Sandra K. Pope

The Association of Menopause and Physical Functioning in Women at Midlife

OBJECTIVES: To determine whether the characteristics of menstrual bleeding and the menopausal transition are associated with physical functioning in women age 40 to 55, after considering ethnicity, ability to pay for basics, body size, and age.

Intensive short course chemotherapy for tuberculous meningitis.

This nonrandomized, open clinical investigation of tubereulous meningitis evaluated 53 children with Stage I (n = 8), Stage II (n = 29) and Stage III (n = 16) disease. The overall mortality was 20.8% (11 of 53) with a rate of sequelae of 35.7% (15 of 42) in survivors reflecting the advanced stages of children at diagnosis. Various combinations of standard antituberculous drugs including isoniazid, rifampin, pyrazinamide, streptomyein and ethambutol were given. Three treatment durations used during various time periods were evaluated: 12, 9 and 6 months with only the 6-month regimen receiving pyrazinamide (PZA). This prospective evaluation demonstrated that: (1) severe disease at presentation is highly associated with early mortality (P < 0.05), regardless of drug regimen; and (2) intensive short course chemotherapy (6 months) with PZA, regardless of stage of disease at presentation, is more efficacious than longer course therapy (9 or 12 months) without PZA in preventing total negative outcomes and sequelae (P < 0.05). This study demonstrates that a 6-month regimen containing PZA can be used in treating children with tuberculous meningitis.

Black and White Differences in Cognitive Function Test Scores: What Explains the Difference?

Several studies have reported that older black and Latino adults have lower cognitive function test scores than older white adults, but few have comprehensively examined reasons for score differences. This study evaluates whether differences in health and socioeconomic indicators, including literacy level, can explain differences in cognitive function test scores between older black and white adults.

Patterns of Parenting Behavior in Young Mothers.

PATTERNS OF PARENTING BEHAVIOR IN YOUNG MOTHERS* Leanne Whiteside-Mansell, Sandra K. Pope, and Robert H. Bradley** Children of young mothers are thought to be at risk for developmental delay and behavioral problems. In this study, the parenting behaviors of 193 White and African American mothers 15-24 years of age were assessed when their children were 12 and 36 months old. Cluster analysis of 3 dimensions of parenting was used to identify 5 types of parenting patterns. Evidence supporting these parenting clusters included interpretable mean scores; expected differences in childrens cognitive and social development; and differences in familial, maternal, and child factors. The strongest discriminating factor-maternal IQ-was associated with more positive parenting behavior patterns. Among the mothers with the lowest IQ scores, the most discriminating factor was the birth of additional children. The results of this study support the assumption that parenting is dynamic and multidimensional. Since the 1960s, when the birth rate among unwed teenagers began increasing and young mothers began shifting away from adoption as an option for providing care for their infants, society has shown accelerated concern for young parents as caregivers. Many young mothers lack financial resources and stable environments; many of their children will spend at least part of their lives in poverty. Children of young mothers are thought to be at risk for developmental delay and behavioral problems because of the low quality of caregiving provided by their young mothers. Although research concerning the direct influence of maternal age on parenting behaviors is mixed (Conger, Yang, & Burgess, 1984; Elster, McAnarney, & Lamb, 1983; Jones, Green, & Krauss, 1980), there is evidence that younger mothers interact differently with their children and are less competent parents than older mothers on some dimensions of parenting. Several studies indicate that young mothers provide less stimulation to their children than older mothers (Brooks-Gunn & Chase-Lansdale, 1991; Carlson, Labarba, Sclafani, & Bowers, 1986; Coll, Vahr, Hoffman, & Oh, 1986; King & Fullard, 1982; Luster & Rhoades, 1989; Parks & Arndt, 1990; Reis, Barbera-Stein, & Bennett, 1986; Schilmoeller & Baranowski, 1985) and, in particular, provide less verbal stimulation to their infants (Coll, Hoffman, & Oh, 1987; Field, Widmayer, Stringer, & Ignatoff, 1980; McAnarney, Lawrence, Ricciuti, Polley, & Szilagyi, 1986; Reis & Herz, 1987; Schilmoeller & Baranowski, 1985; vonWindeguth & Urbano, 1989). In addition, young mothers demonstrate less acceptance of infant behavior (are more punitive) than older mothers (McAnarney et al., 1986; Reis & Herz, 1987). However, Lamb and Ketterlinus (1990), after reviewing the literature, concluded that there is no evidence that young mothers are more likely to neglect or abuse their offspring. Some researchers reason that young women are immature (generally measured by maternal age) and psychologically unprepared to parent. They suggest that young mothers, like adolescents in general, are absorbed with their own needs, have not developed adequate coping mechanisms, and are struggling to gain autonomy (Helm, 1988; Jones et al., 1980). Others argue that age per se may not be the issue. They maintain that young mothers represent a diverse group and that environmental and family factors associated with young parenthood may be more determinative of parenting than the age of the mother (King & Fullard, 1982; Osofsky, Culp, & Ware, 1988; Roosa, Fitzgerald, & Carlson, 1982). Because many young mothers are single, live in poverty, possess few resources, and experience more than normal stresses, it is difficult to separate the influence of environmental factors and young age (Elster et al., 1983; Ketterlinus, Lamb, & Nitz, 1991). In effect, young mothers are often at risk for distress, which makes it more difficult for them to provide nurturant, stimulating care (McLoyd, 1990). …

