The importance of fulfilling unmet needs of rural and urban adolescents with substance abuse.

PROBLEM: Because of the negative impact on health of drug and alcohol use, this study examined adolescent needs and substance use. METHODS: Subjects (N = 191) were adolescents aged 14 to 19 in a rural and an urban high school. A modified version of the Need Subscale from the Addiction Research Center Maturation Scale measured a feeling of satisfaction related to meeting basic needs, and an investigator's prepared questionnaire elicited current use of alcohol, nicotine, and marijuana. FINDINGS: Individuals with feelings of unmet needs were more likely to be current drinkers. Rural/urban residence was not a significant predictor in a multivariate analysis, but religiosity was. CONCLUSIONS: A feeling of unmet needs seems to be an important factor in adolescent substance use.

Patient knowledge of upper respiratory infections: implications for antibiotic expectations and unnecessary utilization.

BACKGROUND: Upper respiratory infections (URIs) account for many of the visits in primary care and are commonly treated with ineffective antibiotic therapy. The purpose of this study was to examine patient beliefs in the effectiveness of antibiotics and the likelihood of seeking care for normal presentations of URIs. METHODS: We conducted a survey of 961 adults (> or = 18 years of age) from an undifferentiated patient population in a university-based family practice residency clinic in metropolitan Kentucky, a private internal medicine practice in nonmetropolitan Kentucky, and, in metropolitan Louisiana, an emergency department and a convenience sample from the community. RESULTS: Seventy-two percent of the sample reported that they would seek care with a condition of 5 days' duration with cough, sore throat, and discolored nasal discharge. Sixty-one percent of the sample expressed their belief that antibiotics are effective for a condition of 5 days' duration with cough, sore throat, and clear nasal discharge; 79% said that they believed antibiotics are effective when there is discolored discharge (P = .0001). Medicaid recipients were most likely to seek care across the symptom complexes. Higher education was related to a decreased belief in the effectiveness of antibiotics for the scenario with clear discharge (P .001), but to an increased belief in the effectiveness of antibiotics in the scenario with discolored discharge (P = .003). The strongest predictor of both likelihood of utilization and belief in effectiveness of antibiotics was usual use of antibiotics for the URI symptom complexes. CONCLUSIONS: Patients lack understanding of the normal presentation of a URI and the effectiveness of antibiotics as a treatment. A confusion about the meaning of discolored nasal discharge is particularly evident, and past antibiotic use may contribute to inappropriate utilization and expectations for antibiotics.

Substance use among adolescents: fulfilling a need state.

A factor that has received little investigation concerns the feeling state of need fulfillment and how this may relate to the significant public health problem of adolescent substance use. A survey of 823 students was conducted at a suburban public high school in the Southeastern United States. The questionnaire contained a scale focusing on fulfillment of adolescent needs, the Children's Depression Inventory, and items on current substance use. The results of t-tests indicated that the higher the adolescent is on the Need scale, the greater the likelihood of engaging in substance use (p < .05). Further, results indicated that cigarette smoking, drinking alcohol, and smoking marijuana are associated with significantly higher scores on the Need scale for both males and females. Although the Need scale was significantly positively correlated with the Children's Depression Inventory (r = .45, p = .0001), the two feeling states were not collinear. However, the Need scale was not significantly correlated with age, indicating that the need state is not simply a developmental process (r = .04, p = .11). The results suggest that a feeling state of unfulfilled needs may propel adolescents into the destructive behavior of substance use. A state of high wants and needs that cannot be gratified simply in a complex society may be a precursor of substance use.

Depression, suicidal ideation, and substance use among adolescents. Are athletes at less risk?

OBJECTIVES: To determine the relationship between participation in high school athletic programs and depression, suicidal ideation, and substance use, and to study the high-risk behaviors of suicidal ideation and substance use. DESIGN: Survey. SETTING: A suburban public high school in Kentucky. PARTICIPANTS: We received 823 (80%) responses from 1030 potential respondents. Athletes (ie, participation on a high school athletic team) were compared with non-athletes. MEASURES: Depression was measured by the Children's Depression Inventory by an index of suicidal ideation by an indicator of a past suicide attempt, and by current use of tobacco, alcohol, marijuana, and cocaine. RESULTS: Thirty percent of the sample participate in school athletic teams. Athletes are less depressed, have less suicidal ideation and attempts, and are less likely to currently smoke cigarettes or marijuana. The use of smokeless tobacco and cocaine was not related to athletic participation. After controlling for demographic characteristics, no difference in alcohol use was found between athletes and nonathletes. CONCLUSIONS: Athletic participation is a marker for a decreased likelihood of depression and some high-risk behaviors in adolescents. Future research could help in creating alternative interventions beyond participation in varsity and junior varsity athletic teams.