Diana Pineda

Substance use predisposes youth to various negative health outcomes and social consequences. This is of particular interest among military-connected youth in the United States. The present study sought to explore predictors of lifetime and recent substance use in a normative sample of military and not military-connected youth. Data are from a sub-sample of the California Healthy Kids Survey. The final sample consisted of 14,149 youth (13.3% military-connected). Items included in the present analyses included: present familial military affiliation (no one, parent, sibling), number of deployments (none, one, two or more), gender, grade, and race/ethnicity. Substance use items assessed whether the youth reported lifetime use of alcohol, tobacco, marijuana, other drugs, and prescription drugs; and recent (past 30 days) use of alcohol tobacco, marijuana and other drugs. Logistic regression analysis revealed that military connection (parent or sibling compared to not connected) was not si...

Substance use in adolescence has been found to co-occur with poor mental health. This is of particular interest among military-connected youth in the United States who may experience stress associated with family member deployments and may be at increased risk for both substance use and depressed mood. The present study sought to explore predictors of concurrent substance use and negative affect in a normative sample of military and not military-connected youth. Data are from a sub-sample of the California Healthy Kids Survey (n=14,149). Items in the present analyses included: present familial military affiliation (no one, parent, and sibling), number of deployments (none, one, two or more), gender, grade, and race/ethnicity. Substance use items assessed whether the youth reported past 30 days use of alcohol, tobacco, marijuana, or other drugs concurrent with self-reports of negative affect (i.e., not feeling good about life). Rates of co-occurrence were highest for those reporting ...

Purpose: The wars in Iraq and Afghanistan are adversely affecting the psychological and behavioral outcomes of children in military families. Of the studies that have explored the relationship between deployment and the behavioral health of adolescents, most have focused on assessing mental health and wellbeing. The stressors associated with being a military-connected youth, however, can predispose youth to internalizing and externalizing behaviors, including substance use. While substance use in adolescence predisposes youth to numerous negative academic, health and/or social outcomes, few studies on military-connected adolescents have focused specifically on substance use as an outcome. To our knowledge, no large-scale normative studies of adolescent substance use have been published that focus exclusively on military and non-military connected youth. The purpose of the present study is to examine the prevalence and correlates of lifetime and current substance use by military conn...

The results of implementing mental health screening within cancer screening and diagnostic programs serving low-income ethnic minority women are reported. Multi-phased screening for anxiety and depression was provided as part of structured health education and intensive case management services to improve abnormal mammogram or Pap test follow-up. Seven hundred fifty-three women were enrolled in the Screening Adherence Follow-up Program. Ten percent (n = 74) met criteria for depressive or anxiety disorder. Women with depressive or anxiety disorders were more likely to have cancer, significant psychosocial stress, fair or poor health status, a comorbid medical problem, and limitation in functional status. Forty-seven women with disorders were receiving no depression care.

The purpose of this study was to test an intervention (the Screening Adherence Follow-up Program [SAFe]) that was designed to reduce the number of known barriers to diagnostic follow-up adherence and initiation of treatment among women with low incomes who had abnormal mammogram findings. The investigators developed and implemented a highly structured, theory- and evidence-based intervention that combined health education, counseling, and systems navigation, which was delivered by a team consisting of a peer counselor and a social worker who held a masters degree. A scripted baseline telephone interview identified potential barriers to follow-up adherence and provided counseling interventions for each patient. Patients were assigned to different service intensities based on the level of risk for nonadherence. Patients with significant mental health symptoms, psychosocial stressors, or who had received a diagnosis of cancer were referred to the team social worker for further assessme...

Cervical cancer incidence and mortality rates are dramatically higher among low-income women than in the general population, in part due to poor adherence to recommended diagnostic follow-up after an index Pap test. This report describes a pilot study of the Screening Adherence Follow-Up Program (SAFe), an individualized, structured case management program designed to assess for and intervene in response to a variety of potential personal and systems barriers to follow-up adherence. Interventions included health education, counseling, and systems navigation. A clinical decision-making algorithm was used to determine service intensity and level of intervention. Services were provided to 196 low-income women, predominantly Latinas, who had either a low-grade or high-grade squamous intraepithelial lesion (LGSIL or HGSIL) abnormal Pap result. Adherence rates to at least one follow-up appointment after enrollment and baseline intervention were 83% following LGSIL and 93% for HGSIL. Over 1 year post-enrollment, 41% of women with LGSIL were fully adherent, with 42% partially adherent; 61% of women with HGSIL were fully adherent, with 32% partially adherent. In a comparison group of 369 nonenrollees (women who refused participation or could not be located for consent), adherence rates were 58% for LGSIL and 67% for HGSIL. A survey among a random sample of women served indicated that 93% were "mostly" or "very" satisfied, overall, with SAFe services. The intervention team--a peer counselor and a master's degreed social worker--addressed multiple psychosocial and systems navigation problems to reduce potential barriers to adherence, including knowledge, attitudinal, psychosocial, psychological distress, systems communication, and resource access problems. SAFe appears highly acceptable to women and may significantly enhance medical care management following an abnormal cervical screen for a carefully targeted group of women at risk for suboptimal follow-up adherence.