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Mavragani A, Cheng X, Zhang J, Yannam JS, Barnes AJ, Koch JR, Hayes R, Gimm G, Zhao X, Purohit H, Xue H. Social Media Data Mining of Antitobacco Campaign Messages: Machine Learning Analysis of Facebook Posts. J Med Internet Res 2023; 25:e42863. [PMID: 36780224 PMCID: PMC9972210 DOI: 10.2196/42863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/10/2023] [Accepted: 01/23/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Social media platforms provide a valuable source of public health information, as one-third of US adults seek specific health information online. Many antitobacco campaigns have recognized such trends among youth and have shifted their advertising time and effort toward digital platforms. Timely evidence is needed to inform the adaptation of antitobacco campaigns to changing social media platforms. OBJECTIVE In this study, we conducted a content analysis of major antitobacco campaigns on Facebook using machine learning and natural language processing (NLP) methods, as well as a traditional approach, to investigate the factors that may influence effective antismoking information dissemination and user engagement. METHODS We collected 3515 posts and 28,125 associated comments from 7 large national and local antitobacco campaigns on Facebook between 2018 and 2021, including the Real Cost, Truth, CDC Tobacco Free (formally known as Tips from Former Smokers, where "CDC" refers to the Centers for Disease Control and Prevention), the Tobacco Prevention Toolkit, Behind the Haze VA, the Campaign for Tobacco-Free Kids, and Smoke Free US campaigns. NLP methods were used for content analysis, including parsimonious rule-based models for sentiment analysis and topic modeling. Logistic regression models were fitted to examine the relationship of antismoking message-framing strategies and viewer responses and engagement. RESULTS We found that large campaigns from government and nonprofit organizations had more user engagements compared to local and smaller campaigns. Facebook users were more likely to engage in negatively framed campaign posts. Negative posts tended to receive more negative comments (odds ratio [OR] 1.40, 95% CI 1.20-1.65). Positively framed posts generated more negative comments (OR 1.41, 95% CI 1.19-1.66) as well as positive comments (OR 1.29, 95% CI 1.13-1.48). Our content analysis and topic modeling uncovered that the most popular campaign posts tended to be informational (ie, providing new information), where the key phrases included talking about harmful chemicals (n=43, 43%) as well as the risk to pets (n=17, 17%). CONCLUSIONS Facebook users tend to engage more in antitobacco educational campaigns that are framed negatively. The most popular campaign posts are those providing new information, with key phrases and topics discussing harmful chemicals and risks of secondhand smoke for pets. Educational campaign designers can use such insights to increase the reach of antismoking campaigns and promote behavioral changes.
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Affiliation(s)
| | - Xiaolu Cheng
- School of Computer Science and Engineering, Changshu Institute of Technology, Suzhou, Jiangsu Province, China
| | - Jun Zhang
- Department of Physics and Engineering, College of Engineering and Science, Slippery Rock University of Pennsylvania, Slippery Rock, PA, United States
| | - Jaya Sindhu Yannam
- Department of Health Administration and Policy, College of Public Health, George Mason University, Fairfax, VA, United States
| | - Andrew J Barnes
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - J Randy Koch
- Department of Psychology, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, VA, United States.,Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, United States
| | - Rashelle Hayes
- Department of Psychiatry, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Gilbert Gimm
- Department of Health Administration and Policy, College of Public Health, George Mason University, Fairfax, VA, United States
| | - Xiaoquan Zhao
- Department of Communication, College of Humanities and Social Sciences, George Mason University, Fairfax, VA, United States
| | - Hemant Purohit
- Department of Information Sciences and Technology, College of Engineering and Computing, George Mason University, Fairfax, VA, United States
| | - Hong Xue
- Department of Health Administration and Policy, College of Public Health, George Mason University, Fairfax, VA, United States
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Lin SY, Zhou W, Koch JR, Barnes AJ, Yang R, Xue H. The Association Between Tobacco Retailer Outlet Density and Prevalence of Cigarette Smoking in Virginia. Nicotine Tob Res 2023; 25:36-42. [PMID: 35752162 DOI: 10.1093/ntr/ntac154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 05/22/2022] [Accepted: 06/23/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE We examine the association between tobacco retail outlet density and adult smoking prevalence at the county level in Virginia, controlling for spatial autocorrelations. AIMS AND METHODS Pooling data from 2020 County Health Rankings (compiled data from various sources including, but not limited to, the National Center for Health Statistics-Mortality Files, the Behavioral Risk Factor Surveillance System (BRFSS), and the American Community Survey) and Counter Tools, we conducted regression analyses that accounted for spatial autocorrelation (spatial lag models, LMlag) and adjusted for county-level access to healthcare, demographics, SES, environmental factors, risk conditions or behaviors, and population health measures. RESULTS Our estimates provide evidence that every increase of one tobacco retail outlet per 1000 persons was associated with 1.16 percentage points (95% CI: 0.80-1.52) higher smoking prevalence at the county level in Virginia after controlling for spatial autocorrelation. The effect of outlet density was largely explained by social determinants of health such as SES, risky conditions or behaviors, and environmental factors. We further noticed that the impact of social determinants of health were closely related and can be explained by indicators of population health (rates of mental distress (β = 1.49, 95% CI: 1.31-1.67) and physical inactivity (β = 0.07, 95% CI: 0.04-0.10). CONCLUSIONS Although higher tobacco outlet density was associated with an increase in county-level smoking prevalence, the impact of outlet density was largely explained by social determinants of health and mental illness. Improving well-being at the community level could be a promising strategy in future tobacco control policies. IMPLICATION The influence of tobacco outlet density seems to be explained by other social determinants of health and population level of mental or physical health. Thus, efforts to reduce tobacco use and consequent negative health effects should explore the impact of improving regional living standards. However, a sole focus on economic growth may not be sufficient, whereas a focus on such things as promoting work-life balance and improving overall well-being at the community level may be more.
