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Background: Insufficient funding is frequently identified as a critical barrier to the implementation and sustainment of evidence-based practices (EBPs). Thus, increasing access to funding is recognized as an implementation strategy. Policies that create earmarked taxes-defined as taxes for which revenue can only be spent on specific activities-are an increasingly common mental health financing strategy that could improve the reach of EBPs. This project's specific aims are to (1) identify all jurisdictions in the USA that have implemented earmarked taxes for mental health and catalogue information about tax design; (2) characterize experiences implementing earmarked taxes among local (e.g., county, city) mental health agency leaders and other government and community organization officials and assess their perceptions of the acceptability and feasibility of different types of policy implementation strategies; and (3) develop a framework to guide effect earmarked tax designs, inform the selection of implementation strategies, and disseminate the framework to policy audiences., Methods: The project uses the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to inform data collection about the determinants and processes of tax implementation and Leeman's typology of implementation strategies to examine the acceptability and feasibility strategies which could support earmarked tax policy implementation. A legal mapping will be conducted to achieve aim 1. To achieve aim 2, a survey will be conducted of 300 local mental health agency leaders and other government and community organization officials involved with the implementation of earmarked taxes for mental health. The survey will be followed by approximately 50 interviews with these officials. To achieve aim 3, quantitative and qualitative data will be integrated through a systematic framework development and dissemination process., Discussion: This exploratory policy implementation process study will build the evidence base for outer-context implementation determinants and strategies by focusing on policies that earmarked taxes for mental health services., (© 2023. The Author(s).)

Funders increasingly encourage social and health service organizations to strengthen their impact on public health through the implementation of evidence-based interventions (EBIs). Local governments in the U.S. often utilize market-based contracting to facilitate EBI delivery via formal relationships with non-governmental community-based organizations (CBOs). We sought to understand how the discourses embedded within contracting to compete and perform influence how CBOs represent and accomplish their work. We draw on qualitative interviews conducted with government administrators (N=16) overseeing contracts for one child welfare EBI, SafeCare ® and the leaders (N=25) of organizations contracted to implement this program. Participants endorsed competition, capacity, and collaboration as ideals within marketized contracting. Yet they expressed doubt about marketplace meritocracy and described the costs incurred in building the necessary organizational infrastructure to deliver EBIs and compete for contracts. We discuss the implications of marketized EBI contracting for CBOs and the limitations it poses for evidence-based public health, especially in socially marginalized communities.

Objectives: To determine the population prevalence and determinants of hepatitis B (Hep B) status, and status discordance, among pregnant women and their male partners in Nigeria., Methods: Cross-sectional study assessing the seroprevalence of Hep B virus in a cohort of 16 920 pregnant women and their male partners in northcentral Nigeria. Rapid HBsAg antibody test was used for Hep B diagnosis. Demographic, socio-economic and behavioural information was collected through interviewer-administered questionnaires and evaluated as determinants of Hep B status and couple status discordance using logistic regression., Results: Of 16 920 participants who had a Hep B test result, 6750 couples and 1316 discordant couples were identified. The prevalence of Hep B among all participants was 10.9%, with lower prevalence among pregnant women (10.2%) than their male partners (11.9%), P < 0.001. The prevalence of Hep B sero-discordance among couples was 19.5% (1316/6750). Younger age, prior Hep B testing and a prior positive Hep B test increased the odds of Hep B infection while being a woman decreased the odds of Hep B among all participants, and among couples. Furthermore, polygamy (adjusted odds ratio [AOR]: 1.49, 95% confidence interval [CI]: 1.19-1.87), prior Hep B testing (AOR: 2.38, 95% CI: 1.14-4.97) and a prior positive Hep B test result were significant determinants of status discordance among the participating couples., Conclusion: The prevalence of Hep B among pregnant women and their male partners in northcentral Nigeria is high. A large-scale intervention is required to reduce Hep B prevalence in this setting., (© 2020 John Wiley & Sons Ltd.)

