Parity getting worse,not better: Milliman report

Medical and behavioral (addiction and mental health) care are further apart now than they were two years ago, according to a study published by Milliman Inc. last week. The report, commissioned by the Bowman Family Foundation, shows that the gap for employees and their families between mental/addiction care and medical/surgical care is widening. The report, Addiction and Mental Health vs. Physical Health: Widening Disparities in Network Use and Provider Reimbursement, is based on actual claim data in 50 states for 37 million employees and their dependents.     

A scope-of-practice survey leading to the development of standards of practice for health promotion in higher education

To review and analyze the scope of practice of health promotion services and draft standards of quality indicators for higher education communities, the American College Health Association (ACHA) initiated a Task Force on Health Promotion in Higher Education in May 1996. Members of the task force developed a National Survey on Health Promotion and Education in Institutions of Higher Education and mailed the survey to a stratified random sample of 600 ACHA member institutions, as well as to 97 key "best-practice health promotion leaders". The larger sample produced a 75.3% response rate, and 90.7% of the key informants returned usable surveys. The authors report selected findings from both groups that chronicle the state of health promotion practice in higher education at the close of the 20th century. The task force used the findings to establish a data-driven framework for the Year 2001 Standards of Practice for Health Promotion in Higher Education.     

The health demographic profile system: current and longitudinal data base for social area analysis

The development of the Health Demographic Profile System, which is based on the 1980 census, is described. The system includes social and economic indicators designed to identify high risk target populations, in terms of mental health and general health service needs, as well as to describe the social and economic structure of both mental health service and other small geographic areas. The report describes: (1) the original system, that is, the Mental Health Demographic Profile System (MHDPS), which is based on the 1970 census, including details of the approach and content, (2) the 1980 provisional indicators and planned products, (3) plans for the development of a longitudinal system based on 1960, 1970, and 1980 data, and (4) current and future studies related to the 1980 Health Demographic Profile System.     

Single motherhood and children's health

This analysis employs the recently released Hispanic Health and Nutrition Examination Survey (hispanic HANES) and the National Health and Nutrition Examination Survey II (NHANES) to determine the effect of a mother's marital status on her report of her child's health for Mexican-American, black, and non-Hispanic white children aged 6 months to 11 years. The results reveal that single mothers report poorer overall physical health for their children than do mothers in intact marriages. Several social and cultural factors, including marital status, acculturation, and income, affect the accuracy of mother's assessments. The analysis also documented the extensive dependence of single mothers, especially minority-group mothers, on public programs. In summary, a mother's report of her child's health is the result of a complex interaction of cultural, demographic, and social class factors. This analysis revealed that marital status operates differently for 3 racial and ethnic groups, and that poverty and the stresses associated with single motherhood decrease levels of reported health for children. Analysis of a matched sample of Mexican-American children and their mothers revealed that, net of physician's assessment of a child's health, a mother's depression score is among the most significant predictors of her assessment of her child's health.     

ADOLESCENTS' INCONSISTENCY IN SELF-REPORTED SMOKING: A COMPARISON OF REPORTS IN SCHOOL AND IN HOUSEHOLD SETTINGS

Extent and sources of inconsistency in self-reported cigarette smoking between self-administered school surveys and household interviews was examined in two longitudinal multiethnic adolescent samples, the urban Transition to Nicotine Dependence in Adolescence (TND) (N = 832) and the National Longitudinal Study of Adolescent Health (Add Health) (N = 4,414). Inconsistency was defined as a positive report of smoking in school followed by a negative report in the household. Smoking questions were ascertained with paper-and-pencil instruments (PAPI-SAQ) in school in both studies, and computer-assisted personal interviewing (CAPI) in TND but audio computer-assisted self-interviewing (ACASI) in Add Health in the household. In TND, 23.5 percent of youths who reported smoking lifetime and 20.4 percent of those who reported smoking the last 12 months in the school survey reported in the household never having smoked; in Add Health, the latter was 8.6 percent. Logistic regressions identified five common correlates of inconsistency across the two studies: younger age, ethnic minority status, lesser involvement in deviant activities, having nonsmoking parents and friends. In TND, interviewing of youth and parent by the same interviewer increased inconsistent reporting. Matching the definition of inconsistent reporting and the age, gender and race/ethnic distributions of TND on an urban Add Health subsample reduced the predicted rate of inconsistency in TND. The estimated bias attributable to CAPI compared with ACASI methodology did not reach significance in the aggregated matched samples suggesting that irrespective of administration mode, household interviews decrease reporting of smoking, especially among younger, minority and more conventional youths embedded in a social network of nonsmokers.     

