Effects of tobacco use among rural African American young adult males

ScienceDaily (Aug. 1, 2011) — Tobacco related disease is a primary source of mortality for African American men. Recent studies suggest that "alternative" tobacco products may have supplanted cigarettes as the most common products used by young African Americans, according to new research published in the August 2011 issue of Otolaryngology -- Head and Neck Surgery.

While the tobacco-related disease burden is higher in African American adults, prevalence rates of tobacco use among young African American teens are surprisingly lower than those reported for whites. This picture changes in early adulthood. According to the National Survey on Drug Use and Health conducted between 2002-2005, 29.7% of white males 18 years of age and older reported smoking cigarettes in the past 30 days as compared to 33.6%% of African American men.

Study results show cigarettes were the most common product ever (54%) and currently (39.9%) used. Participants who attended school for 12 years or attended religious services were less likely to use cigarettes. Marijuana and blunts, mini-cigars, were used next most commonly. Only 35 respondents (8.9%) currently used mini-cigars. Other products, bidis/kreteks, smokeless tobacco, and pipes were used uncommonly in this sample.

"Tobacco-related disease disparities are magnified in the rural counties of the Black Belt region in rural Alabama," said study author William Carroll, MD. "The Black Belt counties are named for the rich dark soil that supported the agricultural industry of an earlier era. These counties are predominantly African American, among the poorest counties in the US, and are characterized by striking health disparities when compared to the remainder of the state and the nation as a whole."

The study included interviewer administered surveys that were completed among African American males, aged 19 to 30, in five of the Black Belt counties of rural Alabama. Participants were stratified by income (above and below poverty level) and educational level (12th grade above/below) with target representation in the stratification table informed by U.S. census data for the Black Belt counties. Distribution of survey participants within the stratification table was monitored to ensure representative sampling of the Black Belt counties.

Cigarette use prevalence in rural Alabama far exceeds that measured statewide for African American men of the same age. Effective community based intervention must target cigarette initiation and cessation in this vulnerable population.

Otolaryngology -- Head and Neck Surgery is the official scientific journal of the American Academy of Otolaryngology -- Head and Neck Surgery Foundation (AAO-HNSF). The study's authors are William R. Carroll, MD; Herman R. Foushee, Jr., PhD; Claudia M. Hardy, MPA; Tammi Floyd; Catherine F. Sinclair, MD; Isabel Scarinci, PhD.

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The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by American Academy of Otolaryngology - Head and Neck Surgery, via EurekAlert!, a service of AAAS.

Journal Reference:

W. R. Carroll, H. R. Foushee, C. M. Hardy, T. Floyd, C. F. Sinclair, I. Scarinci. Tobacco Use among Rural African American Young Adult Males. Otolaryngology -- Head and Neck Surgery, 2011; 145 (2): 259 DOI: 10.1177/0194599811404968

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Inpatient hospitalization rates appear to have increased among children and adolescents with psychiatric disorders, but decreased among elderly

ScienceDaily (Aug. 1, 2011) — Over a 10-year period, rates of short-stay inpatient hospitalizations increased for children and adolescents but decreased for elderly who had a primary psychiatric diagnosis, according to a report published Online First today by Archives of General Psychiatry, one of the JAMA/Archives journals. The article also finds the proportion of inpatient days paid for by private health insurance appeared to decline among children, adolescents and adults.

According to background information in the article, inpatient care for psychiatric conditions in short-stay settings increased from 1970 through the 1990s as long-term psychiatric hospitalization decreased. Since then, payers have reduced expenditures in these acute care settings and mental health policy makers and advocates have emphasized treatment alternatives with less restrictiveness and less negative stigma. Between 1990 and 2000, admissions to U.S. inpatient psychiatric services declined, but various data have suggested an increase in more recent years.

Joseph C. Blader, Ph.D., from the Stony Brook University School of Medicine, State University of New York, Stony Brook, evaluated trends in acute care hospitalizations for primary psychiatric diagnoses between 1996 and 2007, segmented by patient-level variables. He used demographic, clinical and payment data from the National Hospital Discharge Survey on a probability sample of discharges from short-stay facilities. Patients included in the study had a primary psychiatric diagnosis and were classified as children (ages 5 to 13 years), adolescents (ages 14 to 19 years), adults (ages 20 to 64 years) or elderly individuals (ages 65 years and older). Payers were classified as private, government or other (self-pay, no charge and other payment).

