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Background and Aims: The increasing trend in alcohol consumption among women, exacerbated by the COVID‐19 pandemic, is of growing concern. Screening, brief intervention, and referral to treatment in primary care is an efficacious and cost‐effective treatment approach for unhealthy alcohol use. However, disparities exist in delivery of brief interventions by sex, age and race/ethnicity. This study measures brief intervention rates among eligible patients by sex, age and race/ethnicity and their intersectionality, in the context of a program of systematic alcohol screening and brief intervention program in adult primary care in a large, integrated health‐care delivery system. Design, Setting and Participants: This was a population‐based observational study among primary care clinics in an integrated health‐care delivery system in Northern California, USA. The participants comprised adult (18+) patients (n = 287 551) screening positive for unhealthy alcohol use between January 2014 and December 2017. Measurements: Receipt of brief intervention, patient and provider characteristics from electronic health records. Findings Multi‐level logistic regression showed that women had lower odds of receiving brief intervention than men among all age, racial/ethnic groups and drinking levels. Sex differences were greater among those aged 35–49 years [odds ratio (OR) = 0.67, 95% confidence interval (CI) = 0.64, 0.69]) and 50–65 years (OR = 0.69, 95% CI =0.66, 0.72) than among other age groups. Sex differences in odds of receiving brief intervention were greater for the Latino/Hispanic group for women versus men (OR = 0.69, 95% CI = 0.66, 0.72) and smaller for the Asian/Pacific Islander group (OR = 0.76, 95% CI = 0.72, 0.81). Conclusion: In the United States, compared with men, women appear to have lower odds of receiving brief intervention for unhealthy alcohol use across all age groups, particularly during middle age. Black women and Latina/Hispanic women appear to be less likely to receive brief intervention than women in other race/ethnicity groups. Receipt of brief intervention does not appear to differ by drinking levels between men and women. [ABSTRACT FROM AUTHOR]

Background: Health systems have developed automated telephone call programs to screen and triage patients' post‐hospital discharge issues and concerns. The aims of our study were to determine whether and how older adults engage with automated post‐hospital discharge telephone programs and to describe the prevalence of patient‐reported post‐discharge issues. Methods: We identified all telephone calls made by an urban academic medical center as part of a post‐hospital discharge program between May 1, 2018 and April 30, 2019. The program used automated telephone outreach to patients or their caregivers that included 11 distinct steps 3 days post‐discharge. All adults discharged home from the hospital, were included, and we categorized patients into ≤64 years, 65–84 years, and ≥85 years age groups. We then compared call reach rate, completeness of 11‐step calls and patient‐reported issues between age groups. Results: Eighteen thousand and seventy six patients were included. More patients 65–84 years old were reached compared to patients ≤64 years old (84.3% vs. 78.9%, AME 5.52%; 95%CI: 3.58%–7.45%). Completion rates of automated calls for those ≥85 years old were also high. Patients ≥85 years old were more likely to have questions about their follow‐up plans and need assistance scheduling appointments compared to those ≤64 years old (19.0% vs. 11.9%, AME 7.0% (95%CI: 2.7%–11.3%). Conclusion: Post‐hospital automated telephone calls are feasible and effective at reaching older adults. Future work should focus on improving discharge communication to ensure older adults are aware of their follow‐up plan and appointments. [ABSTRACT FROM AUTHOR]

Background: Diagnostic and Statistical Manual (DSM) alcohol use disorder (AUD) criteria are written in broad enough terms to apply to diverse populations. The current analyses evaluate whether the endorsement of criteria changes with increasing age in individuals with persistent AUDs. Methods: Data regarding AUDs persisting across 3 timepoints between average ages of 31 and 43 were gathered about every 5 years from 318 interviews for 106 San Diego Prospective Study (SDPS) AUD male probands. Similar data regarding persistent AUDs across 2 timepoints were obtained from 136 interviews with 68 SDPS AUD offspring between average ages of 21 and 27. Changes in the endorsement of each AUD criterion were evaluated using Cochran's Q test. Results: For AUD probands across time, significant decreases were observed in the proportions endorsing 4 criteria (tolerance, withdrawal, failure to fulfill obligations, and using alcohol in hazardous situations). Increased rates of endorsement were documented for 3 criteria (drinking alcohol in higher amounts or for longer periods of time, spending a great deal of time regarding alcohol, and continued use despite social or interpersonal problems). Significant increases in rates of endorsements for offspring were seen for spending a great deal of time regarding alcohol and giving up or reducing important activities in order to drink. Conclusions: These data indicate that the salience of many DSM AUD criterion items changed significantly with age in both SDPS generations among individuals with persistent AUDs. The current results support the need for additional systematic research to determine whether specific criterion items might need to be weighted differently in evaluating older and younger individuals with persistent AUDs. [ABSTRACT FROM AUTHOR]

