Faculty Bibliography

Four-hundred eighty-three patients with cancer and their informal caregivers were studied. Patients reported on met and unmet needs in personal care activities (bathing and dressing), instrumental activities (heavy and light housekeeping, cooking, shopping), transportation (medical and general), and home health care (health/treatment assistance). A minority (18.9%) experienced an unmet need. Hierarchical logistic regression was used to identify significant predictors of any unmet need. Patients were more likely to report any unmet needs when their illness/treatment resulted in restricted activity days, when their financial resources were reduced enough for them to apply for Medicaid or Public Assistance, or when their caregivers were not their spouses. Although in general, the likelihood of an unmet need decreased as the number of domains of assistance provided by the caregiver increased, if that care was associated with a high level of burden, the odds of a patient reporting an unmet need actually increased.

The prevalence and intensity of different caregiving burdens experienced by spousal caregivers and the association of these burdens with various patient illness and treatment-related conditions were examined in a sample of 295 married cancer patients and their spouses. The spousal caregivers were confronted with a wide range of burdens associated with their caregiving responsibilities. Objective, as compared to subjective, caregiver burdens were more strongly associated with patient disease and treatment-related conditions. Compared to husbands, wives experienced more burden and these burdens were more strongly associated with the various disease and treatment conditions.

The interrelationships of depression and suicide with adolescent drug use, delinquency, eating disorders, and the risk factors for these different problems were investigated among 597 9th and 11th graders in an urban high school. There is a strong association of drug use with suicidal ideation among girls, and a stronger relationship with attempts among girls and boys. Suicidal youths are ill-adjusted and display a lack of attachment and commitment to family and school. Causal models indicate that poor interpersonal interactions with parents, absence of peer interactions, and life events lead to depression, which in turn leads to suicidal ideation. Depressive symptoms are the strongest predictors of suicidal ideation. Among females, depression predicts drug involvement, and in turn, drug use increases suicidal ideation. Drug use is only one class of problem behaviors that constitutes a risk factor for suicidal behavior in adolescence. Delinquency and eating disorders also have direct effects on suicidal ideation beyond those of depressive affect. As for drug involvement, these problem behaviors are more predictive of suicidal behavior among girls than boys. Similarity and specificity of the predictors for problem behaviors within and between the sexes are discussed. Although young women use drugs to handle feelings of depression, drug use appears ineffective in the long run in relieving these depressive feelings. Understanding the dynamics of suicidal ideation in adolescence has important public health implications, since ideation is a strong predictor of attempts, especially among females.

Traditionally family members (spouse, adult children, parents) are the main providers of emotional support and practical assistance to seriously ill persons. However, for those groups most affected by AIDS-homosexuals, IVDUs, and infants born to high-risk group members-traditional sources of social support may be weak or nonexistent and alternative sources of support are needed. For the care giver-family member, spouse, lover or partner, friend, or volunteer buddy- providing informal support and assistance to an AIDS patient throughout the course of the illness can be particularly stressful. Care giving involves a restructuring of care givers' personal and social lives, adversely affecting their outside employment, leading to feelings of fatigue, emotional and physical exhaustion, and imposing severe financial burdens. When an illness is long and extended, such as AIDS, care givers are at risk for becoming over-extended and depleting their physical, emotional, and financial resources. Consequently, AIDS patients may find that when their needs are greatest, they may have exhausted their informal resources for assistance, placing themselves at high risk for unmet needs.

Healthy parents' perceptions of their competence to meet children's needs during the terminal illness of the other parent were measured on five major domains of parent-child relationships and parental functioning central to children's healthy development. Significant declines from pre-illness competence were perceived, of which the greatest were in emotional sensitivity and responsiveness, and ability to set limits and impose discipline. Implications for the development of preventive intervention strategies are discussed.

The predictors of cessation of marijuana and cocaine use were examined in a longitudinal cohort of young adult men and women (N = 1222). Six domains of predictors were examined: socioeconomic background variables, participation in the social roles of adulthood, degree of drug involvement, social context of drug use, health status, and deviant activities and conventionality of life experiences. Factors that predicted cessation of use in adulthood paralleled those that predicted lack of initiation in adolescence: conventionality in social role performance, social context unfavorable to the use of drugs, and good health. A most important predictor was prior degree of involvement in licit and illicit drugs. In multivariate analyses, degree of prior drug involvement remained the strongest predictor of drug cessation for of marijuana use, while friends' use was the most important for cocaine. Those who use drugs in response to social influences are more likely to stop using them than those who also use drugs for psychological reasons.

Patterns of initiation, persistence, and cessation of use of licit, illicit, and prescribed drugs are presented for a longitudinal cohort from their middle to the late twenties. The cohort is representative of adolescents formerly enrolled in public secondary high schools in New York State. No additional initiation of cigarettes, alcohol, and illicit drugs occurred in the four-year follow-up interval, except for cocaine and pills. The largest proportional increase of new users occurred for prescribed psychoactive drugs. Alcohol showed the most persistence of use, followed by cigarettes and marijuana. As the cohort ages, those who continue to use illicit drugs actively do so at lower levels of intensity than at younger ages. For each drug class, the persistence of use is strongly related to earlier intensity of involvement. By age 29, men have accumulated almost twice as many months of use of illicit drugs as women.