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Purpose: This prospective cohort study analyzed hospitalization data over a 7-year period for 5,503 female Navy recruits first assessed in 1996-1997.Methods: Participants' age, education, race/ethnicity, occupation, and traditionality of military occupation were analyzed as predictors of hospitalization for mental health diagnoses occurring 7-8 years after entry into the Navy.Results: 5.2% of women was hospitalized at least once for a mental health disorder over the 7-8 year follow-up period. Thirteen percent of all hospitalizations for the cohort were for mental health reasons. Adjustment reaction/acute stress reaction and personality disorders were the 2 most frequent mental disorders. Asian/ Pacific Islanders with more than a high school education and those in the younger age ranges were significantly less likely than others to be hospitalized for a mental disorder.Conclusions: Results underscore that mental health issues among young military women during peacetime are not a trivial source of morbidity. [ABSTRACT FROM AUTHOR]

Background: Recombinant activated human coagulation factor VII (rFVIIa), an intravascular strategy to promote clotting, is being used as an adjunct to surgical control of bleeding in combat trauma patients.Objective: To describe the initial experiences with rFVIIa administered to combat casualties at US Navy-Marine Corps medical treatment facilities in Iraq, and to compare survival outcomes of those treated with rFVIIa to controls not receiving rFVIIa.Methods: Medical encounter data from the US Navy-Marine Corps Combat Trauma Registry were retrospectively reviewed to identify all battle-injured patients documented as having received rFVIIa during the period May 2004 to January 2006 of Operation Iraqi Freedom. Available clinical and injury related data are presented to characterise the patients. To assess effects of rFVIIa on survival outcomes, rFVIIa cases were matched to controls on injury severity and age.Results: 22 battle-injured patients from the Combat Trauma Registry received rFVIIa. Primarily young US Marines, these patients typically had penetrating injuries from improvised explosive devices and gunshot wounds. Injuries were often abdominal. The average dose used was similar to that reported in another study of civilian trauma patients, although dosing varies widely in the existing experimental and anecdotal literature. Over two-thirds (68%) of the rFVIIa patients survived-an identical outcome seen for a matched control group of 22 patients.Conclusions: Survival of seriously injured combat casualties was good, although identical to that of a control group. Methodological limitations of this retrospective study preclude making firm conclusions about the effectiveness of rFVIIa. Future controlled studies are needed for safety and efficacy testing of rFVIIa in combat trauma patients. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To describe smoking and quitting history among multiethnic adolescent smokers and examine these as correlates of readiness to quit. METHODS: Data were analyzed from 121 high school smokers. Sociodemographic characteristics, self-reported smoking history, number and duration of recent quit attempts, attitudes toward smoking/quitting, and readiness to quit were included. RESULTS: Smoking and quitting history variables were associated with adolescents' stage of readiness to quit. A reasonably consistent pattern emerged in which those in the preparation stage were significantly different from the precontemplators and contemplators. CONCLUSIONS: Results are discussed in terms of interventions matched to individuals' readiness to quit. [ABSTRACT FROM AUTHOR]

The present study evaluated two relapse-prevention interventions intended to help women smokers maintain the "quit status" mandated during Navy basic training. Women with any smoking experience before entering the Navy (N = 2,781) were assigned to either a control group or to one of two intervention groups (access to a telephone help line or receive a series of monthly mailings) after graduating from basic training. Smoking/quit rates at 3, 6, and 12 months after graduation were assessed with mailed surveys. Response rates to the surveys ranged from 39% to 52%. There were no phone or mail intervention effects: cessation rates for the three conditions at the 12-month follow-up were 43% for control, 45% for the mail intervention, and 41% for the phone intervention. Results suggest the need for more aggressive relapse-prevention efforts, although quit rates were higher than expected "spontaneous" quit rates, indicating an impact of the totally smoke-free recruit training environment. [ABSTRACT FROM AUTHOR]

Community health advisors (CHAs), also known as promotores, are lay individuals in the community that others tend to look toward for advice and support. Studies incorporating CHAs are relatively rare, and CHAs have not been used in previous intervention studies to reduce environmental tobacco smoke (ETS) exposure. The present study pilot tested a CHA assessment instrument and examined the effects of promotora training on CHAs' knowledge, attitudes, and beliefs concerning ETS reduction. Participants were 11 women recruited from the local community. CHA training produced changes on several psychosocial constructs. Anticipated outcomes regarding ETS reduction and emotional reactions related to volunteering in the community were more positive after training. Self-esteem and self-efficacy showed increases after training. Future research will investigate the relationship between the psychosocial characteristics measured in the assessment instrument and subsequent success implementing the ETS reduction intervention. [ABSTRACT FROM AUTHOR]

The purpose of the study was to describe smoking-related knowledge and attitudes of a specific group of Latino smokers, and to identify sociodemographic correlates. This study is one of the few to provide information about smoking-related psychosocial variables and their correlates among a Latino subgroup. A survey was administered to a volunteer sample of adult smokers of Mexican-origin (n = 278) to assess their sociodemographic characteristics, and smoking-related knowledge and attitudes. Measures of smoking-related attitudes targeted six constructs: self-efficacy for quitting smoking, anticipated outcomes, intentions to quit, normative expectations, social support, and barriers to quitting. Smoking/cessation knowledge was assessed with a 14 item test. This sample of smokers had high knowledge and positive attitudes about quitting smoking. Several sociodemographic variables were associated with attitudinal knowledge variables, although no consistent pattern of association was seen. Results underscore the complexity between smoking-related attitudes and sociodemographic factors, and are discussed in terms of implications for culturally-tailored interventions. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine associations between cigarette availability measures with trial (ie, first) use of cigarettes. METHODS: At Time 1 and one year later (Time 2), 478 adolescents completed smoking surveys. Trial smoking at Time 2 was predicted from Time 1 availability variables (prospective prediction), as well as Time 2 availability variables (cross-sectional prediction). RESULTS: Offers from friends/classmates were a significant cross-sectional predictor. In prospective analyses, greater perceptions of ease of obtaining cigarettes from parents and greater frequency of offers from an adult were related to trial smoking. CONCLUSIONS: Adult influences, including parental factors, may predispose a young adolescent to smoke. [ABSTRACT FROM AUTHOR]

