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Teagle WL, Norris ET, Rishishwar L, Nagar SD, Jordan IK, Mariño-Ramírez L. Comorbidities and ethnic health disparities in the UK biobank. JAMIA Open 2022; 5:ooac057. [PMID: 36313969 PMCID: PMC9272510 DOI: 10.1093/jamiaopen/ooac057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/15/2022] [Accepted: 06/24/2022] [Indexed: 11/15/2022] Open
Abstract
Objective The goal of this study was to investigate the relationship between comorbidities and ethnic health disparities in a diverse, cosmopolitan population. Materials and Methods We used the UK Biobank (UKB), a large progressive cohort study of the UK population. Study participants self-identified with 1 of 5 ethnic groups and participant comorbidities were characterized using the 31 disease categories captured by the Elixhauser Comorbidity Index. Ethnic disparities in comorbidities were quantified as the extent to which disease prevalence within categories varies across ethnic groups and the extent to which pairs of comorbidities co-occur within ethnic groups. Disease-risk factor comorbidity pairs were identified where one comorbidity is known to be a risk factor for a co-occurring comorbidity. Results The Asian ethnic group shows the greatest average number of comorbidities, followed by the Black and then White groups. The Chinese group shows the lowest average number of comorbidities. Comorbidity prevalence varies significantly among the ethnic groups for almost all disease categories, with diabetes and hypertension showing the largest differences across groups. Diabetes and hypertension both show ethnic-specific comorbidities that may contribute to the observed disease prevalence disparities. Discussion These results underscore the extent to which comorbidities vary among ethnic groups and reveal group-specific disease comorbidities that may underlie ethnic health disparities. Conclusion The study of comorbidity distributions across ethnic groups can be used to inform targeted group-specific interventions to reduce ethnic health disparities.
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Affiliation(s)
- Whitney L Teagle
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | - Emily T Norris
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA.,Applied Bioinformatics Laboratory, Atlanta, Georgia, USA.,School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, USA.,PanAmerican Bioinformatics Institute, Valle del Cauca, Cali, Colombia
| | - Lavanya Rishishwar
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA.,Applied Bioinformatics Laboratory, Atlanta, Georgia, USA.,School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, USA.,PanAmerican Bioinformatics Institute, Valle del Cauca, Cali, Colombia
| | - Shashwat Deepali Nagar
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, USA.,PanAmerican Bioinformatics Institute, Valle del Cauca, Cali, Colombia
| | - I King Jordan
- Applied Bioinformatics Laboratory, Atlanta, Georgia, USA.,School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, USA.,PanAmerican Bioinformatics Institute, Valle del Cauca, Cali, Colombia
| | - Leonardo Mariño-Ramírez
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA.,PanAmerican Bioinformatics Institute, Valle del Cauca, Cali, Colombia
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Sanchez K, Gryczynski J, Carswell SB, Schwartz RP. Development and Feasibility of a Spanish Language Version of the Tobacco, Alcohol, Prescription Drug, and Illicit Substance Use (TAPS) Tool. J Addict Med 2021; 15:61-67. [PMID: 32657958 DOI: 10.1097/adm.0000000000000699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The Tobacco, Alcohol, Prescription drug, and illicit Substance use (TAPS) Tool is a validated two-stage screening and brief assessment in primary care for unhealthy substance use. We developed a Spanish language version of the TAPS Tool and conducted a small study of its feasibility, acceptability, and preliminary validity. METHODS Participants were adult primary care patients ages 18 or older with Spanish as their primary language (N = 10 for development/refinement using qualitative congnitive interviewing; N = 100 for the preliminary validation study). The Spanish language TAPS Tool was administered in both interviewer- and selfadministered tablet format (in random order). We examined disclosure of substance use on the TAPS by administration format, and compared it with established measures for identifying substance use and substance use disorders. RESULTS The Spanish language TAPS was feasible to use and participants reported high levels of acceptability. The rates of past 12-month substance use were 11% for tobacco, 28% for risky alcohol, 4% for illicit drugs, 1% for nonmedical prescription drugs and substance use disorders rates were 7% for tobacco, 2% for alcohol, and 1% for other substances. The selfadministered TAPS elicited 1, 3, and 1 additional disclosures of tobacco, risky, alcohol, and marijuana use than the interviewer-administered TAPS, respectively. Rates of disclosure on the TAPS were similar to those on established measures for past 12-month and 3-month time frames. CONCLUSIONS The current study represents a starting point for expanding the availability of the TAPS Tool beyond its original English language version into Spanish. The Spanish language TAPS Tool could expand options for substance use screening in primary care settings with Spanish-dominant/preferred populations. TRIAL REGISTRATION The studies were registered with www.clinicaltrials.gov: NCT03879785, March 19, 2019.