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Affiliation(s)
- Shuo-Yu Lin
- Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, VA, USA
| | - Weiyu Zhou
- Department of Statistics, Volgenau School of Engineering, George Mason University, Fairfax, VA, USA
| | - J Randy Koch
- Department of Psychology and the Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
| | - Andrew J Barnes
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Ruixin Yang
- Department of Geography and Geoinformation Science, College of Science, George Mason University, Fairfax, VA, USA
| | - Hong Xue
- Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, VA, USA
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Myers B, Koch JR, Johnson K, Harker N. Factors associated with patient-reported experiences and outcomes of substance use disorder treatment in Cape Town, South Africa. Addict Sci Clin Pract 2022; 17:8. [PMID: 35109915 PMCID: PMC8812030 DOI: 10.1186/s13722-022-00289-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 01/18/2022] [Indexed: 12/15/2022] Open
Abstract
Background Interventions are needed to improve the quality of South Africa’s substance use disorder (SUD) treatment system. This study aimed to identify factors associated with patient-reported suboptimal access, quality, and outcomes of SUD treatment to guide the design of targeted quality improvement initiatives. Method We analysed clinical record and patient survey data routinely collected by SUD services in the Western Cape Province, South Africa. The sample included 1097 treatment episodes, representing 32% of all episodes in 2019. Using multivariate logistic regression, we modelled socio-demographic, substance use and treatment correlates of patient-reported suboptimal access to, quality and outcomes of SUD treatment. Results Overall, 37.9% of patients reported substantial difficulties in accessing treatment, 28.8% reported suboptimal quality treatment, and 31.1% reported suboptimal SUD outcomes. The odds of reporting poor access were elevated for patients identifying as Black/African, in residential treatment, with comorbid mental health problems, and longer histories of substance use. Length of substance use, comorbid mental health problems, and prior SUD treatment were associated with greater likelihood of reporting suboptimal quality treatment. Patients with comorbid mental health problems, polysubstance use, who did not complete treatment, and who perceived treatment to be of poor quality were more likely to report suboptimal outcomes. Conclusion This study is among the first to use patient-reported experiences and outcome measures to identify targets for SUD treatment improvement. Findings suggest substantial room to improve South African SUD treatment services, with targeted efforts needed to reduce disparities in outcomes for patients of Black/African descent, for those with comorbid mental health problems, and for patients who have chronic substance use difficulties. Interventions to enhance the relevance, appropriateness, and acceptability of SUD services for these patient sub-groups are needed to improve system performance.
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Affiliation(s)
- Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA, 6102, Australia. .,Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa. .,Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - J Randy Koch
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Kim Johnson
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Nadine Harker
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.,School of Public Health, University of Cape Town, Cape Town, South Africa
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Myers B, Johnson K, Lucas W, Govender R, Manderscheid R, Williams PP, Koch JR. South African service users' perceptions of patient-reported outcome and experience measures for adolescent substance use treatment: A qualitative study. Drug Alcohol Rev 2019; 38:823-830. [PMID: 31659815 DOI: 10.1111/dar.12996] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 08/19/2019] [Accepted: 08/27/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND AIMS Patient-reported outcome measures (PROM) and experience measures (PREM) for substance use disorder (SUD) treatment exist for adults but have unknown relevance for adolescents. This study aimed to explore adolescents' perceptions of effective SUD treatment and possible barriers to completing PROMs and PREMs to guide efforts to adapt the South African Addiction Treatment Services Assessment (SAATSA) for adolescents. DESIGN AND METHODS Five focus groups were conducted with 38 adolescent service users recruited from residential and outpatient SUD treatment facilities in South Africa. Group discussions explored perceptions of treatment components necessary for desired SUD treatment outcomes, treatment experiences that support engagement in care, and perceptions of PROM and PREM completion. RESULTS Participants viewed treatment elements that enhance motivation for change, coping and emotional regulation; provide recreational alternatives to substance use; and improve family relationships and home environments as critical to positive treatment outcomes. They reflected that provider characteristics and developmentally and culturally appropriate services facilitated engagement in treatment. PROM and PREM completion seemed acceptable, with participants suggesting ways to enhance their appeal. DISCUSSION AND CONCLUSION Findings confirm that adult-oriented PROMs and PREMs require adaptation for adolescents. Service user inputs identified ways to expand the content of the SAATSA to better reflect adolescents' treatment priorities. These inputs have also guided changes to item formulation and administration procedures to enhance the SAATSA's acceptability for adolescents. Ensuring the SAATSA addresses treatment outcomes and experiences that matter to adolescents is vital for generating information to guide improvements to adolescent SUD services.
