Understanding Geographic Disparities in Mortality.

A rich literature shows that early-life conditions shape later-life outcomes, including health and migration events. However, analyses of geographic disparities in mortality outcomes focus almost exclusively on contemporaneously measured geographic place (e.g., state of residence at death), thereby potentially conflating the role of early-life conditions, migration patterns, and effects of destinations. We employ the newly available Mortality Disparities in American Communities data set, which links respondents in the 2008 American Community Survey to official death records, and estimate consequential differences based on the method of aggregation we use: the unweighted mean absolute deviation of the difference in life expectancy at age 50 measured by state of birth versus state of residence is 0.58 years for men and 0.40 years for women. These differences are also spatially clustered, and we show that regional inequality in life expectancy is higher based on life expectancies by state of birth, implying that interstate migration mitigates baseline geographic inequality in mortality outcomes. Finally, we assess how state-specific features of in-migration, out-migration, and nonmigration together shape measures of mortality disparities by state (of residence), further demonstrating the difficulty of clearly interpreting these widely used measures.

All-cause mortality and residential racial and ethnic segregation and composition as experienced differently by individual-level race, ethnicity, and gender: Mortality disparities in american communities data.

PURPOSE: Use a large nationally representative population to evaluate whether differences in mortality in relation to residential racial and ethnic segregation and diversity varied by gender, and race or Hispanic ethnicity in the United States. METHODS: The Mortality Disparities in American Communities (MDAC) was used to evaluate mortality risk in relation to segregation. MDAC is a nationally representative record linkage of the 2008 American Community Survey data with mortality outcomes derived from the National Death Index through 2015. Gender-stratified mortality risk for White, Black, and Hispanic groups in relation to quartiles of residential segregation, composition, and diversity were modeled using parametric survival regression with an exponential distribution, adjusted for individual-level socioeconomic characteristics. RESULTS: The study population included >3,950,000 individuals and >273,000 all-cause mortality outcomes. Statistically significant differences in associations were observed with Black segregation vs. Hispanic segregation across Black or Hispanic groups; some differences in stratification by gender for Hispanic and Non-Hispanic Black groups, but gender-stratified associations were more similar in non-Hispanic Whites. CONCLUSIONS: Future multidisciplinary and ethnographic research is needed to identify the specific structural mechanisms by which these associations differ to support means by which to more effectively target public health interventions.

Alcohol Craving and Psychiatric Disorders Among Current Drinkers.

BACKGROUND AND OBJECTIVES: Previous research has shown that alcohol craving is associated with psychiatric comorbidities. However, no population studies have examined the odds of psychiatric disorders in cravers and noncravers. The purpose of this study was to investigate current prevalence rates and odds ratios of psychiatric disorders among alcohol drinkers with and without alcohol craving in a population-based sample. We also compared four craving groups (cravers with and without alcohol use disorder [AUD], noncravers with and without AUD) for psychiatric comorbidities. METHODS: The study data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). A subset of the NESARC sample (N = 22 000) who reported alcohol use during the past 12 months was included. Prevalence rates of psychiatric disorders were compared among current drinkers with alcohol craving (N = 900) and without alcohol craving (N = 21 500). RESULTS: Cravers had higher prevalence rates of current psychiatric disorders than noncravers. Even after adjustment for other psychiatric disorders including AUD, cravers had significantly higher odds of any substance use disorder (adjusted odds ratio [AOR], 9.01), any mood disorder (AOR, 1.78), any anxiety disorder (AOR, 1.86), and any personality disorder (AOR, 1.92) than noncravers. Interestingly, cravers without AUD had even higher rates of any anxiety disorder and any personality disorder than noncravers with AUD. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Alcohol craving is associated with a higher prevalence of various psychiatric disorders. These findings suggest that alcohol craving may be related to transdiagnostic features that are present across various psychiatric disorders. (Am J Addict 2021;30:34-42).

Can antipoverty programmes save lives? Quasi-experimental evidence from the Earned Income Tax Credit in the USA.

