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901 to 925 of 1,310Integrating Mental Health and HIV Services in Zimbabwean Communities: A Nurse and Community-led Approach to Reach the Most Vulnerable.
Alcohol use and depression negatively impact adherence, retention in care, and HIV progression, and people living with HIV (PLWH) have disproportionately higher depression rates. In developing countries, more than 76% of people with mental health issues receive no treatment. We hypothesized that stepped-care mental health/HIV integration provided by multiple service professionals in Zimbabwe would be acceptable and feasible. A three-phase mixed-method design was used with a longitudinal cohort of 325 nurses, community health workers, and traditional medicine practitioners in nine communities. During Phase 3, 312 PLWH were screened by nurses for mental health symptoms; 28% were positive. Of 59 PLWH screened for harmful alcohol and substance use, 36% were positive. Community health workers and traditional medicine practitioners screened 123 PLWH; 54% were positive for mental health symptom…
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The Need for New Emphasis on Batterers Intervention Programs.
Although Batterers' Intervention Programs (BIPs) remain a crucial part of victim safety and coordinated community responses, they have received less support and less attention by scholars than other parts of the domestic violence system. Research on BIPs also suggests that they have not been particularly effective at preventing recidivism, are prone to attrition, and increasingly lack the support and confidence of the courts. Nevertheless, BIPs remain one of the few viable alternatives to incarceration for perpetrators of domestic violence. This article examines the historical and empirical reasons for the apparent lack of effectiveness of BIPs. New research suggests avenues for improvement. This begins with incorporating existing research findings, consistency in implementation of best practice models, better diagnosis of personality characteristics of perpetrators and of types of viole…
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Perceived Discrimination in Health Care and Mental Health/Substance Abuse Treatment Among Blacks, Latinos, and Whites.
Background: Experiences of discrimination in health care settings may contribute to disparities in mental health outcomes for blacks and Latinos. We investigate whether perceived discrimination in mental health/substance abuse visits contributes to participants' ratings of treatment helpfulness and stopped treatment.
Research methods: We used data from 3 waves of the California Quality of Life Survey, a statewide population-based telephone survey assessing mental health/substance disorders and their treatment. In a sample of 1099 adults (age 18-72) who indicated prior year mental health/substance abuse visits, we examined: experiences of discrimination that occurred during health care and mental health/substance abuse visits, ratings of treatment helpfulness, and reports of stopping treatment early.
Results: Fifteen percent of California adults reported discrimination during a health car…
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Adverse childhood experiences and behavioral problems in middle childhood.
Children who have been exposed to maltreatment and other adverse childhood experiences (ACEs) are at increased risk for various negative adult health outcomes, including cancer, liver disease, substance abuse, and depression. However, the proximal associations between ACEs and behavioral outcomes during the middle childhood years have been understudied. In addition, many of the ACE studies contain methodological limitations such as reliance on retrospective reports and limited generalizability to populations of lower socioeconomic advantage. The current study uses data from the Fragile Families and Child Wellbeing Study, a national urban birth cohort, to prospectively assess the adverse experiences and subsequent behavior problems of over 3000 children. Eight ACE categories to which a child was exposed by age 5 were investigated: childhood abuse (emotional and physical), neglect (emotion…
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Risk factors for child maltreatment in an Australian population-based birth cohort.
Child maltreatment and other adverse childhood experiences adversely influence population health and socioeconomic outcomes. Knowledge of the risk factors for child maltreatment can be used to identify children at risk and may represent opportunities for prevention. We examined a range of possible child, parent and family risk factors for child maltreatment in a prospective 27-year population-based birth cohort of 2443 Australians. Physical abuse, sexual abuse, emotional abuse, neglect and witnessing of domestic violence were recorded retrospectively in early adulthood. Potential risk factors were collected prospectively during childhood or reported retrospectively. Associations were estimated using bivariate and multivariate logistic regressions and combined into cumulative risk scores. Higher levels of economic disadvantage, poor parental mental health and substance use, and social ins…
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Lifson AR, Workneh S, Shenie T, Ayana DA, Melaku Z, Bezabih L, Waktola HT, Dagne B, Hilk R, Winters KC, Slater L (2017)MEDLINE-indexed journal, not yet read by usAddiction science & clinical practice13 citations Prevalence and factors associated with use of khat: a survey of patients entering HIV treatment programs in Ethiopia.
