Mandatory Minimum Sentencing Policies and Cocaine Use in the U.S., 1985–2013

Background: As of May 2017, the United States federal government renewed its prioritization for the enforcement of mandatory minimum sentences for illicit drug offenses. While the effect of such policies on racial disparities in incarceration is well-documented, less is known about the extent to which these laws are associated with decreased drug use. This study aims to identify changes in cocaine use associated with mandatory minimum sentencing policies by examining differential sentences for powder and crack cocaine set by the Anti-Drug Abuse Act (ADAA) (100:1) and the Fair Sentencing Act (FSA), which reduced the disparate sentencing to 18:1.Methods: Using data from National Survey on Drug Use and Health, we examined past-year cocaine use before and after implementation of the ADAA (1985–1990, N = 21,296) and FSA (2009–2013, N = 130,574). We used weighted logistic regressions and Z-tests across models to identify differential change in use between crack and powder cocaine. Prescription drug misuse, or use outside prescribed indication or dose, was modeled as a negative control to identify underlying drug trends not related to sentencing policies.Results: Despite harsher ADAA penalties for crack compared to powder cocaine, there was no decrease in crack use following implementation of sentencing policies (odds ratio (OR): 0.72, p = 0.13), although both powder cocaine use and misuse of prescription drugs (the negative control) decreased (OR: 0.59, p \u3c 0.01; OR: 0.42, p \u3c 0.01 respectively). Furthermore, there was no change in crack use following the FSA, but powder cocaine use decreased, despite no changes to powder cocaine sentences (OR: 0.81, p = 0.02), suggesting that drug use is driven by factors not associated with sentencing policy. Conclusions: Despite harsher penalties for crack versus powder cocaine, crack use declined less than powder cocaine and even less than drugs not included in sentencing policies. These findings suggest that mandatory minimum sentencing may not be an effective method of deterring cocaine use

Mandatory Minimum Sentencing Policies and Cocaine Use in the U.S., 1985–2013

Background: As of May 2017, the United States federal government renewed its prioritization for the enforcement of mandatory minimum sentences for illicit drug offenses. While the effect of such policies on racial disparities in incarceration is well-documented, less is known about the extent to which these laws are associated with decreased drug use. This study aims to identify changes in cocaine use associated with mandatory minimum sentencing policies by examining differential sentences for powder and crack cocaine set by the Anti-Drug Abuse Act (ADAA) (100:1) and the Fair Sentencing Act (FSA), which reduced the disparate sentencing to 18:1.Methods: Using data from National Survey on Drug Use and Health, we examined past-year cocaine use before and after implementation of the ADAA (1985–1990, N = 21,296) and FSA (2009–2013, N = 130,574). We used weighted logistic regressions and Z-tests across models to identify differential change in use between crack and powder cocaine. Prescription drug misuse, or use outside prescribed indication or dose, was modeled as a negative control to identify underlying drug trends not related to sentencing policies.Results: Despite harsher ADAA penalties for crack compared to powder cocaine, there was no decrease in crack use following implementation of sentencing policies (odds ratio (OR): 0.72, p = 0.13), although both powder cocaine use and misuse of prescription drugs (the negative control) decreased (OR: 0.59, p \u3c 0.01; OR: 0.42, p \u3c 0.01 respectively). Furthermore, there was no change in crack use following the FSA, but powder cocaine use decreased, despite no changes to powder cocaine sentences (OR: 0.81, p = 0.02), suggesting that drug use is driven by factors not associated with sentencing policy. Conclusions: Despite harsher penalties for crack versus powder cocaine, crack use declined less than powder cocaine and even less than drugs not included in sentencing policies. These findings suggest that mandatory minimum sentencing may not be an effective method of deterring cocaine use

Study Protocol for Investigating Physician Communication Behaviours that Link Physician Implicit Racial Bias and Patient Outcomes in Black Patients with Type 2 Diabetes Using an Exploratory Sequential Mixed Methods Design

