Nikki Wooten | University of South Carolina (original) (raw)
Projects by Nikki Wooten
Click to edit project descriptionFunded by the Wounded Warrior Project, Principal Investigator (s... more Click to edit project descriptionFunded by the Wounded Warrior Project, Principal Investigator (subaward), in collaboration with the Military Family Research Institute at Purdue University, the South Carolina National Guard, and the SC Department of Mental Health of the South Carolina STAR Behavioral Health Providers' Training Program (SC STAR). SC STAR will provide behavioral health training to civilian behavioral health providers to provider services to military personnel, veterans, and their families. We will also maintain a registry of South Carolina behavioral health providers who have received training to provide services to military and veteran populations.
This K01 Mentored Research Scientist Career Development Award, the Army Warrior Care Project (AWC... more This K01 Mentored Research Scientist Career Development Award, the Army Warrior Care Project (AWCP), supports the candidate in developing an independent research career to investigate modifiable risk and protective factors associated with behavioral health problems (substance use and mental health problems) and behavioral health service utilization in Army service members who deployed to Iraq and Afghanistan. The AWCP specifically focuses on Army service members assigned to Warrior Transition Units (WTUs), which are co-located with military treatment facilities and provide comprehensive behavioral health care to ill, injured, and wounded service members. Career development objectives include training the candidate in advanced biostatistical, epidemiological, and health services research methods to conduct population-based research using a unique database consisting of Department of Defense Military Health System data. The specific aims of the proposed AWCP are to: (1) determine the probability of WTU assignment and estimate the treatment effect of receiving comprehensive behavioral health care in WTUs among Army service members returning from Iraq and Afghanistan deployments FY2008 to FY2012; (2) determine demographic, military, deployment, and post-deployment behavioral health factors associated with WTU assignment and onset of post-deployment substance use problems and/or diagnoses among Army WTU members; and (3) identify the military-related
pre-disposing, enabling, and need factors associated with post-deployment behavioral health problems and behavioral health service utilization among Army WTU members. The moderating effect of gender and race/ethnicity on post-deployment behavioral health status and behavioral health service utilization will also be examined.
The AWCP is innovative because it focuses on: comprehensive behavioral health care in Army WTUs, gender and racial/ethnic differences in access to and receipt of military behavioral health care, and use of cross-sectional and longitudinal data, including objective (medical claims) and subjective (self-report) Military Health System data.
See Warrior Care Project at http://wcp.sc.edu for additional information,
Papers by Nikki Wooten
Journal of Human Behavior in the Social Environment
Sleep
Study ObjectivesWe examined whether women service members and veterans who reported recent combat... more Study ObjectivesWe examined whether women service members and veterans who reported recent combat and/or sexual trauma experiences had a greater risk of insomnia compared with women who did not report these recent experiences, and whether insomnia would be associated with a greater risk of mental health outcomes.MethodsWe analyzed two waves of survey data (2011–2013, Time 1 [T1] and 2014–2016, Time 2 [T2]) from 26 443 current and former women service members from the Millennium Cohort Study. We assessed recent traumas in the past 3 years, and probable insomnia at T1 and probable post-traumatic stress disorder (PTSD) and depression at T2. A longitudinal mediation model was used to quantify separate indirect effects of recent traumas on mental health outcomes through probable insomnia.ResultsWomen who had experienced recent sexual assault (odds ratio [OR] = 1.68; 95% CI = 1.24–2.10), sexual harassment (OR = 1.22; 95% CI = 1.05–1.41), and combat (OR = 1.34; 95% CI = 1.20–1.49) at T1 ha...