Background: Khat, a plant native to East Africa, has psychoactive constituents similar to amphetamine. Chronic khat use can lead to psychological dependence with multiple physical and mental health harms, complicating clinical management of people living with HIV. In two Ethiopian cities where khat is common, we evaluated prevalence and correlates of khat use among patients new to HIV care.
Methods: During 2013-2014, we surveyed 322 patients recently enrolled in HIV clinics in Dire Dawa and Harar about khat use, demographics, smoking and alcohol use, clinical illness, food insecurity, and social support. We analyzed factors associated with khat use in the past year, as well as heaviest use of khat (based on greatest number of hours used in a typical month).
Results: 242 (75%) respondents reported lifetime khat use; 209 (65%) reported khat use during the previous year. 54% of khat users s…
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Afifi TO, Ford D, Gershoff ET, Merrick M, Grogan-Kaylor A, Ports KA, MacMillan HL, Holden GW, Taylor CA, Lee SJ, Peters Bennett R (2017)MEDLINE-indexed journal, not yet read by usChild abuse & neglect113 citations Spanking and adult mental health impairment: The case for the designation of spanking as an adverse childhood experience.
Adverse Childhood Experiences (ACEs) such as child abuse are related to poor health outcomes. Spanking has indicated a similar association with health outcomes, but to date has not been considered an ACE. Physical and emotional abuse have been shown in previous research to correlate highly and may be similar in nature to spanking. To determine if spanking should be considered an ACE, this study aimed to examine 1): the grouping of spanking with physical and emotional abuse; and 2) if spanking has similar associations with poor adult health problems and accounts for additional model variance. Adult mental health problems included depressive affect, suicide attempts, moderate to heavy drinking, and street drug use. Data were from the CDC-Kaiser ACE study (N=8316, response rate=65%). Spanking loaded on the same factor as the physical and emotional abuse items. Additionally, spanking was ass…
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Young men's suicidal behavior, depression, crime, and substance use risks linked to childhood teasing.
The consequences in adulthood of bullying, teasing, and other peer victimization experiences in childhood rarely have been considered in prospective studies. Studies of peer victimization are mixed regarding whether negative outcomes are explained by pre-existing child vulnerabilities. Furthermore, replication of prior studies with broader definitions and other methods and demographic groups is needed. Based on mother, father, and teacher reports at ages 10-12 years, we classified American boys (n=206) from higher delinquency neighborhoods as perpetrators of teasing, victims, perpetrator-victims, or uninvolved (n=26, 35, 29, and 116, respectively). Family income, parent and child depressive symptoms, and child antisocial behavior served as controls. Boys were assessed to age 34 years for suicide-attempt history (including death) and adult (ages 20-32 years) suicidal ideation, depressive …
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Substance Use in Undergraduate Students With Histories of Attention-Deficit/Hyperactivity Disorder (ADHD): The Role of Impulsivity.
Background: Emerging adulthood (18-25 years old) is regarded as a time of identity exploration that includes a peak in risky behaviors, such as substance use and misuse. Attention-deficit/hyperactivity disorder (ADHD) is also associated with greater levels of risky behaviors, including substance use and misuse; however, there is a lack of research on substance use by emerging adults with ADHD, in particular the potential mechanisms that may facilitate this risk.
Objectives: The present study builds on the existing research regarding the association between ADHD and substance use by examining roles of multiple facets of impulsivity in facilitating this association during emerging adulthood.
Methods: In a sample of 197 undergraduate students (24 students with an ADHD diagnostic history), we assessed for components of impulsivity (e.g., urgency, sensation-seeking) and rates of alcohol abuse…
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Girls with childhood ADHD as adults: Cross-domain outcomes by diagnostic persistence.
Objective: To ascertain adult outcomes in 10 domains reflecting symptomatology (internalizing, externalizing, self-injury, substance use), attainment (education, employment), and impairment (health, social, driving, overall) as a function of both childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) and persistence of ADHD symptoms across time.
Method: We prospectively followed 140 grade-school-aged girls with rigorously diagnosed childhood ADHD and 88 age- and ethnicity-matched comparison girls for 16 years. Outcome measures were obtained via self- and parent-report questionnaires, interviews, and objective tests.
