Mental and Social Health Commons^™

Foothills Academy: A Program Ranking And Comparative Analysis Of Residential Treatment Programs, William Aaron

MPA/MPP/MPFM Capstone Projects

The Foothills Academy is an all male adolescent residential treatment facility in Albany, Kentucky. As more states turn toward alternative treatment options to address the growing needs of youth suffering from mental and emotional disorders and substance abuse issues, demand for more efficient treatment programs is on the rise. To remain competitive and to administer the best treatment services for their clients, residential treatment programs must utilize industry best practices that allow efficient use of public funds. By identifying high performing programs, those programs may then be studied to identify factors key to individual program success.

My findings were consistently …

What Is The Impact Of Kentucky’S Pharmacy Recovery Network?, Benjamin Paul Clark

MPA/MPP/MPFM Capstone Projects

Problem Statement: This capstone will focus on Kentucky’s Pharmacy Recovery Network (PRN). In general, professional recovery networks are organizations that act as a liaison between professional state boards and the health professionals who are dealing with substance abuse and addictions that sometimes result in negative consequences to that individual and/or their profession. Instead of a “one-strike and you are out” approach, these organizations recognize that there is a disease process occurring. Thus, as opposed to engaging in strictly punitive measures, a rehabilitative approach is chosen to allow the health professional an opportunity to recover and successfully reenter into their profession. …

Cognitive Therapy For The Treatment Of Depressive Symptoms In Patients With Heart Failure, Rebecca L. Dekker

University of Kentucky Doctoral Dissertations

Depressive symptoms are common in patients with heart failure (HF) and adversely affect mortality, morbidity, and health-related quality of life. Cognitive therapy (CT) has been proposed as a non-pharmacological treatment for depressive symptoms in patients with HF. However, there is currently little evidence to support use of CT in patients with HF.

The purpose of this dissertation was to develop and test a brief, nurse-delivered CT intervention for the treatment of depressive symptoms in patients with HF. Prior to testing the intervention, preliminary work was conducted resulting in four manuscripts: 1) a review of the evidence for CT in treating …

Executive Deficits In Amyotrophic Lateral Sclerosis: Examining The Consequences Of Self-Regulatory Impairment On Quality Of Life, Abbey R. Roach

University of Kentucky Doctoral Dissertations

Amyotrophic Lateral Sclerosis (ALS) is a fatal neurodegenerative disease that attacks the motor system and contributes to a range of cognitive and behavioral impairments (e.g., behavioral and emotional disinhibition, planning and problem solving difficulties, impulsivity, attention, and personality change). This executive dysfunction may contribute to selfregulatory impairment across several domains, including cognitive skills, thought processes, emotion regulation, interpersonal skills, and physiology, that may be crucial to the quality of life (QOL), or well being, of patients and their caregivers. Given the relentless course and prognosis of ALS, palliative treatments for ALS should target the full range of self-regulatory deficits. Thirty-seven …

Overweight Children And Adolescents: Impact On Psychological And Social Development, Kimberly K. Mcclanahan, Marlene B. Huff, Hatim A. Omar

Pediatrics Faculty Publications

The global epidemic of childhood and adolescent overweight has become a major public health concern. Not only are these youth more likely to become obese as adults, and thus more prone to obesity-related diseases than their non overweight peers, they are also likely to suffer emotional and social effects associated with overweight. Overweight in youth has been linked to depression, low self-esteem, eating disorders, negative body image, and stigma. It appears to be bi-directional in nature, with overweight sometimes predicting certain psychological effects and psychosocial issues sometimes predicting overweight. Effective assessment and treatment of psychological and mental health issues in …

Employability After Substance Abuse Treatment In Kentucky: An Analysis Of The Kentucky Treatment Outcome Study, Steven Scrivner

MPA/MPP/MPFM Capstone Projects

Public funding of substance abuse treatment (SAT) in Kentucky dates back to the 1950s when legislators sought to curb the problem of alcoholism through legislative acts. The definition of substance abuse expanded through the years to include other substances such as cocaine, marijuana and opiates.

Employment after SAT is a critically important outcome for policymakers to consider when allocating funds because it assists in social re-integration, helps to prevent relapse and promotes economic self-sufficiency. Because of this, employment is an important factor to consider when assessing the impact SAT has on its clients (participants).

