Substance Use and Intimate Partner Violence: Clarifying the Relevance of Women’s Use and Partners’ Use

Research has shown that, when women and/or their partners are involved in substance use, women’s risk for intimate partner violence (IPV) is higher. Prior research has not examined whether substance use by both women and their partners contributes independently or interactively to women’s risk of victimization and has not identified factors moderating the effect of substance use by victim or partner. Mental health and social support are explored as moderators of the association between women’s victimization and substance use by victim or partner in a study of 590 impoverished women residing in the Los Angeles area. This study found that substance use by both the woman and her partner independently predicted IPV and that social support moderated the effect of women’s substance use. These findings clarify the relevance of substance use in the context of intimate relationships and that of social support as a buffer against IPV among impoverished women.     

Correlates of Pregnant Women’s Participation in a Substance Use Assessment and Counseling Intervention Integrated into Prenatal Care

Maternal and Child Health Journal - Screening and referral for substance use are essential components of prenatal care. However, little is known about barriers to participation in substance use...     

Gestational Women’s Perceptions About the Harms of Cigarette and E-Cigarette Use During Pregnancy

Objectives

The purpose of this study was to examine differences between perceived harm of cigarette and electronic cigarette (e-cigarette) use while pregnant and differences between healthcare providers’ communication about these products during pregnancy.

Methods

A convenience sample of gestational women (n?=?218; ages 18–45) living in the US completed an online survey between May and December 2017. Participants reported perceived likelihood of adverse health outcomes (e.g., low birth weight, sudden infant death syndrome) among infants/children born to mothers who used cigarettes/e-cigarettes. T-tests and two-way ANOVAs examined differences between risk perceptions of using cigarettes/e-cigarettes while pregnant based on pregnancy status (previously pregnant, currently pregnant, future pregnant). Chi-square analyses examined differences between healthcare provider communication about cigarette/e-cigarette use during pregnancy.

Results

Overall, participants believed adverse health outcomes were significantly more likely to be caused by maternal use of cigarettes than e-cigarettes. Participants who planned to be pregnant reported higher endorsement that smoking combustible cigarettes would cause a miscarriage (p?<?.05) or increased blood pressure (p?<?.05) for a child than currently pregnant participants. Participants reported healthcare providers asked about (p?<?.05), advised them not to use (p?<?.001), and talked to them about health effects of smoking combustible cigarettes while pregnant (p?<?.001) significantly more than e-cigarettes.

Conclusions for Practice

Healthcare providers working with pregnant women should perform the 5As behavioral intervention method to provide pregnant women with tobacco cessation care. They should also discuss the absolute harm nicotine exposure (via cigarettes or e-cigarettes) can have on fetal health and development.

     

Parent’s Depression as a Moderator of the Association Between Offspring’s Depressive Symptoms and Use of Combustible Cigarettes and Electronic Vapor Products

The Journal of Behavioral Health Services & Research -     

Measuring Primary Care for Children of Latino Farmworkers: Reliability and Validity of the Parent’s Perceptions of Primary Care Measure (P3C)

This study evaluates the feasibility, reliability, and validity of the Parents Perceptions of Primary Care measure (P3C) in an underserved population: children of Latino farm workers. Bilingual research assistants verbally administered the P3C, as well as a measure of child health-related quality of life (HRQL: the PedsQL 4.0) and demographic questions to 297 Latino farm worker parents of young children, in San Diego and Imperial Counties. The P3C was found to be feasible, as measured by a very low percent of missing/do not know values. Internal consistency reliability for the Total Scale and most subscales was strong. The P3Cs validity was demonstrated through factor analysis of the subscales, by showing that scores were lower for children without a regular physician and for children experiencing foregone health care, and by demonstrating that P3C scores were related to HRQL. The P3C can be useful to various stakeholders in measuring primary care for vulnerable populations.     