Results: Childhood ADHD, whether it remitted or persisted, was a pernicious risk factor for a limited number of poor outcomes, including low educational attainment, unplanned pregnancy, body mass index (BMI), and clinician-rated impairment. Childhood ADHD that…
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Unpacking the impact of adverse childhood experiences on adult mental health.
Exposure to childhood adversity has an impact on adult mental health, increasing the risk for depression and suicide. Associations between Adverse Childhood Experiences (ACEs) and several adult mental and behavioral health outcomes are well documented in the literature, establishing the need for prevention. The current study analyzes the relationship between an expanded ACE score that includes being spanked as a child and adult mental health outcomes by examining each ACE separately to determine the contribution of each ACE. Data were drawn from Wave II of the CDC-Kaiser ACE Study, consisting of 7465 adult members of Kaiser Permanente in southern California. Dichotomous variables corresponding to each of the 11 ACE categories were created, with ACE score ranging from 0 to 11 corresponding to the total number of ACEs experienced. Multiple logistic regression modeling was used to examine t…
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Rural Religious Leaders' Perspectives on their Communities' Health Priorities and Health.
Objectives: In traditionally underserved communities, faith-based interventions have been shown to be effective for health promotion. Religious leaders-generally the major partner in such interventions-however, are seldom are consulted about community health priorities and health promotion preferences. These insights are critical to ensure productive partnerships, effective programming, and sustainability.
Methods: Mixed-methods surveys were administered in one of the nation's most under-resourced regions: rural Appalachia. A sample of 60 religious leaders, representing the main denominations in central Appalachia, participated. Measures included closed- and open-ended survey questions on health priorities and recommendations for health promotion. Descriptive statistics were used for closed-ended survey items and conventional qualitative content analysis was used for open-ended responses…
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Methods to Assess Adverse Childhood Experiences of Children and Families: Toward Approaches to Promote Child Well-being in Policy and Practice.
Background: Advances in human development sciences point to tremendous possibilities to promote healthy child development and well-being across life by proactively supporting safe, stable and nurturing family relationships (SSNRs), teaching resilience, and intervening early to promote healing the trauma and stress associated with disruptions in SSNRs. Assessing potential disruptions in SSNRs, such as adverse childhood experiences (ACEs), can contribute to assessing risk for trauma and chronic and toxic stress. Asking about ACEs can help with efforts to prevent and attenuate negative impacts on child development and both child and family well-being. Many methods to assess ACEs exist but have not been compared. The National Survey of Children's Health (NSCH) now measures ACEs for children, but requires further assessment and validation.
Methods: We identified and compared methods to assess…
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Income Inequality and the Differential Effect of Adverse Childhood Experiences in US Children.
Objective: Adverse childhood experiences (ACEs) can affect health and development across the life course. Despite a general understanding that adversity is associated with lower income, we know less about how ACEs manifest at different income levels and how these income-related patterns affect children's health and development.
Methods: Data from the 2011 to 2012 National Survey of Children's Health were used to examine the prevalence of 9 ACEs in US children, across 4 levels of household income, and in relationship to 5 parent-reported measures of child health. Bivariate analyses and multivariable logistic regression models were used to examine the associations between number of ACEs and children's health outcomes on the basis of the 4 income groups.
Results: When partitioned according to income strata, the proportion of children who experienced ACEs showed a steep income gradient, part…
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Individual, peer, and family factor modification of neighborhood-level effects on adolescent alcohol, cigarette, e-cigarette, and marijuana use.
Background: Neighborhood factors reported subjectively by residents and measured objectively at the census tract are both associated with adolescent alcohol, tobacco (cigarette and electronic cigarette), and other drug (marijuana) (ATOD) use. Less clear is how these neighborhood factors are longitudinally associated with each substance. Equivocal findings may be due to lack of consideration of individual, peer, and family effect modifiers, which could help adolescents overcome exposure to stressful neighborhood environments.
Methods: We used multivariate logistic regressions with interaction terms to test whether parental monitoring, resistance self-efficacy (RSE) and being around peers who use ATOD modified the association between four subjective and objective neighborhood measures and odds of using each substance measured one year later among 2539 high school students and college fresh…
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Gradient of association between parenting styles and patterns of drug use in adolescence: A latent class analysis.