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Affiliation(s)
- Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Kim Johnson
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Warren Lucas
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Rajen Govender
- Department of Sociology, University of Cape Town, Cape Town, South Africa.,Violence Injury and Peace Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Ron Manderscheid
- National Association of County Behavioral Health and Developmental Disability Directors, Washington, USA
| | - Petal Petersen Williams
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - J Randy Koch
- Department of Psychology, Virginia Commonwealth University, Richmond, USA
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Breland A, Balster RL, Cobb C, Fagan P, Foulds J, Koch JR, Lipato T, Saliba N, Shihadeh A, Sun S, Eissenberg T. Answering questions about electronic cigarettes using a multidisciplinary model. ACTA ACUST UNITED AC 2019; 74:368-379. [PMID: 30945898 DOI: 10.1037/amp0000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Electronic cigarettes (ECIGs) are a relatively new class of tobacco products and a subject of much debate for scientists and policymakers worldwide. Objective data that address the ECIG risk-benefit ratio for individual and public health are needed, and addressing this need requires a multidisciplinary approach that spans several areas of psychology as well as chemistry, toxicant inhalation, and physiology. This multidisciplinary approach would benefit from methods that are reliable, valid, and swift. For this reason, we formed a multidisciplinary team to develop methods that could answer questions about ECIGs and other potential modified risk tobacco products. Our team includes scientists with expertise in psychology (clinical, community, and experimental) and other disciplines, including aerosol research, analytical chemistry, biostatistics, engineering, internal medicine, and public health. The psychologists on our team keep other members focused on factors that influence individual behavior, and other team members keep the psychologists aware of other issues, such as product design. Critically, all team members are willing to extend their interests beyond the boundaries of their discipline to collaborate effectively with the shared goal of producing the rigorous science needed to inform empirically based tobacco policy. In addition, our trainees gain valuable knowledge from these collaborations and learn that other disciplines are accessible, exciting, and can enhance their own research. Multidisciplinary work presents challenges: learning other scientists' languages and staying focused on our core mission. Overall, our multidisciplinary team has led to several major findings that inform the scientific, regulatory, and public health communities about ECIGs and their effects. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Shumei Sun
- Center for the Study of Tobacco Products
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Myers B, Williams PP, Govender R, Manderscheid R, Koch JR. A Mixed-Methods Evaluation of the Implementation of a Performance Measurement System for South Africa’s Substance Use Treatment Services. J Stud Alcohol Drugs Suppl 2019. [PMID: 30681957 PMCID: PMC6377018 DOI: 10.15288/jsads.2019.s18.131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: Method: Results: Conclusions: Objectifs : Méthode : Résultats : Conclusion : Objetivos: Método: Resultados: Conclusión:
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Affiliation(s)
- Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Petal Petersen Williams
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Rajen Govender
- Department of Sociology, University of Cape Town, Cape Town, South Africa
- Violence Prevention Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Ron Manderscheid
- National Association of County Behavioral Health and Developmental Disability Directors, Washington, DC
| | - J. Randy Koch
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
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Myers B, Williams PP, Govender R, Manderscheid R, Koch JR. Substance abuse treatment engagement, completion and short-term outcomes in the Western Cape province, South Africa: Findings from the Service Quality Measures Initiative. Drug Alcohol Depend 2018; 185:278-284. [PMID: 29482052 DOI: 10.1016/j.drugalcdep.2017.12.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/02/2017] [Accepted: 12/27/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Optimizing the effectiveness of substance use disorder (SUD) treatment is critical in low-and middle-income countries (LMICs) with limited opportunities for SUD treatment. This is the first study to identify targets for interventions to improve the quality of SUD treatment in a LMIC. METHOD We explored correlates of three indicators of treatment quality (treatment engagement, completion and abstinence at treatment exit) using data from a SUD performance measurement system implemented in the Western Cape Province of South Africa. The sample included data from 1094 adult treatment episodes representing 53% of the treatment episodes in 2016. Using multivariate logistic regression analyses, we modeled socio-demographic, substance use and program correlates of treatment engagement, completion, and abstinence at treatment exit. RESULTS Overall, 59% of patients completed treatment (48% of patients from outpatient services). Treatment completion was associated with greater likelihood of abstinence at treatment exit. Patients were more likely to complete treatment if they engaged in treatment, were older, and had more severe drug problems (characterized by daily drug use and heroin problems) and attended programs of shorter duration. Residential treatment was associated with greater likelihood of treatment engagement, completion, and abstinence at treatment exit. CONCLUSION Improving rates of outpatient treatment completion will enhance the effectiveness of South Africa's SUD treatment system. Interventions that promote engagement in treatment, particularly among younger patients; reduce program length through referral to step-down continuing care; and ensure better matching of drug problem to treatment level and type could improve rates of treatment completion.