The Kentucky Alcohol and Other Drug …

Young People's Blood Alcohol Concentration And The Alcohol Consumption City Law, Brazil, Raquel De Boni, Carl G. Leukefeld, Flavio Pechansky

Center on Drug and Alcohol Research Faculty Publications

The paper assesses blood alcohol concentration and risk behaviors for traffic accidents before and after the implementation of a law which prohibits the use of alcoholic beverages on city gas stations. In Porto Alegre, Southern Brazil, young people go out at night and drive to gas station convenience stores to buy alcoholic beverages which are consumed on the premises of parking lots in gas stations. Data were obtained from self-administered questionnaires and breath analyzers in two cross-sectional collections with purposive samples of youngsters in May and July 2006 (n=62, and n=50, respectively). There were no significant differences between the groups …

Social Factors Affecting Treatment Of Cervical Cancer: Ethical Issues And Policy Implications, Shannon N. Westin, Dan Bustillos, Jacalyn B. Gano, Margaret M. Fields, Ann L. Coker, Charlotte C. Sun, Lois M. Ramondetta

CRVAW Faculty Journal Articles

Health care in the United States has become a privilege rather than a right. Patients who have the greatest need are the ones most likely to be denied this privilege. Despite recent advances in disease detection and treatment, many patients do not receive even the bare minimum of care. The high complexity of the health care system in the setting of patients with low levels of health literacy significantly affects the ability to seek and receive treatment in a timely fashion. In addition, lack of insurance, transportation, and social support further complicate access to care. To truly provide a standard …

Obesity, Hypertension, And Mental Health Evaluation In Adolescents: A Comprehensive Approach, Stefan G. Kiessling, Kimberly K. Mcclanahan, Hatim A. Omar

Pediatrics Faculty Publications

The global epidemic of childhood and adolescent obesity in developing and developed countries has become a major public health concern. Given the relation between obesity and hypertension as documented in several landmark studies, it is no surprise that as the prevalence of obesity has increased in the pediatric population, the rates of hypertension have also increased substantially. Hypertension is one of the most important risk factors for cardiovascular diseases and stroke; therefore, evaluation and initiation of appropriate treatment are extremely important in the pediatric population. Evaluation for secondary causes of hypertension, including renovascular, renoparenchymal, and endocrine disease is the approach …

The Health Implications Of Violence Against Women: Untangling The Complexities Of Actual And Chronic Effects: Part Two, Carol E. Jordan

Office for Policy Studies on Violence Against Women Publications

No abstract provided.

Depression, Sensation Seeking, And Maternal Smoking As Predictors Of Adolescent Cigarette Smoking, Judy Van De Venne, Kay Bradford, Catherine A. Martin, Megan Cox, Hatim A. Omar

Family Sciences Faculty Publications

The purpose of this study was to examine maternal and adolescent depression, maternal and teen sensation seeking, and maternal smoking, and their associations with adolescent smoking. Data were collected from a sample of 47 male and 66 female adolescents (ages 11-18 years) and their mothers from three different health clinics. The findings indicated that maternal sensation seeking was linked indirectly with adolescent smoking through teen sensation seeking, both of which were significantly associated with teen smoking (β = 0.29, p < 0.001 and β = 0.32, p < 0.001, respectively). Teen depression was associated positively with teen smoking (β = 0.24, p < 0.01) when controlling for sensation seeking behaviors. Maternal smoking was also directly linked to adolescent smoking (β = 0.20, p < 0.05). These findings underscore a potentially important role of sensation seeking in the origins of adolescent smoking, and clarify pathways of influence with regard to maternal attitudes and behaviors in subsequent teenage nicotine use.

Does Food Stamp Receipt Mediate The Relationship Between Food Insufficiency And Mental Health?, Colleen Heflin, James P. Ziliak

University of Kentucky Center for Poverty Research Discussion Paper Series

Although the Food Stamp Program is the largest entitlement program remaining in the social safety net, comparatively little is known about the potential benefits that the program may confer on recipients. In this paper we examine an important dimension of well being, mental health, and the extent to which participation in the Food Stamp Program may attenuate the effect of food insufficiency on levels of emotional distress. Using longitudinal data from a nationally representative sample of families in the Panel Study of Income Dynamics (PSID) we model emotional distress as a function of food insufficiency and other known risk factors …

Mental Illness And Barriers To Health Care Access, Charlene Powell

MPA/MPP/MPFM Capstone Projects

Statement of Problem

Access to health care in the United States is major concern, despite the fact that the country spends more per capita on health care than any other country. Individuals with mental illness may face greater access problems than the general population.