Background: The most efficient approach for establishing family histories (FHs) asks informants about disorders in their relatives (a Family History Method [FHM]). However, FHMs underestimate family diagnoses. We evaluated if accuracies of young adult offspring report of their father's alcohol use disorders (AUDs) related to the age, sex, education, and/or substance‐related patterns/problems of either the young adult informants or their AUD fathers. Methods: Data from the San Diego Prospective Study (SDPS), a multigenerational 35‐year investigation, compared father/offspring pairs where the proband father's alcohol problems were correctly (Group 1) or incorrectly (Group 2) noted by offspring. In the key analysis, Group 1 versus 2 results were entered into bootstrapped backward logistic regression analyses predicting Group 1 membership. Results: Five proband and one offspring characteristic were associated with correct identification of their father's alcohol problems. None of these related to age, education, or sex. Characteristics associated with correct FHM diagnoses included the father's FH of AUDs, self‐report of drinking despite social/interpersonal or physical/psychological alcohol‐related problems, spending much time related to alcohol, and his having a religious preference. The single offspring item predicting correct identification of the father's problems was the number of DSM alcohol problems of the offspring. Conclusions: In the SDPS, FHM sensitivity was most closely related to the father's drinking characteristics, not the offspring characteristics. While unique aspects of SDPS families potentially limit generalizability of results, the data demonstrate how the FHM can offer important initial steps in the search for genetically related AUD risks in a subset of families. [ABSTRACT FROM AUTHOR]

Background: Distinguishing the impacts of neighborhood income and off‐premise alcohol outlet density on alcohol use has proven difficult, particularly given the conflation of these measures across neighborhood areas. We explicitly test for differential effects related to individual and area income and outlet densities on alcohol use and alcohol use disorders (AUDs) by implementing a stratified microecological sample. Methods: The East Bay Neighborhoods Study included a survey of 984 residents of 72 microenvironments within a geographically contiguous 6‐city area in California and Systematic social observations of each site. The sites included 18 areas in each of 4 strata (high/low median household income and off‐premise outlet density). We assessed 4 outcomes: 28‐day drinking frequency, average quantity of alcohol consumed per drinking occasion, 28‐day drinking volume, and Alcohol Use Disorders Identification Test (AUDIT) score. We used zero‐inflated negative binomial regression with standard errors adjusted for site clusters to relate drinking measures to individual‐level age, race/ethnicity, gender, marital status, education, and income, and neighborhood indicators of site strata, physical disorder, and physical decay. An interaction term was tested representing site‐level by individual‐level income. Results: Living in a high‐income site, regardless of off‐premise alcohol outlet density, was associated with more frequent drinking and higher alcohol dependence/problems. Both individual‐level income and site‐level income were related to greater frequencies of use, but lower income drinkers in high‐income areas drank more than comparable drinkers in low‐income areas. Study participants living in high‐density off‐premise alcohol outlet sites drank less frequently but did not differ in terms of either AUDIT scores or heavy drinking from participants living in low‐density sites. Conclusions: Using a stratified microecological sampling design, we were able to directly assess statistical associations of off‐premise outlet density and neighborhood median household income with patterns of drinking and AUDs. Caution should be used interpreting prior study findings linking off‐premise outlet densities to drinking. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to explore how the age distribution of voters and their mobility affects the probability of passing bonds for the purpose of improving education facilities and to demonstrate the differential motivations within elderly populations rather than viewing elderly voters as a single voting bloc. Method: The study examines California education bond results using logistic regressions to determine the effect that the elderly population as a percent of the population has on the probability of passage. The study also includes the percentage of the elderly population that recently moved into the school district to account for differences in community connection among elderly populations. Result: The result of the study determines that the effect of recent elderly movers on the probability of bond passage is found to be negative, whereas no evidence is found that older households resist educational funding. Conclusion: The conclusion of this study is that part of the reason why the previous literature surrounding the “Gray Peril” has been inconclusive is that the elderly population is not uniform in its opposition to education spending and that other factors such as community connection help determine the strength of that opposition in the elderly community. [ABSTRACT FROM AUTHOR]