JAMA Network Open
IMPORTANCE Few studies have examined the role of problematic anger in long-term adjustment of ser... more IMPORTANCE Few studies have examined the role of problematic anger in long-term adjustment of service members transitioning out of the military. OBJECTIVE To determine the prevalence of problematic anger during the military-to-civilian transition period and the association of problematic anger with adjustment to civilian life. DESIGN, SETTING, AND PARTICIPANTS This cohort study used 2 waves of survey data administered approximately 5 years apart (time 1 [T1; September 26, 2014, to August 25, 2016] and time 2 [T2; October 23, 2019, to August 31, 2021]) from the Millennium Cohort Study, a populationbased military study. Participants were US active-duty service members within 24 months of separating from military service at T1. Statistical analysis was performed from September 2021 to May 2022. EXPOSURES Problematic anger was operationalized as scoring at least 12 points on the 5-item Dimensions of Anger Reactions scale at T1. MAIN OUTCOMES AND MEASURES Behavioral and functional health (depression, posttraumatic stress disorder, problem drinking, functional limitations), relationship health (relationship quality, coping with parental demands, social support), and economic health (major financial problems, financial insecurity, homelessness, employment status) were assessed at T2. Covariates, assessed at T1, included demographics, military characteristics, mental health, problem drinking, and physical health. RESULTS Of the 3448 participants, 2625 (76.1%) were male, 217 (6.3%) were Hispanic, 293 (8.5%) were non-Hispanic Black, and 2690 (78.0%) were non-Hispanic White; the mean (SD) age was 40.1 (8.5) years; 826 (24.0%) met criteria for problematic anger. Prevalence of problematic anger was 15.9% (95% CI, 12.2%-19.7%) 24 months prior to military separation and 31.2% (95% CI, 26.2%-36.2%) 24 months following separation. After adjusting for covariates, problematic anger was associated with greater likelihood of behavioral and functional health outcomes (eg, posttraumatic stress disorder: adjusted odds ratio, 1.55, 95% CI, 1.23-1.96), relationship health difficulties (eg, low social support: aOR, 1.66; 95% CI, 1.23-2.24), and economic difficulties (eg, substantial financial insecurity: aOR, 1.64; 95% CI, 1.13-2.39) at T2. CONCLUSIONS AND RELEVANCE This cohort study found an association between prevalence of problematic anger during the military-to-civilian transition and problematic anger with subsequent adjustment difficulties among US service members. These findings suggest the need to equip service members proactively with skills to identify and manage anger as a way to support them before and during this period of transition.
Many SAS ® procedures can be used to analyze large datasets with correlated data. This study was ... more Many SAS ® procedures can be used to analyze large datasets with correlated data. This study was a secondary analysis of data obtained from the South Carolina Revenue and Fiscal Affairs Office (RFA), which includes medical claims from all health care systems in South Carolina (SC). We used the SAS procedure, GENMOD, to analyze a large dataset with correlated data from Military Health Care (MHS) system beneficiaries who received inpatient behavioral health care in South Carolina Health Care Systems from 2005 to 2014. Behavioral health (BH) was defined by Major Diagnostic Code (MDC) 19 (mental disorders and diseases) and 20 (alcohol and drug use). MDCs are formed by dividing all possible principal diagnoses from the International Classification Diagnostic (ICD-9) codes into 25 mutually exclusive diagnostic categories. The sample included a total of 6,783 BH visits and 4,827 unique military service members, veterans, and their adult and child dependents who have MHS insurance coverage. PROC GENMOD included a multivariate GEE model with type of BH hospitalization (mental health or substance abuse) as the dependent variable; and gender, race, age group, and discharge year as predictors. Hospital ID was used in the repeated statement with different correlation structures. Gender was significant for both independent correlation (p = .0001) and exchangeable structure (p = .0003). However, age group was significant using the independent correlation (p = .0160), but non-significant using the exchangeable correlation structure (p = .0584). SAS is a powerful statistical program for analyzing large, correlated datasets with categorical outcomes.
Journal of Social Work Education, 2015
Military social work is a specialized field of practice spanning the micro-macro continuum and re... more Military social work is a specialized field of practice spanning the micro-macro continuum and requiring advanced social work knowledge and skills. The complex behavioral health problems and service needs of Iraq and Afghanistan veterans highlight the need for highly trained social work professionals who can provide militarily-relevant and culturally-responsive evidenceinformed services. Responding to the military behavioral health workforce and service needs of recently returned veterans presents both opportunities and challenges for military social work education. This article discusses the rationale for a military social work specialization, the need for military social work education, and opportunities and challenges for social work education. An integrated model of intellectual capital is proposed to guide strategic planning for future military social work education. Over a decade of war in Iraq and Afghanistan has raised concerns about the behavioral health problems and treatment needs of Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND) veterans. This "Long War" characterized by a high operations tempo, a dynamic battlefield, multiple deployments, short dwell times, and an unprecedented utilization of women, National Guard, and Reserve forces has resulted in unique individual, family, organizational, and community stressors, as well as co-occurring behavioral, psychological, and physical conditions among recently returned veterans-many who experienced intense combat and remain in military service (Armed Forces Health
Cancer therapy & oncology international journal, 2017
Opioids are widely prescribed for their analgesic properties. Chronic opioid use is a persistent ... more Opioids are widely prescribed for their analgesic properties. Chronic opioid use is a persistent problem in the US. Nevertheless, little is known about its prescribing and utilization patterns and overall expenditures. This study examined secular trends in opioid prescription drug utilization and expenditures, along with factors associated with opioid prescription drug use in US physician offices. National Ambulatory Medical Care Survey (NAMCS) and Medical Expenditure Panel Survey (MEPS) data (2006-2010), both nationally representative surveys, were used to assess the trend, predictors of opioid prescription among US adults (more than 18 years) and the opioid-associated expenditures as a whole and borne by the patients in outpatient settings. Opioid prescription drugs use among US adults in outpatient settings, as a percentage of all prescription drugs, showed a gradual increase since 2006, leveling off in 2010. Opioid prescription drug expenditures showed an upward trend from 2009 ...