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Affiliation(s)
- Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Department of Psychiatry, Stellenbosch University, Cape Town, South Africa.
| | - Petal Petersen Williams
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Rajen Govender
- Department of Sociology, University of Cape Town, Cape Town, South Africa; Violence Prevention Research Unit, South African Medical Research Council, Cape Town, South Africa; Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Ron Manderscheid
- National Association of County Behavioral Health and Developmental Disability Directors, Washington DC, USA; Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - J Randy Koch
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA; Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
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Magidson JF, Lee JS, Johnson K, Burnhams W, Koch JR, Manderscheid R, Myers B. Openness to adopting evidence-based practice in public substance use treatment in South Africa using task shifting: Caseload size matters. Subst Abus 2017; 39:162-166. [PMID: 28934063 DOI: 10.1080/08897077.2017.1380743] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND In response to the lack of coverage for substance use treatment in the Western Cape province of South Africa, the local government expanded funding for evidence-based practices (EBPs) for treating substance use. Yet, little is known about provider and staff attitudes towards adopting EBPs in this setting, which is particularly relevant in this context where task shifting clinical care increases demands on paraprofessional providers. This study aimed to (1) assess attitudes towards adopting EBPs among a range of staff working in substance use treatment in Cape Town using a task shifting model; and (2) evaluate factors associated with openness towards adopting EBPs in this setting. METHODS Staff (n = 87) were recruited from 11 substance use treatment clinics. Demographics and job-related characteristics were assessed. Staff perceptions of organizational factors were assessed using the TCU Organizational Readiness for Change (ORC) scale. The dependent variable, attitudes towards adopting EBPs, was assessed using the Evidence-Based Practice Attitude Scale (EBPAS). RESULTS This study is one of the first to administer the EBPAS in South Africa and found good internal consistency (total score: α = .82). In a multivariable model adjusting for site and factors associated with EBPAS total score at the bivariate level, only smaller caseload size was associated with greater openness to adopting EBPs (B = 1.61, SE = .73; t = 2.21; p<.05). CONCLUSIONS As pressure to scale up implementation of EBPs in South African substance use treatment services intensifies, additional efforts are needed to understand barriers to adopt EBPs in this setting. Supporting staff adoption of EBPs in resource-limited settings may require additional resources to limit staff caseloads in the context of task shifting.
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Affiliation(s)
- Jessica F Magidson
- a Massachusetts General Hospital/Harvard Medical School , Boston , Massachusetts , USA
| | - Jasper S Lee
- b Department of Psychology , University of Miami , Coral Gables , Florida , USA
| | - Kim Johnson
- c Alcohol Tobacco and Other Drug Research Unit, South African Medical Research Council , Cape Town , South Africa
| | - Warren Burnhams
- d City of Cape Town Health, Substance Abuse , Cape Town , South Africa
| | - J Randy Koch
- e Department of Psychology , Virginia Commonwealth University , Richmond , Virginia , USA
| | - Ron Manderscheid
- f National Association of County Behavioral Health and Developmental Disability Directors , Washington DC , USA
| | - Bronwyn Myers
- c Alcohol Tobacco and Other Drug Research Unit, South African Medical Research Council , Cape Town , South Africa.,g Department of Psychiatry and Mental Health , University of Cape Town , Anzio Road, Observatory, Cape Town , South Africa
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Myers B, Govender R, Manderscheid R, Williams PP, Johnson K, Koch JR. Need for and Readiness to Implement a Performance Measurement System for South Africa’s Substance Abuse Treatment Services. Int J Ment Health Addict 2016. [DOI: 10.1007/s11469-016-9706-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Polak K, Dillon P, Koch JR, Miller WG, Thacker L, Svikis D. Energy drink use is associated with alcohol and substance use in eighth, tenth, and twelfth graders. Prev Med Rep 2016; 4:381-4. [PMID: 27547720 PMCID: PMC4986046 DOI: 10.1016/j.pmedr.2016.06.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 06/27/2016] [Indexed: 11/27/2022] Open
Abstract
The increasing prevalence of energy drink (ED) use and its link with negative behaviors and adverse health outcomes has garnered much attention. Use of EDs combined with alcohol among college students has been of particular interest. It is unclear if these relationships develop in the context of college, or if similar associations exist in younger individuals. The present study examined associations between ED consumption patterns and other substance use in an adolescent, school-based sample. Participants were N = 3743 students attending 8th, 10th or 12th grade in a suburban central Virginia public school system who completed a prevention needs assessment survey in 2012. Chi-square analyses and logistic regressions were used to compare rates of alcohol, tobacco and other drug use across three ED use groups: moderate/heavy (12.6%), light (30.5%), and non-users (57%). Over 40% of the sample reported recent (past month) ED use, with males more likely to report moderate/heavy ED use than females (14.0% and 11.1%, respectively; p = 0.02). After adjusting for gender and grade, ED use group predicted lifetime alcohol, tobacco and other drug use (all p < 0.001). Moderate/heavy ED users were most likely and ED non-users were least likely to report using each of the 13 substances in the survey, with light ED users intermediate to the other two groups. Moderate/heavy ED users were consistently most likely to report licit and illicit substance use. Additional research is needed to better understand which adolescents are at greatest risk for adverse health behaviors associated with ED use.
