A cluster randomized trial of an organizational linkage intervention for offenders with substance use disorders: study protocol.

BACKGROUND: Substance use disorders are highly prevalent in community correctional populations, yet these settings frequently are ill-equipped to identify and refer offenders to community-based treatment services. In particular, community corrections staff are often opposed to the use of medication in addiction treatment because of inadequate knowledge, resources, and organizational structures to facilitate client linkages to evidence-based services. METHODS/DESIGN: Each of the NIDA-funded Research Centers recruited 2 criminal justice agencies to participate in the study. Eligibility rules required study sites that were focused on community corrections (i.e., probation or parole), had few or no formal relationships with treatment providers for referring clients to medication-assisted treatment, and had no state or local policies prohibiting such relationships. Sites under the oversight of the same parent agency were eligible only if they were in geographically distinct catchment areas, and could be assigned to different study arms without cross-contamination at any level. The 18 clusters consisted of community corrections officers and their offender caseloads nested within agencies, each of which was partnered with at least one community-based substance abuse treatment program. Randomization was blocked by Research Center, within which one cluster was randomly assigned to a training-only condition (comparison) and the other to training followed by a strategic organizational linkage process (intervention). Line staff received a scientifically-grounded, systematically-delivered training session that addresses gaps in existing knowledge, perceptions, and information about medication-assisted treatment (MAT) and local availability of MAT services. Key decision-makers subsequently were asked to collaborate in a strategic planning process to enhance formal and informal linkages between criminal justice agencies and local MAT providers. It was hypothesized that the two implementation intervention components together would be more likely than staff training alone to improve the process of referring opioid- and alcohol-dependent adults under community supervision to appropriate addiction pharmacotherapy. Outcomes were measured at the client (referrals), line staff (attitudes), and organizational (linkage) levels. DISCUSSION: Through closer collaboration among criminal justice agencies and treatment providers, improved linkages to effective substance abuse treatment should yield significant clinical, public health and public safety benefits.

Positive and negative health behavior changes in cancer survivors: a stress and coping perspective.

Cancer survivors often make health behavior changes in response to their increased risk for subsequent health problems. However, little is known about the mechanisms underlying these changes or whether they differ for positive and negative changes. This cross-sectional study applied a stress and coping model to examine both positive and negative health behavior changes in 250 middle-aged cancer survivors. A structural equation model showed that social support, sense of control over illness course, life meaning, and approach coping were related to positive health behavior changes; a lack of life meaning and avoidance coping were related to negative health behavior changes.

Meaning making and psychological adjustment following cancer: the mediating roles of growth, life meaning, and restored just-world beliefs.

Cancer survivors' efforts at meaning making may influence the extent to which they successfully make meaning from their experience (i.e., experience posttraumatic growth, find life meaningful, and restore beliefs in a just world), which may, in turn, influence their psychological adjustment. Previous research regarding both meaning making processes and meanings made as determinants of adjustment has shown inconsistent effects, partly because of the lack of clearly articulated theoretical frameworks and problematic research strategies. In a 1-year longitudinal study, the authors distinguished the meaning making process from the outcomes of that process (meanings made), employing specific measures of both. The authors tested pathways through which meaning making efforts led to 3 different meanings made (growth, life meaning, and restored just-world belief) in a sample of 172 young to middle-age adult cancer survivors, and they explored whether those meanings made mediated the effect of meaning making efforts on psychological adjustment. Cross-sectional and longitudinal path models of the meaning making process indicate that meaning making efforts are related to better adjustment through the successful creation of adaptive meanings made from the cancer experience. The authors conclude with clinical implications and suggestions for future research.

Pathways to posttraumatic growth versus posttraumatic stress: coping and emotional reactions following the September 11, 2001, terrorist attacks.

Exposure to trauma can lead to both posttraumatic growth and posttraumatic stress, but little is known about the commonalities and differences in the pathways through which they occur. The authors examined coping and emotional reactions as mediators of the effect of television exposure on both posttraumatic growth and posttraumatic stress in a nationally representative sample of 1,004 U.S. adults approximately 6 weeks after the September 11, 2001, terrorist attacks. Although posttraumatic growth and posttraumatic stress symptoms were moderately positively related, the pathways from coping and emotions to the outcomes differed: Positive coping and anger were more strongly related to posttraumatic growth than to posttraumatic stress, and pathways of negative coping and feeling depressed regarding the attacks were more strongly related to stress than to growth. Comparison of models suggested that emotions are both outcomes of and motivators for coping and that patterns of coping and emotions relate differentially to posttraumatic stress and posttraumatic growth.