American Journal of Public Health, 2014
Objectives. We identified to what extent the Department of Defense postdeployment health surveill... more Objectives. We identified to what extent the Department of Defense postdeployment health surveillance program identifies at-risk drinking, alone or in conjunction with psychological comorbidities, and refers service members who screen positive for additional assessment or care. Methods. We completed a cross-sectional analysis of 333 803 US Army active duty members returning from Iraq or Afghanistan deployments in fiscal years 2008 to 2011 with a postdeployment health assessment. Alcohol measures included 2 based on self-report quantity-frequency items—at-risk drinking (positive Alcohol Use Disorders Identification Test alcohol consumption questions [AUDIT-C] screen) and severe alcohol problems (AUDIT-C score of 8 or higher)—and another based on the interviewing provider’s assessment. Results. Nearly 29% of US Army active duty members screened positive for at-risk drinking, and 5.6% had an AUDIT-C score of 8 or higher. Interviewing providers identified potential alcohol problems amon...
Handbook of Stress in the Occupations, 2011
ABSTRACT
Substance Use & Misuse, 2013
SUPIC will examine whether early detection and intervention for post-deployment problems among Ar... more SUPIC will examine whether early detection and intervention for post-deployment problems among Army Active Duty and National Guard/Reservists returning from Iraq or Afghanistan are associated with improved long-term substance use and psychological outcomes. This paper describes the rationale and significance of SUPIC, and presents demographic and deployment characteristics of the study sample (N=643,205), and self-reported alcohol use and health
Journal of Social Work, 2013
Summary Little is known about the contribution made by social workers to empirical evidence on su... more Summary Little is known about the contribution made by social workers to empirical evidence on substance use disorders treatment, especially interventions for African Americans. This article presents a systematic review of 23 articles, presentations, and dissertations written by social workers that focus on substance use disorders treatment interventions with African Americans. The aim of this review is to estimate the extent of contribution made by social workers to the research knowledge base on substance use disorders treatment interventions that are effective among African Americans, and to assess the methodological quality of those studies. Findings The review shows social workers’ contributions to research examining substance use disorders treatment interventions with African Americans is inadequate and the methodological rigor of these studies is slightly below average. Of the 23 articles examined, few studies included only African American samples, and most investigated subs...
Journal of Human Behavior in the Social Environment, 2013
ABSTRACT This article proposes a deployment risk and resilience model to describe military servic... more ABSTRACT This article proposes a deployment risk and resilience model to describe military service and deployment-related factors influencing post-deployment reintegration. Adapted from the resiliency model (Richardson, 1990; 2002), it is a multiphasic framework consistent with biopsychosocial and strengths-based perspectives by focusing on vulnerability, risk, and resilience resulting from military service and deployment experiences as well as feedback loops that occur over the life course. The article is divided into three broad sections that discuss (1) theoretical underpinnings of the model, (2) key components of the model, and (3) future directions for military social work practice.