Background: In Nigeria, there is an estimated 1.9 million people living with HIV (PLHIV), 53% of whom utilize HIV care and services. With decreasing HIV-related deaths and increasing new infections, HIV with its associated comorbidities continue to be a key public health challenge in Nigeria. Untreated, comorbid mental disorders are a critical but potentially modifiable determinant of optimal HIV treatment outcomes. This study aimed to identify the challenges and opportunities related to integrating mental health care into existing HIV programs in Nigeria., Method: Attendees at the Nigeria Implementation Science Alliance (NISA)'s 2019 conference participated in nominal group technique (NGT) exercise informed by the "Exploration, Preparation, Implementation, and Sustainment (EPIS)" framework. The NGT process was conducted among the nominal groups in two major sessions of 30-min phases followed by a 30-min plenary session. Data analysis proceeded in four steps: transcription, collation, theming and content analysis., Results: The two major theoretical themes from the study were - opportunities and challenges of integrating mental health treatment into HIV services. Three sub-themes emerged on opportunities: building on health care facilities for HIV services (screening, counseling, task-sharing monitoring and evaluation frameworks), utilizing existing human resources or workforce in HIV programs (in-service training and including mental health in education curriculum) and the role of social and cultural structures (leveraging existing community, traditional and faith-based infrastructures). Four sub-themes emerged for challenges: double burden of stigma and the problems of early detection (HIV and mental health stigma, lack of awareness), existing policy gaps and structural challenges (fragmented health system), limited human resources for mental health care in Nigeria (knowledge gap and burnout) and dearth of data/evidence for planning and action (research gaps)., Conclusions: Potential for integrating treatments for mental disorders into HIV programs and services exist in Nigeria. These include opportunities for clinicians' training and capacity building as well as community partnerships. Multiple barriers and challenges such as stigma, policy and research gaps would need to be addressed to leverage these opportunities. Our findings serve as a useful guide for government agencies, policy makers and research organizations to address co-morbid mental disorders among PLHIV in Nigeria.

Objective: The purpose of this study was to identify the mechanisms through which different aspects of leadership affect mental health practitioners' attitudes toward supervisory feedback., Methods: Data were collected from 363 practitioners nested in 68 treatment teams in public-sector mental health organizations. A multilevel path analysis was conducted to examine the associations of transformational leadership (supervisor's ability to inspire others to follow a course of action) and leader-member exchange (quality of the supervisor-practitioner relationship) with practitioner attitudes toward feedback., Results: Transformational leadership and leader-member exchange were directly and positively associated with practitioners' attitudes toward feedback. Transformational leadership was also indirectly associated with practitioners' attitudes toward feedback through the quality of supervisor-practitioner relationships., Conclusions: Study results contribute to the growing body of evidence suggesting that leaders play a key role in shaping mental health service delivery. Both leadership behavior and high-quality supervisor-practitioner relationships are important in supporting practitioners in delivering evidence-based mental health care. Policymakers, administrators, and researchers should consider an integrative approach when developing leadership training interventions.

Background: Cognitive problems in people with schizophrenia predict poor functional recovery even with the best possible rehabilitation opportunities and optimal medication. A psychological treatment known as cognitive remediation therapy (CRT) aims to improve cognition in neuropsychiatric disorders, with the ultimate goal of improving functional recovery. Studies suggest that intervening early in the course of the disorder will have the most benefit, so this study will be based in early intervention services, which treat individuals in the first few years following the onset of the disorder. The overall aim is to investigate different methods of CRT., Methods: This is a multicentre, randomised, single-blinded, controlled trial based in early intervention services in National Health Service Mental Health Trusts in six English research sites. Three different methods of providing CRT (intensive, group, and independent) will be compared with treatment as usual. We will recruit 720 service users aged between 16 and 45 over 3 years who have a research diagnosis of non-affective psychosis and will be at least 3 months from the onset of the first episode of psychosis. The primary outcome measure will be the degree to which participants have achieved their stated goals using the Goal Attainment Scale. Secondary outcome measures will include improvements in cognitive function, social function, self-esteem, and clinical symptoms., Discussion: It has already been established that cognitive remediation improves cognitive function in people with schizophrenia. Successful implementation in mental health services has the potential to change the recovery trajectory of individuals with schizophrenia-spectrum disorders. However, the best mode of implementation, in terms of efficacy, service user and team preference, and cost-effectiveness is still unclear. The CIRCuiTS trial will provide guidance for a large-scale roll-out of CRT to mental health services where cognitive difficulties impact recovery and resilience., Trial Registration: ISRCTN, ISRCTN14678860 , Registered on 6 June 2016.

