Large National Sample Research Articles

Lingering Effects of Loss? Widowhood and Substance Use in the LGB Population

Little is known about widowhood's effects on externalizing expressions of distress, like substance use, among sexual minorities. Our study is the first to address this issue using a large national sample of LGB individuals living in the United States. Using the 2010 Aging with Pride: National Health, Aging, and Sexuality/Gender Study ( n = 2,258), we ran logistic regression models predicting current smoking, past 30-day binge drinking, and past year drug use. Widowhood predicted higher odds of drug use. These results were found for currently partnered individuals, suggesting that widowhood's effects are not completely offset by current partnership. In contrast, widowhood did not predict smoking or binge drinking. All results held for women and men. Results suggest that LGB widowhood's effects on substance use vary by current partner status and substance type. These findings contrast with those of studies examining widowhood's effects on internalized expressions of distress, which consistently find detrimental effects.

Latent typology of nonsuicidal self‐injury and differences in mental health outcomes

AbstractNonsuicidal self‐injury (NSSI), defined as deliberate acts of self‐harm without suicidal intent, significantly impacts adults. NSSI involves various behaviors, varying in frequency and severity as well as intersecting with one another. To uncover unobserved subtypes of NSSI, this study utilized latent class analysis (LCA) to precisely identify a latent typology of NSSI among adults using a large national sample (N = 18,798; Mage = 21.73; SD = 4.93). Additionally, differences in mental health outcomes, including depression and anxiety, across the identified latent subtypes of NSSI were examined in the LCA model. The findings revealed eight distinct latent subtypes, demonstrating statistically significant differences in depression and anxiety, including multimethod—severe, multimethod—moderate, multimethod—mild, cutting—dominant multimethod, unimethod—pulling hair, unimethod—interfering with wound healing, unimethod—punching/banging, and unimethod—punching/banging an object. These findings underscore the distinct characteristics and mental health needs of each latent subgroup and suggest more tailored and targeted approaches for counseling practice.

Quantity of delta-9-tetrahydrocannabinol consumption and cannabis use disorder among daily cannabis consumers.

Amid escalating cannabis legalization and daily consumption in the United States (US), determining the risk of cannabis use disorder (CUD) and relevant consequences among daily consumers has become a public health priority. Understanding these risks requires valid assessment of the daily quantity of delta-9-tetrahydrocannabinol (THC) consumed and its relation to consequences. This study characterized daily cannabis consumption using a new method for estimating milligrams of THC (mgTHC), and examined the relationship between daily mgTHC and CUD severity in a large national sample of daily consumers. US adult (aged 18+ years) daily cannabis consumers (n = 4134) completed a comprehensive online survey of cannabis consumption patterns (e.g. frequency, quantity, product types, potencies, administration methods) and Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) CUD criteria. The primary exposure was past-week daily mgTHC consumption, calculated from survey responses to queries about product type, amount and potency consumed and including adjustments for puff size and loss of THC from specific methods of administration. The primary outcomes were (1) number of CUD criteria (range = 0-11) and (2) CUD severity categories: none, mild, moderate, severe. Median daily consumption was ~130 mgTHC, with substantial variability (25% ≤ 50 mg and 25% ≥ 290 mg). On average, participants endorsed 2.5 CUD criteria, and 65% met criteria for CUD (39% mild, 18% moderate, 8% severe). Greater daily mgTHC predicted higher CUD criteria count [betalog(mgTHC) = 0.50, 95% confidence interval (CI) = 0.267-0.734] and higher odds of mild [log odds ratio (logOR) = 0.238, 95% CI = 0.184-0.292], moderate (logOR = 0.303, 95% CI = 0.232-0.374) or severe (logOR = 0.335, 95% CI = 0.236-0.435) CUD. Among daily consumers of cannabis, there appears to be a positive relationship between the daily quantity of cannabis consumed (measured in milligrams of delta-9-tetrahydrocannabinol) and both the risk and severity of cannabis use disorder.