Children and Youth Services Review, 2013
ABSTRACT Objective: Little is known about perception and determination of child maltreatment acro... more ABSTRACT Objective: Little is known about perception and determination of child maltreatment across countries. Although differences in perception and determination of maltreatment across regions of a single country are well documented, comparative knowledge across countries remains sparse. This internet survey examined perception of abusive behaviors and factors considered important in determining maltreatment in three countries (i.e., the United States, Ghana, and Nigeria). Method: Forty-five abusive behaviors comprising physical, sexual, and emotional abuse, child neglect, and child labor, as well as 13 factors considered important in determining maltreatment, were examined among a convenience sample of 327 respondents in the United States, Ghana, and Nigeria. Respondents were recruited within and outside universities in the three countries and links to the survey were sent to respondents who are nonstudents. Results: With all the countries combined, consensus was high for 15 of the 45 abusive behaviors, although levels of consensus and perceptions varied by country and race. Consensus was high for all of the abusive behaviors among respondents in the United States, 36 of the abusive behaviors among respondents in Ghana, and none of the abusive behaviorsamong respondents in Nigeria. Respondents who are White/Caucasian were significantly more likely to perceive 5 of the behaviors as abuse than respondents who are Black/non-Caucasian. Similarly, factors considered important in determining maltreatment differed by country and race. Respondents in the United States and Ghanawere more likely to consider 9 of the 13 factors important in determining maltreatment compared to respondents in Nigeria. Also, Caucasians/Whites weremore likely to consider 6 of the 13 factors important in determining maltreatment compared to Blacks/non-Caucasians. Conclusion: Despite racial and regional differences, there are indications that cross-cultural consensus on perception and determination of abusive behaviors is possible. Understanding differences in socio-cultural experiences may help bridge the current gaps in cross-cultural consensus on perception and determination of abusive behaviors.
SAGE Research Methods Cases, 2014
ABSTRACT Military research requires innovative methods to access a highly mobile, technologically... more ABSTRACT Military research requires innovative methods to access a highly mobile, technologically savvy population subject to stressful work environments, frequent relocations, prolonged family separations, and overseas deployments. Social media and remote communication technology allow researchers to recruit military service members and their families for quantitative and qualitative research regardless of geographical location or time zone. Understanding the benefits and risks of using these technologies is essential to optimizing sampling strategy, data security, confidentiality, and ethical application of technology in military research. This methodological case study describes the use of social media and remote communication technology in mixed methods research examining military service and deployment experiences of women serving in the United States Army during Operations Iraqi Freedom, Operations Enduring Freedom, and Operations New Dawn. Implications for using social media and remote communications in future military research is also discussed.
Journal of Racial and Ethnic Health Disparities
Objective To evaluate whether computer-based prostate cancer screening decision aids enhance deci... more Objective To evaluate whether computer-based prostate cancer screening decision aids enhance decision self-efficacy for African-American men, culturally relevant and reliable measures are needed. However, limited psychometric evidence exists on the health-related decision self-efficacy of African-American men. This study describes the development and psychometric evaluation of the 11-item Informed Prostate Cancer Screening Decision Self-Efficacy Scale among 354 African-American men. Methods Exploratory factor analysis was conducted with maximum-likelihood estimation and polychoric correlations followed by Promax and Varimax rotations. Results Exploratory factor analysis yielded a one-factor, 11-item model of the modified scale with excellent internal consistency reliability at 0.95 and factor loadings ranging from 0.70 to 0.90. Both parallel analysis and a scree plot confirmed the retention of one factor, and the standardized root mean square residual (0.06) indicated that the factor structure explained most of the correlations. Conclusions Findings suggest the one-factor, 11-item Informed Prostate Cancer Screening Decision Self-Efficacy Scale has excellent psychometric properties and utility in reliably measuring health-related decision self-efficacy in African-American men. Future research is needed to confirm this factor structure among socio-demographically diverse African Americans.
Click to edit project descriptionFunded by the Wounded Warrior Project, Principal Investigator (s... more Click to edit project descriptionFunded by the Wounded Warrior Project, Principal Investigator (subaward), in collaboration with the Military Family Research Institute at Purdue University, the South Carolina National Guard, and the SC Department of Mental Health of the South Carolina STAR Behavioral Health Providers' Training Program (SC STAR). SC STAR will provide behavioral health training to civilian behavioral health providers to provider services to military personnel, veterans, and their families. We will also maintain a registry of South Carolina behavioral health providers who have received training to provide services to military and veteran populations.