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Affiliation(s)
- Katherine Sanchez
- School of Social Work, University of Texas at Arlington, TX (KS); Friends Research Institute, Baltimore, MD (JG, SBC, RPS); COG Analytics, Potomac, MD
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Eghaneyan BH, Sanchez K, Haeny AM, Montgomery L, Lopez-Castro T, Burlew AK, Rezaeizadeh A, Killian MO. Hispanic participants in the National Institute on Drug Abuse's Clinical Trials Network: A scoping review of two decades of research. Addict Behav Rep 2020; 12:100287. [PMID: 32637563 PMCID: PMC7330873 DOI: 10.1016/j.abrep.2020.100287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/10/2020] [Accepted: 05/25/2020] [Indexed: 01/08/2023] Open
Abstract
Hispanics experience multiple structural barriers to adequate substance use treatment. Effective interventions for Hispanic populations exist. Measurement equivalence and culturally-tailored programs are essential.
Introduction Hispanics significantly underutilize substance abuse treatment and are at greater risk for poor treatment outcomes and dropout. Two decades of research from the National Drug Abuse Treatment Clinical Trials Network (CTN) offers an opportunity to increase our understanding in how to address the disparities experienced by Hispanics in substance abuse treatment. Methods A scoping review was utilized to determine what has been learned from the CTN about Hispanic populations with substance use disorder. A systematic search was conducted within the CTN Dissemination Library and nine databases. Potentially relevant studies were independently assessed by two reviewers for inclusion. Results Twenty-four studies were included in the review. Results identified issues in measurement, characteristics of Hispanic substance use, effective interventions, and gaps for future research. Characteristics that interfere with treatment participation were also identified including low employment rates, less likelihood of having insurance, lower rates of internet access, and increased travel time to services, as were treatment issues such as high rates of alcohol and tobacco use. Effective interventions were identified; however, the effectiveness of these interventions may be limited to specific factors. Conclusions Despite efforts to improve inclusion of minority populations, Hispanics remain underrepresented in clinical trials. Future research including Hispanic populations should examine measurement equivalence and consider how cultural and historical experiences, as well as patient characteristics, influence utilization of services. Finally, more studies are needed that examine the impact of structural factors that act as barriers to treatment access and engagement and result in significant disparities in treatment outcomes.
