Rikki Patton

Correlates of depressive symptoms among at-risk youth presenting to the emergency department☆

OBJECTIVEnThe studys objective was to identify correlates of depressive symptoms among at-risk youth in an urban emergency department (ED).nnnMETHODnA systematic sample of adolescents (ages 14-18) in the ED were recruited as part of a larger study. Participants reporting past-year alcohol use and peer aggression self-administered a survey assessing: demographics, depressive symptoms and risk/protective factors. Logistic regression identified factors associated with depressive symptoms.nnnRESULTSnAmong 624 adolescents (88% response rate) meeting eligibility criteria, 22.8% (n=142) screened positive for depressive symptoms. In logistic regression, depressive symptoms were positively associated with female gender [odds ratio (OR): 2.84, 95% confidence interval (CI): 1.78-4.51], poor academic performance (OR: 1.57, 95% CI: 1.01-2.44), binge drinking (OR: 1.88, 95% CI: 1.21-2.91), community violence exposure (OR: 2.25, 95% CI: 1.59-3.18) and dating violence (OR: 2.14, 95% CI: 1.36-3.38) and were negatively associated with same-sex mentorship (OR: 0.52, 95% CI: 0.29-0.91) and older age (OR: 0.55, 95% CI 0.34-0.89). Including gender interaction terms did not significantly change findings.nnnCONCLUSIONSnScreening and intervention approaches for youth in the urban ED should address the co-occurrence of depressive symptoms with peer and dating violence, alcohol and nonmarijuana illicit drug use.

Prevalence and correlates of transactional sex among an urban emergency department sample: Exploring substance use and HIV risk

Men and women involved in transactional sex (TS) report increased rates of HIV risk behaviors and substance use problems as compared with the general population. When people engaged in TS seek health care, they may be more likely to utilize the emergency department (ED) rather than primary care services. Our goal was to examine the prevalence and correlates of TS involvement among an ED sample of men and women. Adults ages 18-60 were recruited from an urban ED, as part of a larger randomized control trial. Participants (n = 4,575; 3,045 women, 1,530 men) self-administered a screening survey that assessed past 3-month substance use (including alcohol, marijuana, illicit drugs, and prescription drugs) and HIV risk behaviors, including TS (i.e., being paid in exchange of a sexual behavior), inconsistent condom use, multiple partners, and anal sex. Of the sample, 13.3% (n = 610) reported TS within the past 3 months (64.4% were female). Bivariate analysis showed TS was significantly positively associated with alcohol use severity, marijuana use, and both illicit and prescription drug use, and multiple HIV risk behaviors. These variables (except marijuana) remained significantly positively associated with TS in a binary logistic regression analysis. The prevalence of recent TS involvement among both male and female ED patients is substantial. These individuals were more likely to report higher levels of alcohol/drug use and HIV risk behaviors. The ED may be a prime location to engage both men and women who are involved in TS in behavioral interventions for substance use and sexual risk reduction.

Prevalence and Correlates of Depression and Drinking Behaviors Among Adolescents and Emerging Adults in a Suburban Emergency Department

ABSTRACT Background: Both alcohol use and depression are concerning health issues among youth. The Emergency Department (ED) is a critical location to access youth with depressive symptoms and alcohol misuse. Objectives: To inform future interventions in the ED, this study examined the relationship between drinking behaviors and depressive symptoms among youth seeking ED care. Methods: Youth ages 14–20 were recruited from a level-1 trauma ED located in the Midwest as part of a larger ongoing study. Participants completed an electronic screening survey, which included assessment of alcohol use, depressive symptoms, and demographic variables. Two logistic regression models were conducted to assess the relationship between depressive symptoms with alcohol consumption and specific alcohol-related consequences. Results: Among 3,659 participants, bivariate analysis indicated that individuals screening positive for depression were more likely to be female, nonwhite, receive public assistance, and report higher scores on both alcohol consumption and alcohol-related consequences. Regression analyses indicated alcohol consumption, inability to stop drinking once starting, and feelings of guilt or remorse after drinking were significantly positively related to screening positive for depression. Conclusions/Importance: Current findings support use of the ED as a location for identifying youth who are experiencing co-morbid alcohol use and depressive symptoms. Future research should focus on the effectiveness of brief intervention in the ED that focuses on the co-occurrence of alcohol misuse and depressive symptoms among youth.