This K01 Mentored Research Scientist Career Development Award, the Army Warrior Care Project (AWC... more This K01 Mentored Research Scientist Career Development Award, the Army Warrior Care Project (AWCP), supports the candidate in developing an independent research career to investigate modifiable risk and protective factors associated with behavioral health problems (substance use and mental health problems) and behavioral health service utilization in Army service members who deployed to Iraq and Afghanistan. The AWCP specifically focuses on Army service members assigned to Warrior Transition Units (WTUs), which are co-located with military treatment facilities and provide comprehensive behavioral health care to ill, injured, and wounded service members. Career development objectives include training the candidate in advanced biostatistical, epidemiological, and health services research methods to conduct population-based research using a unique database consisting of Department of Defense Military Health System data. The specific aims of the proposed AWCP are to: (1) determine the probability of WTU assignment and estimate the treatment effect of receiving comprehensive behavioral health care in WTUs among Army service members returning from Iraq and Afghanistan deployments FY2008 to FY2012; (2) determine demographic, military, deployment, and post-deployment behavioral health factors associated with WTU assignment and onset of post-deployment substance use problems and/or diagnoses among Army WTU members; and (3) identify the military-related
pre-disposing, enabling, and need factors associated with post-deployment behavioral health problems and behavioral health service utilization among Army WTU members. The moderating effect of gender and race/ethnicity on post-deployment behavioral health status and behavioral health service utilization will also be examined.
The AWCP is innovative because it focuses on: comprehensive behavioral health care in Army WTUs, gender and racial/ethnic differences in access to and receipt of military behavioral health care, and use of cross-sectional and longitudinal data, including objective (medical claims) and subjective (self-report) Military Health System data.
See Warrior Care Project at http://wcp.sc.edu for additional information,
Journal of Human Behavior in the Social Environment
Sleep
Study ObjectivesWe examined whether women service members and veterans who reported recent combat... more Study ObjectivesWe examined whether women service members and veterans who reported recent combat and/or sexual trauma experiences had a greater risk of insomnia compared with women who did not report these recent experiences, and whether insomnia would be associated with a greater risk of mental health outcomes.MethodsWe analyzed two waves of survey data (2011–2013, Time 1 [T1] and 2014–2016, Time 2 [T2]) from 26 443 current and former women service members from the Millennium Cohort Study. We assessed recent traumas in the past 3 years, and probable insomnia at T1 and probable post-traumatic stress disorder (PTSD) and depression at T2. A longitudinal mediation model was used to quantify separate indirect effects of recent traumas on mental health outcomes through probable insomnia.ResultsWomen who had experienced recent sexual assault (odds ratio [OR] = 1.68; 95% CI = 1.24–2.10), sexual harassment (OR = 1.22; 95% CI = 1.05–1.41), and combat (OR = 1.34; 95% CI = 1.20–1.49) at T1 ha...
JAMA Network Open
IMPORTANCE Few studies have examined the role of problematic anger in long-term adjustment of ser... more IMPORTANCE Few studies have examined the role of problematic anger in long-term adjustment of service members transitioning out of the military. OBJECTIVE To determine the prevalence of problematic anger during the military-to-civilian transition period and the association of problematic anger with adjustment to civilian life. DESIGN, SETTING, AND PARTICIPANTS This cohort study used 2 waves of survey data administered approximately 5 years apart (time 1 [T1; September 26, 2014, to August 25, 2016] and time 2 [T2; October 23, 2019, to August 31, 2021]) from the Millennium Cohort Study, a populationbased military study. Participants were US active-duty service members within 24 months of separating from military service at T1. Statistical analysis was performed from September 2021 to May 2022. EXPOSURES Problematic anger was operationalized as scoring at least 12 points on the 5-item Dimensions of Anger Reactions scale at T1. MAIN OUTCOMES AND MEASURES Behavioral and functional health (depression, posttraumatic stress disorder, problem drinking, functional limitations), relationship health (relationship quality, coping with parental demands, social support), and economic health (major financial problems, financial insecurity, homelessness, employment status) were assessed at T2. Covariates, assessed at T1, included demographics, military characteristics, mental health, problem drinking, and physical health. RESULTS Of the 3448 participants, 2625 (76.1%) were male, 217 (6.3%) were Hispanic, 293 (8.5%) were non-Hispanic Black, and 2690 (78.0%) were non-Hispanic White; the mean (SD) age was 40.1 (8.5) years; 826 (24.0%) met criteria for problematic anger. Prevalence of problematic anger was 15.9% (95% CI, 12.2%-19.7%) 24 months prior to military separation and 31.2% (95% CI, 26.2%-36.2%) 24 months following separation. After adjusting for covariates, problematic anger was associated with greater likelihood of behavioral and functional health outcomes (eg, posttraumatic stress disorder: adjusted odds ratio, 1.55, 95% CI, 1.23-1.96), relationship health difficulties (eg, low social support: aOR, 1.66; 95% CI, 1.23-2.24), and economic difficulties (eg, substantial financial insecurity: aOR, 1.64; 95% CI, 1.13-2.39) at T2. CONCLUSIONS AND RELEVANCE This cohort study found an association between prevalence of problematic anger during the military-to-civilian transition and problematic anger with subsequent adjustment difficulties among US service members. These findings suggest the need to equip service members proactively with skills to identify and manage anger as a way to support them before and during this period of transition.