Perceived Parental Legitimacy as a Moderator of Parent−Child Communication’s Effects on Latina/o Adolescent Substance Use

Utilizing primary socialization theory (PST) and longitudinal survey data from 381 Latina/o sixth- through eighth-grade students, we hypothesized that four types of parent anti-substance use messages (i.e., parents’ own past substance use, religious beliefs, respect for family, and peer resistance) would discourage Latina/o students’ substance use, particularly when the students perceived their parents’ anti-substance use messages were legitimate. The results supported moderation. For Latina/o students who thought that their parents’ anti-substance use messages were legitimate, many of the anti-substance use messages were negatively related to substance use, but the associations were positive or nonsignificant for Latina/o students who thought that their parents’ anti-substance use messages were not legitimate. The findings extend past work on PST and anti-substance use parent?child communication, highlighting the importance of perceived legitimacy and message content.     

Emerging Adults’ Discussion of Substance Use and Sexual Behavior with Providers

Emerging adulthood (ages 18–25) is a time of increased autonomy and associated with a high rate of risky substance use and sexual behavior. As emerging adults (EA) increasingly have more independence, they have the ability to make health decisions, including whether to see a provider (primary care (PCP) and/or gynecologist (GYN)) and whether to discuss substance use and sexual behavior. The current study aimed to determine: (1) factors associated with PCP and GYN health-care seeking by sexually active EA who use alcohol and/or marijuana; (2) gender differences in substance use and sexual risk topics initiated by providers; (3) whether PCPs compared to GYNs discuss different topics with women. Alcohol and/or marijuana-using, sexually active EA (n = 500) were recruited as part of a health behaviors study. Among participants, 39% did not see a PCP in the previous year. Women, White individuals, and EA with health insurance were most likely to attend a PCP appointment. Even among participants who saw a provider, many participants reported that providers did not initiate a discussion about substance use (approximately half discussed substance use) and sexual behavior (about half discussed STI history, two-thirds discussed condom use, and three-quarters discussed sexual partners). Among women with a PCP and GYN provider, discussions on substance use were more likely to be initiated by a PCP while sexual issues were more likely to be initiated by a GYN. Thus, even among sexually active, substance-using EA, central topics – specifically substance use and sexual behavior – are not routinely brought up by providers.     

Pregnant and Postpartum People with Substance Use Disorders: Understanding the Obstetrical Care Provider’ s Roles and Responsibilities

Maternal and Child Health Journal - Peripartum individuals with substance misuse are a high-risk population that challenge clinicians and child welfare specialists alike. Federal legislation was...     

Intraindividual Variability of School Bonding and Adolescents’ Beliefs About the Effect of Substance Use on Future Aspirations

The study examines the dynamic relationship between school bonding, beliefs about the deleterious effects of substance use on future aspirations, and subsequent substance use among a sample of 1065 male and female middle school students. First, a mediation model was assessed. Adolescents perceptions about the harmful effects of substance use on their future aspirations emerged as a salient mediator of the relationship between school bonding and subsequent substance use. Second, the intraindividual variability of school bonding and its effect on students beliefs about the potential harm of substance use on future aspirations was assessed through random-coefficient models.⁵ Students who tended to be poorly bonded to school were less likely to perceive that substance use may impede the attainment of their future goals. Furthermore, a strong intraindividual effect of school bonding was observed, indicating that as a student became more or less bonded to school his/her belief that substance use could affect future aspirations similarly changed.     

Vulnerable Women’s Perceptions of Individual Versus Group Prenatal Care: Results of a Cross-Sectional Survey

Introduction Vulnerable pregnant women (e.g. women with low socio-economic status or recent immigrants) are less likely to receive adequate prenatal care or to attend perinatal education classes. CenteringPregnancy (CP) is a model of group prenatal care which combines assessment, education and support. This study aimed to assess patient experience among vulnerable women in group prenatal care compared to individual care. Methods Women participating in CP at a community-based health centre in urban Alberta were eligible to participate. A convenience sample of women who received individual care at a low-risk maternity clinic served as comparison. Women were asked a series of questions on their prenatal care experience. Demographic and patient responses were compared using Chi square, fisher’s exact and t tests. Results Forty-five women accessing CP and 92 women accessing individual care participated. Women in CP were younger, more likely to be single and having their first baby than women in individual care. Women in CP were significantly more likely to report having received enough information on exercise during pregnancy (92 vs. 66%, p?=?0.002), breastfeeding (95 vs. 70%, p?=?0.002) and baby care (95 vs. 67%, p?=?0.001). Women in CP were more likely to report that they felt their prenatal care providers were interested in how the pregnancy was affecting their life (100 vs. 93%, p?≤?0.001). Discussion Group prenatal care provides a positive experience and improved information exchange among vulnerable populations. Programs interested in engaging, educating and empowering vulnerable pregnant women may benefit from implementation of group care.     