OBJECTIVE: To estimate the impact of state-level supplements of the Earned Income Tax Credit (EITC) on mortality in the USA. The EITC supplements the wages of lower-income workers by providing larger returns when taxes are filed. SETTING: Nationwide sample spanning 25 cohorts of people across every state in the USA. PARTICIPANTS: 793 000 respondents within the National Longitudinal Mortality Survey (NLMS) between 1986 and 2011, a representative sample of the USA. INTERVENTION: State-level supplementation to the EITC programme. Some, but not all, states added EITC supplementation to varying degrees beginning in 1986 (Wisconsin) and most recently in 2015 (California). Participants who were eligible in states with supplementary programmes were compared with those who were not eligible for supplementation. Comparisons were made both before and after implementation of the supplementary programme (a difference-in-difference, intent-to-treat analysis). This quasi-experimental approach further controls for age, gender, marital status, race or ethnicity, educational attainment, income and employment status. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was survival at 10 years. Secondary outcome measures included survival at 5 years and survival to the end of the intervention period. RESULTS: We find an association between state supplemental EITC and survival, with a HR of 0.973 (95% CI=0.951-0.996) for each US$100 of EITC increase (p<0.05). CONCLUSION: State-level supplemental EITC may be an effective means of increasing survival in the USA.

The influence of undertreated chronic pain in a national survey: Prescription medication misuse among American indians, Asian Pacific Islanders, Blacks, Hispanics and whites.

OBJECTIVE: Disparities in the assessment and treatment of chronic pain among racial/ethnic may lead to self-treatment for undertreated pain. This study examines whether pain intensity among US racial/ethnic groups' influences rates of psychotherapeutic prescription drug misuse. METHODS: Data included civilian, non-institutionalized adults (age 18-99 years) residing in the United States (n = 34,653) from Waves 1 and 2 of the National Epidemiological Survey on Alcoholism and Related Conditions (NESARC; 2004-2005). The primary outcome variable was prescription drug misuse/PDM (i.e., use without a prescription or other than as prescribed) including tranquilizers, sedatives, stimulants, or opioids. Predictor variables included self-reported race/ethnicity (American Indian, Black, Hispanic, or White) and pain intensity. Data were analyzed in 2019. RESULTS: Overall, White and Hispanic participants' pain intensity had a significantly curvilinear relationship with frequency of prescription medication (p < 0.01). PDM rose with pain intensity until pain levels reached "severe," then PDM rates fell, not significantly differing from the "no pain" levels (χ2(1) = 0.65, p = 0.42). PDM rates for Black participants remained lowest of all other racial/ethnic groups and plateaued with increasing pain intensity. CONCLUSIONS: Our results indicate that undertreated chronic pain may drive rates of PDM among varying racial/ethnic groups. Providing equitable assessment and treatment of pain intensity remains critical. Additional research is needed to examine provider decision-making and unconscious bias, as well as patient health beliefs surrounding perceived need for prescription pain medications.

Personality disorders and social support in cannabis dependence: A comparison with alcohol dependence.

BACKGROUND: Cannabis use disorder (CUD) has been linked to personality disorders (PDs) and interpersonal problems, though these relationships have been understudied. We examined PDs and social support associated with cannabis dependence and how it may be distinguishable from alcohol dependence on these indices in a large representative sample. METHOD: Data on social support and Diagnostic and Statistical Manual of Mental Disorders-IV substance dependence and PDs were assessed in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (N > 34,500). RESULTS: Cannabis dependence was associated with higher rates of personality disorders and lower social support. Lifetime cannabis dependence without alcohol dependence was associated with higher rates of all PDs than alcohol dependence without cannabis dependence (with the exception of borderline PD). Cannabis dependence alone was also associated with lower social support than alcohol dependence alone. LIMITATIONS: The survey was conducted in 2004-2005 and relied on DSM-IV criteria. CONCLUSIONS: These findings highlight a broad range of PDs as well as deficits in social support in cannabis dependence. The potential interrelationships between interpersonal dysfunction and CUD as well as the relevance of PDs to treatment for CUD warrant further research.

Pain interference and alcohol, nicotine, and cannabis use disorder in a national sample of substance users.