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Affiliation(s)
- Kathryn Polak
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | - Pamela Dillon
- Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, VA, United States
| | - J Randy Koch
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States; Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, United States
| | - Willis G Miller
- School of Education, Virginia Commonwealth University, Richmond, VA, United States
| | - Leroy Thacker
- School of Nursing, Virginia Commonwealth University, Richmond, VA, United States
| | - Dace Svikis
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States; Institute for Women's Health, Virginia Commonwealth University, Richmond, VA, United States
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Myers B, Govender R, Koch JR, Manderscheid R, Johnson K, Parry CDH. Development and psychometric validation of a novel patient survey to assess perceived quality of substance abuse treatment in South Africa. Subst Abuse Treat Prev Policy 2015; 10:44. [PMID: 26545736 PMCID: PMC4636825 DOI: 10.1186/s13011-015-0040-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 11/02/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A hybrid performance measurement system that combines patient-reported outcome data with administrative data has been developed for South African substance abuse treatment services. This paper describes the development and psychometric validation of one component of this system, the South African Addiction Treatment Services Assessment (SAATSA). METHODS First, a national steering committee identified five domains and corresponding indicators on which treatment quality should be assessed. A decision was made to develop a patient survey to assess several of these indicators. A stakeholder work group sourced survey items and generated additional items where appropriate. The feasibility and face validity of these items were examined during cognitive response testing with 16 patients. This led to the elimination of several items. Next, we conducted an initial psychometric validation of the SAATSA with 364 patients from residential and outpatient services. Exploratory (EFA) and confirmatory factor analyses (CFA) were conducted to assess the latent structure of the SAATSA. Findings highlighted areas where the SAATSA required revision. Following revision, we conducted another psychometric validation with an additional sample of 285 patients. We used EFA and CFA to assess construct validity and we assessed reliability using Cronbach's measure of internal consistency. RESULTS The final version of the SAATSA comprised 31 items (rated on a four-point response scale) that correspond to six scales. Four of these scales are patient-reported outcome measures (substance use, quality of life, social connectedness and HIV risk outcomes) that together assess the perceived effectiveness of treatment. The remaining two scales assess patients' perceptions of access to and quality of care. The models for the final revised scales had good fit and the internal reliability of these scales was good to excellent, with Cronbach's α ranging from 0.72 to 0.89. CONCLUSION A lack of adequate measurement tools hampers efforts to improve the quality of substance abuse treatment. Our preliminary evidence suggests that the SAATSA, a novel patient survey that assesses patients' perceptions of the outcomes and quality of substance abuse treatment, is a psychometrically robust tool that can help fill this void.
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Affiliation(s)
- Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Rajen Govender
- Department of Sociology, University of Cape Town, Cape Town, South Africa.
| | - J Randy Koch
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.
| | - Ron Manderscheid
- National Association of County Behavioral Health and Developmental Disability Directors, Washington DC, USA.
| | - Kim Johnson
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - Charles D H Parry
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa.
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Koch JR, Breland A. Behavioral Healthcare Staff Attitudes and Practices Regarding Consumer Tobacco Cessation Services. J Behav Health Serv Res 2015; 44:399-413. [DOI: 10.1007/s11414-015-9477-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kader R, Seedat S, Govender R, Koch JR, Parry CD. Hazardous and harmful use of alcohol and/or other drugs and health status among South African patients attending HIV clinics. AIDS Behav 2014; 18:525-34. [PMID: 23921585 DOI: 10.1007/s10461-013-0587-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There is growing recognition of the influence of substance use, particularly alcohol use, on HIV disease progression. This study investigated how hazardous/harmful use of alcohol and drugs impacts the health status of 1503 patients attending HIV clinics. Of the sample, 37 % indicated hazardous/harmful drinking and 13 % indicated a drug problem. Hazardous/harmful use of alcohol and drugs was significantly related to health status, with participants using substances more likely to have TB-positive status (χ(2) = 4.30, p < 0.05), less likely to be on ARVs (χ(2) = 9.87, p < 0.05) and having lower CD4 counts (t = 4.01, p < 0.05). Structural equation modelling confirmed the centrality of hazardous/harmful use of alcohol as a direct and indirect determinant of disease progression. Based on these findings it is recommended that patients attending HIV clinics be routinely screened for problematic alcohol and/or drug use, with strong emphasis on ensuring ARV adherence in those with problematic alcohol use.