The study found increases in discharges for children and adolescents, as well as more moderate increases for adults, while discharge rates for elderly patients declined. However, the total inpatient days increased from 1,845 days per 100,000 in 1996 to 4,370 days in 2007 for children and from 5,882 days per 100,000 in 1996 to 8,247 days in 2007 for adolescents; again, a decrease was seen among elderly individuals, from 10,348 days per 100,000 in 1996 to 6,517 in 2007. Also, during the years studied, the proportion of inpatient days covered by private payers decreased among children, adolescents, and adults. Through the period surveyed, primary diagnoses of bipolar disorder increased and primary diagnoses of anxiety decreased.

"In conclusion, a substantial increase in acute care psychiatric hospitalization rates and inpatient occupancy for children and adolescents, a moderate increase in the hospitalization rate of adults, and a steep decline for elderly individuals represent significant developments in mental health treatment in the United States with potentially strong ramifications for quality of care and service financing," writes Blader. "Investigation of the clinical and organizational determinants of these trends, and their impact on patient outcomes, are vital to understanding their implications."

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by JAMA and Archives Journals.

Journal Reference:

Joseph C. Blader. Acute Inpatient Care for Psychiatric Disorders in the United States, 1996 Through 2007. Archives of General Psychiatry, 2011; DOI: 10.1001/archgenpsychiatry.2011.84

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Adolescent boys among those most affected by Washington state parental military deployment, study suggests

ScienceDaily (July 21, 2011) — In 2007, nearly two million children in the United States had at least one parent serving in the military. Military families and children, in particular, suffer from mental health problems related to long deployments.

A new study from researchers at the University of Washington (UW) concludes that parental military deployment is associated with impaired well-being among adolescents, especially adolescent boys. The study, "Adolescent well-being in Washington state military families," was published online in the American Journal of Public Health.

Lead author Sarah C. Reed, who has a master's degree from the UW School of Public Health, said the findings show that it is time to focus more on the children that are left behind in times of war. "There is a lot of research about veterans and active-duty soldiers, and how they cope or struggle when they return from a deployment," said Reed. "Those studies hit the tip of the iceberg of how families are coping and how their children are doing."

Adolescents are uniquely vulnerable to adverse health effects from parental military deployment. Healthy development, including identifying a sense of self and separation from family, can be interrupted during parents' active military service.

Media exposure and the developmental ability to understand the consequences of war may further disrupt adolescents' adjustment and coping. Teens may also have additional responsibilities at home after a parent's deployment, researchers said.

UW researchers used data from the Washington state 2008 Healthy Youth Survey, administered to more than 10,000 adolescents in 8th, 10th- and 12th grade classrooms. Female 8th graders with parents deployed to combat appear to be at risk of depression and thoughts of suicide, while male counterparts in all grades are at increased risk of impaired well-being in all of the areas examined (low quality of life, binge drinking, drug use and low academic achievement).

National research organizations, including RAND Health and the RAND National Security Research Division, have studied what's known as the "invisible wounds" of war. But Reed and her team said existing research is not enough. "We have to figure out more of what's going on within families and with children, and what's going to be helpful to mitigate the difficult things -- including risky behaviors by adolescents -- that are happening in families," she said.

Reed said that implementing or strengthening school-based programs that target affected adolescents would be a good starting point. Research and support programs also need to be beefed up, based on the research team's analysis. "There seem to be a lot of programs available but they are scattered and hard to navigate," said Reed. "In Washington state, schools have support programs, but they appear to be disconnected. There's a lot of energy in terms of people who would like to help, but a more cohesive effort in reaching out to adolescents and providing services is important."

Reed and her team are working on a follow-up study, analyzing parental military service and adolescent behaviors of school-based physical fighting, weapon carrying and gang membership.

Funding for the study was supported by a grant from the Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health & Human Services. Co-authors on the study include Janice Bell, UW assistant professor of health services, and Todd Edwards, UW research assistant professor of health services, both in the UW School of Public Health.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Washington, via EurekAlert!, a service of AAAS.

Journal Reference:

Sarah C. Reed, Janice F. Bell, Todd C Edwards. Adolescent Well-Being in Washington State Military Families. American Journal of Public Health, 2011; DOI: 10.2105/AJPH.2011.300165

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