Functional limitations in women at midlife: the role of health conditions, behavioral and environmental factors

This study examined risk factors for functional limitations in a community-based sample of 16,065 women from 5 ethnic groups, aged 40-55 years, enrolled in the Study of Womens Health Across the Nation. Almost 20% of this sample reported physical-functioning limitations. Functional limitations were associated with numerous disease conditions, including high blood pressure, diabetes, heart attack or angina, arthritis, osteoporosis, and cancer, and with several behavioral and environmental risk factors, including body mass index, difficulty paying for basics, and high levels of perceived stress. Consistent with findings in older women, this study shows that in addition to health conditions, potentially modifiable risk factors including high body mass index, difficulty paying for basics, and high levels of stress are associated with physical-functioning limitations of women at midlife.

Gender differences in rural adolescent drinking patterns

PURPOSE The purpose of this study was to examine differences in rural adolescent male and female drinking patterns, problem drinking behavior, and the factors associated with problem drinking behavior. METHODS An anonymous written survey was administered to 2,297 adolescents, aged 12 to 18 years, in a rural Mississippi River Delta county. Potential risk factors for problem drinking behavior examined included demographic, behavioral, peer, and parental characteristics. Drinking patterns were examined separately for male and female adolescent drinkers. RESULTS Individual factors associated with problem drinking behavior for these rural adolescents were consistent with previous research. However, these factors were gender specific in prevalence. Males were more likely than females to report all of the behavioral and peer risk factors associated with problem drinking, except depressive symptoms, which were more frequently reported by females than males. The interactions of gender with race and gender with peer approval of drinking were significantly associated with problem drinking. The ratio of male to female problem drinkers among African-American adolescents was twice as high as the ratio among Caucasian adolescents. Females were much more strongly influenced by peer disapproval of drinking than were males. CONCLUSIONS Prevention and intervention programs may be more effective for rural females if they target depression and focus on support systems, whereas intensive programs for adolescents with multiple high risk behaviors may be more effective for rural males.

Church Attendance or Religiousness

SUMMARY The purpose of the study was to determine if religiousness, instead of church attendance, was related to alcohol consumption, other drug use, and delinquency after considering socio-demographic, familial and peer factors. Many researchers argue that religion only inhibits relative minor, or ascetic, offenses, such as underage consumption of alcohol. They also argue that religion ceases to be related to offenses when more important influences like peer associations are considered. This study consisted of a stratified random sample of 3,551 adolescents, grades seven through nine, from 66 public high schools in a southern state. The findings indicate that religiousness is significantly related to all three offenses studied when other study factors are simultaneously considered, whereas church attendance has a modest relationship to drug use. The treatment implications of these findings are discussed.

