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Objective: Nutrition and physical activity are key components of daily diabetes care in young children with type I diabetes (T1D). Normative developmental behavioral challenges related to nutrition and physical activity complicate management of T1D. The current pilot study evaluated the feasibility, acceptability, and indications of behavior change of an intervention aimed at improving nutrition and physical activity in young children with T1D. Method: Thirty-6 parents of young children (ages 2-5 years, M - 4.2) with T1D from 2 clinics in the Washington, DC area were randomized to receive the type One Training (TOTs) program or Usual Care (UC). Assessments included recruitment and completion rates, participant acceptability, and outcomes including glycemic variability via continuous glucose monitoring, nutritional intake via remote food photography, physical activity via accelerometers, and parental report on behavior and psychosocial functioning. Results: Despite recruitment challenges, the TOTs program was feasible to administer, with high program and assessment completion rates. Acceptability ratings were very high but differed by recruitment site. Participants randomized to TOTs had an increase in percent of time in target glycemic range and reduction in behavioral feeding problems between baseline and follow-up while those randomized to UC did not. Participants in UC demonstrated a decrease in in moderate to vigorous physical activity at follow-up. Conclusions: The TOTs program demonstrated preliminary feasibility and acceptability. Future research will examine components of treatment for evidence of efficacy and target the intervention to those most likely to benefit. Keywords: type 1 diabetes, young children, parents, eating, Type I diabetes (T1D) occurs in 1 in 500-600 children and incidence is increasing annually, with higher growth in young children ages 0-9 years (Dabelea et al., 2014; Mayer-Davis et [...]

Background Accurately diagnosing urinary tract infections (UTI) in children with neuropathic bladders can be difficult given the lack of specificity of both clinical symptoms and routine screening tests. We aimed to identify a priori unknown classes/groups of children with neuropathic bladder with respect to symptoms and UA results and examine their relationships with odds of UTI. Methods We used latent class analysis (LCA) to identify unobserved classes/groups of children with neuropathic bladder based on symptoms and urinalysis (UA) results, respectively. Demographic and clinical data were gathered by retrospective chart review of a cohort with neuropathic bladder. Symptoms and UA results were obtained by chart review of visits where urine culture was ordered. Results Around 193 patients were included in UA results analysis and 179 in symptom-based analysis. Two latent classes of patients were identified with respect to symptoms, labeled 'pyelonephritis class' and 'cystitis class,' and two, with respect to UA results, were labeled 'positive UA class' and 'negative UA class.' The pyelonephritis class had significantly higher odds of UTI compared to the asymptomatic class. While odds of UTI in cystitis class were higher than the asymptomatic class, this difference was not statistically significant. Positive UA class had significantly higher odds of UTI compared to negative UA class. Conclusion Two unobserved classes/groups exist in children with neuropathic bladder with respect to symptoms, corresponding to cystitis and pyelonephritis, and two classes of UA results that correspond with either a positive or negative UA. Our results suggest a differential approach to treatments may be considered., Author(s): Catherine S. Forster [sup.1] , Jichuan Wang [sup.2] [sup.3] Author Affiliations: (1) grid.239560.b, 0000 0004 0482 1586, Department of Pediatrics, Children's National Health System, , 111 Michigan Ave NW, [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2009.06.002 Byline: Tyrone F. Borders (a), Brenda M. Booth (b)(c), Russel S. Falck (d), Carl Leukefeld (e), Jichuan Wang (d), Robert G. Carlson (d) Keywords: Health-related quality of life; Methamphetamine; Cocaine; Rural; Natural history; SF-8 Abstract: The primary objective of this study was to investigate whether drug use severity is associated with physical health-related quality of life (HRQL) over time. Data are from a longitudinal, multi-state, natural history community study of users of cocaine and/or methamphetamine who were interviewed at 6-month intervals over 2years with a 79% follow-up participation rate. Physical HRQL was assessed with the physical component summary (PCS) of the SF-8acents Health Survey and drug, alcohol, and psychiatric severity were all assessed with the Addiction Severity Index (ASI). Random coefficient regression analyses were conducted to test for longitudinal associations between the independent variables and SF-8 PCS scores. Reductions in drug use severity over time were accompanied by only minor improvements in SF-8 PCS scores, underscoring the potential long-term harm of illicit drug use on physical health. Greater psychiatric severity was strongly associated with lower SF-8 PCS scores, suggesting that clinical attention to mental health issues could potentially lead to improvements in perceived physical health as well as among stimulant users. Author Affiliation: (a) Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, United States (b) Division of Health Services Research, Department of Psychiatry, University of Arkansas for Medical Sciences, United States (c) VA Health Services Research and Development, Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, United States (d) Center for Interventions, Treatment, and Addictions Research, Boonshoft School of Medicine, Wright State University, United States (e) Department of Behavioral Science, College of Medicine, University of Kentucky, United States

