Increasing Employee Awareness of the Signs and Symptoms of Heart Attack and the Need to Use 911 in a State Health Department

INTRODUCTION: Early recognition of the signs and symptoms of a heart attack can lead to reduced morbidity and mortality. METHODS: A workplace intervention was conducted among 523 Montana state health department employees in 2003 to increase awareness of the signs and symptoms of heart attack and the need to use 911. All employees received an Act in Time to Heart Attack Signs brochure and wallet card with their paychecks. Act in Time posters were placed in key workplace areas. A weekly e-mail message, including a contest entry opportunity addressing the signs and symptoms of heart attack, was sent to all employees. Baseline and follow-up telephone surveys were conducted to evaluate intervention effectiveness. RESULTS: Awareness of heart attack signs and symptoms and the need to call 911 increased significantly among employees from baseline to follow-up: pain or discomfort in the jaw, neck, or back (awareness increased from 69% to 91%); feeling weak, light-headed, or faint (awareness increased from 79% to 89%); call 911 if someone is having a heart attack or stroke (awareness increased from 84% to 90%). Awareness of chest pain, pain or discomfort in the arms or shoulders, and shortness of breath were more than 90% at baseline and did not increase significantly at follow-up. At baseline, 69% of respondents correctly reported five or more of the signs and symptoms of heart attack; 89% reported correctly at follow-up. CONCLUSION: This low-cost workplace intervention increased awareness of the signs and symptoms of heart attack and the need to call 911

The Juvenile Justice Behavioral Health Services Cascade: A New Framework for Measuring Unmet Substance Use Treatment Services Needs Among Adolescent Offenders

Overview—Substance use and substance use disorders are highly prevalent among youth under juvenile justice (JJ) supervision, and related to delinquency, psychopathology, social problems, risky sex and sexually transmitted infections, and health problems. However, numerous gaps exist in the identification of behavioral health (BH) problems and in the subsequent referral, initiation and retention in treatment for youth in community justice settings. This reflects both organizational and systems factors, including coordination between justice and BH agencies. Methods and Results—This paper presents a new framework, the Juvenile Justice Behavioral Health Services Cascade (“Cascade”), for measuring unmet substance use treatment needs to illustrate how the cascade approach can be useful in understanding service delivery issues and identifying strategies to improve treatment engagement and outcomes for youth under community JJ supervision. We discuss the organizational and systems barriers for linking delinquent youth to BH services, and explain how the Cascade can help understand and address these barriers. We provide a detailed description of the sequential steps and measures of the Cascade, and then offer an example of its application from the Juvenile Justice – Translational Research on Interventions for Adolescents in the Legal System project (JJ-TRIALS), a multi-site research cooperative funded by the National Institute on Drug Abuse. Conclusion—As illustrated with substance abuse treatment, the Cascade has potential for informing and guiding efforts to improve behavioral health service linkages for adolescent offenders, developing and testing interventions and policies to improve interagency and cross-systems coordination, and informing the development of measures and interventions for improving the implementation of treatment in complex multisystem service settings

Clinician identified barriers to treatment for individuals in Appalachia with opioid use disorder following release from prison: a social ecological approach

Abstract Background The non-medical use of opioids has reached epidemic levels nationwide, and rural areas have been particularly affected by increasing rates of overdose mortality as well as increases in the prison population. Individuals with opioid use disorder (OUD) are at increased risk for relapse and overdose upon reentry to the community due to decreased tolerance during incarceration. It is crucial to identify barriers to substance use disorder treatment post-release from prison because treatment can be particularly difficult to access in resource-limited rural Appalachia. Methods A social ecological framework was utilized to examine barriers to community-based substance use treatment among individuals with OUD in Appalachian Kentucky following release from prison. Semi-structured qualitative interviews with 15 social service clinicians (SSCs) employed by the Department of Corrections were conducted to identify barriers at the individual, interpersonal, organizational/institutional level, community, and systems levels. Two independent coders conducted line-by-line coding to identify key themes. Results Treatment barriers were identified across the social ecological spectrum. At the individual-level, SSCs highlighted high-risk drug use and a lack of motivation. At the interpersonal level, homogenous social networks (i.e., homophilious drug-using networks) and networks with limited treatment knowledge inhibited treatment. SSC’s high case load and probation/parole officer’s limited understanding of treatment were organizational/institutional barriers. Easy access to opioids, few treatment resources, and a lack of community support for treatment were barriers at the community level. SSC’s noted system-level barriers such as lack of transportation options, cost, and uncertainty about the implementation of the Affordable Care Act. Conclusions More rural infrastructure resources as well as additional education for family networks, corrections staff, and the community at large in Appalachia are needed to address barriers to OUD treatment. Future research should examine barriers from the perspective of other key stakeholders (e.g., clients, families of clients) and test interventions to increase access to OUD treatment