Many SAS ® procedures can be used to analyze large datasets with correlated data. This study was ... more Many SAS ® procedures can be used to analyze large datasets with correlated data. This study was a secondary analysis of data obtained from the South Carolina Revenue and Fiscal Affairs Office (RFA), which includes medical claims from all health care systems in South Carolina (SC). We used the SAS procedure, GENMOD, to analyze a large dataset with correlated data from Military Health Care (MHS) system beneficiaries who received inpatient behavioral health care in South Carolina Health Care Systems from 2005 to 2014. Behavioral health (BH) was defined by Major Diagnostic Code (MDC) 19 (mental disorders and diseases) and 20 (alcohol and drug use). MDCs are formed by dividing all possible principal diagnoses from the International Classification Diagnostic (ICD-9) codes into 25 mutually exclusive diagnostic categories. The sample included a total of 6,783 BH visits and 4,827 unique military service members, veterans, and their adult and child dependents who have MHS insurance coverage. PROC GENMOD included a multivariate GEE model with type of BH hospitalization (mental health or substance abuse) as the dependent variable; and gender, race, age group, and discharge year as predictors. Hospital ID was used in the repeated statement with different correlation structures. Gender was significant for both independent correlation (p = .0001) and exchangeable structure (p = .0003). However, age group was significant using the independent correlation (p = .0160), but non-significant using the exchangeable correlation structure (p = .0584). SAS is a powerful statistical program for analyzing large, correlated datasets with categorical outcomes.
Journal of Social Work Education, 2015
Military social work is a specialized field of practice spanning the micro-macro continuum and re... more Military social work is a specialized field of practice spanning the micro-macro continuum and requiring advanced social work knowledge and skills. The complex behavioral health problems and service needs of Iraq and Afghanistan veterans highlight the need for highly trained social work professionals who can provide militarily-relevant and culturally-responsive evidenceinformed services. Responding to the military behavioral health workforce and service needs of recently returned veterans presents both opportunities and challenges for military social work education. This article discusses the rationale for a military social work specialization, the need for military social work education, and opportunities and challenges for social work education. An integrated model of intellectual capital is proposed to guide strategic planning for future military social work education. Over a decade of war in Iraq and Afghanistan has raised concerns about the behavioral health problems and treatment needs of Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND) veterans. This "Long War" characterized by a high operations tempo, a dynamic battlefield, multiple deployments, short dwell times, and an unprecedented utilization of women, National Guard, and Reserve forces has resulted in unique individual, family, organizational, and community stressors, as well as co-occurring behavioral, psychological, and physical conditions among recently returned veterans-many who experienced intense combat and remain in military service (Armed Forces Health
Cancer therapy & oncology international journal, 2017
Opioids are widely prescribed for their analgesic properties. Chronic opioid use is a persistent ... more Opioids are widely prescribed for their analgesic properties. Chronic opioid use is a persistent problem in the US. Nevertheless, little is known about its prescribing and utilization patterns and overall expenditures. This study examined secular trends in opioid prescription drug utilization and expenditures, along with factors associated with opioid prescription drug use in US physician offices. National Ambulatory Medical Care Survey (NAMCS) and Medical Expenditure Panel Survey (MEPS) data (2006-2010), both nationally representative surveys, were used to assess the trend, predictors of opioid prescription among US adults (more than 18 years) and the opioid-associated expenditures as a whole and borne by the patients in outpatient settings. Opioid prescription drugs use among US adults in outpatient settings, as a percentage of all prescription drugs, showed a gradual increase since 2006, leveling off in 2010. Opioid prescription drug expenditures showed an upward trend from 2009 ...