Connecting the Dots: Examining Transgender Women’s Utilization of Transition-Related Medical Care and Associations with Mental Health,Substance Use,and HIV

Findings on access to general healthcare for transgender people have emerged, but little is known about access to transition-related medical care for transwomen (i.e., hormones, breast augmentation, and genital surgery). Transgender women have low access to general medical care and are disproportionately at risk for substance use, mental illness, and HIV. We conducted an analysis to determine if utilization of transition-related medical care is a protective factor for health risks to transgender women and to investigate if care differs by important demographic factors and HIV status. A secondary analysis was conducted using data from a 2010 HIV surveillance study using respondent-driven sampling to recruit 314 transwomen in San Francisco. Survey-corrected logistic regression models were used to estimate odds ratios for six psychosocial health problems—binge drinking, injection drug use, anxiety, depression, suicidal ideation, and high-risk intercourse—comparing various levels of utilization of transition-related medical care. Odds ratios were also calculated to determine if utilization of transition-related medical care was related to less overlap of risk domains. We found that Latina and African American transwomen had significantly lower estimated utilization of breast augmentation and genital surgery, as did transwomen who identified as transgender rather than female. Overall, utilization of transition-related medical care was associated with significantly lower estimated odds of suicidal ideation, binge drinking, and non-injection drug use. Findings suggest that utilization of transition-related medical care may reduce risk for mental health problems, especially suicidal ideation, and substance use among transwomen. Yet, important racial/ethnic and gender identity disparities in utilization of transition-related medical care need to be addressed.     

Use of cellular or cordless telephones and the risk for non-Hodgkin’s lymphoma

Objectives: To evaluate the use of cellular and cordless telephones as the risk factor for non-Hodgkin’s lymphoma (NHL). Methods: Male and female subjects aged 18–74 years living in Sweden were included during a period from 1 December 1999 to 30 April 2002. Controls were selected from the national population registry. Exposure to different agents was assessed by questionnaire. Results: In total, 910 (91%) cases and 1016 (92%) controls participated. NHL of the B-cell type was not associated with the use of cellular or cordless telephones. Regarding T-cell NHL and >5 year latency period, the use of analogue cellular phones yielded: odds ratio (OR) = 1.46, 95%; confidence interval (CI) = 0.58–3.70, digital: OR=1.92, 95%; CI=0.77–4.80 and cordless phones: OR=2.47; CI=1.09–5.60. The corresponding results for certain, e.g. cutaneous and leukaemia, T-cell lymphoma for analogue phones were: OR=3.41, 95%; CI=0.78–15.0, digital: OR=6.12, 95%; CI=1.26–29.7 and cordless phones: OR=5.48, 95%; CI=1.26–23.9. Conclusions: The results indicate an association between T-cell NHL and the use of cellular and cordless telephones, however based on low numbers and must be interpreted with caution. Regarding B-cell NHL no association was found.     