This report presents the final evaluation of Language for Health, part of a federally funded initiative to develop heart disease prevention interventions for low-literate populations. Language for Health specifically intervened with recent immigrants enrolled in English-as-a-second-language classes, incorporating nutritional behavior change materials into English-language curricula. Latino participants (n =732) were exposed to either nutrition education or stress management classes (attention-placebo group) designed specifically for low English-literate adults. Participants completed physiological measures assessing blood pressure, total and high-density lipoprotein (HDL) cholesterol, waist and hip circumference, and weight. Self-report surveys were administered to collect students' nutrition-related knowledge, attitudes, self-reported fat avoidance behaviors, and demographic information. Data were collected at baseline, 3-month posttest, and 6-month follow-up. Results indicated long-term effects of the intervention on nutrition knowledge and fat avoidance, yet only short-term effects on total cholesterol:HDL ratio and systolic blood pressure. [ABSTRACT FROM AUTHOR]

Objective: To test a smoking relapse prevention program for Navy women recently graduated from recruit training. Methods: Motivational materials were mailed to women at critical relapse points following recruit training graduation. Smoking was asssessed at 6 months post-graduation through a self-report survey. Results: A higher proportion of women exposed to the mail intervention had tried to quit smoking, although there were no significant differences in the overall relapse rate between intervention and control groups. Conclusion: The smoking relapse prevention tested did not succeed. [ABSTRACT FROM AUTHOR]

Focuses on a study which describe the results and effectiveness of Language for Health, a nutritional-related cardiovascular health program for limited English proficient adults enrolled in English-as-a-second-language classes. Goal of the nutrition education program; Psychosocial outcomes related to nutrition; Methodology; Results and discussion.

Objective: To investigate the relationship between socioeconomic status (SES) and cardiovascular disease (CVD) risk factors among Hispanic adults enrolled in English as a Second Language classes. Methods: Subjects (n=332) completed assessments of systolic and diastolic blood pressure, total and HDL cholesterol, body mass, smoking status, alcohol consumption, physical activity, family history of premature CVD, dietary fat intake, and six SES/social class indicators: Spanish literacy, acculturation to U.S. culture, years of education, years in the United States, income, and employment status. Results: In general, SES was inversely related to CVD risk factors. Conclusion: Although the patterns of relationships between the various SES indicators and CVD risk factors varied, so did findings by gender. [ABSTRACT FROM AUTHOR]

The purpose of the study was to assess the reliability and validity of a culturally adapted behavioral test of tobacco refusal skills (i.e., ability to turn down a cigarette offer) for Latino youth. Seventh grade students in San Diego, USA, and Tijuana, Mexico, listened to audiotaped tobacco offers either in English or Spanish, and their responses were recorded and coded for content and quality of tobacco refusals. The test was hypothesized to be sensitive to the effects of smoking prevention programms; therefore, validity was assessed in a quasi-experimental design with intervention and control groups. Subjects were tested at baseline and 6 months after the intervention group had completed a culturally adapted eightsession program that taught effective tobacco refusal strategies Intraclass test-retest reliabilities were .75 for boys and .57 for girls, and internal consistency coefficients were .73 for boys and .82 for girls. Analyses for boys indicated no differential change by condition in the types of refusals used pre-to-post, nor -any change in the quality of refusals to cigarette offers. For girls, the only intervention effect was a reduction in the use of aggressive responses. Results suggest limitations of the tobacco refusal skills test for Latinos. [ABSTRACT FROM AUTHOR]

A representative sample of 406 U.S. Navy commands, including all medical treatment facilities, was surveyed in 1990 about their activities and programs to prevent the use of tobacco and promote smoking cessation during the preceding year. The vast majority of Navy commands (86 percent) provided some type of tobacco cessation educational materials or programs. However, the most common activities typically were rated as only 'somewhat useful' in helping to curb tobacco use. Almost one-half of all commands offered psychological or behavioral cessation programs. Survey respondents estimated that approximately one-third of those persons who attended such a program stopped their tobacco use and nearly one-half reduced their tobacco use as a result of the program. Over-the-counter smoking cessation aids were not widely available at Navy exchange stores, individual commands, or medical treatment facilities. Furthermore, only 61 percent of all commands reported that they had a written policy or instruction regarding tobacco use. Only about one-third of medical treatment facilities had a routine system for identifying tobacco users by glancing at their medical records. However, it was estimated that 80 percent of medical treatment facility physicians routinely asked their patients about their tobacco use. The authors discuss the need for a more active Navy approach in prevention and cessation efforts and a routine system for identifying tobacco users from their medical records. In addition, inequities in cessation efforts were found among command subgroups. [ABSTRACT FROM AUTHOR]

Background: Drug overdoses are the leading cause of injury death in the United States with an estimated 105,752 individuals dying from an overdose in the United States in a 12-month period ending October 2021. Given that people who have opioid use disorder (OUD) are at an increased risk of death, it is crucial to assess risk factors associated with opioid overdose to improve interventions., Objectives: We examine factors associated with non-fatal overdose among a suburban/exurban population with OUD in Southern California., Methods: Participants were recruited by convenience sampling (n = 355) and were interviewed between November 2017 to August 2018. Participants were eligible for the study if they had a history of pharmaceutical opioid use., Results: A total of 198 (55.8%) participants reported at least one overdose in their lifetime. A total of 229 participants identified as male, 124 identified as female, and 2 identified as non-binary. When controlling for demographic factors, non-oral opioid administration at first opioid use (AOR 2.82, 95% CI 1.52-5.22), having a history of methadone detoxification, (AOR 2.23, 95% CI 1.27-3.91), history of buprenorphine detoxification (AOR 1.77, 95% CI 1.02-3.07), and history of 12 step attendance (AOR 1.89, 95% CI 1.12-3.20) were found to be independently and positively associated with lifetime opioid overdose., Conclusions: Detoxification with buprenorphine and methadone was found to be associated with having a non-fatal opioid overdose. Buprenorphine and methadone should not be prescribed as a detoxification medication as long-term use of medication for OUD results in better outcomes than medication that is used short-term.

Objective: To explore the feasibility and acceptability of Proyecto Mariposa , a culturally-tailored survivorship care program for rural Latina breast cancer patients., Design: Single group mixed-method approach., Methods: Feasibility of recruitment, intervention and evaluation, and perceptions about the intervention were assessed with 18 rural Latina breast cancer patients from the US/Mexico border region. Pre-post assessments evaluated change in patients' knowledge and concerns about survivorship care, and their self-efficacy about patient-physician interaction and managing chronic disease., Findings: Feasibility was generally promising but affected by the COVID-19 outbreak. Participants found the intervention to be acceptable and useful, particularly with regard to information provision and encouraging proactive behavior. There was modest pre-post improvement on self-efficacy for managing disease., Conclusions: This pilot study suggested feasibility and acceptability of Proyecto Mariposa for rural Latina breast cancer patients. Change in outcomes was small indicating the need for research with a larger sample to establish reliable findings.