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2006.06.031 Byline: Jichuan Wang, Russel S. Falck, Linna Li, Ahmmed Rahman, Robert G. Carlson Keywords: Rural; Sampling; Respondent-driven sampling (RDS); Hidden population; Substance abuse Abstract: Increasingly, respondent-driven sampling (RDS) is being applied to study not-in-treatment users of illicit drugs. Although RDS has been successfully applied in recruiting active users in densely-populated, metropolitan areas, its utility with hidden populations in rural areas has yet to be determined. This study critically evaluates the sample of not-in-treatment, illicit stimulant drug users (n =249) recruited from the application of RDS in three rural counties in west-central Ohio. The findings of this study largely support the results of earlier studies in urban areas and suggest that RDS is a useful method of sampling hidden drug using populations in less densely populated rural areas. Some limitations of RDS are also discussed. Author Affiliation: Center for Interventions, Treatment and Addictions Research Wright State University, Boonshoft School of Medicine, 3640 Colonel Glenn Highway, 110 Med Sci, Dayton, OH 45435, United States

Objective: Use and production of methamphetamine (MA) has dramatically increased in the United States, especially in rural areas, with concomitant burdens on the treatment and criminal justice systems. However, cocaine is also widely used in many rural areas. The purpose of this article is to contrast MA and cocaine users in three geographically distinct rural areas of the United States. Method: Participants were recent not-in-treatment adult cocaine and MA users living in rural Ohio, Arkansas, and Kentucky, who were recruited by a referral recruitment method for sampling hidden community populations. Participants were interviewed for demographics, drug and alcohol use, criminal justice involvement, and psychological distress (Brief Symptom Inventory). Results: The sample of 706 comprised 29% nonwhite and 38% female participants; the average age was 32.6 years; 58% had a high school education or higher, and 32% were employed. In the past 6 months, they had used either MA only (13%), cocaine only (52%), or both (35%). MA users were seldom (8.2%) nonwhite, but type of stimulant use did not vary by gender. Combined MA/cocaine users reported significantly greater use of alcohol and other drugs, including marijuana and nonprescribed opiates and tranquilizers, and reported significantly higher psychological distress. MA users (with or without cocaine use) had greater odds of recent criminal justice involvement compared with cocaine-only users. Conclusions: There is a clear need for accessible substance-use treatment and prevention services in rural areas of the United States, including services that can address MA, cocaine, polydrug use, and mental health needs. There is a particular need of these services for polydrug users., ALTHOUGH FIRST SYNTHESIZED IN GERMANY and Japan in the late 1800s, methamphetamine (MA) became more widely known in the United States when it was used, manufactured, and distributed by motorcycle [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jsat.2006.01.002 Byline: Richard C. Rapp, Jiangmin Xu, Carey A. Carr, D. Tim Lane, Jichuan Wang, Robert Carlson Keywords: Substance abuse; Barriers; Treatment entry; Centralized intake unit Abstract: The 59-item Barriers to Treatment Inventory (BTI) was administered to 312 substance abusers at a centralized intake unit following assessment but before treatment entry to assess their views on barriers to treatment. Factor analysis identified 25 items in 7 well-defined latent constructs: Absence of Problem, Negative Social Support, Fear of Treatment, Privacy Concerns, Time Conflict, Poor Treatment Availability, and Admission Difficulty. The factorial structure of the barriers is consistent with the findings of other studies that asked substance abusers about barriers to treatment and is conceptually compatible with Andersen's model of health care utilization. Factors were moderately to highly correlated, suggesting that they interact with one another. Selected characteristics were generally not predictive of barrier factors. Overall, results indicate that the BTI has good content validity and is a reliable instrument for assessing barriers to drug treatment. The potential utility of the BTI in assessment settings is discussed. Author Affiliation: Center for Interventions, Treatment, and Addictions Research (CITAR), Boonshoft School of Medicine, Wright State University, 3640 Colonel Glenn Highway, Dayton, OH 45435, USA Article History: Received 21 June 2005; Revised 30 November 2005; Accepted 9 January 2006