Parent–Child Acculturation Patterns and Substance Use among Hispanic Adolescents: A Longitudinal Analysis

Acculturation discrepancy theory predicts that conflicting cultural preferences between adolescents and their parents will increase the adolescents’ risk for behavior problems such as substance use. This study evaluated this hypothesis in a sample of 1683 Hispanic students in Southern California who completed surveys in 9th and 10th grade. Measures included the students’ own cultural orientations and their perceptions of their parents’ preference for their cultural orientations (“Perceived Parental Cultural Expectations”—PPCE). Hispanic PPCE in 9th grade was a risk factor for lifetime, but not past-month, cigarette, alcohol, and marijuana use in 10th grade. The adolescents’ own Hispanic orientation in 9th grade was protective against lifetime and past-month smoking and marijuana use and lifetime alcohol use in 10th grade. The effects of the acculturation variables did not vary according to generation in the U.S. Change in acculturation between 9th and 10th grade was statistically significant but small in magnitude. Increases in parent–child Hispanic acculturation discrepancy (i.e., the difference between the adolescents’ own cultural orientations and their PPCE, with adolescents perceiving that their parents wanted them to be more Hispanic oriented than they actually were) from 9th to 10th grade were associated with an increased risk of substance use. Family-based interventions for acculturating Hispanic families may be useful in decreasing the likelihood of substance use among Hispanic adolescents.     

Women’s Perceptions of Usefulness and Ease of Use of Four Healthy Eating Blog Characteristics: A Qualitative Study of 33 French-Canadian Women

Background

Healthy eating blogs are knowledge translation tools used by nutrition and dietetics practitioners for helping people improve their health behaviors and food choices.

Offender Diversion Into Substance Use Disorder Treatment: The Economic Impact of California’s Proposition 36