US service members injured in the recent conflicts in Iraq and Afghanistan were more likely to survive than those in previous conflicts because of advances in medicine and protective gear. However, there is limited research examining the long-term impact of injuries while deployed on physical and mental quality of life (QOL) among service members. We used data from two time-points with an average follow-up period of 4.27 years (SD = 2.13; n = 118,054) to prospectively examine the association between deployment and injury status with QOL. Data were derived from the Millennium Cohort Study surveys (2001 to 2016) and linked with the Department of Defense Trauma Registry (DoD-TR) among a cohort of US service members from all branches and components. The primary predictor (a combination of deployment and injury status) was comprised of the following four categories: 1) not deployed, 2) deployed and not injured, 3) deployed and non-battle injured, and 4) deployed and battle injured. Demographic, military, psychological and behavioral health, and life stress factors were adjusted for in multivariable models. Outcomes of interest were physical and mental QOL from the Short-Form Health Survey for Veterans (VR-36) measured at ~4 year follow-up. Between group comparisons indicated that those deployed and battle-injured had the greatest decline in both mental (-3.82) and physical (-10.13) QOL scores over time (p < .05). While deployment and injury status were associated with poorer mental and physical QOL in adjusted models; only the association between deployment and injury status with physical QOL was clinically meaningful (more than 2.5). In adjusted models, Time 1 mental and physical QOL explained most of the variance (23-25%) in Time 2 mental and physical health QOL as compared to other covariates (e.g., injury and deployment, and other sociodemographic factors increased variance by ~5%). Time 1 QOL was the most significant predictor of later QOL, but those injured while deployed experienced significant and meaningful decrements to long-term physical QOL. This suggests that prevention and rehabilitation interventions should focus on improving physical health among injured service members to avoid long-term adverse effects., Competing Interests: Rudolph P. Rull is an employee of the U.S. Government. This work was prepared as part of my official duties. Title 17, U.S.C. §105 provides that copyright protection under this title is not available for any work of the U.S. Government. Title 17, U.S.C. §101 defines a U.S. Government work as work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties. Report Number 22-04 was supported by the Military Operational Medicine Research Program, Defense Health Program, and Veterans Affairs under work unit no. 60002. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government. The study protocol was approved by the Naval Health Research Center Institutional Review Board in compliance with all applicable Federal regulations governing the protection of human subjects. Research data were derived from an approved Naval Health Research Center Institutional Review Board protocol, number NHRC.2000.0007.

Rural US Latina breast cancer patients experience language barriers, health literacy issues, and limited access to health care resources that negatively impact survivorship care. This study explored the challenges to survivorship care for rural Latina breast cancer (BC) patients and approaches to supporting survivorship care plans (SCP) from the stakeholders' perspectives. Data were collected via eight focus groups (n = 40) and individual interviews (n = 4) with Latina BC patients, family caregivers, and health care professionals in a rural US-Mexico Border region. Interviews were audio-taped, transcribed, translated, and analyzed using thematic analysis. Themes related to the patient's SCP challenges included: (1) lack of knowledge of treatment information, (2) lack of proactive health behavior, (3) gaps in information for care coordination, (4) psychological distress, and (5) difficulty retaining health information. Respondents expressed that the SCP document could fill patient information gaps as well as support patient communication with their clinicians and family. Rural BC patients demonstrated an acute need for information and active engagement in their survivorship care. The findings indicate the importance of addressing challenges for survivorship care on multiple dimensions: Cognitive, behavioral, social, and structural. Developing a culturally tailored SCP intervention will be imperative to support survivorship care.

Objective: Rates of heavy alcohol use among active-duty military personnel in the United States are high and negatively affect individuals within the service branches. This study tested the effectiveness of a military-focused screening, brief intervention, and referral to treatment (SBIRT) intervention for reducing risky alcohol use among active-duty patients., Method: We used a randomized, parallel, two-group design to test the effectiveness of the SBIRT intervention in a convenience sample of service members recruited from the emergency department of a military hospital. A total of 791 participants were randomized to the SBIRT or usual care conditions, and 472 participants (59.7%) completed a 6-month follow-up. Fifteen percent of the sample was female. Self-reported Alcohol Use Disorders Identification Test (AUDIT), controlled drinking self-efficacy (CDSE), and readiness to change drinking behaviors were assessed at baseline and follow-up., Results: Among higher risk participants (i.e., AUDIT ≥8), results of a complete case analysis showed a significant reduction in scores on the AUDIT-C (consumption questions from the AUDIT) and a significant increase in CDSE. Null findings were observed for intent-to-treat analyses testing the effectiveness of the SBIRT intervention; significant decreases in AUDIT and AUDIT-C scores and significant increases in CDSE were observed over time, irrespective of condition assignment for both complete case and intent-to-treat analyses., Conclusions: Results of a complete case analysis provided some support for the effectiveness of the SBIRT intervention for higher risk participants. The results of the more conservative intent-to-treat analyses did not support any of the study hypotheses. Future SBIRT effectiveness trials should also test electronic SBIRT intervention approaches.

One method in mitigating the impact of COVID-19 is that of contact tracing. It is estimated that in the US, 35,000-100,000 contact tracers will be hired (and trained) to talk to recently-infected individuals, understand who they have exposed to the virus, and encourage those exposed to self-quarantine. The Center for Disease Control recommends the use of motivational interviewing (MI) by contact tracers to encourage compliance with contact tracing/quarantine. Contact tracers need to sensitively communicate with COVID-19-exposed individuals who may also be experiencing other issues caused by the pandemic, such as anxiety, depression, grief, anger, intimate partner violence, health problems, food insecurity, and/or unemployment. Social workers are particularly prepared to address the mental health and other psychosocial problems that may be encountered in the tracing process. This article describes contact tracing, its use in other diseases, the role of MI, psychosocial issues that contact tracers may encounter, and how social work can respond to these needs. A sample dialogue of contact tracing using MI is presented with a discussion of the content and skills used in the process., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021.)