The objective of this study was to determine the frequency, principal diagnoses, and correlates of emergency department (ED) visits made by persons with a history of crack-cocaine use (n = 333) over a 3-year period. Data were collected from participant self-reports and hospital records. During the study a total of 643 ED visits were made by 211 people, ranging from 53.5 to 76.7/100 persons/year. Injury and poisoning accounted for the largest single category of ED visits (29.5%). Men had lower odds of visiting the ED (OR = 0.79, 95% CI = 0.62-0.99), as did participants with higher levels of education (OR = 0.83, 95% CI = 0.73-0.94). Number of times in drug abuse treatment (OR=1.04, 95% CI = 1.01-1.09), having a chronic disease (OR = 1.46, 95% CI = 1.06-1.99), and higher Addiction Severity Index composite medical scores (OR = 1.62, 95% CI = 1.15-2.29) increased the odds of an ED visit. Factors in addition to drug use are likely to affect ED utilization rates among crack-cocaine smokers. Keywords: Cocaine, crack, substance abuse, emergency department utilization, ASI, INTRODUCTION The use of cocaine hydrochloride and its smokeable base form, crack, continues to be a serious public health concern in the United States. Epidemiological data show about 28 million [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2005.04.017 Byline: Russel S. Falck, Jichuan Wang, Robert G. Carlson, Harvey A. Siegal Keywords: MDMA; Depression; Substance abuse; BDI-II; Epidemiology Abstract: Research suggests that MDMA can cause serotonin depletion as well as serotonergic neurodegradation that may result in depression among users of the drug. Several small-scale studies have used various editions of the Beck Depression Inventory (BDI) to quantify depressive symptomatology among MDMA users. This study represents the largest application of the BDI to date to explore symptoms of current depression among a community sample of young adult MDMA users (n =402). Internal consistency testing of the BDI-II with this sample revealed Cronbach's [alpha] =.92. Results show a mean BDI-II score of 9.8, suggesting low levels of depressive symptomatology among study participants. Two-thirds of the sample had scores that placed them in the non-depressed/minimal depression category, while 4.7% had scores indicative of severe depression. Logistic regression analysis revealed that men were significantly less likely than women and people who used opioids were significantly more likely than non-users to have higher levels of depressive symptomatology. Higher lifetime occasions of MDMA use were marginally related to symptoms of serious depression. Author Affiliation: Center for Interventions, Treatment and Addictions Research, Wright State University School of Medicine, 3640 Colonel Glenn Highway, Dayton, OH 45435, USA

This study describes the drug-use practices and treatment histories of 249 not-in-treatment, drug-using individuals living in small towns in rural Ohio. Respondent-driven sampling was used to recruit participants who answered questionnaires administered by interviewers. Descriptive statistics and latent class analysis (LCA) were used to examine the data. The illicit drugs most commonly used in the 6 months before entering the study were marijuana (89.6%), cocaine hydrochloride (80.3%), and crack cocaine (76.3%). Injection drug use was not uncommon. About a third of the sample experienced drunkenness frequently. Less than 14% had been in substance abuse treatment recently. LCA revealed two groups: (1) heavy users of virtually all drug classes and (2) moderate-to-light users of fewer drug classes. White and younger people were more likely to be classified in the heavy user group. The results suggest that comprehensive substance abuse prevention and treatment programs are needed in rural communities. Keywords: Substance abuse; Rural; Cocaine; Oxycodone; Epidemiology

Substance use by adolescents continues to present a problem schools must address. Data from survey research can prove useful in helping schools determine the nature and extent of youth drug use. This study identified variations in drug use prevalence among ninth grade students in different school districts in the same locale in Ohio. Possible explanations for the differences were explored. Students (n = 3,016) from 12 suburban high schools anonymously completed self-report drug use questionnaires. School and community-level data were collected from other sources. Cluster analysis was used to group the school districts. ANOVA revealed statistically significant differences (P ≤ 0.001) in levels of drug use by cluster. The cluster with significantly lower levels of drug use consisted of districts with at least one fulltime drug abuse prevention coordinator, higher economic levels, and the highest per pupil expenditures. Drug use among youth is influenced, at least in part, by local contextual factors. Local survey data can inform local policy and programs. These findings have practical implications for policymakers, program developers, and school districts in other areas of the country. (J Sch Health. 2002;72(7):288-293), Drug use by young people continues to constitute a major public health concern. (1) It is the precursor to substance abuse which, according to some policy analysts, represents this nation's [...]