Aims To determine the prevalence of depression and diabetes distress in adults with Type 1 diabetes and the rate of false-positives when compared with rates of major depressive disorder. Methods The sample consisted of 368 individuals with Type 1 diabetes, aged > 19 years. Individuals completed: the eight-item Patient Health Questionnaire depression scale (PHQ8), which was coded using four scoring criteria (scores > 10, >12 and >15, and Diagnostic and Statistical Manual of Mental Disorders 5 ( DSM) algorithm scores); the Type 1 Diabetes Distress Scale; and the Structured Clinical Interview for DSM Disorders (SCID) to assess major depressive disorder. Results The prevalence rates of depression according to the eight-item Patient Health Questionnaire were: score >10, 11.4%; score >12, 7.1%; score >15, 3.8%; and positive algorithm result, 4.6%. The prevalence of major depressive disorder was 3.5%; and the prevalence of at least moderate diabetes distress was 42.1%. Depending on the criterion used, the false-positive rate when using the Patient Health Questionnaire compared with the results when using the SCID varied from 52 to 71%. Of those classified as depressed on the PHQ-8 or Structured Clinical Interview for DSM Disorders, between 92.3 and 96.2% also reported elevated diabetes distress. No significant association was found between any group classed as having depression according to the PHQ8 or the SCID and HbA1c concentration. Depression was significantly associated with more other life stress, more complications and a lower level of education. Conclusions We found an unexpectedly low rate of current depression and major depressive disorder in this diverse sample of adults with Type 1 diabetes, and a very high rate of false-positive results using the Patient Health Questionnaire. Considering the high prevalence of diabetes distress, much of what has been considered depression in adults with Type 1 diabetes may be attributed to the emotional distress associated with managing a demanding chronic disease and other life stressors and not necessarily to underlying psychopathology. [ABSTRACT FROM AUTHOR]

Background Neurobehavioral consequences of heavy prenatal alcohol exposure are well documented; however, the role of age or sex in these effects has not been studied. The current study examined the effects of prenatal alcohol exposure, sex, and age on neurobehavioral functioning in children. Methods Subjects were 407 youth with prenatal alcohol exposure ( n = 192) and controls ( n = 215). Two age groups (child [5 to 7 years] or adolescent [10 to 16 years]) and both sexes were included. All subjects completed standardized neuropsychological testing, and caregivers completed parent-report measures of psychopathology and adaptive behavior. Neuropsychological functioning, psychopathology, and adaptive behavior were analyzed with separate 2 (exposure history) × 2 (sex) × 2 (age) multivariate analyses of variance (MANOVAs). Significant effects were followed by univariate analyses. Results No 3-way or 2-way interactions were significant. The main effect of group was significant in all 3 MANOVAs, with the control group performing better than the alcohol-exposed group on all measures. The main effect of age was significant for neuropsychological performance and adaptive functioning across exposure groups with younger children performing better than older children on 3 measures (language, communication, socialization). Older children performed better than younger children on a different language measure. The main effect of sex was significant for neuropsychological performance and psychopathology; across exposure groups, males had stronger language and visual spatial scores and fewer somatic complaints than females. Conclusions Prenatal alcohol exposure resulted in impaired neuropsychological and behavioral functioning. Although adolescents with prenatal alcohol exposure may perform more poorly than younger exposed children, the same was true for nonexposed children. Thus, these cross-sectional data indicate that the developmental trajectory for neuropsychological and behavioral performance is not altered by prenatal alcohol exposure, but rather, deficits are consistent across the 2 age groups tested. Similarly, observed sex differences on specific measures were consistent across the groups and do not support sexually dimorphic effects in these domains. [ABSTRACT FROM AUTHOR]

This section offers news briefs on relating to addiction as of June 2016. It announces the implementation of the Cigarettes and Other Tobacco Products (Packaging and Labelling) Amendment Rules 2014 in India. It reports the prescription drug monitoring to be introduced in Victoria to prevent overdoses, as well as the ruling by the Texas Supreme Court upholding a state Supreme Court decision to impose a special tax on cigarette makers.