Deconstructing spiritual well-being: existential well-being and HRQOL in cancer survivors.

We demonstrate the utility of partitioning the spiritual well-being (SpWB) construct into spiritual and religious components using results from a study of the relationship of existential well-being to health-related quality of life (HRQOL) in a sample of 237 cancer survivors. Existential and religious well-being were measured using the FACIT-Sp-12 and HRQOL was measured using the mental and physical component scores of the SF-12. In hierarchical linear regression analyses, existential well-being fully mediated religious well-being's effect on HRQOL and explained unique variance in both the mental and physical HRQOL domains, controlling for demographic, disease, and psychosocial variables previously shown to impact HRQOL. Religious well-being was not predictive of HRQOL.

Risk factors for hospitalization among Medicare home care patients.

This study determined factors associated with an increased risk of ending Medicare home health care because of hospitalization and examined specific types of and reasons for hospitalization. Sample members (N = 922) were followed from admission to discharge as they received home care from Ohio Medicare-certified home care agencies between December 1999 and March 2002. Potential patient-level risk factors were predisposing, enabling, or need variables, and an agency-level variable denoting hospital affiliation or free-standing status was examined as a second-level risk factor. Among those hospitalized (18.3%), more than 80.0% experienced emergency hospitalizations, mostly for acute exacerbations of chronic diseases. Statistically significant risk factors for hospitalization included dyspnea severity, functional disability level, skin or wound problems, diabetes, case mix score, and guarded rehabilitation prognosis. Home care agencies might reduce hospitalizations by using clinical prognosis as a key resource for team communication and by helping patients and families anticipate potential acute exacerbations of chronic diseases and manage these events at home.

Medicare and Medicaid home health and Medicaid waiver services for dually eligible older adults: risk factors for use and correlates of expenditures.

PURPOSE: The purpose of this work was to, among frail dually eligible older adults, determine risk factors for the likelihood of using Medicare home health and Medicaid home health services and to, among service users, determine correlates of Medicare home health, Medicaid home health, and Medicaid waiver service expenditures. DESIGN AND METHODS: Dually eligible individuals enrolled in Connecticut's Medicaid home- and community-based services (HCBS) waiver program for the aged (N = 5,232) were identified from a statewide database containing person-level linked data from Medicare claims, Medicaid claims, and uniform clinical assessment forms. Expenditures, based on claims data, were observed from the month following clinical assessment over the period August 1995 to December 1997. RESULTS: In multivariate models controlling for medical conditions and sociodemographic variables, similar functional disability measures were strongly associated with the probability of the use of, and expenditures for, Medicare home health and Medicaid home health services; severe cognitive impairment was strongly associated with greater Medicaid waiver service expenditures. IMPLICATIONS: Given the similarity of factors associated with Medicare and Medicaid home health service use and expenditures, greater integration of Medicare and Medicaid financing, reimbursement, and delivery strategies for home health services may be feasible and warranted for dually eligible older adults enrolled in state Medicaid HCBS waiver programs.

Strategies for enrolling diverse older women in an osteoporosis trial.

OBJECTIVES: This study reviewed a consumer-oriented process for recruiting research volunteers age 65 or older for an osteoporosis clinical trial. METHODS: Odds ratios were used to estimate the relative importance of methods to enroll research volunteers from three racial or ethnic groups. RESULTS: Nine hundred and four women were screened; 168 African American, White, and Hispanic women enrolled. Mailings and media were effective when the target population was large and knowledgeable about the disease and treatment being investigated. Efficiency of mailings was increased when individuals in the mailing list were familiar with research and the research center. An interpersonal approach was more effective than a media-based approach when the target population was small, unaware of their personal risk of the disease, and unfamiliar with research and research center. DISCUSSION: Information on the characteristics of potential volunteers and their communities will enable readers to evaluate the applicability of recruitment methods used.