Factor analysis of the feeding and eating in AutiSm Together Assessment

BackgroundAutistic children experience high rates of feeding challenges, negatively affecting their.health, eating patterns, and social eating experiences. The Feeding and Eating in AutiSm Together; FEAST, a caregiver-report questionnaire, was developed to characterize feeding challenges in autistic children ages 2 to 12 years. The purpose of this study is to determine the construct validity of the FEAST assessment using a large national sample of autistic children. MethodA large national sample (N = 396) of caregivers completed the online survey. An ordinal confirmatory factor model using a robust weighted least squares approach validated the four predicted groupings of feeding challenges (sensory processing; behavior; oral.motor skills; and gastrointestinal) with generally strong loadings onto the four distinct.factors. ResultsModel fit statistics indicated good model fit (Robust Root Mean Square Error of.Approximation=.080, Robust Comparative Fit Index =.909, Robust Tucker-Lewis.Index=.901) Findings provide preliminary confirmation of the construct validity of the.FEAST assessment to characterize feeding difficulties for autistic children ages 2–12. Small to medium correlations between all factors indicate items successfully targeted.four unique areas of feeding challenge. For all factors, the largest correlation was with.behavior. ConclusionAssessments developed to address the complex feeding and mealtime challenges for.autistic children are essential to identify and integrate the most appropriate intervention.approaches. FEAST offers researchers and clinicians with a comprehensive and psychometrically sound assessment tool to address autistic children’s unique feeding.challenges.

Exploring therapist effectiveness across multiple domains over time.

Despite the common assumption that increased therapist experience correlates with improved client outcomes, studies reveal inconsistent relationships between therapist experience and therapy effectiveness. Some studies have demonstrated a slight worsening of client outcomes as therapists gain more experience. Yet, there are few studies that have examined how therapists change in their client outcomes over time, especially across different outcomes (e.g., depression, life functioning, anxiety). The present study used the Behavioral Health Measure-17 to investigate therapist effectiveness over time on multiple treatment outcomes (e.g., general distress, life functioning, anxiety, alcohol/drug use) using a large naturalistic sample of 613 professional therapists and 42,690 clients over approximately 12 years of psychotherapy data. Our results show a significant decrease in client outcomes over time in three domains: general distress, life functioning, and anxiety, albeit small-sized effects. Our findings also indicate that therapist caseload and baseline severity were not associated with predicting client outcomes and that, unexpectedly, the severity of therapist caseloads decreased over time. These findings underscore the importance of a nuanced understanding of therapist effectiveness, challenging the assumption of universal improvement with experience. Furthermore, we believe that these findings may offer preliminary support for matching therapists with clients based on domain-specific strengths. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Perioperative Outcomes of Total Hip Arthroplasty in Trisomy 21 Patients in Comparison With a Control Population: Analysis From a Large National Sample of 367,894 Patients.

Literature on the outcomes of total hip arthroplasty (THA) has established the procedure as a gold standard for hip arthritis. However, postoperative outcomes after THA in specific conditions such as Down's syndrome (DS) have been sparsely described. This large database analysis of over 367,000 patients was aimed at evaluating the immediate postoperative results including morbidity and mortality rates after THA among DS patients and comparing these with a control population. Data from the National Inpatient Sample (NIS) database Healthcare Cost and Utilization Project (HCUP) was reviewed retrospectively from 2016 to 2019 on THAs. Among 367,894 patients, 129 were identified with a diagnosis of DS. Complex primaries and revisions were excluded. Demographics, admission details, and perioperative variables including morbidity and mortality rates were compared between DS patients and controls. Patients with DS were younger than the control population (43.3 versus 65.9 years, p=0.002), had a greater preponderance of men, had a lower incidence of smoking and diabetes, and had a relatively higher incidence of non-elective THA. The former also had a longer mean length of stay (LoS) and higher mean costs to healthcare. Two patients with DS died after a THA, making the mortality rate 17-fold higher in DS patients. Higher rates of postoperative anemia (31.8% versus 19.6%, p<0.001), pneumonia (2.3% versus 0.3%), and pulmonary embolism (p=0.0.12) were seen in the DS group. Also seen in the DS group were higher risks of periprosthetic fractures (p=0.020) and periprosthetic joint infections (PJIs) (p=0.047). Results from a total hip arthroplasty continue to positively transform the lives of patients with end-stage hip arthritis from varying etiologies. In the special cohort of Down's syndrome, a thorough discussion is essential with reference to the relatively higher morbidity and mortality in this group of patients. Documented conversations between patients and their families and healthcare providers should consist of detailed deliberations on the pros and cons of surgery and its potential impacts.

