Association Between Chronic Disease and Substance Use Among Older Adults in Tennessee

Background: Substance use and misuse have a negative impact on health care outcomes, specifically in the older adult population. Older adults are at risk due to several factors occurring toward the end of life such as changing family dynamics, loss of friends and loved ones, and chronic diseases. Substance use in older adults with chronic diseases in rural areas remains poorly studied. This study examines older adults greater than 55 of age in the state of Tennessee, U.S.A. Design and methods: Data was extracted from the 2019 National Behavioral Risk Factor Surveillance System (BRFSS) with a subsample for the State of Tennessee (N = 6242) and individuals over age 55 (N = 3389). Results: At least 33.7% (N = 1143) of older adults have a chronic disease, and 24.4% (N = 828) have at least two or more chronic diseases. Alcohol use in the past month was reported in 29.4% of older adults; however, chronic disease status was not associated with alcohol use. Marijuana use and smoking in the past month were significant for older adults with two or more chronic diseases. Low income and less high school education were associated with chronic disease and smoking. Conclusions: Marijuana use and smoking were found to be significant in older adults with chronic disease, but not with alcohol use. Preventative measures such as screening tools, education, and providing resources to patients should be targeted to populations at risk to promote overall health outcomes

Early Age of Cannabis Initiation and Its Association With Suicidal Behaviors

Background: Suicide rates in the U.S. have continued to rise over the last 2 decades. The increased availability and broader legalization of cannabis is a public health concern, particularly among adolescents. The objective of this study was to examine the association between the age of cannabis initiation and lifetime suicidal ideations and attempts in a sample of adults aged 18 or older. Methods: Data are from the Collaborative Psychiatric Epidemiology Surveys (CPES), 2001 to 2003 (N = 15 238). The primary objective of the CPES was to collect data about the prevalence of mental disorders, impairments associated with these disorders, and their treatment patterns from representative samples of majority and minority adult populations in the U.S. Logistic regression analyses were conducted to test the association between cannabis initiation age (early ⩽14 years old; later \u3e14 years old) and outcomes of lifetime suicide ideation and attempts. Cigarette use, cannabis use, gender, income, race, education, and age were controlled for the analyses. Results: Overall, 12.5% of participants reported suicide ideation, while 4.2% reported attempt. Early cannabis use was associated with a higher risk of suicide ideation (AOR = 3.32, 95% CI [2.75, 3.80]) than later cannabis use (AOR = 2.15, 95% CI [1.92, 2.39]). Early cannabis use was associated with a higher risk of suicide attempt (AOR = 4.38, 95% CI [3.48, 5.52]) than later cannabis use (AOR = 2.56, 95% CI [2.14, 3.06]). Wald chi-squared tests revealed significant differences between the early and late initiation for both ideation (χ2 = 26.99; P \u3c .001) and attempts (χ2 = 26.02; P \u3c .001). Conclusions: Significant associations were found between early initiation of cannabis and suicide behaviors. As suicide rates continue to rise, it is recommended that clinicians, treatment providers, and other professionals consider the use of cannabis at an early age as a risk for subsequent suicide behaviors

Key Determinants of Using Telehealth Technologies Among Underserved Populations from the Perspective of Patients and Providers

Background: The utilization of telehealth has had a substantial impact on transforming and enhancing the methods by which healthcare is presently delivered. The potential benefits of telehealth in improving the health of vulnerable populations and underserved communities are substantial. The aims of this study were to examine the association between social determinants of health and patient perceptions of their experiences with telehealth. We will analyze how perceptions differ across specialization, race, gender, and other key determinants; examine how patient’s self-rated physical health and mental health influences perceptions and attitudes about telehealth utilization; and evaluate differences in perceptions and attitudes, experience with patient interactions and overall telehealth experiences between mental health providers and non-mental health providers. Methods: A scoping review was completed to explore literature regarding telehealth administration and underserved populations following the PRIMSA-ScR guidelines. Multivariable logistic regression was then conducted to assess the relationship between self-rated mental health and self-rated physical health and the primary predictor variables telehealth usability, telehealth satisfaction, and telehealth experiences. Finally, a mixed-methods study was conducted to evaluate differences in perceptions and attitudes, experience with patient interactions and overall telehealth experiences mental health-care providers and non-mental healthcare providers. Results: The scoping literature review highlights how telehealth is used in diverse settings, but more research needs to be done to determine best practices for both healthcare providers and patients utilizing telehealth. The study focused on self-reported health found significant associations between high mean scores on telehealth usability, telehealth satisfaction, and telehealth experiences and good self-reported mental and physical health. Lastly, the study looking at provider differences highlighted that the reliability of the telemedicine platform, the ability to trust the telemedicine application, and video visits being a convenient form of healthcare delivery was greater for mental healthcare providers than non-mental healthcare providers. Implications: These findings highlight the need for studies examining telehealth satisfaction, telehealth usability and telehealth experiences amongst providers and patients in underserved areas. Further research is needed to gain a deeper understanding of the telehealth access requirements of underserved communities and can aid in the development of evidence-based guidelines for the delivery of telehealth services

Experiences, Perceptions, and Usage of Telehealth Services Among Mental Healthcare Providers and Non-Mental Healthcare Providers