Latina breast cancer survivors are less likely to receive a comprehensive Survivorship Care Plan (SCP) than non-Latina Whites. Evidence-based and theory driven interventions are needed to promote a culturally and linguistically responsive SCP. This paper describes the application of Intervention Mapping (IM) in the development of Proyecto Mariposa , a comprehensive SCP program targeting Latina breast cancer survivors living in a rural U.S.-Mexico border region. We conducted a needs assessment using focus groups ( n = 40) and individual interviews ( n = 4) with stakeholders to elicit their needs and preferences relating to SCPs and SCP aid (Step1). Content analysis of transcripts was conducted using Atlas.ti. The findings informed the development of a matrix of change objectives where we selected specific behavioral theories to ground the practical application of the SCP program (Step 2). We identified behavioral theories and the practical application of behavioral change (Step 3) and designed and developed a comprehensive SCP program which consisted of a culturally-and linguistically-adapted SCP document and animated video as an SCP aid (Step 4). The systematic application of the IM framework resulted in the development of a comprehensive and culturally tailored SCP intervention. Stakeholder active involvement in the cultural tailoring of the program was imperative and strengthens the SCP intervention.

The survival rate of those injured in combat in overseas contingency operations is higher than in previous conflicts. There is a need to assess the long-term psychosocial and quality of life outcomes of those injured in combat, yet surveying this population presents inherent challenges. As part of a large-scale, longitudinal examination of patient-reported outcomes of service members injured on deployment, the present manuscript evaluated the effectiveness of three postal strategies on response rates: (1) mailing a study prenotification postcard, (2) mailing the survey invitation in a larger envelope, and (3) including a small cash preincentive ($2). Evaluation of these strategies yielded mixed results in this population. Neither the prenotification postcard nor inclusion of a $2 cash preincentive significantly increased response rates. However, use of a larger envelope to mail the survey invitation significantly increased the response rate by 53.1%. Researchers interested in collecting patient-reported outcomes among military populations, including those with combat-related injuries, may find that increasing the visibility of recruitment materials is more effective for improving response rates than attempting to cognitively prime or offer prospective participants preincentives., (© Association of Military Surgeons of the United States 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The purpose of this descriptive study was to examine gender differences in the characteristics of clients in a large Driving Under the Influence (DUI) program in Southern California. We analyzed secondary de-identified data from a large DUI program for the years 2009-2014 (n = 19,619). Sociodemographic characteristics, measures of physical and mental comorbidity, and alcohol use severity measures were compared for male and female clients. Women averaged 32.85 years of age (SD = 10.70), while men were slightly older at 34.2 years (SD = 11.19). Females comprised an increasingly greater percentage of the client population over the time period studied (27.6%-30.7%). In a multivariable model, compared to male clients, females were more likely to be White non-Hispanic, not currently married, and younger. Women were more likely than men to report anxiety, depression, and a history of domestic violence. Blood alcohol content at arrest and measures of hazardous drinking did not differ significantly by gender. Results suggested that gender-specific DUI programs might be useful.

Background: Alcohol misuse has been an ongoing issue for the US Armed Services, with the Marine Corps maintaining the highest levels of problematic drinking. Broad environmental, social, and policy factors play an important role in alcohol misuse but are rarely studied as objective measures., Methods: This case study used a pattern-matching approach to examine the associations between objective on- and off-base community environmental risk and protective factors and 4 objective alcohol-related outcomes at 3 large Marine Corps installations. The study utilized existing aggregated data from Marine Corps electronic data sources and information from internet searches of installation and community services and characteristics. Installation-level alcohol misuse outcomes included the rates of personnel receiving non-medical alcohol services, combined inpatient and outpatient alcohol-related primary diagnoses, alcohol-related domestic violence, and driving under the influence arrests. Installation-level environmental correlates included dollars spent on alcohol sales, density of alcohol outlets, extent of alternative activities, and installation and off-base sociodemographic factors., Results: In general, younger age, enlisted pay grade, and being stationed overseas were related with higher rates of alcohol-related problems among Marines. Greater on-base alcohol sales (both in bars and stores), as well as a greater density of restaurants and bars that serve alcohol, were associated with alcohol misuse outcomes. Several community factors were also associated with alcohol misuse. The hypothesized protective effects of alternative activities were inconsistent., Conclusions: Findings suggest that environmentally-oriented strategies, particularly restricting on-base sales of alcohol, may help to reduce alcohol-related harm in the Marine Corps.

Introduction: Alcohol misuse, in particular binge drinking, is a serious concern among military personnel because it is strongly associated with adverse consequences and has a deleterious effect on readiness. Although most alcohol misuse studies have focused on individual risk factors, studies are increasingly examining environmental influences and strategies for reducing alcohol risks. The purpose of this study is to address gaps in what is known about how service members' perceptions of environmental factors are related to binge drinking in the U.S. Marine Corps., Materials and Methods: The relationship between Marines' self-reports of environmental factors and alcohol binge drinking was assessed in this correlational study using data from three large Marine Corps installations drawn from the Department of Defense 2011 Health Related Behaviors Survey of Active Duty Military Personnel (N = 2,933). We proposed several directional hypotheses based on existing civilian and military studies of alcohol use and misuse, as well as health behavior theory., Results: Agreement with the statements that alcoholic beverages cost too much, that drinking might negatively affect one's military career, and that one's immediate supervisor and installation discourage alcohol use were independently associated with decreased odds of binge drinking (i.e., protective factors). Perceptions that alcoholic beverages are difficult to get was particularly protective; the odds of having binged were lower for participants who endorsed this belief than for those who did not. Perceptions that drinking is part of being in one's unit was a risk factor for binge drinking (odds ratio = 1.29)., Conclusion: Even after accounting for strong sociodemographic correlates, binge drinking was independently associated with a number of environmentally oriented perceptions. Beliefs that alcohol is affordable and easy to access were the strongest environmental correlates of increased risk of binge drinking. Addressing the threat alcohol misuse poses to both Marines and mission readiness will likely require multiple strategies, including both policy and environmental changes.

Purpose: Little is known about the long-term, health-related quality of life (HRQOL) of those wounded in combat during Operations Enduring Freedom, Iraqi Freedom, and New Dawn. The present study described the overall HRQOL for a large group of US service members experiencing mild-to-severe combat-related injuries, and assessed the unique contribution of demographics, service- and injury-related characteristics, and mental health factors on long-term HRQOL., Method: The Wounded Warrior Recovery Project examines patient-reported outcomes in a cohort of US military personnel wounded in combat. Participants were identified from the Expeditionary Medical Encounter Database, a US Navy-maintained deployment health database, and invited to complete a web-based survey. At the time of this study, 3245 service members consented and completed the survey. Hierarchical linear regression analyses were conducted to assess the unique contribution of each set of antecedents on HRQOL scores., Results: HRQOL was uniquely associated with a number of demographics, and service- and injury-related characteristics. Nevertheless, screening positive for posttraumatic stress disorder (B = - .09; P < .001), depression (B = - .10; P < .001), or both as a set (B = - .19; P < .001) were the strongest predictors of lower long-term HRQOL., Conclusions: Postinjury HRQOL among service members wounded in combat was associated with service and injury experience, and demographic factors, but was most strongly linked with current mental health status. These findings underscore the significance of mental health issues long after injury. Further, findings reinforce that long-term mental health screening, services, and treatment are needed for those injured in combat.