Supporting treatment adherence for resilience and thriving (START): protocol for a mHealth randomized controlled trial

BackgroundAlthough behavioral interventions show some promise for reducing stimulant use and achieving durable viral suppression in sexual minority men (SMM) with HIV, scalable mHealth applications are needed to optimize their reach and cost-effectiveness.MethodsSupporting Treatment Adherence for Resilience and Thriving (START) is a randomized controlled trial (RCT) testing the efficacy and cost-effectiveness of a mHealth application that integrates evidence-based positive affect regulation skills with self-monitoring of adherence and mood. The primary outcome is detectable HIV viral load (i.e., > 300 copies/mL) from self-collected dried blood spot (DBS) specimens at 6 months. Secondary outcomes include detectable DBS viral load at 12 months, self-reported stimulant use severity, anti-retroviral therapy (ART) adherence, and positive affect over 12 months. A national sample of up to 250 SMM with HIV who screen positive for stimulant use disorder and reporting suboptimal ART adherence is being recruited via social networking applications through April of 2024. After providing informed consent, participants complete a run-in period (i.e., waiting period) including two baseline assessments with self-report measures and a self-collected DBS sample. Those who complete the run-in period are randomized to either the START mHealth application or access to a website with referrals to HIV care and substance use disorder treatment resources. Participants provide DBS samples at baseline, 6, and 12 months to measure HIV viral load as well as complete self-report measures for secondary outcomes at quarterly follow-up assessments over 12 months.DiscussionTo date, we have paid $117,500 to advertise START on social networking applications and reached 1,970 eligible participants ($59.77 per eligible participant). Although we identified this large national sample of potentially eligible SMM with HIV who screen positive for a stimulant use disorder and report suboptimal ART adherence, only one-in-four have enrolled in the RCT. The run-in period has proven to be crucial for maintaining scientific rigor and reproducibility of this RCT, such that only half of consented participants complete the required study enrollment activities and attended a randomization visit. Taken together, findings will guide adequate resource allocation to achieve randomization targets in future mHealth research SMM with HIV who use stimulants.Trial RegistrationThis protocol was registered on clinicaltrials.gov (NCT05140876) on December 2, 2021.

National trends in patterns of under-vaccination in early childhood: National Immunization Survey-Child, United States, 2011–2021

ABSTRACT Background The study's objective was to examine national trends in patterns of under-vaccination in the United States. Research design and methods The National Immunization Survey-Child (NIS-Child) is an annual cross-sectional survey that collects provider-verified vaccination records from a large national probability sample of children. Records from the 2011–2021 NIS-Child were used to assess receipt of the combined 7-vaccine series by age 24 months. Based on prior work, patterns indicative of hesitancy included zero vaccines, not starting ≥1 series, and consistent vaccine-limiting. Patterns indicative of practical issues included starting all series but missing doses. Up-to-date (UTD) was defined as receiving all doses in the combined 7-vaccine series. Results The study population comprised 127,257 children. Over the observation period, patterns indicative of hesitancy significantly decreased (p-trend < 0.0001), patterns indicative of practical issues significantly decreased (p-trend < 0.0001), and UTD significantly increased (p-trend < 0.0001). In 2021, the weighted percentage in each category was as follows: probable hesitancy 6.3% (95% confidence interval [CI] 5.4%, 7.2%), probable practical issues 26.0% (95% CI 24.4%, 27.6%), and UTD 67.7% (95% CI 66.0%, 69.4%). Conclusion Over an 11-year period, vaccination coverage in the United States for the combined 7-vaccine series has improved, with patterns suggestive of practical issues or hesitancy declining.