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Affiliation(s)
- R Kader
- Alcohol and Drug Abuse Research Unit, Medical Research Council, P.O. Box 19070, Tygerberg, Cape Town, 7505, South Africa,
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Myers B, Petersen Z, Kader R, Koch JR, Manderscheid R, Govender R, Parry CDH. Identifying perceived barriers to monitoring service quality among substance abuse treatment providers in South Africa. BMC Psychiatry 2014; 14:31. [PMID: 24499037 PMCID: PMC3917424 DOI: 10.1186/1471-244x-14-31] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 02/04/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND A performance measurement system is planned for South African substance abuse treatment services. Provider-level barriers to implementing these systems have been identified in the United States, but little is known about the nature of these barriers in South Africa. This study explored the willingness of South African substance abuse treatment providers' to adopt a performance measurement system and perceived barriers to monitoring service quality that would need to be addressed during system development. METHODS Three focus group discussions were held with treatment providers from two of the nine provinces in South Africa. These providers represented the diverse spread of substance abuse treatment services available in the country. The final sample comprised 21 representatives from 12 treatment facilities: eight treatment centres in the Western Cape and four in KwaZulu-Natal. Content analysis was used to extract core themes from these discussions. RESULTS Participants identified barriers to the monitoring of service quality that included outdated modes of collecting data, personnel who were already burdened by paperwork, lack of time to collect data, and limited skills to analyse and interpret data. Participants recommended that developers engage with service providers in a participatory manner to ensure that service providers are invested in the proposed performance measurement system. CONCLUSION Findings show that substance abuse treatment providers are willing to adopt a performance measurement system and highlight several barriers that need to be addressed during system development in order to enhance the likelihood that this system will be successfully implemented.
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Affiliation(s)
- Bronwyn Myers
- Alcohol and Drug Abuse Research Unit, Medical Research Council, Cape Town, South Africa.
| | - Zainonisa Petersen
- Alcohol and Drug Abuse Research Unit, Medical Research Council, Cape Town, South Africa
| | - Rehana Kader
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - J Randy Koch
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ron Manderscheid
- National Association of County Behavioral Health and Developmental Disability Directors, Washington DC, USA
| | - Rajen Govender
- Department of Sociology and Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Charles DH Parry
- Alcohol and Drug Abuse Research Unit, Medical Research Council, Cape Town, South Africa,Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
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Evans SW, Randy Koch J, Brady C, Meszaros P, Sadler J. Community and school mental health professionals' knowledge and use of evidence based substance use prevention programs. Adm Policy Ment Health 2013; 40:319-30. [PMID: 22544035 DOI: 10.1007/s10488-012-0422-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Youth with learning and behavioral problems are at elevated risk for substance use during adolescence. Although evidence-based substance use prevention and screening practices are described in the literature, the extent with which these are provided to these youth is unclear. Mental health professionals in schools and community mental health centers are in an ideal position to conduct substance use screening and prevention practices since they have frequent contact with this high risk group. In order to determine whether these mental health professionals were using evidence based substance use screening and prevention programs with these youth, we analyzed 345 completed surveys from mental health professionals in schools and community clinics throughout a mid-Atlantic state. Results indicated that a large portion of the respondents were unfamiliar with evidence based practices and they were infrequently used. Implications for the division of labor at schools and community mental health centers are discussed in relation to time allotment and priority for these procedures.
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16
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Kader R, Seedat S, Koch JR, Parry CD. A preliminary investigation of the AUDIT and DUDIT in comparison to biomarkers for alcohol and drug use among HIV-infected clinic attendees in Cape Town, South Africa. ACTA ACUST UNITED AC 2013; 15:346-51. [PMID: 23044889 DOI: 10.4314/ajpsy.v15i5.43] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 08/16/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE There is growing concern about the effect of substance use on HIV treatment outcomes. The study objectives included: (i) evaluating whether the use of validated questionnaires (AUDIT and DUDIT) provide useful and consistent information of alcohol and drug consumption when compared with the use of biomarkers of alcohol in (urine and hair) and drugs in (urine) and (ii) assessing the feasibility of using self-report measures compared with urine and hair tests. METHOD Participants were HIV positive patients attending an HIV community health clinic in Kraaifontein, Cape Town. Hair and urine samples were collected and analysed for alcohol, in Fatty Acid Ethyl Esters (FAEE) and in Ethyl Glucuronide and (EtG), and drugs. Biological markers were compared with self-report measures of alcohol and drug consumption in terms of sensitivity, specificity. Forty-three participants completed the self-report measures, while 30 provided hair and urine samples. RESULTS On the AUDIT, 18 (41.9%) participants screened positive for harmful and hazardous drinking and 13 (30.2%) participants on the DUDIT screened positive for having a drug-related problem. Two of 30 participants (7%) tested positive for alcohol abuse on FAEE analysis. For EtG, 6 of 24 (25%) participants tested positive for alcohol abuse. On hair drug analysis, all 30 participants tested negative for cannabis, amphetamines, opiates, cocaine, PCP and methaqualone. On the urinalysis, 1 of 30 participants tested positive for cannabis and everyone tested negative for all other drugs included in the screening. CONCLUSION Substance use among patients attending HIV clinics appears to be a problem, especially alcohol. Self-report measures seem to be a more cost effective option for screening of alcohol and drug abuse in resource poor settings.
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Affiliation(s)
- R Kader
- Alcohol & Drug Abuse Research Unit, Medical Research Council, Tygerberg, Cape Town, South Africa.
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17
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Abstract
African-American youth with behavioral health problems may be particularly vulnerable to tobacco use and dependence; however, little is known about overall prevalence and factors associated with tobacco use in this population. The present study compared rates of tobacco use for African-Americans (aged 13-17) receiving behavioral healthcare services to state and national prevalence rates. In addition, we examined whether tobacco use prevalence was related to treatment characteristics and services rendered. Retrospective chart reviews were conducted at an urban, public behavioral healthcare agency for youth admitted in 2009. Tobacco use rates among African-Americans receiving behavioral healthcare services were similar to, and in some cases, higher than statewide and national prevalence rates. While tobacco users were more likely to be enrolled in a substance abuse program than in a mental health program, only 2 of 55 youth reporting tobacco use had received documented tobacco cessation treatment. Future work should focus on implementing tobacco cessation prevention and treatment for these youth.
