Xiaowei Yang

Behavior Problems, Academic Skill Delays and School Failure Among School-Aged Children in Foster Care: Their Relationship to Placement Characteristics

We describe the level of behavior problems, academic skill delays, and school failure among school-aged children in foster care. We also examine how behavior problems are associated with academic problems, and explore how these outcomes are related to childrens placement characteristics. Foster parent and child home interviews, as well as teacher telephone interviews were conducted from a randomly selected sample of 302 children aged 6 through 12 years living in out-of-home placement. Interviews included standardized screening measures. Results showed that 27% of the children scored in the clinical range for a behavior problem, and 34% were rated as having at least one behavior problem in the classroom. Twenty-three percent of the children had severe delays in reading or math, 13% had repeated a grade, and 14% had a history of school suspension and/or expulsion. Behavior problems by foster parent report were related to child suspension and/or expulsion from school, but were not associated with severe academic delays or grade retention. Placement characteristics were only sometimes related to these outcomes. Future studies examining the mental health and educational needs of this population should take into account the childs sociodemographic and placement characteristics.

Mental Health Problems and Service Use Among Female Juvenile Offenders: Their Relationship to Criminal History

OBJECTIVE To describe (1) the level of mental health problems and lifetime use of specialty mental health services and special education programs among incarcerated female juvenile offenders and (2) how these indices relate to their criminal history. METHOD Between 1997 and 1998, fifty-four female youths incarcerated in California were interviewed on-site using standardized self-report measures of depression and anxiety symptoms and substance use problems. RESULTS Eighty percent of the youths had symptoms of an emotional disorder or substance use problem, and almost two thirds (63%) had a history of recidivism. Of those with emotional symptoms or a substance use problem, 51% had used specialty mental health services and 58% had been in a special education program during their lifetime. In addition, among recidivistic youths, 82% had a history of a substance use problem and 47% had used specialty mental health services during their lifetime. CONCLUSIONS A substantial proportion of female juvenile offenders merit a mental health evaluation. Interventions for these high-risk youths should include an assessment for substance use disorders because of the association of recidivism and substance use problems in this population.

Help-seeking steps and service use for children in foster care

This study describes help-seeking steps and service-use patterns for school-age children in foster care. It also examines how these access indices are moderated by sociodemographic, enabling, and child disorder factors. Two home interviews and a telephone teacher interview were conducted using a sample of 302 randomly selected children (age 6–12 years) in foster care. The majority of children (80%) were given a psychiatric diagnosis, and 43% of the foster parents perceived a need for mental health services for the child. In the past year, about one-half of the children had received mental health (51%) and special education services (52%). Age and ethnicity, foster parent education, placement history, level of monthly benefits, number of caseworker visits, and disorder characteristics were related to help-seeking steps and mental health service use. Strategies to improve access to mental health services for children in foster care should include interventions at the caregiver and system levels.

Sustained reductions in drug use and depression symptoms from treatment for drug abuse in methamphetamine-dependent gay and bisexual men.

Methamphetamine abusers often complain of feelings of depression that can complicate accurately diagnosing these individuals during treatments for methamphetamine abuse. This article presents an examination of temporal associations between documented methamphetamine use and reported ratings of depression among 162 gay and bisexual male methamphetamine abusers who participated in a 16-week randomized clinical trial of four behavioral therapies for methamphetamine abuse. Methamphetamine use was measured using thrice-weekly urine samples analyzed for drug metabolite. Self-reported depressive symptoms were collected weekly using the Beck Depression Inventory (BDI). At treatment entry, 73.2% of participants rated their depressive symptoms as mild or higher in severity (BDI≥10), with 28.5% reporting BDI scores in the moderate to severe range (BDI≥19). All participants reported significant decreases in depressive symptoms from baseline through the end of treatment, regardless of treatment condition, HIV status, or mood disorder diagnosis. A mixed regression model showed methamphetamine use for up to 5 days prior to the BDI score strongly predicted depressive symptoms (F1,968=18.6, P<.0001), while BDI scores had no significant association with subsequent methamphetamine use. Findings show that behavioral methamphetamine abuse treatment yields reductions in methamphetamine use and concomitant depressive symptom ratings that are sustained to 1 year after treatment entry.

Outcomes using two tailored behavioral treatments for substance abuse in urban gay and bisexual men

This project evaluated two behavioral therapies for substance abuse and concomitant sexual risk behaviors applied to primarily stimulant-abusing gay and bisexual men in Los Angeles. One hundred twenty-eight participants were randomly assigned to 16 weeks of a gay-specific cognitive-behavioral therapy (GCBT, n = 64) or to a gay-specific social support therapy (GSST; n = 64), with follow-up evaluations at 17, 26, and 52 weeks after randomization. No overall statistically significant differences were observed between conditions along retention, substance use, or HIV-related sexual risk behaviors. All participants showed a minimum of twofold reductions in substance use and concomitant sexual risk behaviors from baseline to 52-week evaluations. Among methamphetamine-using participants, the GCBT condition showed significant effects over GSST for reducing and sustaining reductions of methamphetamine. Findings replicate prior work and indicate that GCBT produces reliable, significant, and sustained reductions in stimulant use and sexual risk behaviors, particularly in methamphetamine-abusing gay and bisexual men.