Capability through Participatory Democracy: Sen, Freire, and Dewey.

Abstract This paper explores possible important relationships and sympathies between Amartya Sen’s Capabilities Approach framework for understanding the human condition and the educational ideas of John Dewey and Paolo Freire. All three focus on the importance of democratic values in a fair, well-functioning society, while Sen and Freire especially explore the difficulties and possibilities of oppressed populations. Sen suggests that all humans have a right to choice in determining their life trajectories and should be provided with the tools that allow them to flourish. Both education and democratic values play important roles in creating the types of context that allow individuals and communities to recognize a wide array of human capabilities. We suggest here that the theories of Dewey and Freire offer avenues through educational processes for developing these contexts for expanded human capability. Dewey suggests an educational approach that stresses democratic values and the ability and willingness of individuals to reach out towards new possibilities. Freire stresses the idea of praxis playing a central role in education—a focus on the cycle of everyday action, reflection, and re-creation of action that leads to productive changes in life trajectories. We argue that Sen, Dewey, and Freire together help to offer a new way of understanding education in the twenty-first century.

Rethinking substance abuse treatment with sex workers: How does the capability approach inform practice?

Substance abuse treatment providers commonly provide services for men and women involved in sex work. Sex workers often present to treatment with a complicated array of challenges (M. L. Burnette et al., 2008a; D. C. Ling, W. C. W. Wong, E. A. Holroyd, & S. A. Grayson, 2007; M. Young, C. Boyd, & A. Hubbell, 2000), and, while many scholars have posited the need for adapted interventions for sex workers (L. Nuttbrock, A. Rosenblum, S. Magura, C. Villano, & J. Wallace, 2004; A. Weiner, 1996), there is still a lull in the development of comprehensive, tailored services for sex workers seeking substance abuse treatment (L. Nuttbrock et al., 2004). Augmenting this gap is the lack of a clear framework through which to understand the challenges that sex workers endure and how their challenges may differ from treatment-seeking non-sex workers. In order to address this gap, the current study explored the utility of a social justice framework, namely the Capability Approach, in predicting sex work involvement among a substance-abusing sample. We hypothesize that increased challenges to achieving capability will predict sex work involvement among a substance-abusing sample. Results suggest that the Capability Approach is a useful framework that can be used to differentiate between sex workers and their substance-abusing counterparts and that sex workers experience greater challenges to achieving capability. As such, the current findings support recent calls in the literature for the development of tailored services to meet the needs of this population.

A Brief Report on the Ethical and Legal Guides For Technology Use in Marriage and Family Therapy

Marriage and family therapists (MFTs) use ethical codes and state licensure laws/rules as guidelines for best clinical practice. It is important that professional codes reflect the potential exponential use of technology in therapy. However, current standards regarding technology use lack clarity. To explore this gap, a summative content analysis was conducted on state licensure laws/rules and professional ethical codes to find themes and subthemes among the many aspects of therapy in which technology can be utilized. Findings from the content analysis indicated that while there have been efforts by both state and professional organizations to incorporate guidance for technology use in therapy, a clear and comprehensive roadmap is still missing. Future scholarship is needed that develops clearer guidelines for therapists.

Examining Couple Functioning and Alcohol use Among Latino Couples: A Dyadic Data Analysis

ABSTRACT Background: Prior research suggests that Latinos are at higher risk of alcohol use as compared to their counterparts (NSDUH, 2014). However, little work has been conducted to understand alcohol use among Latinos systemically and more research is needed to better understand the impact of couple functioning on alcohol use among Latino couples. Objectives: The current study aimed to examine how each partners perception of couple functioning impacted alcohol use in Latino dyads. Methods: Using data from 329 Latino dyads from the Building Strong Families (BSF) Project, a structural equation model examining the actor-partner interactions between partner perceptions of couple functioning and each persons alcohol use was analyzed. Results: Correlation analysis revealed that the dyads perceptions of couple functioning were positively correlated. Results from the APIM model indicated males perceptions of couple functioning was positively associated with his own alcohol use, whereas females perceptions of couple functioning was not significantly related to either partners alcohol use. Conclusions/Importance: The findings may help clinicians, researchers, and policy makers to better conceptualize how couple functioning may impact alcohol use among Latino dyads.