AWARENESS OF CARDIOVASCULAR DISEASE RISK IN AMERICAN INDIANS

Objectives: The objective of this study was to identify factors associated with perceived risk for cardiovascular disease (CVD) among older American Indians. Design: In 2003, a telephone survey was conducted in American Indians aged $45 years who lived on or near the seven reservations in Montana. Respondents were asked about their history of CVD and selected risk factors and their perceived risk for CVD. The prevalence of CVD and risk factors among men and women aged$45 years (N5516) was high: CVD (26% and 15%), diabetes (24% and 26%), high blood pressure (48% and 46%), high cholesterol (34% and 40%), smoking (28% and 33%), and obesity (37% vs 46%). Men with a history of CVD (87% vs 46%), high blood pressure (70% vs 44%), high cholesterol (71% vs 53%), and obesity (67% vs 52%) were more likely to report being at risk for heart disease compared to men without these conditions. Women with a history of CVD (98% vs 58%), diabetes (74% vs 60%), high blood pressure (73% vs 56%), high cholesterol (72% vs 60%), and obesity (74% vs 55%) were more likely to report being at risk for heart disease compared to women without these conditions. Neither men nor women associated smoking with their own risk for heart disease. Conclusions: The prevalence of CVD risk factors was high in this population, and most people recognized the risks associated with the modifiable CVD risk factors. However, neither men nor women who smoked reported being at risk for heart disease more frequently than nonsmokers

Utilization of Rural Substance Abuse Treatment: Methamphetamine vs. Other Stimulant Users

The purpose of this study is to use a modified version of the Anderson and Newman (1973) model of health service utilization to identify the significant correlates of substance abuse treatment recidivism, after profiling differences between methamphetamine and other stimulant users. Data were collected from face-to-face interviews with recent stimulant users (past 30 days) in rural Ohio, Arkansas, and Kentucky (n=714). Bivariate analyses distinguished differences in substance use and retrospective service utilization patterns between methamphetamine and other stimulant users. Results from the negative binomial regression indicated that selected predisposing factors, historical health factors, potential enabling factors, and current illness factors significantly promoted the utilization of substance abuse treatment. Despite high levels of recent and lifetime self-reported substance use among these rural stimulant users, treatment services were underutilized. Future studies are needed to examine substance abuse treatment in order to increase treatment utilization in rural areas

Utilization of Rural Substance Abuse Treatment: Methamphetamine vs. Other Stimulant Users

The purpose of this study is to use a modified version of the Anderson and Newman (1973) model of health service utilization to identify the significant correlates of substance abuse treatment recidivism, after profiling differences between methamphetamine and other stimulant users. Data were collected from face-to-face interviews with recent stimulant users (past 30 days) in rural Ohio, Arkansas, and Kentucky (n=714). Bivariate analyses distinguished differences in substance use and retrospective service utilization patterns between methamphetamine and other stimulant users. Results from the negative binomial regression indicated that selected predisposing factors, historical health factors, potential enabling factors, and current illness factors significantly promoted the utilization of substance abuse treatment. Despite high levels of recent and lifetime self-reported substance use among these rural stimulant users, treatment services were underutilized. Future studies are needed to examine substance abuse treatment in order to increase treatment utilization in rural areas

Rural Drug Users: Factors Associated with Substance Abuse Treatment Utilization

The purpose of this study is to use a modified version of Andersen’s (1968, 1995) Behavioral Model of Health Services Use to identify the correlates of the number of substance abuse treatment episodes received by rural drug users. Data were collected from face-to-face interviews with 711 drug users in rural areas of Ohio, Arkansas, and Kentucky. Descriptive analyses examine rural drug users’ substance use histories and retrospective substance abuse treatment service utilization patterns. A negative binomial regression model indicated that selected predisposing, historical health, and enabling factors were significantly associated with the utilization of substance abuse treatment among rural drug users. Despite high levels of recent and lifetime self-reported substance use among these rural drug users, treatment services were underutilized. Future studies are needed to examine the impact of the health care system and characteristics of the external environment associated with rural substance abuse treatment in order to increase utilization among drug users

Rural Drug Users: Factors Associated with Substance Abuse Treatment Utilization

The purpose of this study is to use a modified version of Andersen’s (1968, 1995) Behavioral Model of Health Services Use to identify the correlates of the number of substance abuse treatment episodes received by rural drug users. Data were collected from face-to-face interviews with 711 drug users in rural areas of Ohio, Arkansas, and Kentucky. Descriptive analyses examine rural drug users’ substance use histories and retrospective substance abuse treatment service utilization patterns. A negative binomial regression model indicated that selected predisposing, historical health, and enabling factors were significantly associated with the utilization of substance abuse treatment among rural drug users. Despite high levels of recent and lifetime self-reported substance use among these rural drug users, treatment services were underutilized. Future studies are needed to examine the impact of the health care system and characteristics of the external environment associated with rural substance abuse treatment in order to increase utilization among drug users