Objectives: Middle‐aged and older homeless women have unique health and social service delivery needs; yet, limited research has been conducted in this area. The purpose of this study was to assess perspectives among prefrail and frail, middle‐aged and older homeless women. Design and Sample: Focus group methodology was conducted to assess perspectives among these homeless women (N=20) aged 43 to 62. Measures: Sociodemographic and frailty characteristics were assessed by structured instruments, along with mobility, assistive device use and falls. Results: The average age was 53.4; the majority of the sample was African‐American (70%). In total, 60% reported living in a shelter for the last 30 days, while 20% were unsheltered. The majority of the sample reported walking independently (80%) and not using an assistive device (65%). Over one third (35%) fell in the last 30 days and 70% fell in the last year. Content analysis revealed several themes that included (1) health care needs and challenges experienced; (2) perspectives on sexual decision making; (3) employment difficulties; (4) existing support systems; and (5) development of future program planning. Conclusions: Future research development and implications are discussed. [ABSTRACT FROM AUTHOR]

Objective: Patients' expectations predict important health outcomes. The goal of this study is to describe the types of expectations that hernia and gallbladder patients have for the outcomes of their surgery and to identify relationships between these expectations and both patient‐ and surgeon‐reported variables. Design: Patients (N = 143) at an out‐patient surgery clinic completed self‐report questionnaires before and after a pre‐surgical consultation in which they learned they would be scheduled for surgery. After indicating their general expectations for their surgical outcomes (positive or negative), patients reported specific outcome expectations, which were coded into eight categories: functional improvement, symptom relief, quality‐of‐life improvement, emotional improvement, general health, no effect expected, no response (or unsure) and negative expectations. Results: Functional improvement and symptom relief were the most common types of expectations mentioned by patients. A key finding was a significant difference in the pattern of expectations provided by Hispanic versus non‐Hispanic patients, as well as between patients across the range of health literacy. Conclusions: Patients undergoing hernia and gallbladder surgery have a variety of expectations, and these expectations vary across demographic groups. Patients who are particularly vulnerable to poor physician communication have positive but diffuse expectations. [ABSTRACT FROM AUTHOR]

Background Different drinkers may experience specific risks depending on where they consume alcohol. This longitudinal study examined drinking patterns, and demographic and psychosocial characteristics associated with youth drinking in different contexts. Methods We used survey data from 665 past-year alcohol-using youths (ages 13 to 16 at Wave 1) in 50 midsized California cities. Measures of drinking behaviors and drinking in 7 contexts were obtained at 3 annual time points. Other characteristics included gender, age, race, parental education, weekly disposable income, general deviance, and past-year cigarette smoking. Results Results of multilevel regression analyses show that more frequent past-year alcohol use was associated with an increased likelihood of drinking at parties and at someone else's home. Greater continued volumes of alcohol (i.e., heavier drinking) was associated with increased likelihood of drinking at parking lots or street corners. Deviance was positively associated with drinking in most contexts, and past-year cigarette smoking was positively associated with drinking at beaches or parks and someone else's home. Age and deviance were positively associated with drinking in a greater number of contexts. The likelihood of youth drinking at parties and someone else's home increased over time, whereas the likelihood of drinking at parking lots/street corners decreased. Also, deviant youths progress to drinking in their own home, beaches or parks, and restaurants/bars/nightclubs more rapidly. Conclusions The contexts in which youths consume alcohol change over time. These changes vary by individual characteristics. The redistribution of drinking contexts over the early life course may contribute to specific risks associated with different drinking contexts. [ABSTRACT FROM AUTHOR]