Background: Despite being disproportionately burdened by preventable diseases than more advanced countries, low- and middle-income countries (LMICs) continue to trail behind other parts of the world in the number, quality and impact of scholarly activities by their health researchers. Our strategy at the Nigerian Implementation Science Alliance (NISA) is to utilise innovative platforms that catalyse collaboration, enhance communication between different stakeholders, and promote the uptake of evidence-based interventions in improving healthcare delivery. This article reports on findings from a structured group exercise conducted at the 2016 NISA Conference to identify (1) gaps in developing research capacity and (2) potential strategies to address these gaps., Methods: A 1-hour structured group exercise was conducted with 15 groups of 2-9 individuals (n = 94) to brainstorm gaps for implementation, strategies to address gaps and to rank their top 3 in each category. Qualitative thematic analysis was used. First, duplicate responses were merged and analyses identified emerging themes. Each of the gaps and strategies identified were categorised as falling into the purview of policy-makers, researchers, implementing partners or multiple groups., Results: Participating stakeholders identified 98 gaps and 91 strategies related to increasing research capacity in Nigeria. A total of 45 gaps and an equal number of strategies were ranked; 39 gaps and 43 strategies were then analysed, from which 8 recurring themes emerged for gaps (lack of sufficient funding, poor research focus in education, inadequate mentorship and training, inadequate research infrastructure, lack of collaboration between researchers, research-policy dissonance, lack of motivation for research, lack of leadership buy-in for research) and 7 themes emerged for strategies (increased funding for research, improved research education, improved mentorship and training, improved infrastructure for research, increased collaboration between academic/research institutions, greater engagement between researchers and policy-makers, greater leadership buy-in for research)., Conclusions: The gaps and strategies identified in this study represent pathways judged to be important in increasing research and implementation science capacity in Nigeria. The inclusion of perspectives and involvement of stakeholders who play different roles in policy, research and implementation activities makes these findings comprehensive, relevant and actionable, not only in Nigeria but in other similar LMICs.

American Indians and Alaska Natives (AIANs) experience major disparities in accessing quality care for mental health and substance use disorders. There are long-standing concerns about access to and quality of care for AIANs in rural and urban areas including the influence of staff and organizational factors, and attitudes toward evidence-based treatment for addiction. We conducted the first national survey of programs serving AIAN communities and examined workforce and programmatic differences between clinics located in urban/suburban (n=50) and rural (n=142) communities. We explored the correlates of openness toward using evidence-based treatments (EBTs). Programs located in rural areas were significantly less likely to have nurses, traditional healing consultants, or ceremonial providers on staff, to consult outside evaluators, to use strategic planning to improve program quality, to offer pharmacotherapies, pipe ceremonies, and cultural activities among their services, and to participate in research or program evaluation studies. They were significantly more likely to employ elders among their traditional healers, offer AA-open group recovery services, and collect data on treatment outcomes. Greater openness toward EBTs was related to a larger clinical staff, having addiction providers, being led by directors who perceived a gap in access to EBTs, and working with key stakeholders to improve access to services. Programs that provided early intervention services (American Society of Addiction Medicine level 0.5) reported less openness. This research provides baseline workforce and program level data that can be used to better understand changes in access and quality for AIAN over time., (Copyright © 2016. Published by Elsevier Inc.)