Background: Medical care in the emergency department (ED) is a growing and complex area of outpatient care, with about 256 visits made to EDs every minute in 2013. Studies report that, compared to people who do not use drugs, people who use illicit drugs are more likely to use the ED for their medical care. Self-efficacy has been shown to be a predictor of abstinence or reduced use among drug-using individuals., Objectives: The current study describes drug avoidance self-efficacy among exclusive cannabis-using individuals and other drug-using individuals who use the ED for any reason., Methods: Participants were 693 adult patients visiting the trauma units and EDs of two large urban "safety net" hospitals (i.e., providing care to low-income, uninsured, and vulnerable population) in Southern California who reported using illicit drugs in the past 30 days., Results: For people who use only cannabis, higher drug-avoidance self-efficacy was associated with older age, lower drug involvement scores, lower drug severity scores, and higher readiness to change use. For people who use other drugs, higher drug avoidance self-efficacy scores was associated with lower drug severity scores, lower psychiatric severity scores, higher medical severity scores, and higher readiness to change use., Conclusion: This study identified several factors (some common, some unique) related to higher drug-avoidance self-efficacy for both groups. Results may be important when designing intervention protocols for use in the ED.

Background: The transient nature of military life coupled with environmental and psychosocial stressors increase the risk for alcohol misuse and abuse among active duty (AD) military service members and recent epidemiological studies demonstrate high rates of heavy drinking among AD personnel. Over the past decade, Department of Defense health care systems have observed increases in the utilization of substance use services among military personnel demobilizing from Operation Enduring Freedom and Operation Iraqi Freedom. Given the high rates of heavy drinking and increased use of substance use services in this population of AD personnel, the purpose of this study was to investigate how to best translate and implement an effective alcohol abuse prevention intervention tool (screening, brief intervention, and referral to treatment [SBIRT]) used in civilian populations to a military emergency department (ED) setting., Methods: We conducted focus groups with ED staff as well as short interviews with AD personnel at a Naval Medical Center in the southwestern United States to determine the suitability of SBIRT with military populations as well as how to best translate SBIRT to a military hospital setting., Findings: Participants expressed support for utilizing civilian health educators to conduct the SBIRT intervention; however, many were concerned with issues of confidentiality and were skeptical of whether AD would speak truthfully about alcohol consumption., Conclusions: Results of this formative research study clearly indicate the implementation and translation of SBIRT into a military medical setting require attention to issues related to confidentiality, the veracity of alcohol reporting, as well as use of civilians over AD military personnel to deliver the SBIRT intervention. Furthermore, most participants expressed support for the SBIRT model and felt it could be implemented, with caveats, into a military health care setting such as an ED., (Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.)

Patient navigation is a widely used approach to minimize health disparities among socioeconomically marginalized cancer patients. Although patient navigation is widely used, there is a dearth of studies exploring patient experience with navigators among rural cancer patients. This qualitative study explores the challenges and barriers to cancer care faced by cancer patients living in a US/Mexico border region in Southern California. We individually interviewed 22 cancer patients, most of whom were Latino. Data were analyzed using constant comparison with a reiterative analysis method. The main themes relating to barriers to care and experiences with patient navigators include the following: (1) removing financial barriers, (2) coordinating services, and (3) providing therapeutic interventions. The cancer patients highly valued the navigators for their knowledge about community resources, support, and advocacy. This study suggests that it is imperative that navigators know the regional and binational health care utilization issues that impact patients' access to cancer care.

Background: This study extends what is known about long-term health-related quality of life (HrQoL) and other psychosocial outcomes (i.e., depression, posttraumatic stress disorder [PTSD]) among US military combat amputees serving in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn., Methods: A total of 63 combat amputees were identified from the Wounded Warrior Recovery Project, a study assessing long-term self-reported HrQoL and psychological outcomes among those wounded during military service. Another 477 service members from the Wounded Warrior Recovery Project were identified as a comparison group (i.e., nonamputees with moderate to severe extremity injuries)., Results: After adjusting for age, time since injury, overall injury severity, and traumatic brain injury, amputees had poorer functional HrQoL than those in the nonamputee comparison group overall and in the specific area related to performance of usual activities, and, to some degree, chronic and acute symptoms, and mobility/self-care. On the other hand, depression and PTSD symptoms were not different for the two groups., Conclusion: Results suggest that when assessed over 5 years postinjury, on average, amputees have unique physical and functional limitations, yet do not report greater depression or PTSD symptoms than others seriously injured in combat. It may be that state-of-the-art integrated amputee care that includes support networks and emphasis on adjustment and psychological health may increase successful coping and adjustment, at least to a level that is on par with other types of serious combat injury., Level of Evidence: Epidemiologic/prognostic study, level III.

Youth advocacy for obesity prevention is a promising but under-evaluated intervention. The aims of this study are to evaluate a youth advocacy program's outcomes related to youth perceptions and behaviors, develop an index of youth advocacy readiness, and assess potential predictors of advocacy readiness. Youth ages 9-22 in an advocacy training program (n = 92 matched pairs) completed surveys before and after training. Youth outcomes and potential predictors of advocacy readiness were assessed with evaluated scales. All 20 groups who completed the evaluation study presented their advocacy projects to a decision maker. Two of six perception subscales increased following participation in the advocacy program: self-efficacy for advocacy behaviors (p < .001) and participation in advocacy (p < .01). Four of five knowledge and skills subscales increased: assertiveness (p < .01), health advocacy history (p < .001), knowledge of resources (p < .01), and social support for health behaviors (p < .001). Youth increased days of meeting physical activity recommendations (p < .05). In a mixed regression model, four subscales were associated with the advocacy readiness index: optimism for change (B = 1.46, 95 % CI = .49-2.44), sports and physical activity enjoyment (B = .55, 95 % CI = .05-1.05), roles and participation (B = 1.81, 95 % CI = .60-3.02), and advocacy activities (B = 1.49, 95 % CI = .64-2.32). The youth advocacy readiness index is a novel way to determine the effects of multiple correlates of advocacy readiness. Childhood obesity-related advocacy training appeared to improve youths' readiness for advocacy and physical activity., Competing Interests: Compliance with ethical standards Funding This paper was supported by a grant (# 68508) from the Active Living Research program of the Robert Wood Johnson Foundation. Conflicts of interest Authors Millstein, Woodruff, Linton, and Edwards declare that they have no conflicts of interest. Author Sallis has received grants from the National Institutes of Health, Robert Wood Johnson Foundation (Active Living Research), Centers for Disease Control and Prevention, Nike Inc., and the California Endowment. He is also a part owner of Santech, Inc., and has a consulting relationship with the University of North Carolina, Greensboro, on an NIH grant.