The MHSIP mental health report card. A consumer-oriented approach to monitoring the quality of mental health plans. Mental Health Statistics Improvement Program

Health care report cards have been endorsed as a mechanism for efficiently comparing key quantifiable aspects of performance across a range of health systems or plans. There are challenges in determining what to measure; how to gather and analyze data; and how to report, interpret, and use findings. Mental health has received little attention, and a consumer perspective is typically not included. The proposed MHSIP mental health report card (MMHRC) addresses these concerns. General issues for report cards are discussed, and the MMHRC is described in terms of content, data sources and quality, and analysis and reporting.     

THE ROMANTIC RELATIONSHIPS OF AFRICAN-AMERICAN AND WHITE ADOLESCENTS

Using data from the National Longitudinal Study of Adolescent Health (Add Health), we analyze African-American and white respondents' reports of the nature of their romantic experiences. We explore levels of companionate intimacy, including frequency of interaction and intimate self-disclosure, degree of romantic and sexual intimacy, as well as problem areas including relationship violence and nonexclusivity. African-American respondents report relationships of longer average duration relative to white youths, but overall responses reflect a somewhat less intense or intimate relationship style. These observed differences were not completely attenuated once relevant controls are introduced. We connect these findings to prior research on African-American adolescent family and peer relations, and call for additional research that supplements the behavioral emphasis of Add Health.     

Assessing MSW Students’ Integrated Behavioral Health Skills Using an Objective Structured Clinical Examination

Within the last decade, there has been a significant shift in the field of social work toward competency-based education. This article details the use of the Objective Structured Clinical Examination (OSCE) Adapted for Social Work Performance Rating Scale. We used the measure to evaluate specific practice competencies among students (n=33) participating in a professional workforce development program, funded by the Health Resources Services Administration Behavioral Health Workforce Education and Training for Professionals. We report on students’ performance and their views of the OSCE as an assessment measure and learning experience, and on the interrater reliability and consistency of the OSCE. Results can be used by other social work programs to inform the use of OSCEs to facilitate competency-based assessment.     

The Family Team at Boston Healthcare for the Homeless Program: an integrated approach to care in outreach settings

Since 1986, the Family Team at Boston Health Care for the Homeless Program has implemented an integrated, inter-professional, team-based model of care to serve families experiencing homelessness. The Family Team employs key strategies delineated by the well-established Health Care for the Homeless model, which emphasizes the importance of outreach medicine and a case management “one-stop shop approach”. We include an account of a specific case where the Family Team’s unique model helped a refugee family in Massachusetts access medical and social services otherwise more difficult to obtain. The Family Team’s onsite presence in the hotel-shelter and the team-based approach facilitated diagnosis of and successful treatment for cervical cancer in a mother of eight children. This case report suggests that the Health Care for the Homeless model of care should be more widely adopted in order to best serve homeless families.

Abbreviations: Boston Health Care for the Homeless Program (BHCHP); Emergency Assistance (EA); Health Care for the Homeless (HCH); Massachusetts General Hospital (MGH)     

Screening Adolescents for Health Risks Using Interactive Voice Response Technology

ABSTRACT

This report presents an evaluation of an interactive voice response telecommunications system developed for adolescent health risk screening. The technology provides a means to screen adolescents for general health risks and to score self-reported risk immediately. Adolescents listen to a series of prerecorded risk questions on standard touch-tone telephones and respond by pressing the appropriate keys on the keyboard. Health care workers are provided immediate feedback in the form of a summary fax report. The fax report indicates the adolescent's risk level and suggested interventions. This paper reports on an evaluation of this technology to collect self-reported risk data for 116 adolescents seen in an urban family practice center in Cleveland, Ohio. Clinical impressions of the new technology are reported for a pilot cohort of 22 physicians. The authors examine the process of using this technology to implement screening guidelines in various settings.     

Response to the Critique of the September Meningococcal Vaccine Viewpoint

Abstract

The authors report on a novel and effective peer helper program initiated by the University of Iowa Student Health Service (SHS) in fall 1992 to help prevent the development of active tuberculosis among foreign nationals attending the university. Before instituting the peer program, compliance with tuberculosis-prevention efforts for those students eligible for treatment was less than 5%. Since the peer program was initiated, compliance has risen to 50%.     