Background: To identify different patterns of drug use in adolescence and determine if these are associated with parenting styles and other sociodemographic factors.
Methods: A latent class analysis was conducted using baseline data collected in a sample (n=6381) from a randomized controlled trial conducted to evaluate the effectiveness of the #Tamojunto drug-use prevention program, carried out with 7th- and 8th-grade public school students in six Brazilian cities.
Results: Three latent classes were identified among the students: 1) abstainers/low users (81.54%), 2) alcohol users/binge drinkers (16.65%), and 3) polydrug users (1.80%). A gradient of inverse association was found between parenting styles (authoritative, authoritarian, and indulgent, with the neglectful style as a reference point) and the classes "alcohol users/binge drinkers" (aOR=0.36, 95%CI=0.27-0.47; aOR=0.56, 95%CI=0.4…
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Religious anti-gay prejudice as a predictor of mental health, abuse, and substance use.
Anti-gay, or homonegative, prejudice is generally considered harmful to the wellbeing of sexual minority individuals. However, the origins or nature of such prejudice may vary. Despite a sizable body of literature suggesting homonegative prejudice is frequently religious-based, the psychological impact of exposure to religious anti-gay prejudice remains largely undetermined. Addressing this research gap, the authors examined whether opposition to same-sex sexuality on religious grounds predicted detrimental outcomes among same- and both-sex attracted individuals, as well as their heterosexual counterparts. A nationwide U.S. sample of 1600 individuals-recruited using contemporary online crowd-sourcing techniques designed to limit selection bias-completed a novel inventory assessing interpersonal exposure to religious (as well as nonreligious) homonegative disapproval. Outcome variables as…
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Exposure to Childhood Abuse and Later Substance Use: Indirect Effects of Emotion Dysregulation and Exposure to Trauma.
Little is known about how emotion dysregulation (ED) and trauma exposure differentially affect the relationship between abuse in childhood and adult substance use. We examined associations between child abuse, trauma exposure, ED, and current substance use in an already existing dataset. Participants (N = 2,014 adults, 90% African American) had been recruited from an urban hospital for a parent study. Analyses showed that drug and alcohol use was significantly positively correlated with child abuse (emotional, physical, and sexual), later trauma exposure, and ED (all ps < .001). Linear regression showed that exposure to abuse when older than a child was significantly associated with drug and alcohol use independent of child abuse and demographic variables (R2 Δ = .08, p < .001; R2 Δ = .04, p < .001). ED was significantly associated with drug and alcohol use independently of child abuse, …
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Mental health, migration stressors and suicidal ideation among Latino immigrants in Spain and the United States.
Background: Immigration stress appears to augment the risk for suicide behaviors for Latinos. Yet, specific risk factors that contribute to suicidal ideation (SI) among diverse Latino immigrant populations are not well established.
Methods: Data were collected in Boston, Madrid and Barcelona using a screening battery assessing mental health, substance abuse risk, trauma exposure, demographics, and sociocultural factors. Prevalence rates of lifetime and 30-day SI were compared across sites. Logistic regression modeling was used to identify sociodemographic, clinical, and sociocultural-contextual factors associated with 30-day SI.
Results: Five hundred and sixty-seven Latino patients from primary care, behavioral health and HIV clinics and community agencies participated. Rates of lifetime SI ranged from 29-35%; rates for 30-day SI were 21-23%. Rates of SI were not statistically different …
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Associations Between Adverse Childhood Experiences, High-Risk Behaviors, and Morbidity in Adulthood.
Introduction: Adverse childhood experiences (ACEs) are associated with early mortality and morbidity. This study evaluated the association among ACEs, high-risk health behaviors, and comorbid conditions, as well as the independent effect of ACE components.
Methods: Data were analyzed on 48,526 U.S. adults from five states in the 2011 Behavioral Risk Factor Surveillance System survey. Exposures included psychological, physical, and sexual forms of abuse as well as household dysfunction such as substance abuse, mental illness, violence, and incarceration. Main outcome measures included risky behaviors and morbidity measures, including binge drinking, heavy drinking, current smoking, high-risk HIV behavior, obesity, diabetes, myocardial infarction, coronary heart disease, stroke, depression, disability caused by poor health, and use of special equipment because of disability. Multiple logis…
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The association between adverse childhood experiences (ACEs) and suicide attempts in a population-based study.