BACKGROUND: Pain interference is associated with substance use, but has yet to be considered as a potential indicator of SUDs among substance users. We sought to examine whether moderate and high pain interference would confer risk for SUDs in ever and weekly users. METHODS: Using data from the National Epidemiologic Survey on Alcohol and Related Conditions, logistic regression analyses were conducted to examine the association between pain interference and concurrent and prospective alcohol and nicotine dependence, as well as concurrent cannabis use disorder. Those with no/low pain were used as the reference group. Gender was examined as a moderator. RESULTS: Controlling for relevant covariates, moderate pain interference was associated with past year alcohol (odds ratio [OR] = 1.33, 95% CI, 1.16-1.52, p < .001) and nicotine (OR = 1.41, 95% CI 1.27-1.56, p < .001) dependence among ever users. In prospective analyses, moderate pain interference predicted the development of alcohol (Moderate: OR = 1.56, 95% CI, 1.39-1.75, p < .001) and nicotine (OR = 1.37, 95% CI, 1.14-1.65, p < .001) dependence. Similar results were found with high pain and for weekly users. Both moderate and high pain interference were associated with past-year occurrence of cannabis use disorder for women but not men. High pain predicted the development of nicotine dependence exclusively among males. CONCLUSION: Pain interference may confer risk for the occurrence of cannabis use disorder among female cannabis users and the occurrence and development of alcohol and nicotine dependence among users of both genders. Pain interference may be an important factor to monitor in these populations.

Gambling and physical intimate partner violence: Results from the national epidemiologic survey on alcohol and related conditions (NESARC).

BACKGROUND AND OBJECTIVES: Links between intimate partner violence (IPV) and gambling problems are under researched in general population samples. Understanding these relationships will allow for improved identification and intervention. We investigated these relationships and sought to determine whether links were attenuated by axis I and II disorders. METHODS: This study examined data from waves 1 and 2 (N = 25,631) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC); a nationally representative survey of U.S. adults. Gambling symptoms and other psychiatric disorders were measured at wave 1 by the Alcohol Use Disorder and Associated Disability Interview Schedule-DSM-IV Version (AUDADIS-IV). Physical IPV victimization and perpetration in the last 12 months were assessed 3 years later at wave 2 using items from the Conflict Tactics Scale-R. Binary logistic regression models were used to examine associations separately for males and females. RESULTS: Problem gambling was associated with increased odds of both IPV perpetration for males (OR = 2.62, 95%CI = 1.22-5.60) and females (OR = 2.87, 95%CI = 1.29-6.42), and with IPV victimization for females only (OR = 2.97, 95%CI = 1.31-6.74). Results were attenuated with inclusion of axis I and axis II disorders; links between gambling and IPV were weaker than those involving other mental health conditions. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: There are prospective associations with gambling problems and physical IPV which have implications for identification, spontaneous disclosure, and treatment seeking. The links between gambling problems and violence are complex and should not be considered independently of co-occurring mental health and substance use disorders. (Am J Addict 2018;27:7-14).

Is Major Depression Linked to Alcohol-Impaired Driving?

BACKGROUND: Alcohol-impaired driving causes a substantial proportion of motor vehicle accidents. Depression is a prevalent psychiatric disorder among drinker-drivers. Few previous studies have investigated the relationship between major depression and alcohol-impaired driving. OBJECTIVES: We investigated whether depression has a positive relationship with the probability of alcohol-impaired driving after controlling for the co-occurrence of binge drinking and alcohol dependence. METHODS: Our data consisted of drinkers aged 21-64 years from two waves of the National Epidemiologic Survey of Alcohol and Related Conditions. Cross-sectional analysis investigated whether depression is an independent risk factor for drinking-driving. Longitudinal analysis distinguished the relationship of depression onset, continuance, and recovery with changes in drinking-driving behaviors between the waves. These dual approaches allowed comparisons with previous studies. RESULTS: Major depression was a small but statistically significant predictor of changes in alcohol-impaired driving behaviors among males but not females. Binge drinking and alcohol dependence were comparatively stronger predictors. Conclusions/Importance: There is limited empirical support that treating depression reduces drinking and driving in males who do not exhibit symptoms of alcohol use disorders. For persons with co-occurring depression and alcohol use disorders, depression treatment should be part of a strategy for treating alcohol use disorders which are highly related to drinking and driving.

Age of initiation, psychopathology, and other substance use are associated with time to use disorder diagnosis in persons using opioids nonmedically.