A new study examines the link between health status and drug use in a population of crack-cocaine smokers who are not receiving treatment. An assessment of the reliability of the Medical Outcomes Short Form 36 among drug users is assessed.

Objective: The purpose of the study described here is to extend our understanding of needle transfer behaviors among injection drug users (IDUs) by combining both micro and macro variables in a multilevel model. Methods: A sample of 8,404 IDUs interviewed at 18 sites of the National Institute on Drug Abuse (NIDA) Cooperative Agreement for AIDS Community-Based Outreach/Intervention Program (COOP) was used for the study. A multilevel model was employed to deal with intraclass correlation in the sample and to evaluate the impact of micro and macro variables on needle transfer among IDUs. Results: A significant intraclass correlation was detected in the sample. Needle transfer was associated with both the individual characteristics and the features of the social setting in which they were embedded. Some of the micro slopes were fixed, while some varied from site to site, depending on the values of macro variables. The micro intercept and the micro slope of ethnicity vary randomly across social settings, while they are partially determined by macro variables. Conclusion: Considering the intraclass correlation in the data and the effects of contextual features on individual behaviors, multilevel analysis of HIV risk behaviors should be considered when combining data from micro and macro levels (e.g., individual and project site levels)., INTRODUCTION The prevalence of HIV among injection drug users (IDUs) is often attributed to using syringes and needles previously used by someone else. Although some studies suggest that IDUs have [...]

Purpose: Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric forms measure symptoms and function of pediatric patients experiencing chronic disease by using the same measures. Comparability is one of the most important purposes of the PROMIS initiative. This study aimed to test the factorial structures of four symptom measures (i.e., Anxiety, Depression, Fatigue, and Pain Interference) in the original English and the Chinese versions and examine the measurement invariance of the measures across two cultures.Methods: Four PROMIS Pediatric measures were used to assess symptoms, respectively, in Chinese (n = 232) and American (n = 200) children and adolescents (8-17 years old) in treatment for cancer or in survivorship. The categorical confirmatory factor analysis (CCFA) model was used to examine factorial structures, and multigroup CCFA was applied to test measurement invariance of these measures between the Chinese and American samples.Results: The CCFA models of the four PROMIS Pediatric symptom measures fit the data well for both the Chinese and American children and adolescents. Minor partial measurement invariance was identified. Factor means and factor variances of the four PROMIS measures were not significantly different between the two populations.Conclusions: Our results provide evidence that the four PROMIS Pediatric symptom measures have valid factorial structures and a statistical property of measurement invariance across American and Chinese children and adolescents with cancer. This means that the items of these measures were interpreted in a conceptually similar manner by two groups. They could be readily used for meaningful cross-cultural comparisons involving pediatric oncology patients in these two countries. [ABSTRACT FROM AUTHOR]

Context: No prospective studies address disease-specific advance care planning (ACP) for adults living with HIV/AIDS.Objective: To examine the efficacy of FAmily-CEntered (FACE) ACP in increasing ACP and advance directive documentation in the medical record.Methods: Longitudinal, two-arm, randomized controlled trial with intent-to-treat design recruited from five hospital-based outpatient HIV clinics in Washington, DC. Adults living with HIV and their surrogate decision-makers (N = 233 dyads) were randomized to either an intensive facilitated two-session FACE ACP (Next Steps: Respecting Choices goals of care conversation and Five Wishes advance directive) or healthy living control (conversations about developmental/relationship history and nutrition).Results: Patients (n = 223) mean age: 51 years, 56% male, 86% African-American. One hundred ninety-nine dyads participated in the intervention. At baseline, only 13% of patients had an advance directive. Three months after intervention, this increased to 59% for the FACE ACP group versus 17% in the control group (P < 0.0001). Controlling for race, the odds of having an advance directive in the medical record in the FACE ACP group was approximately seven times greater than controls (adjusted odds ratio = 6.58, 95% CI: 3.21-13.51, P < 0.0001). Among African-Americans randomized to FACE, 58% had completed/documented advance directives versus 20% of controls (P < 0.0001).Conclusions: The FACE ACP intervention significantly improved ACP completion and advance directive documentation in the medical record among both African-American and non-African-American adults living with HIV in Washington, DC, providing health equity in ACP, which can inform best practices. [ABSTRACT FROM AUTHOR]