Aim: This pilot study explored the feasibility and acceptability of a stage-tailored motivational interviewing intervention with education that focuses on changes in end-of-life (EOL) communication, completion of advance directives (ADs), and readiness for advance care planning (ACP)., Methods: One group pretest-posttest design was implemented with 30 low-income older adults., Results: This pilot study showed its feasibility in enhancing ACP. Action for ACP-that is, identifying a proxy for decision making and documenting EOL treatment preference in an AD-increased significantly by 23.3% (n = 7). The participants' readiness for ACP, knowledge, self-efficacy, positive attitudes, and perceived importance of ACP increased significantly after the intervention., Conclusion: Health care professionals and service providers who interact with older adults should tailor ACP dialogues in accordance with individuals' motivation., (© The Author(s) 2015.)

Background and Objectives: The purpose of this study is to extend what is known about medical marijuana and non-medical marijuana users who visit the emergency department (ED) by exploring differences in their sociodemographic characteristics and their drug-related problem severity., Methods: Of 292 consecutively enrolled exclusive marijuana-only users visiting the ED for any reason, 37% (n = 107) reported using marijuana on the advice of a medical doctor, and 63% (n = 185) reported that they did not use it under the advice of a medical doctor (ie, non-medical user). Participants denied using any other drug with the exception of alcohol. Participants completed the Addiction Severity Index-Lite which provided composite and individual items related to drug use problems, psychiatric problems, medical problems, and alcohol use problems. Self-efficacy for avoiding drug use and sociodemographic characteristics were also collected., Results: In a multivariate model, compared to non-medical marijuana users, medical users reported a higher frequency of days of use, more money spent on marijuana, and lower readiness to change use of marijuana, yet lower frequency of drug problems and tended to be low-risk versus moderate-severe risk users. Medical marijuana use was associated with a greater number of days of psychological problems., Discussion and Conclusions: Results for medical marijuana users might be interpreted as consistent with that of routine, self-administered treatment for medical or psychological problems., Scientific Significance: Results suggest behavioral health interventions in acute care settings should consider treating non-medical marijuana users differently than medical users due to the greater drug-related problems associated with non-medical use. (Am J Addict 2016;25:385-391)., (© 2016 American Academy of Addiction Psychiatry.)

Background: Youth advocacy has been successfully used in substance use prevention but is a novel strategy in obesity prevention. As a precondition for building an evidence base for youth advocacy for obesity prevention, the present study aimed to develop and evaluate measures of youth advocacy mediator, process, and outcome variables., Methods: The Youth Engagement and Action for Health (YEAH!) program (San Diego County, CA) engaged youth and adult group leaders in advocacy for school and neighborhood improvements to nutrition and physical activity environments. Based on a model of youth advocacy, scales were developed to assess mediators, intervention processes, and proximal outcomes of youth advocacy for obesity prevention. Youth (baseline n = 136) and adult group leaders (baseline n = 47) completed surveys before and after advocacy projects. With baseline data, we created youth advocacy and adult leadership subscales using confirmatory factor analysis (CFA) and described their psychometric properties., Results: Youth came from 21 groups, were ages 9-22, and most were female. Most youth were non-White, and the largest ethnic group was Hispanic/Latino (35.6%). The proposed factor structure held for most (14/20 youth and 1/2 adult) subscales. Modifications were necessary for 6 of the originally proposed 20 youth and 1 of the 2 adult multi-item subscales, which involved splitting larger subscales into two components and dropping low-performing items., Conclusions: Internally consistent scales to assess mediators, intervention processes, and proximal outcomes of youth advocacy for obesity prevention were developed. The resulting scales can be used in future studies to evaluate youth advocacy programs.

Emergency department (ED) settings have gained interest as venues for illegal drug misuse prevention and intervention, with researchers and practitioners attempting to capitalize on the intersection of need and opportunity within these settings. This study of 686 adult patients visiting two EDs for various reasons who admitted drug use compared daily cannabis-only users, nondaily cannabis-only users, and other drug users on sociodemographic and drug-related severity outcomes. The three drug use groups did not differ on most sociodemographic factors or medical problem severity scores. Forty-five percent of the sample was identified as having a drug use problem. ED patients who used drugs other than cannabis were at particular risk for high drug use severity indicators and concomitant problems such as psychiatric problems and alcohol use severity. However, 19-29% of cannabis-only users were identified as having problematic drug use. Furthermore, daily cannabis-only users fared less well than nondaily cannabis users with regard to drug use severity indicators and self-efficacy for avoiding drug use. Results may assist emergency medicine providers and medical social workers in matching patients to appropriate intervention. For example, users of drugs other than cannabis (and perhaps heavy, daily cannabis-only users) may need referral to specialty services for further assessment. Enhancement of motivation and self-efficacy beliefs could be an important target of prevention and treatment for cannabis-only users screened in the ED.

Background: Although screening, brief intervention, and referral to treatment (SBIRT) has shown promise for alcohol use, relatively little is known about its effectiveness for adult illicit drug use. This randomized controlled trial assessed the effectiveness of the SBIRT approach for outcomes related to drug use among patients visiting trauma and emergency departments (EDs) at two large, urban hospitals., Methods: A total of 700 ED patients who admitted using illegal drugs in the past 30 days were recruited, consented, provided baseline measures of substance use and related problems measured with the Addiction Severity Index-Lite (ASI-Lite), and then randomized to the Life Shift SBIRT intervention or to an attention-placebo control group focusing on driving and traffic safety (Shift Gears). Both groups received a level of motivational intervention matched to their condition and risk level by trained paraprofessional health educators. Separate measurement technicians conducted face-to-face follow-ups at 6 months post-intervention and collected hair samples to confirm reports of abstinence from drug use. The primary outcome measure of the study was past 30-day drug abstinence at 6 months post-intervention, as self-reported on the ASI-Lite., Results: Of 700 participants, 292 (42%) completed follow-up. There were no significant differences in self-reported abstinence (12.5% vs. 12.0% , p = 0.88) for Life Shift and Shift Gears groups, respectively. When results of hair analyses were applied, the abstinence rate was 7 percent for Life Shift and 2 percent for Shift Gears (p = .074). In an analysis in which results were imputed (n = 694), there was no significant difference in the ASI-Lite drug use composite scores (Life Shift +0.005 vs. Shift Gears +0.017, p = 0.12)., Conclusions: In this randomized controlled trial, there was no evidence of effectiveness of SBIRT on the primary drug use outcome., Trial Registration: ClinicalTrials.gov NCT01683227.