Labor market institutions and employee self-reported mental health

PurposeThe study draws on emerging research on declining employee mental health, particularly employees with low educational attainment, in human resource management (HRM) and health and tests whether labor market institutions are empirically associated with better mental health among workers from different educational backgrounds.Design/methodology/approachThis study draws on a large national sample of part- and full-time workers and models a conditional relationship between labor market institutions and employee self-rated mental health using ordinary least squares (OLS) models with fixed effects.FindingsThe findings indicate membership in a labor market institution such as a union is positively associated with improved employee mental health, but the relationship is moderated by educational attainment. Union membership is associated with better mental health among employees with low educational attainment and appears to bring these workers up to a level of mental health that is comparable to more highly educated workers, thereby reducing mental health inequality. However, union membership has no effect on the mental health of more highly educated employees.Originality/valueDespite the recognition that declining worker mental health presents challenges for workers, organizations and society, systematic empirical research on institutional mechanisms that may affect mental health is limited. This study draws on data of part- and full-time workers to model the relationship with a sample large enough to specify conditional models to account for heterogeneous relationships conditional on workers' educational attainment. The findings have important implications for our understanding of employee mental health, employment relations and institutional mechanisms to help workers and improve organizational performance.

Dominion, Stewardship, and Perceptions of the Problem of Climate Change

This study assesses the importance of dominion beliefs in relationship to stewardship beliefs in shaping attitudes related to climate change among the American people. Though typically viewed as alternative viewpoints, this study examines two separate measures—one capturing dominion and another capturing stewardship beliefs—allowing for an analysis of how these two viewpoints relate to each other and whether they have differential relationships on attitudes toward climate change. Using a large national sample conducted in 2022, this study reveals that one’s dominion position can only be fully understood in relationship to one’s stewardship position, with the resultant combined measure retaining statistical significance in multivariate analysis, suggesting that theological beliefs related to dominion and stewardship significantly shape climate attitudes beyond what can be accounted for by political variables or other important variables related to climate change.

Characterizing physician directory data quality: variation by specialty, state, and insurer

BackgroundAs U.S. legislators are urged to combat ghost networks in behavioral health and address the provider data quality issue, it becomes important to better characterize the variation in data quality of provider directories to understand root causes and devise solutions. Therefore, this manuscript examines consistency of address, phone number, and specialty information for physician entries from 5 national health plan provider directories by insurer, physician specialty, and state.MethodsWe included all physicians in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) found in ≥ 2 health insurer physician directories across 5 large national U.S. health insurers. We examined variation in consistency of address, phone number, and specialty information among physicians by insurer, physician specialty, and state.ResultsOf 634,914 unique physicians in the PECOS database, 449,282 were found in ≥ 2 directories and included in our sample. Across insurers, consistency of address information varied from 16.5 to 27.9%, consistency of phone number information varied from 16.0 to 27.4%, and consistency of specialty information varied from 64.2 to 68.0%. General practice, family medicine, plastic surgery, and dermatology physicians had the highest consistency of addresses (37-42%) and phone numbers (37-43%), whereas anesthesiology, nuclear medicine, radiology, and emergency medicine had the lowest consistency of addresses (11-21%) and phone numbers (9-14%) across health insurer directories. There was marked variation in consistency of address, phone number, and specialty information by state.ConclusionsIn evaluating a large national sample of U.S. physicians, we found minimal variation in provider directory consistency by insurer, suggesting that this is a systemic problem that insurers have not solved, and considerable variation by physician specialty with higher quality data among more patient-facing specialties, suggesting that physicians may respond to incentives to improve data quality. These data highlight the importance of novel policy solutions that leverage technology targeting data quality to centralize provider directories so as not to not reinforce existing data quality issues or policy solutions to create national and state-level standards that target both insurers and physician groups to maximize quality of provider information.