Briefly Noted

A report from the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Centers for Disease Control and Prevention published in Drug and Alcohol Dependence this month, based on a national survey of 46 opioid treatment programs (OTPs), concludes that buprenorphine and Vivitrol are not given equal footing with methadone as medications used by OTPs. All three are approved by the Food and Drug Administration for the treatment of opioid use disorder. Barriers, including costs, are identified. In addition, the report charges that services for HPV, HIV and other infectious diseases are not adequately integrated into OTPs, and that the reach of OTPs should be expanded. The report, “Characteristics and Current Clinical Practices of Opioid Treatment Programs in the United States,” is by Christopher M. Jones and colleagues; Elinore F. McCance‐Katz, M.D., Ph.D., is the senior author.     

Tribal health programme

In June 1978, the Department of Social Welfare, Government of Maharashtra, commissioned the Centre for Development Studies and Activities (CDSA), Pune, to prepare an Action Programme for the Improvement of Health in the Tribal Areas of Maharashtra. The following is the brief report submitted by CDSA.     

DO RACE AND ETHNICITY MATTER AMONG FRIENDS?

Using the National Longitudinal Study of Adolescent Health (or Add Health), a nationally representative sample of adolescents in 1994–1995, we examine if and how friendship activities differ among interracial, interethnic, and interethnic friendships of white, black, Hispanic, and Asian youths. We find that best friends are more likely than higher-order friends to be from the same ethnic group and that best friends report more shared activities during the past week than do their higher-order friendship counterparts. Hence, we argue that shared activities is a useful indicator of friendship intimacy. In general, interracial friends report fewer shared activities than do intraracial friends, although this difference is strongest for white respondents. Moreover, we find that white, Asian, and Hispanic youths all report fewer activities with their black friends. We find little difference in friendship activities between interethnic and intraethnic friendships. Our findings suggest that, even when youths manage to break racial boundaries in friendship selection, these friendships face greater challenges than do those between individuals of the same race.     

"No secrets" and beyond: recent elder abuse policy in England

This paper provides an overview of English elder abuse policy including guidelines developed for adult protection by their Department of Health in 2000, a report released from the House of Commons Health Committee in 2004 on elder abuse, related policy changes affecting older adults, the mentally incapacitated, and social care regulations, and the launching of public awareness campaigns. In contrast to the U.S., English policy subsumes elder abuse within the larger category of vulnerable adult protection, steers clear of mandatory reporting, emphasizes abuse by formal caregivers rather than domestic violence, relies on a multi-agency approach to investigation and intervention, and supports more remedial, less punitive regulatory oversight.     

American College Health Association National College Health Assessment (ACHA-NCHA) Spring 2005 Reference Group Data Report (Abridged)

Assessing and understanding the health needs and capacities of college students is paramount to creating healthy campus communities. The American College Health Association-National College Health Assessment (ACHA-NCHA) is a survey instrument developed by the ACHA in 1998 to assist institutions of higher education in achieving this goal. The ACHA-NCHA contains approximately 300 questions assessing student health status and health problems, risk and protective behaviors, access to health information, impediments to academic performance, and perceived norms across a variety of content areas (eg, injury prevention; personal safety and violence; alcohol, tobacco, and other drug use; sexual health; weight, nutrition, and exercise; mental health). Twice a year, the ACHA compiles aggregate data from participating institutions in a reference group report for data comparison. Results from the Spring 2005 Reference Group (N = 54,111) are presented in this article.     

American College Health Association-National College Health Assessment (ACHA-NCHA) Spring 2004 Reference Group data report (abridged)

Assessing and understanding the health needs and capacities of college students is paramount to creating healthy campus communities. The American College Health Association-National College Health Assessment (ACHA-NCHA) is a survey instrument developed by the ACHA in 1998 to assist institutions of higher education in achieving this goal. The ACHA-NCHA contains approximately 300 questions assessing student health status and health problems, risk and protective behaviors, access to health information, impediments to academic performance, and perceived norms across a variety of content areas, including injury prevention; personal safety and violence; alcohol, tobacco, and other drug use; sexual health; weight, nutrition, and exercise; and mental health. Twice a year, the ACHA compiles aggregate data from participating institutions in a reference group report for data comparison. Results from the Spring 2004 Reference Group (N = 47,202) are presented in this article.     