Background: As evidence grows about the benefits of policy and environmental changes to support active living and healthy eating, effective tools for implementing change must be developed. Youth advocacy, a successful strategy in the field of tobacco control, should be evaluated for its potential in the field of obesity prevention., Community Context: San Diego State University collaborated with the San Diego County Childhood Obesity Initiative to evaluate Youth Engagement and Action for Health! (YEAH!), a youth advocacy project to engage youth and adult mentors in advocating for neighborhood improvements in physical activity and healthy eating opportunities. Study objectives included documenting group process and success of groups in engaging in community advocacy with decision makers., Methods: In 2011 and 2012, YEAH! group leaders were recruited from the San Diego County Childhood Obesity Initiative's half-day train-the-trainer seminars for adult leaders. Evaluators collected baseline and postproject survey data from youth participants and adult group leaders and interviewed decision makers., Outcomes: Of the 21 groups formed, 20 completed the evaluation, conducted community assessments, and advocated with decision makers. Various types of decision makers were engaged, including school principals, food service personnel, city council members, and parks and recreation officials. Eleven groups reported change(s) implemented as a result of their advocacy, 4 groups reported changes pending, and 5 groups reported no change as a result of their efforts., Interpretation: Even a brief training session, paired with a practical manual, technical assistance, and commitment of adult leaders and youth may successfully engage decision makers and, ultimately, bring about change.

There is a need for more work to understand the quality of life (QOL) outcomes of survivors of Operations Enduring Freedom and Iraqi Freedom combat injury to improve care and treatment, and prevent poor physical, psychological, and social outcomes. We describe the study design and methods of the Wounded Warrior Recovery Project, a study supported by the Department of Defense that will track close to 10,000 military personnel wounded in Operations Enduring Freedom and Iraqi Freedom. The overall objective of the 6-year longitudinal study is to track changes in QOL and describe variations in those changes as they relate to sociodemographic factors, injury characteristics, service-related factors, clinical/diagnostic measures including traumatic brain injury and posttraumatic stress disorder, and medical procedures and services. The Wounded Warrior Recovery Project study will be among the first longitudinal population-based investigations of QOL outcomes after combat injury and will provide a basis upon which large-scale epidemiological studies can be conducted., (Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.)

Assessment of acute mild traumatic brain injury (mTBI) symptoms after a combat blast could aid diagnosis and guide follow-up care. Our objective was to document acute mTBI symptoms following a combat blast and to examine associations between acute symptoms and mental health and service discharge outcomes. A retrospective cohort study was conducted with 1656 service personnel who experienced a combat blast-related mTBI in Iraq. Acute mTBI symptoms were ascertained from point-of-injury medical records. The associations between acute symptoms and posttraumatic stress disorder (PTSD), postconcussion syndrome (PCS), and type of service discharge were examined. Disability discharge occurred in 11% of patients, while 36% had a non-disability discharge and 52% had no recorded discharge. A PTSD and PCS diagnosis was made in 19% and 15% of the sample, respectively. The most common acute mTBI symptoms were headache (62.8%), loss of consciousness (LOC) (34.5%), and tinnitus (33.2%). LOC was predictive of PTSD (odds ratio [OR] 1.54; 95% confidence interval [CI] 1.18, 2.00) and PCS (OR 2.08; 95% CI 1.56, 2.77), while altered mental status (OR 1.53; 95% CI 1.07, 2.17) and previous blast history (OR 1.83; 95% CI 1.15, 2.90) also were predictive of PCS. While no acute mTBI symptoms were associated with discharge outcomes, injury severity was associated with disability discharge. LOC after blast-related mTBI was associated with PTSD and PCS, and injury severity was predictive of disability discharge. The assessment of cognitive status immediately after a blast could assist in diagnosing mTBI and indicate a need for follow-up care.

Introduction: Visits to settings such as emergency departments (EDs) may present a "teachable moment" in that a patient may be more open to feedback and suggestions regarding their risky alcohol and illicit drug-use behaviors. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an 'opportunistic' public health approach that targets low-risk users, in addition to those already dependent on alcohol and/or drugs. SBIRT programs provide patients with comprehensive screening and assessments, and deliver interventions of appropriate intensity to reduce risks related to alcohol and drug use., Methods: This study used a single group pre-post test design to assess the effect of the California SBIRT service program (i.e., CASBIRT) on 6 substance-use outcomes (past-month prevalence and number of days of binge drinking, illegal drug use, and marijuana use). Trained bilingual/bicultural Health Educators attempted to screen all adult patients in 12 EDs/trauma centers (regardless of the reason for the patient's visit) using a short instrument, and then delivered a brief motivational intervention matched to the patient's risk level. A total of 2,436 randomly selected patients who screened positive for alcohol and/or drug use consented to be in a 6-month telephone follow-up interview. Because of the high loss to follow-up rate, we used an intention-to-treat approach for the data analysis., Results: RESULTS of generalized linear mixed models showed modest reductions in all 6 drug-and alcohol-use outcomes. Men (versus women), those at relatively higher risk status (versus lower risk), and those with only one substance of misuse (versus both alcohol and illicit drug misuse) tended to show more positive change., Conclusion: These results suggest that SBIRT services provided in acute care settings are associated with modest changes in self-reported recent alcohol and illicit drug use.

Background: Screening and brief intervention (SBI) is a comprehensive, integrated public health approach to identify and deliver a spectrum of early detection and intervention services for substance use in general medical care settings. Although the SBI approach has shown promise for alcohol use, relatively little is known about its effectiveness for illicit drug use. We are evaluating the SBI approach for drug use using a rigorous randomized controlled trial. The purpose of the report is to describe the overall trial and its programmatic and methodological strengths with a focus on health educator (HE) selection and training. In addition, the baseline characteristics of the recently enrolled multiethnic cohort are described., Methods/design: A randomized two-group repeated measures design is being used in which drug-related outcomes of an intervention group will be compared with those of an attention-placebo control group. Selection of bicultural paraprofessional HEs-their training in research concepts, comorbid mental health issues, special treatment of marijuana use, and nonscripted enhanced motivational interviewing as well as their ongoing monitoring and evaluation-are among the features described. The HEs enrolled, consented, and conducted an intervention among 700 illicit drug users in two large hospital emergency departments/trauma units. To be eligible, a participant needed to be an adult (age ≥18 years), an English or Spanish speaker, awake and able to give consent, and reachable by telephone to schedule a six-month follow-up interview., Discussion: A comprehensive HE training protocol combined with rigorous, ongoing process measurement resulted in skill mastery in many areas and a successful participant recruitment period. Strengths and limitations of the study protocol are discussed as well as the characteristics of those recruited. This trial will be among the first to provide information about the effectiveness of SBI for illicit drug use. Outcome analysis has not yet been completed, but demonstrated programming and design successes have implications for future research and service delivery., Trial Registration: http://NCT01683227.