The Interdisciplinary Collaborative Team (ICT) strategy uses front-line providers as adaptation, training and quality control agents for multi-agency EBT implementation. This study tests whether an ICT transmits fidelity to subsequent provider cohorts. SafeCare was implemented by home visitors from multiple community-based agencies contracting with child welfare. Client-reported fidelity trajectories for 5,769 visits, 957 clients and 45 providers were compared using three-level growth models. Provider cohorts trained and live-coached by the ICT attained benchmark fidelity after 12 weeks, and this was sustained. Hispanic clients reported high cultural competency, supporting a cultural adaptation crafted by the ICT.

Phenotyping of 1,200 'healthy' adults from the UK has been performed through the investigation of diverse classes of hydrophilic and lipophilic metabolites present in serum by applying a series of chromatography-mass spectrometry platforms. These data were made robust to instrumental drift by numerical correction; this was prerequisite to allow detection of subtle metabolic differences. The variation in observed metabolite relative concentrations between the 1,200 subjects ranged from less than 5 % to more than 200 %. Variations in metabolites could be related to differences in gender, age, BMI, blood pressure, and smoking. Investigations suggest that a sample size of 600 subjects is both necessary and sufficient for robust analysis of these data. Overall, this is a large scale and non-targeted chromatographic MS-based metabolomics study, using samples from over 1,000 individuals, to provide a comprehensive measurement of their serum metabolomes. This work provides an important baseline or reference dataset for understanding the 'normal' relative concentrations and variation in the human serum metabolome. These may be related to our increasing knowledge of the human metabolic network map. Information on the Husermet study is available at http://www.husermet.org/. Importantly, all of the data are made freely available at MetaboLights (http://www.ebi.ac.uk/metabolights/).

Background: Evidence-based treatments (EBTs) are not widely available in community mental health settings. In response to the call for implementation of evidence-based treatments in the United States, states and counties have mandated behavioral health reform through policies and other initiatives. Evaluations of the impact of these policies on implementation are rare. A systems transformation about to occur in Philadelphia, Pennsylvania, offers an important opportunity to prospectively study implementation in response to a policy mandate., Methods/design: Using a prospective sequential mixed-methods design, with observations at multiple points in time, we will investigate the responses of staff from 30 community mental health clinics to a policy from the Department of Behavioral Health encouraging and incentivizing providers to implement evidence-based treatments to treat youth with mental health problems. Study participants will be 30 executive directors, 30 clinical directors, and 240 therapists. Data will be collected prior to the policy implementation, and then at two and four years following policy implementation. Quantitative data will include measures of intervention implementation and potential moderators of implementation (i.e., organizational- and leader-level variables) and will be collected from executive directors, clinical directors, and therapists. Measures include self-reported therapist fidelity to evidence-based treatment techniques as measured by the Therapist Procedures Checklist-Revised, organizational variables as measured by the Organizational Social Context Measurement System and the Implementation Climate Assessment, leader variables as measured by the Multifactor Leadership Questionnaire, attitudes towards EBTs as measured by the Evidence-Based Practice Attitude Scale, and knowledge of EBTs as measured by the Knowledge of Evidence- Based Services Questionnaire. Qualitative data will include semi-structured interviews with a subset of the sample to assess the implementation experience of high-, average-, and low-performing agencies. Mixed methods will be integrated through comparing and contrasting results from the two methods for each of the primary hypotheses in this study., Discussion: Findings from the proposed research will inform both future policy mandates around implementation and the support required for the success of these policies, with the ultimate goal of improving the quality of treatment provided to youth in the public sector.