BACKGROUND: Nonmedical use of prescription opioids (NMUPO) is an ongoing public health challenge, as NMUPO is associated with psychopathology, other drug use, and fatal overdose. These concomitant risks are greatest in those with opioid use disorder (OUD), but the development of NMUPO-related use disorder is poorly understood. The primary aim of this study was to establish factors associated with the development of and time to OUD among persons engaged in NMUPO. METHODS: Data were from wave 1 of the National Epidemiologic Study on Alcohol and Related Conditions, with 1755 participants endorsing lifetime NMUPO. Analyses used sequential design-based logistic regression for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) opioid dependence correlates, followed by Cox regression of proportional hazards for correlates (e.g., sociodemographics, age of NMUPO initiation, and psychopathology) of time to dependence in those who developed DSM-IV dependence. RESULTS: Earlier age of NMUPO initiation increased OUD odds (adjusted odds ratio [AOR] = 0.95, 95% confidence interval [CI] = 0.94-0.96) but slowed OUD development (adjusted hazard ratio [AHR] = 1.05, 95% CI = 1.04-1.06) in those who developed OUD (n = 118), after controlling for sociodemographics, psychopathology, and ages of other drug use initiation. Psychopathology and earlier other drug use initiation were associated with higher OUD odds, but only having an alcohol use disorder was associated with shorter time to OUD. CONCLUSIONS: Earlier NMUPO initiation is associated with increased odds of OUD, although those with early initiation had a slower progression to OUD. Programs that prevent early NMUPO initiation, which might lower rates of OUD, and/or identify the later initiators at highest risk for rapid OUD development could have great public health benefits.

The effects of New York City's coordinated public health programmes on mortality through 2011.

Background: In 2003, New York City (NYC) implemented a series of coordinated policies designed to reduce non-communicable disease. Methods: We used coarsened exact matching (CEM) of individuals living inside and outside NYC between the years of 1992-2000 and 2002-10 to estimate difference-in-difference survival time models, a quasi-experimental approach. We also fitted age-period-cohort (APC) models to explore mortality impacts by gender, race, age, borough and cause of death over this same time period. Results: Both CEM and APC models show that survival gains were large in the pre-2003 era of health policy reform relative to the rest of the USA, but small afterwards. There is no clear link between any policy and changes in mortality by age, gender, ethnicity, borough, or cause of death. Conclusions: NYC's gains in survival relative to the rest of the nation were not linked to the city's innovative and coordinated health policy efforts.

Quantifying the individual-level association between income and mortality risk in the United States using the National Longitudinal Mortality Study.

Policy makers would benefit from being able to estimate the likely impact of potential interventions to reverse the effects of rapidly rising income inequality on mortality rates. Using multiple cohorts of the National Longitudinal Mortality Study (NLMS), we estimate the absolute income effect on premature mortality in the United States. A multivariate Poisson regression using the natural logarithm of equivilized household income establishes the magnitude of the absolute income effect on mortality. We calculate mortality rates for each income decile of the study sample and mortality rate ratios relative to the decile containing mean income. We then apply the estimated income effect to two kinds of hypothetical interventions that would redistribute income. The first lifts everyone with an equivalized household income at or below the U.S. poverty line (in 2000$) out of poverty, to the income category just above the poverty line. The second shifts each family's equivalized income by, in turn, 10%, 20%, 30%, or 40% toward the mean household income, equivalent to reducing the Gini coefficient by the same percentage in each scenario. We also assess mortality disparities of the hypothetical interventions using ratios of mortality rates of the ninth and second income deciles, and test sensitivity to the assumption of causality of income on mortality by halving the mortality effect per unit of equivalized household income. The estimated absolute income effect would produce a three to four percent reduction in mortality for a 10% reduction in the Gini coefficient. Larger mortality reductions result from larger reductions in the Gini, but with diminishing returns. Inequalities in estimated mortality rates are reduced by a larger percentage than overall estimated mortality rates under the same hypothetical redistributions.

Probability and correlates of dependence among regular users of alcohol, nicotine, cannabis, and cocaine: concurrent and prospective analyses of the National Epidemiologic Survey on Alcohol and Related Conditions.