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Affiliation(s)
- Brittany H Eghaneyan
- School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Box 19129, Arlington, TX 76019, United States
| | - Katherine Sanchez
- School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Box 19129, Arlington, TX 76019, United States.,Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, United States
| | - Angela M Haeny
- Yale School of Medicine, 34 Park St., New Haven, CT 06519, United States
| | - LaTrice Montgomery
- Center for Addiction Research, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Suite 204, Cincinnati, Ohio 45221, United States
| | - Teresa Lopez-Castro
- The City College of New York, 160 Convent Ave., New York, NY 10031, United States
| | - A Kathleen Burlew
- University of Cincinnati, 2600 Clifton Ave., Cincinnati, OH 45220, United States
| | - Afsaneh Rezaeizadeh
- Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, United States
| | - Michael O Killian
- College of Social Work, Florida State University, 296 Champions Way, UCC 3407, Tallahassee, FL 32309, United States
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Acute and long-term cannabis use among stimulant users: Results from CTN-0037 Stimulant Reduction Intervention using Dosed Exercise (STRIDE) Randomized Control Trial. Drug Alcohol Depend 2019; 200:139-144. [PMID: 31129484 PMCID: PMC6863445 DOI: 10.1016/j.drugalcdep.2019.02.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 02/04/2019] [Accepted: 02/09/2019] [Indexed: 11/22/2022]
Abstract
AIMS The aim of this study was to examine the impact of vigorous intensity, high dose exercise (DEI) on cannabis use among stimulant users compared to a health education intervention (HEI) using data from the Stimulant Reduction Intervention using Dosed Exercise, National Institute of Drug Abuse National Drug Treatment Clinical Trials Network Protocol Number 0037 (STRIDE). METHODS Adults (N = 302) enrolled in the STRIDE randomized clinical trial were randomized to either the DEI or the HEI. Interventions included supervised sessions three times a week during the Acute phase (12 weeks) and once a week during the Follow-up phase (6 months). Cannabis use was measured at each assessment via Timeline Follow Back and urine drug screens. Cannabis use was compared between the groups during the Acute and Follow-up phases using both the intent-to-treat sample and a complier average causal effects (CACE) analysis. FINDINGS Approximately 43% of the sample reported cannabis use at baseline. The difference in cannabis use between the DEI and HEI groups during the Acute phase was not significant. During the Follow-up phase, the days of cannabis use was significantly lower among those in the DEI group (1.20 days) compared to the HEI group (2.15 days; p = 0.04). CONCLUSIONS For those who adhered to the exercise intervention, vigorous intensity, high dose exercise resulted in less cannabis use. Results suggest that there were no significant short-term differences in cannabis use between the groups. Further study on the long-term impact of exercise as a treatment to reduce cannabis use should be considered.
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Trombello JM, Killian MO, Liao A, Sanchez K, Greer TL, Walker R, Grannemann B, Rethorst CD, Carmody T, Trivedi MH. Psychometrics of the Self-Report Concise Associated Symptoms Tracking Scale (CAST-SR): Results From the STRIDE (CTN-0037) Study. J Clin Psychiatry 2019; 79:17m11707. [PMID: 29325238 PMCID: PMC5932219 DOI: 10.4088/jcp.17m11707] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 12/06/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The self-report Concise Associated Symptoms Tracking Scale (CAST-SR) was developed to track mania, irritability, anxiety, panic, and insomnia symptoms among depressed outpatients receiving antidepressant medication. Given the overlap between these domains, depression, and stimulant use disorders, we reexamined CAST-SR psychometrics in a novel sample: individuals with stimulant use disorder receiving aerobic exercise or health education interventions. METHODS Using the subsample of stimulant-dependent (following DSM-IV criteria) individuals prescribed antidepressants (N = 124) from the multisite Stimulant Reduction Intervention Using Dosed Exercise (CTN-0037) trial (total sample N = 302), conducted July 2010 to February 2013, we analyzed CAST-SR data collected at the first assessment after participant's discharge from residential treatment. We also evaluated the convergent/discriminant validity of the CAST-SR with several self-report questionnaires. RESULTS Confirmatory factor analysis revealed a 12-item measure composed of 4 factors: irritability, anxiety, panic, and insomnia. This factor structure loaded only in participants prescribed antidepressant medication, not in those who were not prescribed antidepressants. These results replicate the original CAST-SR factor structure, except for the mania factor, which failed to load. Internal consistency was high (α = 0.92 for total scale and α = 0.78-0.89 for the 4 factors), and convergent validity was established, especially for the insomnia and irritability factors, alongside the total score with depressive symptoms, insomnia, quality of life, suicide risk, and physical health measures. CONCLUSIONS These results demonstrate the factor structure, reliability, and validity of the CAST-SR in a novel population of only individuals with stimulant use disorders receiving both exercise/health education interventions and antidepressant medication. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01141608.
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Affiliation(s)
- Joseph M Trombello
- Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michael O Killian
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
| | - Allen Liao
- Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Current affiliation: Harbor-UCLA Medical Center, Los Angeles, California, USA
| | - Katherine Sanchez
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
- Current affiliation: Center for Applied Health Research, Baylor Scott and White Research Institute, Dallas, Texas, USA
| | - Tracy L Greer
- Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Robrina Walker
- Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Bruce Grannemann
- Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Chad D Rethorst
- Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Thomas Carmody
- Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9119.
- Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Montgomery L, Burlew AK, Haeny AM, Jones CA. A systematic scoping review of research on Black participants in the National Drug Abuse Treatment Clinical Trials Network. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2019; 34:117-127. [PMID: 31246072 DOI: 10.1037/adb0000483] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Black individuals experience a disproportionate burden of substance-related disabilities and premature death relative to other racial/ethnic groups, highlighting the need for additional research. The National Drug Abuse Treatment Clinical Trials Network (CTN), a research platform for multisite behavioral, pharmacological, and integrated trials designed to evaluate the effectiveness of substance use treatments in community settings with diversified patient populations, provides a wealth of research knowledge on substance use. Although CTN trials have enrolled over 5,000 Black individuals since its inception in 2000, there has been no synthesis of the findings, discussion of the implications, or suggestions for future research for Black individuals. Members of the Minority Interest Group of the CTN conducted a scoping review of published research on Black participants in CTN trials. Studies were included if the sample was more than 75% Black and/or specific findings pertaining to Black participants were reported. The review yielded 50 articles, with studies that mostly focused on baseline characteristics, followed by substance use treatment outcomes, HIV/risky sex behaviors, retention, comorbid conditions and measurement issues. This review highlighted the importance of several issues that are critical to understanding and treating substance misuse among Black people, such as the characteristics of Black people entering treatment, measurement equivalence, and engaging/retaining adolescents and young adults in treatment. There is still a continued need to identify the most effective treatments for Black individuals who use substances. The CTN offers several untapped opportunities to further advance research on Black individuals who use substances (e.g., secondary analyses of publicly available data). (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Sanchez K, Greer TL, Walker R, Carmody T, Rethorst CD, Trivedi MH. Racial and ethnic differences in treatment outcomes among adults with stimulant use disorders after a dosed exercise intervention. J Ethn Subst Abuse 2017; 16:495-510. [PMID: 28524806 DOI: 10.1080/15332640.2017.1317310] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The current study examined differences in substance abuse treatment outcomes among racial and ethnic groups enrolled in the Stimulant Reduction Intervention using Dosed Exercise (STRIDE) trial, a multisite randomized clinical trial implemented through the National Institute on Drug Abuse's (NIDA's) Clinical Trials Network (CTN). STRIDE aimed to test vigorous exercise as a novel approach to the treatment of stimulant abuse compared to a health education intervention. A hurdle model with a complier average causal effects (CACE) adjustment was used to provide an unbiased estimate of the exercise effect had all participants been adherent to exercise. Among 214 exercise-adherent participants, we found significantly lower probability of use for Blacks (z = -2.45, p = .014) and significantly lower number of days of use for Whites compared to Hispanics (z = -54.87, p = <.001) and for Whites compared to Blacks (z = -28.54, p = <.001), which suggests that vigorous, regular exercise might improve treatment outcomes given adequate levels of adherence.
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Affiliation(s)
- Katherine Sanchez
- a School of Social Work , The University of Texas at Arlington , Arlington , Texas
| | - T L Greer
- b University of Texas Southwestern Medical Center , Dallas , Texas
| | - R Walker
- b University of Texas Southwestern Medical Center , Dallas , Texas
| | - T Carmody
- b University of Texas Southwestern Medical Center , Dallas , Texas
| | - C D Rethorst
- b University of Texas Southwestern Medical Center , Dallas , Texas
| | - M H Trivedi
- b University of Texas Southwestern Medical Center , Dallas , Texas
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Montgomery L, Carroll KM. Comparable efficacy of behavioral and pharmacological treatments among African American and White cocaine users. J Ethn Subst Abuse 2017; 16:445-459. [PMID: 28441119 DOI: 10.1080/15332640.2017.1308287] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Multiple randomized clinical trials (RCTs) have evaluated a range of treatments for cocaine dependence, but few of these have focused specifically on the racial diversity observed among cocaine-dependent patients. The present analyses evaluated racial variation in cocaine use and addiction-related psychosocial outcomes at baseline and follow-up among 388 African American and White adults participating in 1 of 5 RCTs evaluating a range of pharmacological and behavioral treatments for cocaine use disorders. General linear modeling (GLM) indicated significant racial variation in cocaine and psychosocial indicators at baseline. At baseline, there were significant racial differences in the number of days paid for work in the 30 days prior to the study, age, days of cocaine use in the past month, age of first cocaine use, psychosocial problems (i.e., employment, cocaine, legal, and family), public assistance status, and prevalence of lifetime anxiety disorders. There were no significant main or interaction effects of race and study on treatment outcomes at posttreatment. These findings suggest that despite significant racial differences at baseline, the pharmacological and behavioral treatments resulted in fairly comparable outcomes across racial groups in these 5 RCTs.