Research Question

• Does mental illness predict greater difficulties with access to health care?

Methodology

The 2004 National Health Interview Survey (NHIS) was used to examine the barriers to health care among individuals reporting a mental illness diagnosis. Nine questions relating to health access problems were drawn from the survey and combined into an access index. Multivariate …

A Model Program For Youth Suicide Prevention, Hatim A. Omar

Pediatrics Faculty Publications

Youth suicide continues to be one of the leading causes of death in the United States. Nation wide it is the third leading cause of death in the 10-24 year old age group. The rate of suicide varies somewhat from state to state. In the state of Kentucky, youth suicide is the second leading cause of death. This article describes a grass root, community-based program for youth suicide prevention and its impact on the community. The Stop Youth Suicide Campaign was launched in October 2000 and included more than 30 local agencies. This program worked. through public education, education of …

Social Support Protects Against The Negative Effects Of Partner Violence On Mental Health, Ann L. Coker, Paige H. Smith, Martie P. Thompson, Robert E. Mckeown, Lesa Bethea, Keith E. Davis

CRVAW Faculty Journal Articles

Objectives: Social support for abused women may reduce the impact of abuse on mental health, yet few studies have addressed this issue. We wish to determine associations between intimate partner violence (IPV) and mental health outcomes and to assess the protective role of abuse disclosure and support on mental health among abused women.

Methods: A cross-sectional survey was conducted of 1152 women, ages 18–65, recruited from family practice clinics from 1997 through 1999. They were screened for IPV during a brief in-clinic interview, and physical and mental health status was assessed in a follow-up interview.

Results: IPV, defined as sexual, …

Early Adolescent Through Young Adult Alcohol And Marijuana Use Trajectories: Early Predictors, Young Adult Outcomes, And Predictive Utility, Kate Flory, Donald Lynam, Richard Milich, Carl Leukefeld, Richard Clayton

Psychology Faculty Publications

The present study takes a developmental approach to subgrouping and examines the trajectories of substance use from early adolescence through young adulthood among a community sample of 481 individuals. The patterns of use were examined, subgroups were identified separately for men and women and for alcohol and marijuana, and psychosocial predictors and psychopathology outcomes that differentiated the groups were identified. The results revealed three substantially overlapping subgroups for both alcohol and marijuana: early onset, late onset, and nonuser. Although the general patterns of which dependent variables were related to group were similar for alcohol and marijuana, a closer examination revealed …

Group Therapy For Incarcerated Women Who Experienced Interpersonal Violence: A Pilot Study, Rebekah G. Bradley, Diane R. Follingstad

CRVAW Faculty Journal Articles

This study evaluated effectiveness of group therapy for incarcerated women with histories of childhood sexual and/or physical abuse. The intervention was based on a two-stage model of trauma treatment and included Dialectical Behavior Therapy skills and writing assignments. We randomly assigned 24 participants to group treatment (13 completed) and 25 to a no-contact comparison condition (18 completed). We evaluated treatment effects, using the Beck Depression Inventory, Inventory of Interpersonal Problems, and Trauma Symptom Inventory. The data demonstrate significant reductions in PTSD, mood, and interpersonal symptoms in the treatment group.

Psychosocial Stress And Cervical Neoplasia Risk, Ann L. Coker, Sharon M. Bond, Margaret M. Madeleine, Kathryn J. Luchok, Lucia Pirisi

CRVAW Faculty Journal Articles

OBJECTIVE: We assessed the association between psychosocial stress and preinvasive cervical neoplasia development controlling for HR-HPV infection.

METHODS: This case-control study enrolled low-income women receiving family planning services at health department clinics. There were 59 cases with biopsy confirmed HSIL and 163 with low-grade SIL and 160 controls with normal cervical cytology. A modified SLE scale was used to measure stressful events and the perceived impact of the event in the prior 5 years. Unconditional logistic regression was used to assess SIL risk and stressful events scores and by subscales.

RESULTS: After adjusting for age, HR-HPV infection, and lifetime number …

Adolescent Substance Use And Abuse, Finn Green

Kaleidoscope

No abstract provided.