OBJECTIVE: Research on the progression from substance use to dependence typically relies on lifetime retrospective reports of dependence among ever users. We sought to evaluate probability and correlates of dependence among recent (past-year) weekly users of alcohol, nicotine, cannabis, and cocaine through cross-sectional and prospective analyses. METHODS: Data on substance use (assessed by the Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV) and DSM-IV psychiatric disorders were assessed in 2 waves (Wave 1, N = 43,093; Wave 2, N = 34,653) through the National Epidemiologic Survey on Alcohol and Related Conditions. RESULTS: Conditional risk of dependence varied by frequency of substance use, although it was relatively stable for nicotine use. Among weekly past-year substance users at Wave 1, rates of dependence when rates of past-year dependence at Wave 1 were combined with new cases of dependence reported at Wave 2 were 15.6% for alcohol, 25.0% for cannabis, and 67.3% for nicotine. For past-year weekly users of cocaine at Wave 1, 49.9% met criteria for past-year dependence. Multiple demographic characteristics and past-year psychiatric disorders were correlated with past-year dependence, even among daily users. Men were generally more likely than women to be dependent on alcohol, cannabis, and cocaine, although women were more likely to be dependent on nicotine. Prospective analyses indicated that depressive disorders at Wave 1 predicted subsequent development of alcohol dependence (odds ratio [OR] = 1.40; 95% CI, 1.19-1.65; P < .05). Further, 33.5% of weekly tobacco smokers who were nondependent at Wave 1 developed dependence later on. CONCLUSIONS: The present findings highlight the importance of frequency of use when determining the addictiveness of substances and suggest that certain demographic variables and psychiatric disorders are associated with substance dependence even among regular substance users.

Effects of intimate partner violence, PTSD, and alcohol use on cigarette smoking in a nationally representative sample.

BACKGROUND AND OBJECTIVES: Separate literatures indicate that intimate partner violence (IPV), posttraumatic stress disorder (PTSD), and alcohol use are independently associated with increased risk for cigarette smoking. No previous studies have examined the co-occurrence of these problems on smoking quantity and potential gender-specific relationships. This study will address this gap in the literature. METHODS: Data from Wave 2 of the National Epidemiologic Study on Alcohol and Related Conditions (NESARC) were examined. Variables were assessed during the past year. Individuals (N = 25,604) who reported being married, dating, or involved in a romantic relationship were included. RESULTS: Among men, PTSD and alcohol use were associated with more cigarettes smoked per day. Among women, PTSD, alcohol use, and IPV victimization were associated with more cigarettes smoked per day. Women who experienced IPV victimization smoked approximately three additional cigarettes per day. DISCUSSION AND CONCLUSIONS: IPV victimization, PTSD, and alcohol use were associated with cigarettes smoked among women, while IPV experiences were not associated with smoking risk among men. SCIENTIFIC SIGNIFICANCE: These findings represent an important contribution to the existing literature in that it elucidates the compounding relationship between a common and complex comorbidity and cigarette smoking. Findings indicate a critical need to implement routine smoking screening and intervention in venues where intimate partner violence is commonly encountered, such as advocacy and substance use treatment settings. (Am J Addict 2016;25:283-290).

The Validity of Race and Hispanic-origin Reporting on Death Certificates in the United States: An Update.

Objectives This report presents the findings of an updated study of the validity of race and Hispanic-origin reporting on death certificates in the United States, and its impact on race- and Hispanic origin-specific death rates. Methods The latest version of the National Longitudinal Mortality Study (NLMS) was used to evaluate the classification of race and Hispanic origin on death certificates for deaths occurring in 1999­2011 to decedents in NLMS. To evaluate change over time, these results were compared with those of a study based on an earlier version of NLMS that evaluated the quality of race and ethnicity classification on death certificates for 1979­1989 and 1990­1998. NLMS consists of a series of annual Current Population Survey files (1973 and 1978­2011) and a sample of the 1980 decennial census linked to death certificates for 1979­2011. Pooled 2009­2011 vital statistics mortality data and 2010 decennial census population data were used to estimate and compare observed and corrected race- and Hispanic origin-specific death rates. Results Race and ethnicity reporting on death certificates continued to be highly accurate for both white and black populations during the 1999­2011 period. Misclassification remained high at 40% for the American Indian or Alaska Native (AIAN) population. It improved, from 5% to 3%, for the Hispanic population, and from 7% to 3% for the Asian or Pacific Islander (API) population. Decedent characteristics such as place of residence and nativity affected the quality of reporting on the death certificate. Effects of misclassification on death rates were large for the AIAN population but not significant for the Hispanic or API populations.