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Affiliation(s)
- Alison B Breland
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA 23298-0310, USA.
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Weaver MF, Dupre MA, Cropsey KL, Koch JR, Sood BA, Wiley JL, Balster RL. Addiction epidemiology in adolescents receiving inpatient psychiatric treatment. Addict Behav 2007; 32:3107-13. [PMID: 17630222 PMCID: PMC2651151 DOI: 10.1016/j.addbeh.2007.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2006] [Revised: 04/13/2007] [Accepted: 06/04/2007] [Indexed: 10/23/2022]
Abstract
This study sought to characterize adolescent psychiatric inpatient populations from two sites and to determine correlates of substance use disorders (SUD). Screening procedures for SUD differ substantially between these sites. A retrospective review of adolescent inpatients (n=636) revealed that the populations were similar in gender, race and age. Rates of SUD at the site with a formalized SUD screening regimen were higher (39%) than those at the other site (16.5%). Similar correlates of SUD were observed across sites, including older age, legal involvement, sexual activity, childhood disruptive disorder, and tobacco use. These results suggest that SUD is a major issue in adolescent psychiatric patients. More rigorous screening for SUD and its correlates may facilitate earlier detection of substance use in this vulnerable population.
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Affiliation(s)
- Michael B Blank
- Center for Mental Health Policy and Services Research, Univeristy of Pennsylvania, Philadelphia 19104, USA.
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20
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Kessler RC, Berglund PA, Bruce ML, Koch JR, Laska EM, Leaf PJ, Manderscheid RW, Rosenheck RA, Walters EE, Wang PS. The prevalence and correlates of untreated serious mental illness. Health Serv Res 2001; 36:987-1007. [PMID: 11775672 PMCID: PMC1089274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVE To identify the number of people in the United States with untreated serious mental illness (SMI) and the reasons for their lack of treatment. DATA SOURCE/STUDY DESIGN The National Comorbidity Survey; cross-sectional, nationally representative household survey. DATA COLLECTION An operationalization of the SMI definition set forth in the Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act identified individuals with SMI in the 12 months prior to the interview. The presence of SMI then was related to the use of mental health services in the past 12 months. PRINCIPAL FINDINGS Of the 6.2 percent of respondents who had SMI in the year prior to interview, fewer than 40 percent received stable treatment. Young adults and those living in nonrural areas were more likely to have unmet needs for treatment. The majority of those who received no treatment felt that they did not have an emotional problem requiring treatment. Among those who did recognize this need, 52 percent reported situational barriers, 46 percent reported financial barriers, and 45 percent reported perceived lack of effectiveness as reasons for not seeking treatment. The most commonly reported reason both for failing to seek treatment (72 percent) and for treatment dropout (58 percent) was wanting to solve the problem on their own. CONCLUSIONS Although changes in the financing of services are important, they are unlikely by themselves to eradicate unmet need for treatment of SMI. Efforts to increase both self-recognition of need for treatment and the patient centeredness of care also are needed.
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Affiliation(s)
- R C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA
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21
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Affiliation(s)
- M V Rao
- Department of Plant Biology and the Plant Biotechnology Center, Ohio State University, Columbus 43210, USA
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22
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Koch JR, Creelman RA, Eshita SM, Seskar M, Mullet JE, Davis KR. Ozone sensitivity in hybrid poplar correlates with insensitivity to both salicylic acid and jasmonic acid. The role of programmed cell death in lesion formation. Plant Physiol 2000; 123:487-96. [PMID: 10859179 PMCID: PMC59017 DOI: 10.1104/pp.123.2.487] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/1999] [Accepted: 02/09/2000] [Indexed: 05/18/2023]
Abstract
Our earlier studies demonstrated that the ozone-sensitive hybrid poplar clone NE-388 displays an attenuated level of ozone-, wound-, and phytopathogen-induced defense gene expression. To determine if this reduced gene activation involves signal transduction pathways dependent on salicylic acid (SA) and/or jasmonic acid (JA), we compared the responses of NE-388 and an ozone-tolerant clone, NE-245, to these signal molecules. JA levels increased in both clones in response to ozone, but only minimal increases in SA levels were measured for either clone. Treatment with SA and methyl jasmonate induced defense gene expression only in NE-245, indicating that NE-388 is insensitive to these signal molecules. DNA fragmentation, an indicator of programmed cell death (PCD), was detected in NE-245 treated with either ozone or an avirulent phytopathogen, but was not detected in NE-388. We conclude that these clones undergo two distinct mechanisms of ozone-induced lesion formation. In NE-388, lesions appear to be due to toxic cell death resulting from a limited ability to perceive and subsequently activate SA- and/or JA-mediated antioxidant defense responses. In NE-245, SA-dependent PCD precedes lesion formation via a process related to the PCD pathway activated by phytopathogenic bacteria. These results support the hypothesis that ozone triggers a hypersensitive response.