Retrospective Analysis Of Youth Evaluated For Suicide Attempt Or Suicidal Ideation In An Emergency Room Setting, Julie Hagedorn, Hatim A. Omar

Pediatrics Faculty Publications

Suicide is the third leading cause of death in adolescents and a major contributor to morbidity in this age group. The objective of this study was to look at the demographics, major stressors and factors leading to attempting suicide as well as the methods of attempted suicide in adolescents admitted to two hospitals in a medium size city. Medical records were reviewed of adolescents admitted to two area hospitals for attempted suicide between 7/1/97-12/31/99. Coroner's data on completed suicide were also reviewed. In the study period a total of 287 persons aged 21 years or under were admitted for attempted …

Attitudes Towards Guns: Associations With Alcohol Use And Impulsive Behaviors, Catherine A. Martin, Arch G. Mainous, Harriett H. Ford, Rosalie Mainous, Susan Slade, David Martin, Hatim A. Omar

Psychiatry Faculty Publications

This study was an investigation of the association of attitudes toward guns with self-reports of alcohol/drug use, and impulsivity. Participants included 160 male and female high school students, who completed five questions regarding attitudes toward guns, in addition to questions about alcohol/drug use. Data were analyzed using t-tests. Males were more likely to feel that a home was safer with a gun. Feeling positively about a gun was associated with alcohol use in males and impulsive, aggressive behavior in males and females. A greater understanding of attitudes toward guns must take into account gender, alcohol use, and impulsive and aggressive …

Adolescent And Young Adult Substance Use: Association With Sensation Seeking, Self Esteem And Retrospective Report Of Early Pubertal Onset. A Preliminary Examination, Catherine A. Martin, T. K. Logan, Carl Leukefeld, Rich Milich, Hatim Omar, Richard Clayton

Psychology Faculty Publications

Structured questionnaires were administered to investigate the relationship between early pubertal onset, substance abuse, sensation seeking, and self-esteem. The current study presents data from 1,002 subjects, who were followed from the 6th to the 10th grades and again at the age of 20. In females, early pubertal onset was associated with greater cigarette use and lower self-esteem. Further the interaction of early pubertal onset and low self-esteem was predictive for cigarette use in females, as was early pubertal onset and high sensation seeking. Late pubertal onset was associated with decreased alcohol use and lower sensation seeking in males, with the …

Assessment Of Clinical Partner Violence Screening Tools, Ann L. Coker, Brian O. Pope, Paige H. Smith, Maureen Sanderson, James R. Hussey

CRVAW Faculty Journal Articles

Objective: to compare the Women’s Experience with Battering Scale (WEB) with the Index of Spouse Abuse-Physical Scale (ISA-P) as screening tools to identify intimate partner violence (IPV).

Methods: We conducted a large cross-sectional survey of women age 18 to 65 attending one of two family practice clinics from 1997 to 1998. All women completed both the WEB and the ISA-P and a telephone interview. We figured agreement estimates between the two tools, used stratified analyses to evaluate attributes of those more likely to screen as battered or physically assaulted, and compared associations between the WEB and ISA-P and a range …

Street-Based Female Adolescent Puerto Rican Sex Workers: Contextual Issues And Health Needs, Margarita Burgos, Donna L. Richter, Belinda Reininger, Ann L. Coker, Ruth Saunders, Margarita Alegria, Mildred Vera

CRVAW Faculty Journal Articles

Adolescent sex workers potentially have many health needs but are included rarely in health assessments; therefore, little is known about their needs or how to reach them. This study examines the motivations, social context, and health needs of street-based adolescent sex workers. The results show these youths are more likely to experience negative health outcomes, such as unintended pregnancies and sexually transmitted infections, when they are using drugs or are depressed. These findings suggest the need for comprehensive programming to include individual, interpersonal, and greater environmental interventions. Examples for reaching adolescent sex workers are discussed.

Violence Against Women In Sierra Leone: Frequency And Correlates Of Intimate Partner Violence And Forced Sexual Intercourse, Ann L. Coker, Donna L. Richter

CRVAW Faculty Journal Articles

Violence against women is a significant public health problem which impacts women, men, and children. Little is known about the frequency or correlates of violence against women in Africa. In this cross-sectional study, we found that 66.7% of 144 women surveyed in a study of AIDS knowledge, attitude, and behaviours, report being beaten by an intimate male partner and 50.7% report having ever been forced to have sexual intercourse; 76.6% of women report either forced sex or intimate partner violence. Circumcised women were most likely to report intimate partner violence and forced sexual intercourse. To improve the health of women …

Ambulatory Electromyogram Activity In The Upper Trapezius Region: Patients With Muscle Pain Vs. Pain-Free Control Subjects, Charles R. Carlson, Kennen T. Wynn, John Edwards, Jeffrey P. Okeson, Arthur J. Nitz, Don E. Workman, Jeffrey Cassisi

CRVAW Faculty Journal Articles

Study Design: This study compared the ambulatory electromyogram activity of persons reporting pain in the shoulder and cervical regions with an equal group of persons not reporting such pain. Ambulatory electromyogram data were obtained over 3-day periods. In addition, all participants completed several standard psychological questionnaires.

