Shawna L. Carroll Chapman

E-cigarette prevalence and correlates of use among adolescents versus adults: A review and comparison

Perceived safer than tobacco cigarettes, prevalence of electronic cigarette (e-cigarette) use is increasing. Analyses of cartridges suggest that e-cigarettes may pose health risks. In light of increased use and the potential for consequences, we searched Google Scholar and Pubmed in July of 2013 using keywords, such as e-cigarette and vaping, to compare differences and similarities in prevalence and correlates of e-cigarette use among adolescents (grades 6-12) versus adults (aged ≥18 years). Twenty-one studies focused on e-cigarette use. Ever-use increased among various age groups. In 2011, ever-use was highest among young adults (college students and those aged 20-28; 4.9%-7.0%), followed by adults (aged ≥18; 0.6%-6.2%), and adolescents (grades 6-12 and aged 11-19; <1%-3.3%). However, in 2012 adolescent ever-use increased to 6.8% and, among high school students, went as high as 10.0%. While the identified common correlate of e-cigarette use was a history of cigarette smoking, a notable proportion of adolescents and young adults who never smoked cigarettes had ever-used e-cigarettes. E-cigarette use was not consistently associated with attempting to quit tobacco among young adults. Adults most often reported e-cigarettes as a substitute for tobacco, although not always to quit. Reviewed studies showed a somewhat different pattern of e-cigarette use among young people (new e-cigarette users who had never used tobacco) versus adults (former or current tobacco users). Research is needed to better characterize prevalences, use correlates, and motives of use in different population groups, including how adolescent and young adult experimentation with e-cigarettes relates to other types of substance use behaviors.

Substance Abuse among Individuals with Intellectual Disabilities

Individuals with disabilities are a growing population that confronts multiple disadvantages from social and environmental determinants of health. In particular, the 7-8 million people in the U.S. with an intellectual disability (ID) suffer disproportionately from substance use problems, largely because of a lack of empirical evidence to inform prevention and treatment efforts for them. Although available research could inform future research efforts, studies are scattered across disciplines with the last review synthesizing findings written more than five years ago. To consider more recent findings with earlier works, PubMed, PsychINFO, and Google Scholar were searched and produced 37 peer-reviewed texts across multiple disciplines, 15 from 2006 or later. While the prevalence of alcohol and illicit drug use in this population are low, the risk of having a substance-related problem among ID substance users is comparatively high. Gaps in the research and population subgroups that warrant special attention are identified, such as individuals with borderline and mild ID, individuals with co-occurring mental illness, and individuals who are incarcerated. Compared with substance abusers without ID, ID substance abusers are less likely to receive substance abuse treatment or remain in treatment. Research is needed to better gauge the magnitude of substance use problems, identify prevention strategies, and specify treatment components that meet the unique needs of individuals with ID.

Postpartum Substance Use and Depressive Symptoms: A Review

National survey data suggest that new mothers have high prevalences of alcohol and illicit drug use. Depression correlates with substance use, and new mothers with postpartum depression may be at high risk for substance use. Understanding postpartum substance use and its relationship to postpartum depression can inform future research and intervention. A literature search was conducted resulting in 12 studies published from 1999–2012 examining postpartum alcohol use, drug use, or combined postpartum depression and substance use. Postpartum alcohol (prevalence range 30.1%–49%) and drug use (4.5%–8.5%) were lower than use among not pregnant, not postpartum women (41.5%–57.5%, 7.6%–10.6%, respectively) but higher than use among pregnant women (5.4%–11.6%, 3.7%–4.3%, respectively). Correlates of postpartum problem drinking were being unemployed, unmarried, and a cigarette smoker. Prevalence of drug use was highest among white new mothers, followed by blacks and Hispanics, but black new mothers appeared at greater risk of drug use. No identified studies examined correlates of postpartum drug use beyond race/ethnicity. Postpartum depressive symptoms were prevalent among postpartum substance users and those with a substance use history (19.7%–46%). The postpartum period is a critical time. Prevalent substance use and the scarcity of studies warrant research to identify means to reduce maternal substance use.

Suicide and substance use among female veterans: A need for research

BACKGROUND The number of female veterans is increasing. Veterans Administration (VA) enrollment increased over 40% from past eras. However, little research has focused on their mental health. We reviewed literature to examine associations of substance use with suicide in female veterans, identify research gaps, and inform future studies. METHODS Google Scholar, Pub Med, and PsychINFO were searched using: substance use, female veteran, and suicide. Exclusion criteria (e.g., not discussing U.S. veterans) left 17 articles. RESULTS Nine studies examined completed suicide among veterans. In most recent years, rates of deaths were greater for veterans than nonveterans, including females. Completed suicide was associated with past trauma, young age, and a mental disorder. Studies have often not addressed substance use. Three studies examined completed suicide among VA treated veterans without examining substance use as an associated factor. Rates of completed suicides were also higher among veterans than nonveterans, including females. A large proportion of females also had a mental diagnosis. Five studies examined substance use and attempted or completed suicide among VA treated veterans. Veterans in poor mental health had increased odds of suicide mortality; women with a substance use disorder (SUD) had a higher hazard ratio for completed suicide than men with a SUD. Engagement in substance abuse treatment decreased odds of suicide attempt among veterans. CONCLUSION Available data suggest that suicide rates are higher among female veterans than women in the general population. Substance use may increase the likelihood of suicidal behaviors among female veterans, particularly those with a mental diagnosis.