Pathological and problem gambling in substance use treatment: Results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

BACKGROUND AND OBJECTIVES: Pathological and problem gambling may be common yet frequently undetected conditions in substance use treatment. This paper reports findings on the prevalence of gambling comorbidities in these clinical contexts that are generalizable across regions and settings. It indicates the implications of such conditions for treatment of substance use problems. METHODS: A U.S. representative sample of n = 402 patients reporting past-year treatment for substance use problems was derived from wave 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Weighted prevalence estimates were produced and regression analyses used to examine correlates of gambling symptoms. RESULTS: Rates of lifetime pathological gambling (5+ DSM-IV symptoms) and problem gambling (3+ DSM-IV symptoms) were 4.3% (s.e. = 1.3%) and 7.2% (s.e. = 1.6%), respectively. Lifetime gambling symptoms were associated with Axis II disorders, but no Axis I diagnoses. There was limited evidence of associations with substance usage, mental or physical health and medical utilization. There were associations with financial crises and relationship breakdown, during and after treatment. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Gambling problems are elevated in substance use treatment but may be less common than previously thought; when considered nationally and across clinical settings. They may have modest associations with clinical characteristics given high levels of psychiatric severity that characterise treatment seeking samples overall. Notwithstanding, the results suggest that gambling comorbidities should be standard considerations in substance use treatment. They may signal complex conditions characterised by pervasive underlying psychopathology, and psychosocial difficulties that accumulate over time.

Quality of life and risk of psychiatric disorders among regular users of alcohol, nicotine, and cannabis: An analysis of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC).

Research is limited on the effects of regular substance use on mental health-related outcomes. We used a large nationally representative survey to examine current and future quality of life and risk of psychiatric disorders among past-year regular (weekly) users of alcohol, nicotine, and cannabis. Data on psychiatric disorders and quality of life from two waves (Wave 1 N = 43,093, Wave 2 N = 34,653) of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) were used to test study aims. In cross-sectional analyses, regular nicotine and cannabis use were associated with higher rates of psychiatric disorder, though regular alcohol use was associated with lower rates of disorders. Prospective analyses found that regular nicotine use predicted onset of anxiety, depressive, and bipolar disorders. Regular alcohol use predicted lower risk of these disorders. Regular cannabis use uniquely predicted the development of bipolar disorder, panic disorder with agoraphobia, and social phobia. Lastly, regular alcohol use predicted improvements in physical and mental health-related quality of life, whereas nicotine predicted deterioration in these outcomes. Regular cannabis use predicted declines in mental, but not physical health. These data add to the literature on the relations between substance use and mental and physical health and suggest increased risk of mental health problems among regular nicotine and cannabis users and better mental and physical health among regular alcohol users. Examination of mechanisms underlying these relationships is needed.

Tobacco use and suicide attempt: longitudinal analysis with retrospective reports.

BACKGROUND: Suicide has been associated with smoking/tobacco use but its association of and change in smoking/tobacco use status with suicide attempt (SA) is not well established. METHODS: We investigated whether persistent, former tobacco use, initiation, quitting tobacco use, relapse to tobacco use, and DSM-IV nicotine dependence predict independently SA using Wave 1 and 2 data of the National Epidemiologic Survey of Alcohol and Related Conditions. Data from 34,653 US adults interviewed at Wave 1 (2001-02) and Wave 2 (2004-05) were analyzed. The main outcome measure was SA between Wave 1 and Wave 2 as reported at Wave 2. RESULTS: Among the 1,673 respondents reporting lifetime SA at Wave 2, 328 individuals reported SA between Wave 1 and Wave 2. Current and former tobacco use at Wave 1 predicted Wave 2 SA independently of socio-demographic characteristics, psychiatric history, and prior SA (Adjusted Odds Ratio (AOR): 1.49; 95% CI: 1.13-1.95, AOR: 1.31; 95% CI:1.01-1.69, respectively versus never tobacco users). The strongest association with SA was observed among former tobacco users who relapsed after Wave 1 (AOR: 4.66; 95% CI: 3.49-6.24) and among tobacco use initiators after Wave 1 (AOR: 3.16; 95% CI: 2.23-4.49). Persistent tobacco use (current tobacco use at both Wave 1 and Wave 2) also had an increased risk of SA (AOR: 1.89; 95% CI: 1.47-2.42). However, former tobacco users in both Waves 1 and 2 did not show a significantly elevated risk for SA in Wave 2 (AOR:1.09, 95% CI: 0.78-1.52) suggesting that the risk resided mainly in Wave 1 former tobacco users who relapsed to tobacco use by Wave 2. DSM-IV nicotine dependence did not predict SA at Wave 2. CONCLUSION: In a representative sample of US adults, relapse, tobacco use initiation, and persistent tobacco use, which are amenable to intervention, were associated with risk of SA.

