Faculty Bibliography

Adult smokers were recruited during routine health care visits at primary care clinics located in three urban hospitals and were given a brief intervention and nicotine replacement therapy. Analyses compared bicultural (BC: n=60) or less acculturated (LA: n=138) Latinos and non-Latino White (NL: n=417) participants. Both Latino groups were significantly different from NL subjects in smoking rate and nicotine dependence. However, BC and NL subjects differed significantly from LA subjects in perceived benefits of quitting, perceived risk from smoking, and negative affect smoking. LA subjects had higher cessation rates than either BC or NL groups. Regression analyses showed that nicotine dependence and confidence in quitting predicted cessation at month 6, and acculturation appeared to moderate the relationship between smoking cessation and both confidence in quitting and nicotine dependence. These results provide support for the viability of brief interventions for smoking provided through health care delivery systems. Results also suggest that characteristics previously shown to be predictive of successful cessation in mixed or non-Latino populations may not be equally predictive of cessation across members of diverse populations.

OBJECTIVE:Prior research on health care utilization after treatment for substance misuse disorders has not accounted for posttreatment clinical outcomes as well as putative confounds associated with both substance use and health care. This study examined the association of posttreatment health care utilization with treatment factors (program type and time in treatment) and baseline psychological/behavioral risk factors (smoking status and level of depressive, alcohol and drug dependence symptoms). The study also examined whether posttreatment clinical outcomes-participation in aftercare, Alcoholic Anonymous (AA) attendance, substance use, depressive symptoms and smoking- were associated with subsequent health care utilization. METHOD/METHODS:We analyzed predictors of posttreatment medical hospitalizations and emergency department (ED) use among 15,041 participants in a multistate treatment evaluation project conducted from 1987 to 1995. RESULTS:Greater time in treatment reduced the likelihood of future hospitalizations and ED use, whereas clients in outpatient treatment were less likely to be hospitalized. Baseline measures of depressive, alcohol and drug dependence symptoms were each independently associated with subsequent health care use. Posttreatment aftercare participation reduced the likelihood of future hospitalization and ED use, whereas AA attendance also reduced the likelihood of hospitalization. In addition, posttreatment counts of depressive symptoms increased the likelihood of future hospitalization and ED use. Substance relapse increased the likelihood of subsequent ED use. CONCLUSIONS:The study supports the public health importance of substance misuse disorders treatment, with greater treatment involvement associated with lower high-cost medical utilization. Treatment clinical outcomes-posttreatment relapse and depressive symptoms-partially mediate the effect of treatment on health care utilization.

Cigarette smoking is the largest preventable cause of death and morbidity in the United States. Heightened recognition of this public health concern has led researchers from multiple and varied disciplines to address this complex and multidimensional behavior. The need for an alternative research paradigm, focusing on a transdisciplinary approach that integrates work across disciplines in order to advance the field most quickly, has been identified. This recognized need led to the development of the Transdisciplinary Tobacco Use Research Centers (TTURC) initiative, funded jointly by the National Cancer Institute, the National Institute on Drug Abuse, and The Robert Wood Johnson Foundation. This paper discusses the formation and early implementation stages of the initiative, including meetings that led to the development of the TTURCs, funders' and research centers' perspectives on implementation, and early observations about the products of the initiative.

Many women at high risk for HIV infection face resistance and, in some cases, violence as a response to their requests for condom use. The current study investigated how domestically violent and nonviolent men reacted to various condom negotiation approaches. Ten different scenarios, in which the partner provides a justification for a condom request or the context suggests one, were presented to 84 male inmates selected at random from a county jail. As predicted, condom scenarios factored into groupings with content suggestive of high and low relationship threat. Of the justifications presented, yeast infections generated more favorable responses than standard HIV prevention messages. The riskiest condom negotiation scenario was one that suggested infidelity on the part of the woman. Level of male violence severity in the relationship predicted more coercive responses to suggestions of a woman's infidelity. The results suggest that creative strategies that do not call into question the fidelity or commitment of either partner may be more effective in getting men to use condoms and/or to not react violently.

The goal of this study was to better understand the experience of women suffering from interstitial cystitis (IC), a chronic pain condition that has, as of yet, received little attention from psychosocial investigators. Eighty women with IC participated. The results from this study demonstrate that, in addition to frequency of voiding (the hallmark symptom of the disorder), IC sufferers also endure significant pain and depression. Levels of pain experienced by IC patients during their most painful flares exceed levels of pain experienced by other chronic pain patients. Similarly, levels of depression experienced by IC patients exceed those evidenced by the general population and by other populations of chronic pain patients. Furthermore, the pain and depression experienced by IC patients may be predicted by cognitive factors. Severity of pain is associated with self-efficacy for coping with pain. Severity of depression is associated with pain, self-efficacy for coping with pain, and self-stigmatization.

This study used a model derived from social-information processing theory to investigate how men with a history of domestic violence would react to a condom request. The study used path analysis to examine men's attributional and evaluative responses as potential predictors of coercion and condom use compliance. Men responded to a hypothetical situation in which their main partner requested that they use a condom. Among 100 county jail inmates, men who used severe forms of domestic violence differed from moderately violent and nonviolent men in their tendency to react negatively to condom requests. Condom-specific attributions were significant predictors of condom use and coercive actions but were not consistently different across abuse groups. Attributions that increased the likelihood of negative responding were infidelity, selfishness, competition for dominance, or suspicion of the man's fidelity.