A comprehensive workplace intervention and its outcome with regard to lifestyle, health and sick leave: the AHA study

This study is a prospective multicentre cohort study entitled Work and Health in the Processing and Engineering Industries, the AHA Study (AHA is the Swedish abbreviation for the study). Four large workplaces in Sweden participated during the years from 2000 to 2003. The present report has two objectives: (1) to present a comprehensive occupational health intervention programme and (2) to evaluate this programme with a focus on lifestyle (smoking and exercise), health related quality of life (HRQoL) and sick leave. Interventions were provided on an individual and group level, including evidence-based methods for four health/focus areas (individual level) and a group intervention based on a survey-feedback methodology. The analyses in this report were exclusively employed at an organizational level. The proportion of smokers decreased at three companies and the course of the HRQoL was advantageous at two of the companies as compared to a gainfully employed reference group. A significant decrease in sick leave was revealed at one company, whereas a break in an ascending sick-leave trend appeared at a second company as compared to their respective corporate groups. This comprehensive workplace intervention programme appears to have had positive effects on smoking habits, HRQoL and sick leave.     

Masturbation and Sexual Health

Abstract

In this study we applied research examining the hypothesized benefits of masturbation in dealing with sexual problems to the urgent health crisis posed by the HIV/AIDS pandemic. This is the first study to test the hypothesized relationship between masturbation and HIV risk as predicted by the Sexual Health Model, a sex-positive approach to sexual health developed in response to the need for a more explicit focus on sexuality and relationships in HIV prevention. This is also the first study to examine the relationship between several masturbation variables (i.e., masturbation guilt, lifetime masturbation, and current masturbation) and HIV-related sexual behaviors and attitudes in a sample of African American women (N =239). Data was collected using face-to-face structured interviews as part of the Women's Initiative for Sexual Health (WISH), a randomized, controlled trial of an HIV prevention intervention based on the Sexual Health Model, targeting low income, adult African American women. Contrary to expectations, results showed that participants who reported masturbating were more likely to report having multiple partners, being in a nonmonogamous relationship and engaging in high-risk sexual behaviors. There was no significant relationship between level of masturbation guilt and HIV risk nor between masturbation and consistent condom use or attitudes toward condoms. This study adds to the growing empirical support for associations between sexual health variables and safer sex and argues for a more explicit focus on sexuality in HIV prevention.     

Home care reimbursement for technology-dependent children: Its impact on parental distress

The distress of 52 parents with a technology-dependent child at home is measured using a standardized psychological inventory. Fifty-eight percent of these parents report enough symptoms to classify them as needing psychiatric intervention. Cost savings to third-party payers are accelerating the trend toward home care (rather than institutionalized care). Yet, these findings point to an underestimated cost to families in terms of parents' psychological well-being. One factor associated with less distress for mothers is having services reimbursed through the Medicaid Model Waiver Program, which provides a comprehensive plan for home care services. In contrast, services reimbursed by private third-party payers are more variable, placing greater financial strain and uncertainty on parents, which is associated with greater psychological distress. These results suggest the need for further study of the long-term impact on parents caring for technology-dependent children at home.Reprint requests to Barbara J. Leonard, R.N., Ph.D., Maternal and Child Health Major, Division of Human Development and Nutrition, School of Public Health, Box 197 UMHC, University of Minnesota, Minneapolis, MN 55455, (612) 625-3660.This study was supported in part by BRSG Number 2-S07-RR05448-25 awarded to the University of Minnesota, School of Public Health by the Biomedical Research Grant Program, Division of Research and Resources, National Institute of Health. Additional support was provided by the Department of Health and Human Services, State of Minnesota, Academic Computing Services and Systems, University of Minnesota and special project funds from the University of Minnesota School of Public Health.Barbara J. Leonard is an Assistant Professor and Chair of the Maternal and Child Health Major, Division of Human Development and Nutrition, School of Public Health, University of Minnesota, MN 55455. Her research interests include children with developmental disabilities, their parents, and siblings. She received her Ph.D. from the University of Minnesota.Janny Dwyer Brust is a Research Fellow in the Maternal and Child Health Major at the University of Minnesota. Her research interests include issues related to the care of chronically ill children and sexually abused children. She received her M.P.H. from the University of Minnesota.Joan Patterson is an Assistant Professor in the Maternal and Child Health Major and Associate Director of the Center for Children with Chronic Illness and Disability at the University of Minnesota. Her research interests include family adaptation to chronic illness and family stress and coping. She received her Ph.D. from the University of Minnesota.