Characteristics of Rural Crack and Powder Cocaine Use: Gender and Other Correlates

Background: Little is known about the relationship of gender with cocaine use in rural areas. This study describes these relationships among stimulant users residing in rural areas of Arkansas, Kentucky, and Ohio. Objectives: Understanding the characteristics of crack and powder cocaine users in rural areas may help inform prevention, education, and treatment efforts to address rural stimulant use. Methods: Participants were 690 stimulant users, including 274 (38.6%) females, residing in nine rural counties. Cocaine use was measured by self-report of cocaine use, frequency of use, age of first use, and cocaine abuse/dependence. Powder cocaine use was reported by 49% of this sample of stimulant users and 59% reported using crack cocaine. Findings: Differing use patterns emerged for female and male cocaine users in this rural sample; females began using alcohol, marijuana, and cocaine at later ages than males but there were no gender differences in current powder cocaine use. Females reported more frequent use of crack cocaine and more cocaine abuse/dependence than males, and in regression analyses, female crack cocaine users had 1.8 times greater odds of reporting frequent crack use than male crack users. Conclusions and Scientific Significance: These findings suggest differing profiles and patterns of cocaine use for male and female users in rural areas, supporting previous findings in urban areas of gender-based vulnerability to negative consequences of cocaine use. Further research on cocaine use in rural areas can provide insights into gender differences that can inform development and refinement of effective interventions in rural communities.

Monitoring and managing metabolic effects of antipsychotics: a cluster randomized trial of an intervention combining evidence-based quality improvement and external facilitation

BackgroundTreatment of psychotic disorders consists primarily of second generation antipsychotics, which are associated with metabolic side effects such as overweight/obesity, diabetes, and dyslipidemia. Evidence-based clinical practice guidelines recommend timely assessment and management of these conditions; however, research studies show deficits and delays in metabolic monitoring and management for these patients. This protocol article describes the project ‘Monitoring and Management for Metabolic Side Effects of Antipsychotics,’ which is testing an approach to implement recommendations for these practices.Methods/DesignThis project employs a cluster randomized clinical trial design to test effectiveness of an evidence-based quality improvement plus facilitation intervention. Eligible study sites were VA Medical Centers with ≥300 patients started on a new antipsychotic prescription in a six-month period. A total of 12 sites, matched in pairs based on scores on an organizational practice survey, were then randomized within pairs to intervention or control conditions.Study participants include VA employees involved in metabolic monitoring and management of patients treated with antipsychotics at participating sites. The intervention involves researchers partnering with clinical stakeholders to facilitate tailoring of local implementation strategies to address barriers to metabolic side-effect monitoring and management. The intervention includes a Design Phase (initial site visit and subsequent development of a local implementation plan); Implementation Phase (guided by an experienced external facilitator); and a Sustainability Phase. Evaluation includes developmental, implementation-focused, progress-focused and interpretative formative evaluation components, as well as summative evaluation. Evaluation methods include surveys, qualitative data collection from provider participants, and quantitative data analysis of data for all patients prescribed a new antipsychotic medication at a study site who are due for monitoring or management of metabolic side effects during the study phases. Changes in rates of recommended monitoring and management actions at intervention and control sites will be compared using time series analyses.DiscussionImproving monitoring for metabolic side effects of antipsychotics, as well as promoting timely evidence-based management when these effects emerge, will lead to improved patient safety and long-term outcomes. This article discusses key strengths and challenges of the study.Trial registrationNCT01875861

Spiritual Well-Being, Relationships, and Work Satisfaction in the Treatment of Homeless Veterans with Alcohol/Other Drug Problems

SUMMARY This study examined a random sample of 600 homeless male veterans, aged 46 to 65, who served in the military during the Vietnam War. The purpose of the study was to identify predictors of readmission to an inpatient treatment program for alcohol and drug abuse in a 2-year follow-up. Among the strongest predictors were comorbidity, suicidal thoughts, memory loss, and childhood sexual and physical abuse. Improvements in family relationships, friendships, work satisfaction, and spiritual well-being were positively related to length of time homeless veterans remained in the community without readmission. Discussion of these findings for service provisions was presented.