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Affiliation(s)
- J R Koch
- Department of Molecular Genetics, The Ohio State University, Columbus 43210-1002, USA
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23
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Farrell SP, Blank M, Koch JR, Munjas B, Clement DG. Predicting whether patients receive continuity of care after discharge from state hospitals: policy implications. Arch Psychiatr Nurs 1999; 13:279-85. [PMID: 10618825 DOI: 10.1016/s0883-9417(99)80059-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This article reports the results of a comprehensive study of predictors of factors influencing continuity of care for individuals discharged from state hospitals to communities. Continuity of care is defined and the predisposing, enabling and need factors are examined using a statewide database. The conceptual model is based on community support system principles, and it drives the research. The findings will influence policy, which will then affect community support system principles. Logistic regression analysis is employed as statistical analysis that lends itself to graphical form. Implications for policy and future research are presented.
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Affiliation(s)
- S P Farrell
- University of Virginia, School of Nursing, Charlottesville 22903-3320, USA
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Abstract
Increasing demands for accountability in the delivery of public mental health services are engendering organized systems of treatment outcome monitoring. As such systems are designed and implemented, it is critical that key stakeholders be involved to the greatest extent possible in developing assessment instruments and methodologies so as to ensure relevance and acceptability of the outcome management system. A multistakeholder-based initiative for developing standardized outcome assessment for public mental health services in Virginia is described. Key components of the initiative include the process by which stakeholders were enlisted, the identification of recommended assessment instruments, and a pilot project that began the evaluation of the feasibility, utility, and cost-benefit of using the instruments. To illustrate features of this initiative, the child/adolescent mental health pilot project is described in detail. Implications for behavioral health administrators and next steps for Virginia's outcome management system are discussed, highlighting the role of key stakeholders.
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Affiliation(s)
- J R Koch
- Virginia Department of Mental Health, Mental Retardation, and Substance Abuse Services, Richmond 23218, USA
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Sheldon-Keller AE, Koch JR, Watts AC, Leaf PJ. The provision of services for rural youth with serious emotional and behavioral problems: Virginia's Comprehensive Services Act. Community Ment Health J 1996; 32:481-95. [PMID: 8891414 DOI: 10.1007/bf02251047] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The problems of the delivery of mental health and social services to rural children and adolescents encapsulate many of the problems in the larger health care system. Consequently, many of the principles underlying the President's Health Security Plan are applicable to the reformation of this more specialized service system. The experience of the Commonwealth of Virginia in implementing the Comprehensive Services Act (CSA) highlights the scope of vision needed to transform an existing service delivery system into a coordinated system of care on a state-wide scale.
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Abstract
In a study to determine differences in continuity of care for state hospital patients discharged to rural and urban areas, all community mental health centers in Virginia were asked to complete a brief questionnaire about each patient discharged to the centers in fiscal year 1992. Discharges to rural centers had significantly higher levels of continuity of care on four of five dimensions of continuity. The authors conjecture that rural centers' lower staff ratios and decreased role boundaries may make them better able than urban centers to carry out the diverse tasks needed to help discharged patients resume community living.
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Affiliation(s)
- S P Farrell
- South-eastern Rural Mental Health Research Center, Charlottesville, Virginia, USA
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Carpenter JL, Obnibene AJ, Gorby EW, Neimes RE, Koch JR, Perkins WL. Antituberculosis drug resistance in south Texas. Am Rev Respir Dis 1983; 128:1055-8. [PMID: 6418044 DOI: 10.1164/arrd.1983.128.6.1055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The incidence of antituberculosis drug resistance in South Texas has been tabulated. Age, sex, and ethnic group were not found to significantly influence the incidence of resistance. The incidence of resistance to isoniazid (NH) was 16.4%, ethambutol, 3.9%, rifampin, 10.6%, and streptomycin, 7.8%. There was a 7.3% rate of resistance to INH and/or ethambutol or rifampin for any individual organism (i.e., to 2 of the 3 most commonly used antituberculosis drugs). We conclude that the incidence of single and multiple antituberculosis drug resistance in South Texas is higher than previously reported.
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Gibson DT, Koch JR, Schuld CL, Kallio RE. Oxidative degradation of aromatic hydrocarbons by microorganisms. II. Metabolism of halogenated aromatic hydrocarbons. Biochemistry 1968; 7:3795-802. [PMID: 5722247 DOI: 10.1021/bi00851a003] [Citation(s) in RCA: 177] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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29
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Gibson DT, Koch JR, Kallio RE. Oxidative degradation of aromatic hydrocarbons by microorganisms. I. Enzymatic formation of catechol from benzene. Biochemistry 1968; 7:2653-62. [PMID: 4298226 DOI: 10.1021/bi00847a031] [Citation(s) in RCA: 373] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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30
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Karl HL, Koch JR, Schneider H, Buth W, Surak JG. Synthesis of Tris(monofluorophenyl) methane and Tris (parafluorophenyl) methane. Science 1949; 110:72-3. [PMID: 17774961 DOI: 10.1126/science.110.2846.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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