Purpose The study examined the relationships among pain, pain coping, and sleep, and assessed factors (age, gender, frequency, and intensity of pain) that affect pain, coping, and sleep in children with sickle cell disease ( SCD). Methods Participants (66) were 39 children ( M = 11.5 years) and 27 adolescents ( M = 15.5 years) with SCD who completed an electronic visual analog scale ( eVAS), Pain Coping Questionnaire, and Pittsburg Sleep Quality Index. Results About two-thirds of the children reported pain the previous month. No significant differences were found between pain and age, gender, pain intensity, or frequency. Most children coped with pain by seeking information, problem solving, seeking social support, and positive self-statements. There were significant negative correlations in males between worse pain severity and behavioral distraction and internalizing or catastrophizing. The majority (91.2%) had mild to severe sleep disturbances, with 18.2% requiring sleeping medication three or more times a week. There were no significant differences between sleep and age, gender, pain intensity, or frequency. Conclusion Children with SCD experience pain that affects sleep patterns and the way they cope with pain. Nurses need to concurrently assess pain, coping, and sleep and promote sleep hygiene and positive coping strategies during pain episodes. [ABSTRACT FROM AUTHOR]

With the number of older adult arrestees and prisoners increasing rapidly, legal professionals increasingly provide front-line identification and response to age-related health conditions (including cognitive and physical impairments) that may affect legal outcomes, such as the ability to participate in one's defense or stay safe in jail. The goals of this study were to assess the ability of legal professionals to recognize and respond to age-related conditions that could affect legal outcomes and to identify recommendations to address important knowledge gaps. This was a mixed quantitative-qualitative study. Legal professionals (N = 72) in the criminal justice system were surveyed to describe their demographic characteristics, expertise, and prior aging-related training and to inform the qualitative interview guide. Those surveyed included attorneys (district attorneys (25%), public defenders and legal advocates (58%)), judges (6%), and court-affiliated social workers (11%). In-depth qualitative interviews were then conducted with a subset of 10 legal professionals who worked with older adults at least weekly. Results from the surveys and interviews revealed knowledge deficits in four important areas: age-related health, identification of cognitive impairment, assessment of safety risk, and optimization of services upon release from jail. Four recommendations to close these gaps emerged: educate legal professionals about age-related health, train professionals to identify cognitive and sensory impairment, develop checklists to identify those at risk of poor health or safety, and improve knowledge of and access to transitional services for older adults. These findings suggest that geriatrics knowledge gaps of legal professionals exist that may contribute to adverse medical or legal outcomes for older adults involved in the criminal justice system and that partnerships between healthcare and legal professionals are needed to address these challenges. [ABSTRACT FROM AUTHOR]

Background Despite well-known associations between heavy drinking and child physical abuse, little is known about specific risks related to drinking different amounts of alcohol in different drinking venues. This study uses a context-specific dose-response model to examine how drinking in various venues (e.g., at bars or parties) is related to physically abusive parenting practices while controlling for individual and psychosocial characteristics. Methods Data were collected via a telephone survey of parents in 50 cities in California, resulting in 2,163 respondents who reported drinking in the past year. Child physical abuse and corporal punishment were measured using the Conflict Tactics Scale, Parent-Child version. Drinking behaviors were measured using continued drinking measures. Data were analyzed using zero-inflated Poisson models. Results Drinking at homes, parties, or bars more frequently was related to greater frequencies of physically abusive parenting practices. The use of greater amounts of alcohol in association with drinking at bars appeared to increase risks of corporal punishment, a dose-response effect. Dose-response relationships were not found for drinking at homes or parties or drinking at bars for physical abuse nor for drinking at home and parties for corporal punishment. Conclusions Frequencies of using drinking venues, particularly bars and home or parties, are associated with greater use of abusive parenting practices. These findings suggest that a parent's routine drinking activities place children at different risks of being physically abused. They also suggest that interventions that take into account parents' alcohol use at drinking venues are an important avenue for secondary prevention efforts. [ABSTRACT FROM AUTHOR]