Objectives. We determined the costs and savings attributable to the California Substance Abuse and Crime Prevention Act (SACPA), which mandated probation or continued parole with substance abuse treatment in lieu of incarceration for adult offenders convicted of nonviolent drug offenses and probation and parole violators.Methods. We used individually linked, population-level administrative data to define intervention and control cohorts of offenders meeting SACPA eligibility criteria. Using multivariate difference-in-differences analysis, we estimated the effect of SACPA implementation on the total and domain-specific costs to state and county governments, controlling for fixed individual and county characteristics and changes in crime at the county level.Results. The additional costs of treatment were more than offset by savings in other domains, primarily in the costs of incarceration. We estimated the statewide policy effect as an adjusted savings of $2317 (95% confidence interval = $1905, $2730) per offender over a 30-month postconviction period. SACPA implementation resulted in greater incremental cost savings for Blacks and Hispanics, who had markedly higher rates of conviction and incarceration.Conclusions. The monetary benefits to government exceeded the additional costs of SACPA implementation and provision of treatment.The overall societal costs of substance use disorders (SUDs) have in recent years reached disproportionate levels across the nation. The White House Office of National Drug Control Policy1 estimated annual societal costs of $180.9 billion in 2002 and noted that these costs have increased at a higher rate than the US gross domestic product over the past 10 years (5.3% per year vs 5.1% per year). The largest- and fastest-growing cost components were, not surprisingly, those for criminal justice activities, particularly increased spending on law enforcement and adjudication, as well as for incarceration for drug offenses and income-generating crimes. The annual federal budget allocated to combat SUDs for the 2011 fiscal year was $15.5 billion,2 with more than $7.6 billion for domestic law enforcement and interdiction. By comparison, $1.7 billion was allocated for prevention programs and $3.9 billion for treatment services.Public policies regarding criminal justice interventions with drug-using offenders have largely been driven by the acknowledged association between drug use and crime. The research literature has consistently reported that SUDs intensify rates of criminal activity, especially among dependent individuals.3–8 The importance of treating offenders with an SUD is further illustrated by the fact that both severity of drug use and recidivism rates decline during and after treatment.9,10 Consequently, a reduction or cessation of drug use has been targeted as a direct method of reducing drug-related crime and enforcement and as an indirect method of reducing other adverse social consequences associated with drug use.11–13A popular criminal justice approach to dealing with drug-using offenders has been the drug court movement, although these programs can target only a relatively few offenders. A recent systematic review14 determined the impact of adult drug courts in the United States. The nonexperimental and quasi-experimental literatures have indicated that drug courts successfully reduce future criminal behavior and future substance use, at least in the short term, versus traditional adjudication. However, none of the 3 randomized studies identified showed a consistent effect on rearrest rates for drug-involved offenders participating in drug court rather than typical adjudication. The 2 studies examining reconviction and reincarceration, however, demonstrated reduced rates for the drug court group versus those typically adjudicated. A review of California drug courts in particular found that drug court participants’ rearrest rates were reduced by 11% to 14%, with the largest reduction in rearrest rates found among individuals graduating from their treatment programs.15 Research has also been conducted to determine the economic impact of drug courts in the United States and internationally.16–18 Yet many methodological and analytical concerns have been raised in the evaluation of drug courts given the selectivity of participants and other concerns,19 although comprehensive economic analyses are available in the peer-reviewed literature that display reliable cost savings for drug courts.17,20,21In parallel with the national drug court movement, federal, state, and local jurisdictions have experimented with various diversion strategies for drug-involved offenders. One of the most extensive and recent of these was prompted by public dissatisfaction with existing California enforcement policy, which led advocates to propose Proposition 36 in the November 2000 state election, subsequently passed by citizens and enacted into California law as the Substance Abuse and Crime Prevention Act of 2000 (SACPA).22 SACPA represented a major shift in criminal justice policy whereby adults convicted of nonviolent drug offenses who meet SACPA eligibility criteria can be sentenced to probation with SUD treatment instead of incarceration or probation without treatment, regardless of treatment motivation level or other indicators of program suitability. The law was modeled after historical and concurrent offender diversion efforts, including the Treatment Alternatives to Street Crime programs, drug courts, and other diversion efforts and attempted to implement a program more broadly applicable than any previously implemented, in part by removing motivation and suitability criteria for participation.23,24 SACPA eligibility criteria include a requirement of no previous or concurrent serious or violent felonies, physical injury misdemeanors, or concurrent nondrug charges.25The law was written to also allow offenders on probation or parole who commit nonviolent drug offenses or who violate drug-related conditions of community supervision to elect community-based treatment. Incarceration of offenders for program noncompliance is prohibited in most cases, and SACPA provides as many as 3 opportunities for most offenders (2 for parolees) to reenter treatment without incarceration despite initial violations (e.g., stemming from failures to report to treatment or court appointments, subsequent drug-related arrests, or other acts of program noncompliance). In essence, SACPA became a statewide policy that changed the course of criminal justice processing for all eligible offenders and service entities involved, including the courts, district attorneys and public defenders, probation and parole officers, and SUD treatment providers.SACPA required an annual budget of $120 million for the first 5 years, spent primarily on expansion of treatment services. Subsequently, funding authority reverted to the state legislature, which reduced targeted funding for SACPA beginning in fiscal year 2008–2009 and terminated funding indefinitely in 2009–2010. Given the large financial investment and the substantial impact the law has had on SUD treatment in California, determining the economic impact of SACPA implementation, taking into account both the costs of treatment and program administration and the potentially off-setting changes in the costs of health resource utilization, criminal recidivism, and incarceration, is important. We took advantage of individually linked state-level data on criminal justice, corrections, publicly funded health resource utilization, and SUD treatment to determine the economic impact of California’s implementation of the SACPA program.     

System-Level Factors Affecting Clinicians’ Perceptions and Use of Interpreter Services in California Public Hospitals

Professional language interpreters are skilled in the nuances of interpretation and are less likely to make errors of clinical significance but clinicians infrequently use them. We examine system-level factors that may shape clinicians’ perceptions and use of professional interpreters. Exploratory qualitative study in 12 California public hospitals. We conducted in-person key informant interviews with hospital leadership, clinical staff, and administrative staff. Five emergent themes highlight system-level factors that may influence clinicians’ perceptions and use of professional interpreters in hospitals: (1) organization-wide commitment to improving language access for LEP patients; (2) organizational investment in remote interpreter technologies to increase language access; (3)training clinicians on how to access and work with interpreters; (4) hospital supports the training and certification of bilingual staff to serve as interpreters to expand in-person, on-site, interpreter capacity; and (5)organizational investment in readily accessible telephonic interpretation. Multiple system-level factors underlie clinicians’ use of professional interpreters. Interventions that target these factors could improve language services for patients with limited English proficiency.