Objectives: Public Law (P.L.) 110-351, the "Fostering Connections to Success Act," calls for state child welfare agencies to partner with Medicaid and pediatric experts to provide planning and oversight regarding the provision of health and mental health services, including medication, to children in state custody. Recent reports, media cases, and class action lawsuits suggest over-use of psychotropic medications to address the behavioral needs of children in the child welfare system. We examined geographic variability in psychotropic medication use across US child welfare agency catchment areas to determine how rates of psychotropic medication use vary in relation to child, community, child welfare, and health system-level factors., Methods: Cross-sectional analysis of Wave 1 data for the 92 child welfare catchment areas participating in the National Survey of Child and Adolescent Well-being, a random probability sample of 2,504 children ages 2-15 years undergoing investigation for abuse and neglect. We employed multilevel regression modeling to examine the impact of catchment-level variables on medication use, controlling for child-level variables., Results: Fifteen percent of children reported taking psychotropic medications. Rates of medication use across catchment areas ranged widely from 0 to 40%, a 40-fold difference. On multi-level logistic regression modeling, older age (p<.001), male gender (p<.001), emotional and behavioral problems (p<.001), and insurance (p=.05) were associated with psychotropic medication use at the child-level. At the catchment-level, stressful environment within the child welfare system was negatively associated with medication use. No other catchment-level variables examined were found to explain use., Conclusions: Striking disparities in medication use exist across catchment areas in this national sample. Of the catchment variables examined, only stressful environment was related to medication use., Practice Implications: These findings highlight significant geographic variation in medication use that most likely reflect both under-use and over-reliance on psychotropic medication. The link between child welfare environment and medication use suggests the influence of systemic, as opposed to clinical, causes of variation in medication use. This requires greater implementation of organizational processes governing quality of care for this highly vulnerable population., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

An unresolved issue in the field of implementation research is how to conceptualize and evaluate successful implementation. This paper advances the concept of "implementation outcomes" distinct from service system and clinical treatment outcomes. This paper proposes a heuristic, working "taxonomy" of eight conceptually distinct implementation outcomes-acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability-along with their nominal definitions. We propose a two-pronged agenda for research on implementation outcomes. Conceptualizing and measuring implementation outcomes will advance understanding of implementation processes, enhance efficiency in implementation research, and pave the way for studies of the comparative effectiveness of implementation strategies.

Purpose: To examine rates and patterns of health-risk behavior (e.g., sexuality, depression/suicidality, substance use, delinquency) among a national probability sample of youth active to the child welfare/child protective services system. Recent federal legislation, P.L. 110-351, encourages child welfare systems, Medicaid, and pediatric experts to collaborate to ensure youth entering foster care receive comprehensive health examinations., Methods: Analysis of baseline caregiver, caseworker, and child interviews, and assessment data for a subsample (n = 993) of youth, aged 11-15 years, from the National Survey of Child and Adolescent Well-Being, a national probability sample of children and adolescents undergoing investigation for abuse or neglect., Results: Almost half of the sample (46.3%) endorsed at least one health-risk behavior. On Poisson multivariate regression modeling, factors related to higher rates of health-risk behaviors included older age, female gender, abuse history, deviant peers, limited caregiver monitoring, and poor school engagement., Conclusion: Given the heightened vulnerability of this population, early screening for health-risk behaviors must be prioritized. Further research should explore specific subpopulations at risk for health-risk behaviors and possible interventions to change these youths' trajectories., (Copyright (c) 2010 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Across the country, states are reporting increases in the number of children with autistic spectrum disorders (ASD) served each year in the early intervention system. Research examining factors impacting the successful dissemination and implementation of evidence-based practice (EBPs) into service systems for these children is limited. Preliminary information indicates that adoption of EBPs is variable. Provider attitudes toward the adoption of EBPs may be one factor that limits or facilitates implementation of efficacious treatments and these attitudes vary by organizational context and provider individual differences. The current study examines cross-context differences in provider attitudes toward EBPs by comparing the attitudes of 71 education-based early intervention providers working with children with ASD to the attitudes of 238 mental health providers in the public mental health system. This provides the first examination of ASD early intervention provider attitudes toward EBP. Results indicated that early intervention providers reported significantly more favorable attitudes toward adopting EBPs than did mental health providers. Early intervention providers with extended experience in the field perceived less divergence between their current practice and EBPs. Implications are discussed.