Imputation-based strategies for clinical trial longitudinal data with nonignorable missing values.

Biomedical research is plagued with problems of missing data, especially in clinical trials of medical and behavioral therapies adopting longitudinal design. After a literature review on modeling incomplete longitudinal data based on full-likelihood functions, this paper proposes a set of imputation-based strategies for implementing selection, pattern-mixture, and shared-parameter models for handling intermittent missing values and dropouts that are potentially nonignorable according to various criteria. Within the framework of multiple partial imputation, intermittent missing values are first imputed several times; then, each partially imputed data set is analyzed to deal with dropouts with or without further imputation. Depending on the choice of imputation model or measurement model, there exist various strategies that can be jointly applied to the same set of data to study the effect of treatment or intervention from multi-faceted perspectives. For illustration, the strategies were applied to a data set with continuous repeated measures from a smoking cessation clinical trial.

Participants Receiving Dehydroepiandrosterone During Treatment for Cocaine Dependence Show High Rates of Cocaine Use in a Placebo-Controlled Pilot Study.

Twenty-three cocaine-dependent participants were randomly assigned to receive either dehydroepiandrosterone (DHEA; n = 11; 100 mg/day) or placebo (n = 12) in the context of 12 weeks of thrice weekly cognitive-behavioral group counseling. Outcomes were retention, urine drug screening, cocaine craving, adverse experiences, and medication compliance. DHEA-treated participants averaged 45.8 (SD = 28.8) days in treatment, compared with 70.7 (SD = 20.6) days for placebo, r(21) = -2.4, p =.03, and provided 26.8% (SD = 29.3) of urine samples free of cocaine metabolite compared with 70.6% (SD = 39.9) for the placebo condition, r(21) = -3.0, p =.01. No differences were detected between conditions for cocaine craving or adverse experiences. High levels of medication compliance were documented. Results argue against using high doses of DHEA as a pharmacotherapy for cocaine dependence.

A quasi F-test for functional linear models with functional covariates and its application to longitudinal data

Functional linear models are useful in analyzing data from designed experiments and observational studies with functional responses, as well as longitudinal data with a large number of repeated measures on each subject. We propose a quasi F-test for functional linear models with functional covariates and outcomes. We develop a numerical procedure and an efficient approximation for computing p-values, and present a simple way to test individual predictors. For illustration, we apply the proposed procedure to a longitudinal depression data set with repeatedly measured methamphetamine use as a predictor. We conduct a simulation study to assess the size and the power of the test.

A multiple imputation method for incomplete correlated ordinal data using multivariate probit models

ABSTRACT The multiple imputation technique has proven to be a useful tool in missing data analysis. We propose a Markov chain Monte Carlo method to conduct multiple imputation for incomplete correlated ordinal data using the multivariate probit model. We conduct a thorough simulation study to compare the performance of our proposed method with two available imputation methods – multivariate normal-based and chain equation methods for various missing data scenarios. For illustration, we present an application using the data from the smoking cessation treatment study for low-income community corrections smokers.

352 LONG-TERM OUTCOMES FOR PHARMACOLOGICAL AND BEHAVIORAL TREATMENTS FOR METHAMPHETAMINE ABUSE.

Background To date, there are no approved pharmacotherapies for treating methamphetamine abuse; evidence-based treatments for methamphetamine abuse include cognitive behavioral therapy and contingency management. Objective The purpose was to evaluate long-term outcomes for methamphetamine-abusing individuals assigned to different treatment protocols. Methods Participants were randomly assigned to one of four 12-week treatment conditions (sertraline only, placebo only, sertaline with contingency management, and placebo with contingency management). All subjects in this study (N = 180) received a drug counseling platform that involved thrice weekly (Monday, Wednesday, and Friday) 90-minute group sessions of manual-driven cognitive behavioral therapy and provided self-report and urine samples. Results Subjects reported a clinically relevant reduction in number of days of methamphetamine use from baseline (M = 12.23, SD = 9.00) to termination (M = 4.66, SD = 8.49), at 6-month (M = 4.44, SD = 8.19) and 12-month (M = 5.89, SD = 9.33) follow-up. The percent of subjects providing methamphetamine-free urine at baseline was 49%, which compared to 71%, 68%, and 71% at termination, 6- and 12-month follow-up evaluations. Depression scores also showed significant reductions from baseline (M = 13.96, SD = 8.66) to termination (M = 5.08, SD = 6.56), 6- month (M = 5.26, SD = 5.48) and 12-month (M = 6.17, SD = 7.20) evaluations. Longitudinal analysis of post intervention outcomes indicated no group or time differences. Conclusions Previous analyses demonstrated that, during treatment, participants in the sertraline condition had significantly poorer abstinence and retention outcomes compared to those in the placebo condition. Furthermore, subjects that received contingency management were significantly less likely to use methamphetamine compared to those not assigned to receive this therapy. The current study adds to previous findings by demonstrating that there were no measurable differences between conditions at the long-term evaluation. Hence, there is no evidence to support further evaluation of sertraline as a putative pharmacotherapy for methamphetamine abuse. The authors gratefully acknowledge support from the following NIH grants: 1P50 DA 18185; MIDARP 1R24 DA017298.