Introduction Patient-physician racial discordance is associated with Black patient reports of dissatisfaction and mistrust, which in turn are associated with poor adherence to treatment recommendations and underutilisation of healthcare. Research further has shown that patient dissatisfaction and mistrust are magnified particularly when physicians hold high levels of implicit racial bias. This suggests that physician implicit racial bias manifests in their communication behaviours during medical interactions. The overall goal of this research is to identify physician communication behaviours that link physician implicit racial bias and Black patient immediate (patient-reported satisfaction and trust) and long-term outcomes (eg, medication adherence, self-management and healthcare utilisation) as well as clinical indicators of diabetes control (eg, blood pressure, HbA1c and history of diabetes complication). Methods and analysis Using an exploratory sequential mixed methods research design, we will collect data from approximately 30 family medicine physicians and 300 Black patients with type 2 diabetes mellitus. The data sources will include one physician survey, three patient surveys, medical interaction videos, video elicitation interviews and medical chart reviews. Physician implicit racial bias will be assessed with the physician survey, and patient outcomes will be assessed with the patient surveys and medical chart reviews. In video elicitation interviews, a subset of patients (approximately 20–40) will watch their own interactions while being monitored physiologically to identify evocative physician behaviours. Information from the interview will determine which physician communication behaviours will be coded from medical interactions videos. Coding will be done independently by two trained coders. A series of statistical analyses (zero-order correlations, partial correlations, regressions) will be conducted to identify physician behaviours that are associated significantly with both physician implicit racial bias and patient outcomes

Loneliness, Depression, and Inflammation: Evidence from the Multi-Ethnic Study of Atherosclerosis

Objective Both objective and subjective aspects of social isolation have been associated with alterations in immune markers relevant to multiple chronic diseases among older adults. However, these associations may be confounded by health status, and it is unclear whether these social factors are associated with immune functioning among relatively healthy adults. The goal of this study was to examine the associations between perceived loneliness and circulating levels of inflammatory markers among a diverse sample of adults. Methods Data come from a subset of the Multi-Ethnic Study of Atherosclerosis (n = 441). Loneliness was measured by three items derived from the UCLA Loneliness Scale. The association between loneliness and C-reactive protein (CRP) and fibrinogen was assessed using multivariable linear regression analyses. Models were adjusted for demographic and health characteristics. Results Approximately 50% of participants reported that they hardly ever felt lonely and 17.2% felt highly lonely. Individuals who were unmarried/unpartnered or with higher depressive symptoms were more likely to report being highly lonely. There was no relationship between perceived loneliness and ln(CRP) (β = -0.051, p = 0.239) adjusting for demographic and health characteristics. Loneliness was inversely associated with ln(fibrinogen) (β = -0.091, p = 0.040), although the absolute magnitude of this relationship was small. Conclusion These results indicate that loneliness is not positively associated with fibrinogen or CRP among relatively healthy middle-aged adults

Steigerung der Zähigkeit von isotaktischem Polypropylen durch Kontrolle der Morphologie mittels 1,3,5-Benzoltrisamiden

BackgroundWhile restrictive and compensatory eating disorders (e.g. anorexia and bulimia) are associated with elevated risk of suicide, less is known about binge eating disorder (BED). There is suggestive evidence of a U-shaped relationship between body mass index (BMI) and completed suicide, but fewer studies on suicidal ideation or attempts. This study examined the association between BED, BMI, and suicidality, and assessed whether these relationships varied by gender. Methods Data come from the Collaborative Psychiatric Epidemiologic Surveys (N = 14,497). Binge episodes and BED were assessed using the Composite International Diagnostic Inventory (CIDI). BMI was calculated from self-reported height and weight. Suicidal ideation/attempts were assessed using the CIDI. Weighted logistic regression was used to assess the association between binging/BED, BMI and suicidality. Interaction terms were used to assess whether the relationship between BMI and suicidality was moderated by binging/BED, and whether the relationships between binging/BED and BMI differed by gender. Results One-third of adults with BED had a history of suicidality, compared to 19% of those without. Both binging (OR: 1.95, 95% CI: 1.50–2.53) and BED (OR: 2.01, 95% CI: 1.41–2.86) were associated with suicidality in fully-adjusted models. BMI was associated with suicidality in a curvilinear manner, and this relationship was exacerbated by binging/BED (ORBinge eating x BMI: 1.04, 95% CI: 1.01–1.09, p \u3c 0.05). The relationship between BMI and suicidality did not differ by gender (ORgender x BMI: 1.00, p \u3c 0.770). However, the relationship between binge eating and suicidality was stronger for women relative to men (ORgender X binge: 1.87, p \u3c 0.012). Conclusions Binge eating, even below the threshold for BED, is associated with suicidality. BMI is associated with suicidality in a curvilinear manner, and the BMI-suicidality relationship is potentiated by binge eating/BED. Findings support the thoughtful integration of psychiatric care into weight loss programs for adults with a history of binging behavior

Sex and sexual orientation disparities in adverse childhood experiences and early age at sexual debut in the United States: Results from a nationally representative sample