Individual education, area income, and mortality and recurrence of myocardial infarction in a Medicare cohort: the National Longitudinal Mortality Study.

BACKGROUND: The Medicare program provides universal access to hospital care for the elderly; however, mortality disparities may still persist in this population. The association of individual education and area income with survival and recurrence post Myocardial Infarction (MI) was assessed in a national sample. METHODS: Individual level education from the National Longitudinal Mortality Study was linked to Medicare and National Death Index records over the period of 1991-2001 to test the association of individual education and zip code tabulation area median income with survival and recurrence post-MI. Survival was partitioned into 3 periods: in-hospital, discharge to 1 year, and 1 year to 5 years and recurrence was partitioned into two periods: 28 day to 1 year, and 1 year to 5 years. RESULTS: First MIs were found in 8,043 women and 7,929 men. In women and men 66-79 years of age, less than a high school education compared with a college degree or more was associated with 1-5 year mortality in both women (HRR 1.61, 95% confidence interval 1.03-2.50) and men (HRR 1.37, 1.06-1.76). Education was also associated with 1-5 year recurrence in men (HRR 1.68, 1.18-2.41, < High School compared with college degree or more), but not women. Across the spectrum of survival and recurrence periods median zip code level income was inconsistently associated with outcomes. Associations were limited to discharge-1 year survival (RR lowest versus highest quintile 1.31, 95% confidence interval 1.03-1.67) and 28 day-1 year recurrence (RR lowest versus highest quintile 1.72, 95% confidence interval 1.14-2.57) in older men. CONCLUSIONS: Despite the Medicare entitlement program, disparities related to individual socioeconomic status remain. Additional research is needed to elucidate the barriers and mechanisms to eliminating health disparities among the elderly.

The association between nonmedical use of prescription medication status and change in health-related quality of life: results from a Nationally Representative Survey.

BACKGROUND: Nonmedical use of prescription medication (NUPM) is associated cross-sectionally with a host of medical and psychosocial consequences. Few studies, however, have examined longitudinal outcomes based on NUPM indicators. This study aimed to address this gap by examining change in health-related quality of life as a function of NUPM status. METHODS: Data are from waves 1 and 2 of the National Epidemiological Survey on Alcoholism and Related Conditions (NESARC) a household-based, nationally-representative survey of the US population. 34,653 participants who completed both NESARC waves were included in analyses. The primary outcome measure was the 12-item Short Form Health Survey (SF-12), with history of NUPM of opioids, tranquilizer/sedatives and stimulants (examined separately) at wave 1 and any NUPM between waves 1 and 2 used to group participants. Sociodemographic characteristics were used as control variables. RESULTS: Across medication classes, results indicated that individuals who initiated NUPM between waves (initiators) had greater declines or smaller increases on many SF-12 scales, when compared to other groups. Individuals with a history of NUPM at wave 1 but no use between waves (quitters) and never users generally had the best outcomes in terms of change in SF-12 scales, with quitters making larger gains (or smaller losses) in mental health-related quality of life. Persistent users were generally intermediate between initiators and quitters or never users. CONCLUSIONS: These data reinforce the importance of preventing NUPM initiation and of promoting NUPM cessation, highlighting the need for greater use of NUPM-related public health interventions.