Poor oral health as an obstacle to employment for Medicaid beneficiaries with disabilities

OBJECTIVES To inform policy with better information about the oral health-care needs of a Medicaid population that engages in employment, that is, people ages 16 to 64 with Social Security-determined disabilities enrolled in a Medicaid Buy-In program. METHODS Statistically test for significant differences among responses to a Medicaid Buy-In program satisfaction survey that included oral health questions from the Centers for Disease Control and Preventions Behavioral Risk Factor Surveillance System and the Oral Health Impact Profile (OHIP) to results for the states general population and the US general population. RESULTS All measures of dental care access and oral health were significantly worse for the study population as compared with a state general population or a US general population. Differences were particularly pronounced for the OHIP measure for difficulty doing ones job due to dental problems, which was almost five times higher for the study population. CONCLUSIONS More comprehensive dental benefits for the study population could result in increased oral and overall health, and eventual cost savings to Medicaid as more people work, have improved health, and pay premiums for coverage.

Medicaid managed care: Issues for beneficiaries with disabilities

BACKGROUND States are increasingly turning to managed care arrangements to control costs in their Medicaid programs. Historically, such arrangements have excluded people with disabilities who use long-term services and supports (LTSS) due to their complex needs. Now, however, some states are also moving this population to managed care. Little is known about the experiences of people with disabilities during and after this transition. OBJECTIVE To document experiences of Medicaid enrollees with disabilities using long-term services and supports during transition to Medicaid managed care in Kansas. METHODS During the spring of 2013, 105 Kansans with disabilities using Medicaid long-term services and supports (LTSS) were surveyed via telephone or in-person as they transitioned to managed care. Qualitative data analysis of survey responses was conducted to learn more about the issues encountered by people with disabilities under Medicaid managed care. RESULTS Respondents encountered numerous disability-related difficulties, particularly with transportation, durable medical equipment, care coordination, communication, increased out of pocket costs, and access to care. CONCLUSIONS As more states move people with disabilities to Medicaid managed care, it is critically important to address these identified issues for a population that often experiences substantial health disparities and a smaller margin of health. It is hoped that the early experiences reported here can inform policy-makers in other states as they contemplate and design similar programs.

Health Care Access Affects Attitudes About Health Outcomes and Decisions to Apply for Social Security Disability Benefits

This article reports on qualitative findings from a mixed methods study that explored the efficacy of providing enhanced health benefits and services to people with chronic health conditions to reduce their application rates to federal disability programs. Comparing an intervention and control group, the study found that those who received enhanced benefits had reduced health decline. To explore reasons for this reduction, authors conducted focus groups with a sample of participants from both groups. Four themes emerged: (a) Due to the effects of their conditions, most participants believed their health would worsen over time; (b) Intervention group members said their health deterioration would be slowed or prevented, while control group members worried about more rapid decline and the future; (c) Intervention group members related their beliefs about continued health to their ability to access care; (d) Control group members were more likely than intervention group members to indicate they applied or were interested in applying for social security disability benefits. These themes suggest that people who believe they have access to quality health care feel their health can and will improve over time. If health care reform leads to the availability of more comprehensive coverage for people with potentially disabling conditions, growth in federal disability programs may slow.

Food, Class, and Health: The Role of the Perceived Body in the Social Reproduction of Health

The association between social class and cardiovascular health is complex, involving a constant interplay of factors as individuals integrate external information from the media, health care providers, and people they know with personal experience to produce health behaviors. This ethnographic study took place from February 2008 to February 2009 to assess how cardiovascular health information circulating in Kansas City influenced a sample of 55 women in the area. Participants were primarily Caucasian (n = 41) but diverse in terms of age, income, and education. Themes identified in transcripts showed women shared the same idea of an ideal body, young and thin, and associated this perception with ideas about good health, intelligence, and morality. Transcript themes corresponded to those found at health events and in the media that emphasized individual control over determinants of disease. Womens physical appearance and health behaviors corresponded to class indicators. Four categories were identified to represent womens shared beliefs and practices in relation to class, cardiovascular disease, and obesity. Findings were placed within an existing body of social theory to better understand how cardiovascular health information and womens associated beliefs relate to health inequality.