Objectives: The results were analyzed with inferential statistics to determine whether subjects reporting significant pain in the shoulder and cervical regions had greater ambulatory electromyogram activity than an equal number of subjects not reporting pain.

Summary of Background Data: Considerable controversy exists regarding the role of muscle activity in the etiology and maintenance of …

Correlates And Consequences Of Early Initiation Of Sexual Intercourse, Ann L. Coker, Donna L. Richter, Robert F. Valois, Robert E. Mckeown, Carol Z. Garrison, Murray L. Vincent

CRVAW Faculty Journal Articles

This cross-sectional analysis of the 1991 CDC Youth Risk Behavior Survey explored factors associated with an early age at first sexual intercourse. Almost 18% of White males, 49% of Black males, 5% of White females and 12% of Black females were sexually active before age 13. Carrying a weapon to school, fighting, and early (< age 13) experimentation with cigarettes and alcohol were associated with early initiation of sexual activity for all four race and gender groupings. Those initiating sexual activity early had greater numbers of partners but were 50% less likely to use condoms regularly and were two-seven times more likely to have been pregnant or caused a pregnancy. Females who initiated sexual activity early were more likely to have had a sexually transmitted disease (STD). Interventions to postpone sexual activity need to be tailored to the ethnic and gender differences observed in these analyses. Interventions must begin before age 13 and should be comprehensive school-based efforts.

An Unusual Reaction To Opioid Blockade With Naltrexone In A Case Of Posttraumatic Stress Disorder, Paloma Ibarra, Stephen P. Bruehl, James A. Mccubbin, Charles R. Carlson, John F. Wilson, Jane A. Norton, Thomas B. Montgomery

CRVAW Faculty Journal Articles

An unusual behavioral and cardiovascular reaction was observed during opioid blockade with naltrexone in a 32-year-old male who met DSM III-R criteria for post-traumatic stress disorder (PTSD). As part of an ongoing placebo-controlled investigation of the effects of naltrexone on laboratory and ambulatory blood pressure reactivity, this participant reported experiencing feelings of rage, explosive behavior, and other unpleasant symptoms. When compared to all other subjects (N=24), this individual showed significantly greater effects of naltrexone on blood pressure reactivity during the laboratory stressor. His ambulatory blood pressures, when compared to placebo, were significantly increased during the 24-hr period following …

Predisposing Psychological Factors In The Development Of Reflex Sympathetic Dystrophy: A Review Of The Empirical Evidence, Stephen Bruehl, Charles R. Carlson

CRVAW Faculty Journal Articles

Objective: To examine the literature for evidence that psychological factors predispose certain individuals to development of reflex sympathetic dystrophy (RSD).

Data Sources: English-language journal articles that described psychological data on patients diagnosed with RSD, identified through Medline search and bibliography reviews.

Study Selection: All studies reporting data on psychological factors in adult, adolescent, or child patients with RSD were included.

Data Extraction: We extracted data regarding psychological factors in patients with RSD and assessed validity of these studies through evaluation against seven basic research criteria.

Data Synthesis: Of the 20 articles reviewed, 15 reported the presence of depression, anxiety, and/or …

A Controlled Evaluation Of Devotional Meditation And Progressive Muscle Relaxation, Charles R. Carlson, Panayiota E. Bacaseta, Dexter A. Simanton

CRVAW Faculty Journal Articles

The present study was conducted to determine the effects of devotional meditation (DM), defined as a period of prayer and quiet reading and pondering of biblical material, on physiological and psychological variables related to stress. It was hypothesized that religious persons engaging in DM experience physiological and psychological changes similar to those reported for persons using progressive relaxation (PR) exercises. Thirty-six participants, equally divided by sex into 3 groups: DM, PR, and a Wait List Control, underwent extensive psychophysiological assessment prior to and following a systematic introductio to either DM or PR. The hypothesis that DM could generate positive physiological …