Background Due to the COVID-19 pandemic, there was a significant reduction in in-person healthcare visits as a precautionary measure to minimize the risk of infection for both patients and healthcare provides. Consequently, there was a remarkable surge in the adoption of telehealth services, although mental healthcare services were already using it more frequently than primary and specialty care services before the pandemic. Despite the continued increase in telehealth services, there are differing views among healthcare providers on the efficacy of providing healthcare services remotely, leading to an opportunity to investigate this matter further. Objective The primary goal of this study was to evaluate differences in perceptions and attitudes, experience with patient interactions and overall telehealth experiences between mental health providers and non-mental health providers. Methods The proposed study collected primary data through surveying providers across the United States from November 2022-March 2023. The surveys were conducted through REDCap, and disseminated through research staff outreach and recruitment. Providers were asked to complete a 33-item survey, which took them about 30 minutes to finish and queried them about their satisfaction, utilization, and experiences with telehealth. The provider survey was disseminated to both mental health providers and non-mental health providers who use telehealth technology. Descriptive analysis was conducted to determine the characteristics of the population surveyed. Data was then dichotomized by mental health providers vs. non-mental health providers. Differences in mean responses for all variables between mental health and non-mental health providers was assessed using Mann-Whitney U (MW) tests. Results A Mann-Whitney Wilcoxon test indicated that the satisfaction with the telemedicine platform was greater for non-mental healthcare providers than mental healthcare providers (p \u3c .05). A Mann-Whitney Wilcoxon test indicated that the reliability of the telemedicine app for facilitating health care services, that the ability to trust the telemedicine application to work, the lack of physical contact during a video visit being a problem, the video visits being a convenient form of healthcare delivery, the visits on the telehealth system are the same as in-person visits, and that continued use of telehealth services in the future was greater for mental healthcare providers than non-mental healthcare providers (p \u3c .05). Conclusions Looking forward, we expect to see more extensive studies involving providers from various regions and the implementation of additional approaches to enhance their experiences

Association between Financial Barriers to Healthcare Access and Mental Health Outcomes in Tennessee

Objectives: A large number of people cannot afford healthcare services in the United States. Researchers have studied the impact of lack of affordability of health care on the outcomes of various physical conditions. Mental health disorders have emerged as a major public health challenge during the past decade. The lack of affordability of health care also may contribute to the burden of mental health. This research focuses on the association between financial barriers to health care and mental health outcomes in the US state of Tennessee. Methods: We used cross-sectional data contained in the 2019 US Behavioral Risk Factor Surveillance System (BRFSS). We extracted data for the state of Tennessee, which included 6242 adults aged 18 years or older. Multinomial regression analyses were conducted to test the association between not being able to see a doctor with the number of mentally unhealthy days during the past month. We coded the outcome as a three-level variable, ≥20 past-month mentally unhealthy days, 1 to 20 past-month mentally unhealthy days, and 0 past-month mentally unhealthy days. The covariates examined included self-reported alcohol use, self-reported marijuana use, and other demographic variables. Results: Overall, 11.0% of participants reported ≥20 past-month mentally unhealthy days and 24.0% reported 1 to 20 past-month mentally unhealthy days. More than 13% of study participants reported they could not see a doctor because of the cost in the past 12 months. The inability to see a doctor because of the cost of care was associated with a higher risk of ≥20 past-month mentally unhealthy days (relative risk ratio 3.18; 95% confidence interval 2.57-3.92, P \u3c 0.001) and 1 to 19 past-month mentally unhealthy days (relative risk ratio 1.94; 95% confidence interval 1.63-2.32, P \u3c 0.001). Conclusions: Statistically significant associations were observed between the inability to see a doctor when needed because of cost and increased days of poorer mental health outcomes. This research has potential policy implications in the postcoronavirus disease 2019 era with healthcare transformation and significant financial impact

Mental Health and Substance Use among Caregivers in Rural and Non-Metropolitan Areas

Approximately 1 in 5 adults in the U.S. identify as a caregiver. Caregiver is defined as providing care for friends, family members or others on a regular basis, who need medical care. Providing care may be rewarding, it may also be significant burden on the caregiver. Prior research has found that caregiver status has been linked to increase levels of stress. This may be of an increased burden in rural/non-metropolitan areas, where transportation is limited, along with other challenges including access to care, and other factors. The proposed study examines the association of caregiver status and substance use (marijuana, alcohol, and smoking) and depression among rural populations, using a nationally representative sample. We used cross-sectional data from the 2021 Behavioral Risk Factor Surveillance System a nationally representative U.S. telephone-based survey of adults over the age of 18 years and extracted data for non-metropolitan/rural counties. Logistic regression analyses were conducted separately to test the association between self-identified caregiver status and three outcomes, including depression, current marijuana use, and current alcohol use. We controlled for past month alcohol use, income, race, educational status, and age. Caregiver status was identified based on providing care or assistance to a friend of family member over the last 30 days. Overall, 21.7% (n=13,653) of our participants self-identified as a caregiver, while 19.5% reported depression, past month alcohol use (48.2%) , past month smoking (13.5%), and past month marijuana use (4.2%). Self-identified caregiver status was associated with higher odds of depression (OR=1.51, 95% CI, 1.44,1.58), past month marijuana use (OR =1.74, 95% CI, 1.51, 2.01), and past month smoking (OR=1.38 95% CI, 1.31, 1.45). Self-identified caregiver status was not associated with past month alcohol use. The data indicates a need for intervention concerning caregivers in rural areas. These caregivers are working without fiscal compensation for their efforts, as a result, they are more likely to be suffering from depression, and use marijuana and/or tobacco, as a coping mechanism. A few feasible interventions which could be incorporated include professionally led group psycho-social support programs, expanding telehealth services, or developing a standardized protocol for the clinicians of the caregivers. If incorporated in rural areas, these interventions could have a significant impact on the mental/ physical health of caregivers in rural areas. For the areas which do have interventions in place for rural caregivers, expanding awareness and access to the impact of them should be explored