American Journal of Public Health, 2014
Objectives. We identified to what extent the Department of Defense postdeployment health surveill... more Objectives. We identified to what extent the Department of Defense postdeployment health surveillance program identifies at-risk drinking, alone or in conjunction with psychological comorbidities, and refers service members who screen positive for additional assessment or care. Methods. We completed a cross-sectional analysis of 333 803 US Army active duty members returning from Iraq or Afghanistan deployments in fiscal years 2008 to 2011 with a postdeployment health assessment. Alcohol measures included 2 based on self-report quantity-frequency items—at-risk drinking (positive Alcohol Use Disorders Identification Test alcohol consumption questions [AUDIT-C] screen) and severe alcohol problems (AUDIT-C score of 8 or higher)—and another based on the interviewing provider’s assessment. Results. Nearly 29% of US Army active duty members screened positive for at-risk drinking, and 5.6% had an AUDIT-C score of 8 or higher. Interviewing providers identified potential alcohol problems amon...
Handbook of Stress in the Occupations, 2011
ABSTRACT
Substance Use & Misuse, 2013
SUPIC will examine whether early detection and intervention for post-deployment problems among Ar... more SUPIC will examine whether early detection and intervention for post-deployment problems among Army Active Duty and National Guard/Reservists returning from Iraq or Afghanistan are associated with improved long-term substance use and psychological outcomes. This paper describes the rationale and significance of SUPIC, and presents demographic and deployment characteristics of the study sample (N=643,205), and self-reported alcohol use and health
Journal of Social Work, 2013
Summary Little is known about the contribution made by social workers to empirical evidence on su... more Summary Little is known about the contribution made by social workers to empirical evidence on substance use disorders treatment, especially interventions for African Americans. This article presents a systematic review of 23 articles, presentations, and dissertations written by social workers that focus on substance use disorders treatment interventions with African Americans. The aim of this review is to estimate the extent of contribution made by social workers to the research knowledge base on substance use disorders treatment interventions that are effective among African Americans, and to assess the methodological quality of those studies. Findings The review shows social workers’ contributions to research examining substance use disorders treatment interventions with African Americans is inadequate and the methodological rigor of these studies is slightly below average. Of the 23 articles examined, few studies included only African American samples, and most investigated subs...
Journal of Human Behavior in the Social Environment, 2013
ABSTRACT This article proposes a deployment risk and resilience model to describe military servic... more ABSTRACT This article proposes a deployment risk and resilience model to describe military service and deployment-related factors influencing post-deployment reintegration. Adapted from the resiliency model (Richardson, 1990; 2002), it is a multiphasic framework consistent with biopsychosocial and strengths-based perspectives by focusing on vulnerability, risk, and resilience resulting from military service and deployment experiences as well as feedback loops that occur over the life course. The article is divided into three broad sections that discuss (1) theoretical underpinnings of the model, (2) key components of the model, and (3) future directions for military social work practice.
Children and Youth Services Review, 2013
ABSTRACT Objective: Little is known about perception and determination of child maltreatment acro... more ABSTRACT Objective: Little is known about perception and determination of child maltreatment across countries. Although differences in perception and determination of maltreatment across regions of a single country are well documented, comparative knowledge across countries remains sparse. This internet survey examined perception of abusive behaviors and factors considered important in determining maltreatment in three countries (i.e., the United States, Ghana, and Nigeria). Method: Forty-five abusive behaviors comprising physical, sexual, and emotional abuse, child neglect, and child labor, as well as 13 factors considered important in determining maltreatment, were examined among a convenience sample of 327 respondents in the United States, Ghana, and Nigeria. Respondents were recruited within and outside universities in the three countries and links to the survey were sent to respondents who are nonstudents. Results: With all the countries combined, consensus was high for 15 of the 45 abusive behaviors, although levels of consensus and perceptions varied by country and race. Consensus was high for all of the abusive behaviors among respondents in the United States, 36 of the abusive behaviors among respondents in Ghana, and none of the abusive behaviorsamong respondents in Nigeria. Respondents who are White/Caucasian were significantly more likely to perceive 5 of the behaviors as abuse than respondents who are Black/non-Caucasian. Similarly, factors considered important in determining maltreatment differed by country and race. Respondents in the United States and Ghanawere more likely to consider 9 of the 13 factors important in determining maltreatment compared to respondents in Nigeria. Also, Caucasians/Whites weremore likely to consider 6 of the 13 factors important in determining maltreatment compared to Blacks/non-Caucasians. Conclusion: Despite racial and regional differences, there are indications that cross-cultural consensus on perception and determination of abusive behaviors is possible. Understanding differences in socio-cultural experiences may help bridge the current gaps in cross-cultural consensus on perception and determination of abusive behaviors.