Background and Objective Age is highly related to oral health status. The higher prevalence of oral disease within subgroups of the population may reflect a tendency towards 'early aging' and dysregulation of multiple physiological systems. This study examines whether the association between periodontal disease and demographic factors is mediated by physiological measures of health. Material and Methods Logistic regression was used to examine whether biomarkers and demographic factors, such as socio-economic status ( SES) and race/ethnicity, were associated with periodontal disease, and then whether the strength of these relationships could be attributed to associations between demographic variables and physiological measures of systemic health. Results Periodontal disease was associated with measures of SES and race/ethnicity. Furthermore, 1-unit increases in cytomegalovirus ( CMV), optical density, C-reactive protein ( CRP) and glycated hemoglobin ( HbA1c) were associated with a 25% [odds ratio ( OR) = 1.25; 95% confidence interval ( CI): 1.14-1.36], 13% ( OR = 1.13; 95% CI = 1.03-1.24) and 19% ( OR = 1.19; 95% CI = 1.12-1.27) increased likelihood of periodontal disease, respectively. However, when biomarkers and socio-demographic variables were both included in the model, their associations with periodontal disease were significantly reduced or eliminated. Conclusions The risk of periodontal disease is higher among black and/or low-income individuals; however, these associations appear to be partly due to the greater probability of elevated levels of CRP, CMV or HbA1c among these groups. [ABSTRACT FROM AUTHOR]

Low-income Latino immigrants are understudied in elder abuse research. Limited English proficiency, economic insecurity, neighborhood seclusion, a tradition of resolving conflicts within the family, and mistrust of authorities may impede survey research and suppress abuse reporting. To overcome these barriers, promotores, local Spanish-speaking Latinos, were recruited and trained to interview a sample of Latino adults aged 66 and older residing in low-income communities. The promotores conducted door-to-door interviews in randomly selected census tracts in Los Angeles to assess the frequency of psychological, physical, and sexual abuse; financial exploitation; and caregiver neglect. Overall, 40.4% of elderly Latino adults had experienced some form of abuse or neglect within the previous year. Nearly 25% reported psychological abuse, 10.7% physical assault, 9% sexual abuse, and 16.7% financial exploitation, and 11.7% were neglected by their caregivers. Younger age, higher education, and experiencing sexual or physical abuse before age 65 were significant risk factors for psychological, physical, and sexual abuse. Years lived in the United States, younger age, and prior abuse were associated with greater risk of financial exploitation. Years spent living in the United States was a significant risk factor for caregiver neglect. Abuse prevalence was much higher in all mistreatment domains than findings from previous research on community-dwelling elderly adults, suggesting that low-income Latino immigrants are highly vulnerable to elder mistreatment or that respondents are more willing to disclose abuse to promotores who represent their culture and community. [ABSTRACT FROM AUTHOR]

This study examined alcohol use patterns among men and women with depression seeking outpatient psychiatric treatment, including factors associated with recent heavy episodic drinking and motivation to reduce alcohol consumption. The sample consisted of 1,183 patients aged 18 and over who completed a self-administered, computerized intake questionnaire and who scored ≥10 on the Beck Depression Inventory-II (BDI-II). Additional measures included current and past alcohol questions based on the Addiction Severity Index, heavy episodic drinking (≥5 drinks on 1 or more occasions in the past year), alcohol-related problems on the Short Michigan Alcoholism Screening Test (SMAST), and motivation to reduce drinking using the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). Among those who consumed any alcohol in the past year (73.9% of the sample), heavy episodic drinking in the past year was reported by 47.5% of men and 32.5% of women. In logistic regression, prior-year heavy episodic drinking was associated with younger age ( p = 0.011), male gender ( p = 0.001), and cigarette smoking ( p = 0.002). Among patients reporting heavy episodic drinking, motivation to reduce alcohol consumption was associated with older age ( p = 0.008), greater usual quantity of alcohol consumed ( p < 0.001), and higher SMAST score ( p < 0.001). In contrast to prior clinical studies, we examined subdiagnostic alcohol use and related problems among psychiatric outpatients with depression. Patients reporting greater drinking quantities and alcohol-related problems also express more motivation to reduce drinking, providing intervention opportunities for mental health providers that should not be overlooked. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which is concerned with research which investigated the treatment and outcomes of elderly adults with cerebral aneurysms and subarachnoid hemorrhage at comprehensive stroke centers.