Adverse childhood experiences (ACEs) have been linked to early sexual debut, which has been found to be associated with multiple adverse health outcomes. Sexual minorities and men tend to have earlier sexual debut compared to heterosexual populations and women, respectively. However, studies examining the association between ACEs and early sexual debut among men and sexual minorities are lacking. The aim of this study was to examine the sex and sexual orientation disparities in the association between ACEs and age at sexual debut. Data were obtained from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Logistic and linear regression model were used to obtain crude and adjusted estimates and 95% confidence intervals adjusting for age, race/ethnicity, income, education, insurance and marital status for the association between ACEs (neglect, physical/psychological abuse, sexual abuse, parental violence, and parental incarceration and psychopathology) and early sexual debut. Analyses were stratified by sex and sexual orientation. Larger effect estimates depicting the association between ACEs and sexual debut were seen for women compared to men, and among sexual minorities, particularly among men who have sex with men (MSM) and women who have sex with women (WSW), compared to heterosexuals. Sexual health education programs with a focus on delaying sexual debut among children and adolescents should also consider addressing ACEs, such as neglect, physical, psychological and sexual abuse, witnessing parental violence, and parental incarceration and psychopathology. Public health practitioners, researchers and sexual health education curriculum coordinators should consider these differences by sex and sexual orientation when designing these programs

Racial and Ethnic Differences in the Association Between Obesity and Depression in Women

Background: It is generally accepted that obesity and depression are positively related in women. Very little prior research, however, has examined potential variation in this relationship across different racial/ethnic groups. This paper examines the association between obesity and depression in non-Hispanic White, non-Hispanic Black, and Mexican American women. Methods: The sample included women aged 20 years and older in the 2005?2008 National Health and Nutrition Examination Surveys (n=3666). Logistic regression was used to assess the relationship between obesity and depression syndrome (assessed using the Patient Health Questionnaire-9), after adjusting for covariates. We then investigated whether this association varied by race/ethnicity. Results: Overall, obese women showed a 73% greater odds of depression (odds ratio [OR]=1.73; 95% confidence interval [CI]=1.19, 2.53) compared with normal weight women. This association varied significantly, however, by race/ethnicity. The obesity-depression associations for both Black and Mexican American women were different from the positive association found for White women (ORBlack*obese=0.24; 95% CI=0.10,0.54; ORMexican American*obese=0.42; 95% CI=1.04). Among White women, obesity was associated with significantly greater likelihood of depression (OR=2.37; 95% CI=1.41, 4.00) compared to normal weight. Among Black women, although not statistically significant, results are suggestive that obesity was inversely associated with depression (OR=0.56; 95% CI=0.28, 1.12) relative to normal weight. Among Mexican American women, obesity was not associated with depression (OR=1.01; 95% CI=0.59, 1.72). Conclusions: The results reveal that the association between obesity and depression varies by racial/ethnic categorization. White, but not Black or Mexican American women showed a positive association. Next research steps could include examination of factors that vary by race/ethnicity that may link obesity to depression.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140124/1/jwh.2012.4111.pd

Coming unmoored: Disproportionate increases in obesity prevalence among young, disadvantaged white women

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109980/1/oby20913.pd

Co-occurring conditions and health-related quality of life in patients with bipolar disorder

OBJECTIVE: To assess changes in health-related quality of life (HRQOL) and to determine whether co-occurring substance use and medical comorbidities were associated with worse HRQOL over a 1-year period in a naturalistic sample of patients with bipolar disorder. METHOD: Patients enrolled in the Continuous Improvement for Veterans in Care: Mood Disorders (CIVIC-MD), a large prospective study from July 2004 to July 2006, completed baseline and follow-up assessments related to bipolar symptoms, comorbidity, and Short Form 12 HRQOL assessment at baseline and at 1 year later. Predictors of changes in HRQOL mental and physical health component scores were determined, using multivariable linear regression models and path analyses. RESULTS: Of 334 participants, the mean age was 49 years (standard deviation [SD] = 10.1 years; range = 21-78 years), 15.9% women, and 10.8% African American. At baseline, 19.8% reported hazardous drinking, 25.5% reported illicit drug use, and the mean number of co-occurring medical conditions was 2.70 (SD = 2.02). Illicit drug use was associated with worse mental HRQOL (beta = -2.01; p < .05), and increased number of medical comorbidities was significantly associated with worse physical HRQOL over time (beta = -0.71; p < .01). Depressive symptoms exhibited a strong and consistent influence on mental health scores over time, but path analyses revealed that they did not seem to mediate effects of comorbidities on lower HRQOL. CONCLUSIONS: Illicit drug use and medical comorbidity negatively affected mental HRQOL over time, independent of bipolar symptoms, suggesting the need for interventions that address physical health and drug treatment needs for patients with bipolar disorder.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78172/1/894.pd