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McKnight C, Shumway M, Masson CL, Pouget ER, Jordan AE, Des Jarlais DC, Sorensen JL, Perlman DC. Perceived discrimination among racial and ethnic minority drug users and the association with health care utilization. J Ethn Subst Abuse 2017; 16:404-419. [PMID: 28306386 DOI: 10.1080/15332640.2017.1292418] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
People who use drugs (PWUDs) are at increased risk for several medical conditions, yet they delay seeking medical care and utilize emergency departments (EDs) as their primary source of care. Limited research regarding perceived discrimination and PWUDs' use of health care services exists. This study explores the association between interpersonal and institutional racial/ethnic and drug use discrimination in health care settings and health care utilization among respondents (N = 192) recruited from methadone maintenance treatment programs (36%), HIV primary care clinics (35%), and syringe exchange programs (29%) in New York City (n = 88) and San Francisco (n = 104). The Kaiser Family Foundation Survey of Race, Ethnicity, and Medical Care questionnaire was utilized to assess perceived institutional racial/ethnic and drug use discrimination. Perceived institutional discrimination was examined across race/ethnicity and by regular use of ERs, having a regular doctor, and consistent health insurance. Perceived interpersonal discrimination was examined by race/ethnicity. Perceived interpersonal drug use discrimination was the most common type of discrimination experienced in health care settings. Perceptions of institutional discrimination related to race/ethnicity and drug use among non-Hispanic Whites did not significantly differ from those among non-Hispanic Blacks or Hispanics. A perception of less frequent institutional racial/ethnic and drug use discrimination in health care settings was associated with increased odds of having a regular doctor. Awareness of perceived interpersonal and institutional discrimination in certain populations and the effect on health care service utilization should inform future intervention development to help reduce discrimination and improve health care utilization among PWUDs.
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Affiliation(s)
| | | | | | - Enrique R Pouget
- c National Development and Research Institutes, Inc. , New York , New York
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Chartier KG, Sanchez K, Killeen TK, Burrow A, Carmody T, Greer TL, Trivedi MH. Men and women from the STRIDE clinical trial: An assessment of stimulant abstinence symptom severity at residential treatment entry. Am J Addict 2015; 24:336-40. [PMID: 25694201 DOI: 10.1111/ajad.12190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 11/20/2014] [Accepted: 12/04/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Gender-specific factors associated with stimulant abstinence severity were examined in a stimulant abusing or dependent residential treatment sample (N = 302). METHOD Bivariate statistics tested gender differences in stimulant abstinence symptoms, measured by participant-reported experiences of early withdrawal. Multivariate linear regression examined gender and other predictors of stimulant abstinence symptom severity. RESULTS Women compared to men reported greater stimulant abstinence symptom severity. Anxiety disorders and individual anxiety-related abstinence symptoms accounted for this difference. African American race/ethnicity was predictive of lower stimulant abstinence severity. DISCUSSION AND CONCLUSIONS Women were more sensitive to anxiety-related stimulant withdrawal symptoms. SCIENTIFIC SIGNIFICANCE Clinics that address anxiety-related abstinence symptoms, which more commonly occur in women, may improve treatment outcome.
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Affiliation(s)
- Karen G Chartier
- Virginia Commonwealth University, School of Social Work and Department of Psychiatry, Richmond, Virginia
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