Brazilian adolescents drink alcoholic beverages. The mean age of drinking initiation was 14 years of age. Older adolescents, as well as those living in the southern part of Brazil, those who are not attending school and those who are working, and black individuals and those with personal income reported a higher frequency of drinking. Socio-demographic factors such as gender, income bracket, family income and student status do increase the amount of alcohol consumed. Males report a higher frequency of binge drinking than females. Moreover, more than half of the males that had drunk in the previous year reported having engaged in binge drinking on at least one occasion. Beer represents approximately half of all the drinks consumed by adolescents. There was no significant difference between genders in the kind of alcohol consumed. DISCUSSION Among adolescents who drink, the consumption of several drinks is frequent. Alcohol consumption varies from region to region, social economic status (including self-generated income) and age. These findings are discussed in light of their importance for the development of alcohol prevention policies in Brazil.

Longitudinal model predicting mutual partner violence among white, black, and hispanic couples in the United States general population

This analysis determines the longitudinal predictors of male-to-female (MFPV) or female-to-male (FMPV) alone and mutual partner violence (MPV) among White, Black, and Hispanic couples. A national sample of couples 18 years of age or older was interviewed in 1995 and again in 2000. Participants constitute a multistage area probability sample representative of married and cohabiting couples from the 48 contiguous United States. Results indicate that most couples reporting violence engage in MPV. After controlling for other factors, Blacks are 3 times more likely to report MPV at follow-up and Hispanics are 9 times more likely to report MFPV. The results indicate that ethnic minorities are at greater risk of MPV. In addition, the predictors of partner violence vary depending on the type of partner violence. These findings highlight the importance of distinguishing different types of partner violence and have important epidemiological and prevention implications.

A Randomized, Double‐Blind, Placebo‐Controlled Trial of Quetiapine in Patients with Bipolar Disorder, Mixed or Depressed Phase, and Alcohol Dependence

BACKGROUND Alcohol dependence is common in bipolar disorder (BPD) and associated with treatment nonadherence, violence, and hospitalization. Quetiapine is a standard treatment for BPD. We previously reported improvement in depressive symptoms, but not alcohol use, with quetiapine in BPD and alcohol dependence. However, mean alcohol use was low and a larger effect size on alcohol-related measures was observed in those with higher levels of alcohol consumption. In this study, efficacy of quetiapine in patients with BPD and alcohol dependence was examined in patients with higher mean baseline alcohol use than in the prior study. METHODS Ninety outpatients with bipolar I or II disorders, depressed or mixed mood state, and current alcohol dependence were randomized to 12 weeks of sustained release quetiapine (to 600 mg/d) add-on therapy or placebo. Drinking was quantified using the Timeline Follow Back method. Additional assessment tools included the Hamilton Rating Scale for Depression, Inventory of Depressive Symptomatology-Self-Report, Young Mania Rating Scale, Penn Alcohol Craving Scale, liver enzymes, and side effects. Alcohol use and mood were analyzed using a declining-effects random-regression model. RESULTS Baseline and demographic characteristics in the 2 groups were similar. No significant between-group differences were observed on the primary outcome measure of drinks per day or other alcohol-related or mood measures (p > 0.05). Overall side effect burden, glucose, and cholesterol were similar in the 2 groups. However, a significant weight increase was observed with quetiapine at week 6 (+2.9 lbs [SE 1.4] quetiapine vs. -2.0 lbs [SE 1.4], p = 0.03), but not at week 12. Scores on the Barnes Akathisia Scale increased significantly more (p = 0.04) with quetiapine (+0.40 [SE 0.3]) than placebo (-0.52 [SE 0.3]) at week 6 but not week 12. Retention (survival) in the study was similar in the groups. CONCLUSIONS Findings suggest that quetiapine does not reduce alcohol consumption in patients with BPD and alcohol dependence.

Ethnic Differences in the Effect of Drug Use and Drug Dependence on Brief Motivational Interventions Targeting Alcohol Use

BACKGROUND We examined the effects of baseline drug use and dependence on alcohol use outcomes following brief motivational intervention for at-risk drinking (BMI-ETOH). METHODS HLM models were developed to test the interaction of drug use and dependence with BMI-ETOH for alcohol use among Hispanic (n=539), Caucasian (n=667), and black (n=287) patients admitted to a Level-1 trauma center who screened positive for alcohol misuse. RESULTS Analyses of an interaction of drug dependence and BMI-ETOH at baseline showed significant positive effects among Hispanics but not Caucasians or Blacks at six- and 12-months for percent days abstinent (6-month: B=0.27, SE=0.10, p=0.006; 12-month: B=0.41, SE=0.11, p<0.001), volume per week (6-month: B=-1.91, SE=0.77, p=0.01; 12-month: B = -2.71, SE=0.86, p=0.002), and maximum amount consumed (6-month: B = -1.08, SE=0.46, p=0.02; 12-month: B = -1.62, SE=0.52, p=0.002). CONCLUSIONS Baseline drug dependence did not negatively impact drinking outcomes. Among Hispanics, those with drug dependence at baseline who received a BMI-ETOH demonstrated consistent improvements across drinking outcomes. While the effects of drug use at baseline on drinking outcomes following BMI-ETOH varied by type of drug used and ethnicity, additional research is required.