Objectives: To further our understanding of the relationship between Adverse Childhood Experiences (ACEs) and suicidal behaviour, this study investigates the association between three types of ACEs and lifetime suicide attempts, while considering potential gender-specific and mediating effects.
Methods: Data were obtained from the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH), a cross-sectional, population-based survey comprised of respondents aged 18 or older who provided self-reported data on past experiences of suicide attempts, as well as childhood sexual abuse (CSA), childhood physical abuse (CPA) and parental domestic violence (PDV) (n = 22 559). After testing for ACE by gender interactions, we estimated the odds of lifetime suicide attempts for each ACE and then investigated whether depression, anxiety, substance abuse and chronic pain acted as mediators of the rel…
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Stress and Multiple Substance Use Behaviors Among Hispanic Adolescents.
Hispanic adolescents reported a higher annual prevalence of use of nearly all major drugs compared to non-Hispanic White and African American adolescents. Cultural or minority stressors, such as those related to the acculturation process, discrimination, immigration, poverty, and community violence, have been implicated in these outcomes. Unfortunately, few studies have examined how these stressors may have a differential or additive effect when considered simultaneously. The current study examined the relation between stress and multiple substance use behaviors in a sample of Hispanic adolescents (n = 1036), age 11-19 years old. Latent class analysis identified subgroups of Hispanic adolescents based on combinations of substance use behaviors. General linear models were used to examine mean differences by class among the eight domains of stress. Fit statistics revealed a six-class struc…
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The contribution of stress, cultural factors, and sexual identity on the substance abuse, violence, HIV, and depression syndemic among Hispanic men.
Objectives: The purpose of this study was to confirm the substance abuse, violence, HIV, and depression syndemic among Hispanic men, and to test whether stress and sociocultural factors, including acculturation, family support, and sexual orientation, predict this syndemic.
Method: A cross-sectional survey was administered to 164 Hispanic men using standardized measures for Hispanic Stress (Cervantes, Padilla, & Salgado de Snyder, 1991), substance abuse (Kelly et al., 1994), violence (Peragallo et al., 2005), risk for HIV (González-Guarda, Peragallo, Urrutia, Vasquez, & Mitrani, 2008), and depression (Center for Epidemiologic Studies Scale, CES-D; Radloff, 1977).
Results: Results from Structural Equation Modeling (SEM) supported the syndemic factor among Hispanic men. While family/cultural stress and homosexual identity were risk factors for the syndemic factor, family support was protec…
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Nature and determinants of suicidal ideation among U.S. veterans: Results from the national health and resilience in veterans study.
Background: Suicidal thoughts and behaviors among U.S. military veterans are a major public health concern. To date, however, scarce data are available regarding the nature and correlates of suicidal ideation (SI) among U.S. veterans. This study evaluated the prevalence and correlates of suicidal ideation in a contemporary, nationally representative, 2-year prospective cohort study.
Method: Data were analysed from a total of 2157 U.S. veterans who participated in the National Health and Resilience Veterans Study (NHRVS; Wave 1 conducted in 2011; Wave 2 in 2013). Veterans completed measures assessing SI, sociodemographic characteristics, and potential risk and protective correlates.
Results: The majority of veterans (86.3%) denied SI at either time point, 5.0% had SI onset (no SI at Wave 1, SI at Wave 2), 4.9% chronic SI (SI at Waves 1 and 2), and 3.8% had remitted SI (SI at Wave 1, no SI…
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Immediate drop-out rate in adolescent substance abusers: an out-patient chart review from North India.
Introduction: Although a number of management strategies are available for adolescent substance abusers, the outcomes are limited due to high drop out. The factors related to drop out in adolescent substance users, especially in low and middle income countries (LAMIC) have been sparsely studied.
Objective: To study the personal, family and clinical variables related to immediate drop out in adolescent substance abusers.
Materials and methods: A retrospective outpatient chart review was carried out for adolescent substance abusers aged 12-19 years from January 2012 to December 2014.
Results: Of the 89 patients, 57 (64%) dropped out immediately. The majority of adolescent substance users were >17 years (85%), having some education (90%), belonging to a joint family (76%), having good family support (66%). Drop out was higher in those with later onset and less duration of substance abuse (3…
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