The purpose of this study was to describe career performance outcomes after combat blast injury and to examine the relationship between the injury severity and type of military discharge. A retrospective cohort study of 4,255 male servicemembers injured in a combat blast as a part of Operation Iraqi Freedom was completed. In the total sample, 37.8% experienced a normal discharge and 8.3% had an early discharge. Of the 2,229 members who had a discharge code, 29.8% experienced a disability discharge. Both early attrition and disability discharge proportions were higher in those with posttraumatic stress disorder (PTSD) than in those without PTSD. There was a significant interaction between PTSD and injury severity in the discharge disability outcome. In those without PTSD, there was a dose-response relationship between injury severity and disability discharge. In those with PTSD, injury severity predicted disability discharge. The relationship between injury severity and disability discharge was less striking in servicemembers with PTSD than without PTSD. The effect of PTSD and injury severity on career performance outcomes after blast injuries should be factored into outcome planning.

Introduction: Explosions have caused a greater percentage of injuries in Iraq and Afghanistan than in any other large-scale conflict. Improvements in body armour and field medical care have improved survival and changed the injury profile of service personnel. This study's objective was to determine the nature, body region, and severity of injuries caused by an explosion episode in male service personnel., Materials and Methods: A descriptive analysis was conducted of 4623 combat explosion episodes in Iraq between March 2004 and December 2007. The Barell matrix was used to describe the nature and body regions of injuries due to a combat explosion., Results: A total of 17,637 International Classification of Diseases, Ninth Revision (ICD-9) codes were assigned to the 4623 explosion episodes, with an average of 3.8 ICD-9 codes per episode. The most frequent single injury type was a mild traumatic brain injury (TBI; 10.8%). Other frequent injuries were open wounds in the lower extremity (8.8%) and open wounds of the face (8.2%), which includes tympanic membrane rupture. The extremities were the body regions most often injured (41.3%), followed by head and neck (37.4%) and torso (8.8%)., Conclusion: The results of this study support previous observations of TBI as a pre-eminent injury of the wars in Iraq and Afghanistan, with mild TBI as the most common single injury in this large cohort of explosion episodes. The extremities had the highest frequency of injuries for any one body region. The majority of the explosion episodes resulted in more than one injury, and the variety of injuries across nearly every body region and injury type suggests a complex nature of explosion injuries. Understanding the constellation of injuries commonly caused by explosions will assist in the mitigation, treatment, and rehabilitation of the effects of these injuries., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Smoking, drinking, and illicit drug use are leading causes of morbidity and mortality, both during adolescence as well as later in life. Although for some adolescents, substance use may last for only a brief period of experimentation, use of these substances in adolescence may have negative consequences. The determination of how well national and local policy and intervention efforts address teen substance use depends largely on the collection of valid and accurate data. Assessments of substance use rely heavily on retrospective self-report measures. The reliability and validity of self-reported substance use measures, however, may be limited by various sources of measurement error. This study utilizes four waves of data from the National Longitudinal Survey of Youth spanning eight years. Our wave-to-wave analyses examined the accuracy of self-reported age of onset for cigarette, alcohol and marijuana users. Findings indicate that approximately one-fourth of cigarette users, one-fifth of alcohol users and one-third of marijuana users reported their age of onset exactly the same across waves. Of those who reported the age of onset inaccurately, the error tended to be in the direction of reporting their age of onset as older at a latter wave relative to what was reported previously, known as forward telescoping. Results from multiple linear regression analyses showed that the single most consistent variable associated with telescoping was the number of years since the substance was first reported. Time since first report was the single consistent and strongly associated with telescoping in each wave-to-wave comparison for all three substances under study. Implications for policy and research are discussed.

Objective: This study evaluated the utility of a brief field-based intervention to reduce alcohol use and alcohol-related problems among men who have sex with men., Method: A randomized control trial was designed to test a brief alcohol intervention against an attention-placebo control intervention. Over a 13-week period in fall 2009, a sample (n = 152) of men who have sex with men was recruited at a local gay bar in San Diego, CA, and were randomized to a brief alcohol intervention or an attention-placebo control group. Sober bar patrons were recruited before bar entrance and asked to undergo a brief survey and give a breath alcohol sample at exit from the bar., Results: Breath alcohol concentrations at exit from the bar were not significantly different between those in the experimental alcohol feedback condition and those in the attention-placebo control condition. However, among participants in the experimental condition, those categorized as high risk for alcohol-related problems at entrance drank significantly less than planned as compared with participants categorized as low risk for alcohol-related problems., Conclusions: Brief, venue-based interventions may be appropriate for men who have sex with men who plan to drink at rates that would put them at higher risk of alcohol-related problems. Additional studies exploring the utility of brief intervention in risk settings are warranted.

Aim: To identify if there are different typologies for adolescent self-reporters and recanters for alcohol, cigarette and marijuana use., Methods: This study is a secondary data analysis and utilized four waves of the National Longitudinal Survey of Youth child panel data. The study included adolescents aged ten and older who self-reported ever use of cigarettes (n=872), marijuana (n=854) or alcohol (n=837). Consistent responders were those who reported lifetime use of a specific substance and continued to report such use at each latter wave of data collection. Latent class analyses were utilized to investigate if there are different types of self-reporters for each substance class., Results: Three unique groups for each substance was identified. The first group of users, who had a late age of onset, tended to be consistent self-reporters across waves. Those who were early onset users of cigarettes and marijuana tended to recant their use while early onset alcohol users were consistent reporters. Those with moderate ages of onset had no consistent recanting patterns. The highest degree of recanting was found among the early onset marijuana users., Conclusions: The results suggest that youth who begin their use at an earlier age may not be as reliable reporters as youth who initiate use at later ages. Our results suggest that the veracity of prevalence estimates for licit and illicit substances could be different depending on the age of the respondent., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)