Measurement invariance of alcohol instruments with Hispanic youth

INTRODUCTION Despite their widespread use across clinical and research settings, no study has yet investigated the fit of several standard alcohol measures for Hispanic youth, including those used to assess motivation to change, self-efficacy, peer norms, and problem drinking. This study thus served to address this gap by evaluating measurement invariance with substance-using youth. METHODS We enrolled a large sample of regular substance-using youth who were involved with the justice system (N=368; 72.9% male; 76.9% Hispanic; M age=16.17years). Similar to the broader Hispanic population of the southwest United States (U.S.), Hispanic youth in the sample were on average 3.5th generation (with at least 1 foreign-born grand-parent). Following standard administration and scoring procedures, all youth completed measures of motivation to change (e.g., readiness rulers, intentions to change), self-efficacy (e.g., drink refusal in social situations), peer norms (e.g., peer norms for substance use), and problem drinking (e.g., substance use quantity/frequency; Alcohol Use Disorders Identification Test; Rutgers Alcohol Problems Index; Timeline FollowBack). Measurement equivalence was evaluated via multiple group confirmatory factor analysis. RESULTS Our results indicated that each measure evaluated herein worked equally well for Hispanic and Caucasian youth. We found measurement invariance at every level tested. CONCLUSIONS This study supports the validity and future use of these important and widely-used alcohol use measures for high-risk substance-using Hispanic youth. Further, given the representativeness of this sample within the southwestern U.S., these results show promise for generalizability to U.S.-born Hispanic youth within this geographic region.

Postdischarge nonmedical use of prescription opioids in at-risk drinkers admitted to urban level I trauma centers.

BACKGROUND Nonmedical use of prescription opioids (NM-POs) has reached epidemic proportions in the United States. Unintentional overdose deaths involving prescription opioids have quadrupled since 1999. Herein, we examine NM-POs and their associated risk factors among two cohorts of trauma patients with at-risk drinking. METHODS This secondary analysis examines NM-PO from two separate randomized trials that delivered brief alcohol interventions to patients in urban Level I trauma centers. In the first study, data were collected from 1,493 injured patients at a single trauma center, and in the second study, data were collected from 596 injured patients at two trauma centers. All participants were considered at-risk drinkers because they were admitted for an alcohol related injury as indicated by a positive blood alcohol concentration and/or self-reported heavy drinking. RESULTS In Study 1, NM-PO nearly doubled from 5.2% before admission to 9.8% at 6 months after discharge. At 12 months after discharge, those who reported NM-PO (odds ratio [OR], 2.31; 95% confidence interval [CI], 1.28–4.15) and drug use (OR, 2.62, 95% CI, 1.70–4.04) before admission had the highest odds for postdischarge NM-PO. In Study 2, NM-PO increased from 5.2% before admission to 6.8% at 12 months after discharge. At 12 months after discharge, those who reported NM-PO (OR, 2.71; 95% CI, 1.10–6.66) or drug use (OR, 4.05; 95% CI, 2.00–8.21) before admission had the highest odds for postdischarge NM-PO. CONCLUSION The results suggest that there is an increased risk of postdischarge NM-PO among injured patients with at-risk drinking, particularly among those with a recent history of drug use or NM-PO. Cautious, evidence-based opioid prescribing may reduce exposure to prescription opioids in high-risk patients, risk of subsequent misuse, and possible diversion. LEVEL OF EVIDENCE Prognostic/epidemiologic study, level II.

Factor structure of the Clinical Research Appraisal Inventory (CRAI).

The Clinical Research Appraisal Inventory (CRAI) is a 92-item measure covering 10 domains of research self-efficacy. A known behavioral antecedent, reliable and valid measures of self-efficacy represent a potentially useful tool in the evaluation of research training program efficacy. However, few formal psychometric studies of this instrument exist. Using exploratory factor analysis, we examine the CRAI’s dimensional structure in a new sample of clinical research trainees. In contrast to the multidimensional solutions reported previously, CRAI responses in the present sample were unambiguously one-dimensional (as suggested by a dominant single Eigenvalue and parallel analysis). This discrepant finding may reflect sample differences in research experience, as unlike previous studies, participants had all already obtained a professional degree. The CRAI’s dimensional structure may coalesce into a smaller number of factors as research experience is acquired, and investigators should be mindful of this possibility in future studies of the instrument.

The role of drug use in brief alcohol interventions: a multi-ethnic/racial analysis

Craig Field is with the Health Behavior Research and Training Institute, University of Texas at Austin, Austin, TX, USA -- Geral Cochran is with the Center for Social Work Research, The University of Texas at Austin School of Social Work, Austin, TX, USA -- Raul Caetano is with the School of Health Professions, University of Texas Southwestern Medical Center, Dallas, TX, USA