One of the most critical issues in mental health services research is the gap between what is known about effective treatment and what is provided to consumers in routine care. Concerted efforts are required to advance implementation science and produce skilled implementation researchers. This paper seeks to advance implementation science in mental health services by over viewing the emergence of implementation as an issue for research, by addressing key issues of language and conceptualization, by presenting a heuristic skeleton model for the study of implementation processes, and by identifying the implications for research and training in this emerging field.

Objective: To examine the prevalence of psychiatric disorders among youths from the following five public sectors of care: alcohol and drug services (AD), child welfare (CW), juvenile justice (JJ), mental health (MH), and public school services for youths with serious emotional disturbance (SED) in San Diego, California., Method: The Diagnostic Interview Schedule for Children was administered between October 1997 and January 1999 for 1,618 randomly selected youths aged 6-18 years who were active in at least one of the five sectors., Results: Fifty-four percent of the participants met criteria for at least one study disorder. Attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders (50%) were much more common than anxiety (10%) or mood (7%) disorders. Youths who were active in the MH and SED sectors were more likely than those not in these sectors to meet criteria for a disorder; youths in the CW sector were least likely., Conclusions: Rates of psychiatric disorders, specifically ADHD and disruptive behavior disorders, are extremely high for youths in public sectors of care. Rates are generally higher in sectors designed to serve youths with psychiatric needs, but the prevalence of disorders was also high in sectors not specifically designed for this need (e.g., CW and JJ).

Objective: To examine the prevalence of substance use disorders (SUDs) among adolescents who received services in one or more of the following public sectors of care: alcohol and drug (AD), juvenile justice (JJ), mental health (MH), public school-based services for youths with serious emotional disturbance (SED), and child welfare (CW), in relation to age, gender, and service sector affiliation., Methods: Participants included 1,036 adolescents aged 13 to 18 years, randomly sampled from all youths who were active in at least one of the above five sectors of care (N = 12,662) in San Diego County California. SUDs were assessed through structured diagnostic interviews conducted from October 1997 through January 1999., Results: SUDs were found for youths in all sectors of care, with lifetime rates of 82.6% in AD, 62.1% in JJ, 40.8% in MH, 23.6% in SED, and 19.2% in CW. Rates of SUDs were significantly higher among older youths and males. Sector differences held even when accounting for the effects of age and gender., Conclusions: SUDs are highly prevalent among youths receiving care in the AD service sector as well as other sectors, particularly JJ and MH. These findings have implications for assessment, treatment, and service coordination for youths with SUDs in diverse sectors of public care.

Alcohol expectancies are important in the mediation and prediction of alcohol use. Expectancies for the effects of other drugs, although less well delineated, appear equally important. Therefore, development and validation of expectancy measures for drugs other than alcohol is necessary for evaluating the importance of these constructs. We examined the factor structure, reliability, and validity of the Marijuana Effect Expectancy Questionnaire (MEEQ) and the Stimulant Effect Expectancy Questionnaire (SEEQ) in clinical and community samples of adolescents as they moved into young adulthood (N=279). Confirmatory factor analyses (CFAs) supported the a priori factors, and we found good reliability for most individual scales. Temporal stability and convergent and discriminant validity of drug effect expectancies were supported in this sample of adolescents and young adults. Drug effect expectancies were associated with drug preference and drug use patterns over 2 years. Use of these measures may aid our understanding of the etiology and course of marijuana and stimulant involvement during adolescence and young adulthood.

While there has been increased attention to consumers' satisfaction with mental health services as an indicator of quality of care, little is known about the construct of consumer satisfaction, especially for youth. The goal of this study was to examine potential correlates of adolescents' satisfaction with mental health services. One hundred eighty adolescents who had received out-patient mental health services completed a multidimensional satisfaction scale and measures of behavior problems, attitudes and expectations about treatment, perceived choice/motivation in seeking treatment, and service use history. Results indicate that the strongest unique correlates of satisfaction are severity of behavior problems, positive expectations about services, and perceived choice in seeking services. Satisfaction with services was also associated with service site, length of time in treatment, and reason for entering treatment. Demographic variables were not related to satisfaction. A discussion of the appropriateness of using satisfaction as an indicator of quality of care is included.