SAGE Research Methods Cases, 2014
ABSTRACT Military research requires innovative methods to access a highly mobile, technologically... more ABSTRACT Military research requires innovative methods to access a highly mobile, technologically savvy population subject to stressful work environments, frequent relocations, prolonged family separations, and overseas deployments. Social media and remote communication technology allow researchers to recruit military service members and their families for quantitative and qualitative research regardless of geographical location or time zone. Understanding the benefits and risks of using these technologies is essential to optimizing sampling strategy, data security, confidentiality, and ethical application of technology in military research. This methodological case study describes the use of social media and remote communication technology in mixed methods research examining military service and deployment experiences of women serving in the United States Army during Operations Iraqi Freedom, Operations Enduring Freedom, and Operations New Dawn. Implications for using social media and remote communications in future military research is also discussed.
Journal of Racial and Ethnic Health Disparities
Objective To evaluate whether computer-based prostate cancer screening decision aids enhance deci... more Objective To evaluate whether computer-based prostate cancer screening decision aids enhance decision self-efficacy for African-American men, culturally relevant and reliable measures are needed. However, limited psychometric evidence exists on the health-related decision self-efficacy of African-American men. This study describes the development and psychometric evaluation of the 11-item Informed Prostate Cancer Screening Decision Self-Efficacy Scale among 354 African-American men. Methods Exploratory factor analysis was conducted with maximum-likelihood estimation and polychoric correlations followed by Promax and Varimax rotations. Results Exploratory factor analysis yielded a one-factor, 11-item model of the modified scale with excellent internal consistency reliability at 0.95 and factor loadings ranging from 0.70 to 0.90. Both parallel analysis and a scree plot confirmed the retention of one factor, and the standardized root mean square residual (0.06) indicated that the factor structure explained most of the correlations. Conclusions Findings suggest the one-factor, 11-item Informed Prostate Cancer Screening Decision Self-Efficacy Scale has excellent psychometric properties and utility in reliably measuring health-related decision self-efficacy in African-American men. Future research is needed to confirm this factor structure among socio-demographically diverse African Americans.
Journal of Human Behavior in the Social Environment
Families in Society: Journal of Contemporary Social Sciences. doi: 10.1606/1945-1350.4045., 2010
W ith contributions by nationally and internationally recognized trauma experts, Treating Complex... more W ith contributions by nationally and internationally recognized trauma experts, Treating Complex Traumatic Stress Disorders: An Evidence-Based Guide provides a comprehensive overview of complex trauma, specifically distinguishing complex psychological trauma from other forms of psychological trauma. It thoroughly outlines individual and systemic treatment approaches for adults while acknowledging the limitations regarding empirical knowledge, assessment, and treatment for children and adolescents with complex traumatic stress symptomatology. Although the definition of trauma lacks consensus, Courtois and Ford (2009, p. 1) define complex trauma as multiple traumatic experiences that are repetitive or prolonged, involve direct physical and/or mental harm and abandonment by primary or temporary caregivers, occur at developmentally vulnerable stages over the life course, and have the potential to severely compromise a child's development.
• Total sample (N = 152,447)-Men = 137,814 (90.46%); Women = 14,633 (9.66%) • BHU (n = 56,741); B... more • Total sample (N = 152,447)-Men = 137,814 (90.46%); Women = 14,633 (9.66%) • BHU (n = 56,741); BHU Men = 49,935 (88%); BHU Women = 6806 (12%) • BHU Men-Mean age = 28 (SD =7); Mean #deployments = 2 (SD = 1); Mean length of index deployment = 313 days (SD = 170 days); Mean #dependents = 2 (SD = 2); Mean TRICARE eligible months = 74 (SD = 70); Enlisted = 90.84%; White = 61%; Married = 65.08%. • BHU Women-Mean age = 28 (SD =7); Mean #deployments = 2 (SD = 1); Mean length of index deployment = 300 days (SD = 143 days); Mean #dependents = 1 (SD = 1); Mean TRICARE eligible months = 70 (SD = 66); Enlisted = 86.78%; White = 39.74%; Black = 34.78%; Married = 48.40%.
This study examined gender differences in substance use treatment (SUT) utilization in the year p... more This study examined gender differences in substance use treatment (SUT) utilization in the year prior to deployment for Army service members who returned from Operations Enduring and Iraqi Freedom (OEF/OIF) deployments in FY2010.