Intimate partner violence (IPV) may be a more common problem than some conditions for which pregnant women are routinely screened and evaluated. Screening for IPV necessitates competence in assessment using reliable and valid instruments. The present study examines the concordance in the prevalence of abuse reported by 436 high-risk postpartum mothers using (1) a single item hospital screen, (2) trained paraprofessional interviewer-interview format, and (3) the Conflict Tactics Scale (CTS), a standardized research instrument. The hospital screen identified 4% of the sample as scared, threatened or hurt, the Family Stress Checklist (FSC) identified 16.9% of the fathers as having severe potential for violence, and the CTS identified 18.6% of the sample as victims of physical abuse at the hands of the baby's father. There was minimal overlap between the ratings of severe potential for violence and the occurrence of violence as assessed by the CTS. Study findings illustrate the inadequacy of current procedures for detecting IPV with high-risk populations and highlight the need to develop reliable and valid assessments that can be easily utilized in the hospital setting.

Men in alcohol dependence treatment commonly report elevated levels of stressful life experiences prior to entering treatment. Clinical researchers have argued that training patients to cope with stress is an important aspect of therapy for alcohol dependence. Current age and age of onset of alcohol dependence are two patient characteristics that may relate to stress and allow mental health care providers to anticipate patient needs more readily. This study examines whether current age and age of onset of alcohol dependence are related to the type of stress experienced preceding treatment. Participants were 350 male veterans receiving inpatient treatment for alcohol dependence who completed a semistructured interview-based life stress assessment. The likelihood of life events related to achievement, relationship, and legal problems decreased with age; the likelihood of health difficulties increased with age; and age and age of onset of alcohol dependence interacted to predict health difficulties. These results indicate that the nature of some stress experiences prior to treatment for alcohol dependence may be related to current age and the course of alcohol dependence.

Purpose: To examine the relationship of adolescent alcohol and drug use over a 5-year period to cumulative health problems in late adolescence and young adulthood., Methods: We prospectively examined self-reported health problems in a sample of adolescents, some of whom received treatment for substance use disorders and had consistently poor substance use outcomes (n = 38), some of whom received treatment for substance use disorders and had positive substance use outcomes (n = 30), and a low alcohol and drug use community comparison group (n = 48). Data regarding health-related problems of these adolescents (mean, 15.9 years; 83% Caucasian; 56.5% female) were collected at 2, 4, and 6 years following initial assessments., Results: Alcohol and/or drug involvement severe enough to warrant treatment during adolescence was associated with more cumulative health problems and severe health problems for girls and more cumulative health problems for boys. Protracted and continuous abuse of alcohol and drugs was associated with more cumulative and severe health problems for girls and more severe health problems for boys., Conclusions: These results suggest that significant health problems and concerns are related to both brief and protracted alcohol and drug abuse during adolescence. Health problems will likely become even more evident as early-onset, chronic substance abusers continue to age.

The relative impact of biological family history of alcoholism and exposure to abusive parental drinking on alcohol effect expectancies of adolescent offspring were investigated in the present study. Exposure to familial models of alcohol abuse and biological family history were both predictive of positive alcohol effect expectancies of adolescent offspring. Degree of exposure to an alcohol-abusing family member mediated the relationship between biological family history of alcoholism and adolescent alcohol outcome expectancies. These results support prior findings of expectancy differences between youths with and without a family background of alcoholism and provide evidence supporting the significance of family modeling influences in the development of adolescents' alcohol expectancies.

The emphasis of this study encompasses two major areas: 1) light intensity, 2) color contrast. We were interested in this study to see how the manipulation of these two major variables might aid severely visually handicapped persons (legally blind) to be more productive and comfortable on the job. In the research that National Industries for the Blind did on this subject, it was clear that little has been accomplished in this area with legally blind persons in attempting to see how they might be better assisted in the area of actual work performance.