Preliminary Prevalence Estimates of Sexual Exploitation as Measured by the Sexual Experiences Survey-Victimization (SES-V) in a National US Sample

ABSTRACT The new Sexual Experiences Survey-Victimization (SES-V) was designed to capture a larger range of sexual exploitation and to be applicable to more diverse populations than prior measures. This study represents the first administration of the SES-V in a national sample of adults (N = 347). Participants were recruited from a crowdsourcing platform and selected to reflect the national distribution in terms of age, sex, and race/ethnicity. Rates of sexual exploitation since age 14 were very high in this sample (90%), providing evidence that the SES-V was successful in capturing experiences on the low end of the severity continuum. Using the items corresponding to the FBI definition of rape, 60% of women and 29% of men endorsed rape on the SES-V. Compared to men, women reported higher rates of sexual exploitation overall, and higher rates of every type of sexual exploitation except technology-facilitated. The new SES-V also asks participants to estimate the number of separate instances of four types of sexual exploitation that they have experienced; results provided support for the value of these incident estimates in understanding the scope of sexual exploitation. Finally, this study evaluated new sexual acts and exploitative tactics that were added to the SES-V and found that they demonstrated utility and validity. These findings offer preliminary support for the validity and functionality of the SES-V, although the high prevalence of sexual exploitation on the SES-V is discussed as both a strength and limitation. Future research should evaluate prevalence and demographic differences in a larger national sample.

Partisan Poll Watchers and Americans’ Perceptions of Electoral Fairness

Abstract Poll watchers play an increasingly visible role in American elections, yet there is little research into how their presence shapes beliefs about electoral integrity. On the one hand, poll watchers—like other election observers—may lead voters to be more trusting in elections. On the other hand, poll watchers who expressly represent political parties may contribute to polarized views of electoral integrity. We address this gap with two conjoint experiments and one vignette experiment administered on large national samples. The conjoint experiments vary several features of election polling locations, including the presence of poll watchers, voter identification requirements, and other election regulations. We find that regulations around poll watchers shape views of election fairness, but that the nature of this influence depends on the type and partisanship of poll watchers who are present. The vignette experiment shows that perceptions of poll watchers decline when these individuals act in bad faith; effects are especially large for Republican respondents. These findings help identify the potential that poll watchers have to shape Americans’ beliefs about election fairness and integrity.

Perceptions and Knowledge About Climate Friendly Food Choices and Associations With Dietary Intake and Policy Support in a Large National Sample of US Adults

Perceptions and Knowledge About Climate Friendly Food Choices and Associations With Dietary Intake and Policy Support in a Large National Sample of US Adults

Discrimination in Medical Settings across Populations: Evidence From the All of Us Research Program

IntroductionDiscrimination in medical settings (DMS) contributes to health care disparities in the United States, but few studies have determined the extent of DMS in a large national sample and across different populations. This study estimated the national prevalence of DMS and described demographic and health-related characteristics associated with experiencing DMS in seven different situations. MethodsSurvey data from 41,875 adults participating in the All of Us Research Program collected in 2021-2022 and logistic regression were used to examine the association between sociodemographic and health-related characteristics and self-reported DMS among adults engaged with a health care provider within the past 12 months. Statistical analysis was performed in 2023-2024. ResultsAbout 36.89% of adults reported having experienced at least one DMS situation. Adults with relative social and medical disadvantages had higher prevalence of experiencing DMS. Compared to their counterparts, respondents with higher odds of experiencing DMS in at least one situation identified as female, non-Hispanic Black, having at least some college, living in the South, renter, having other living arrangement, being publicly insured, not having a usual source of care, having multiple chronic conditions, having any disability, and reporting fair or poor health, p<0.05. ConclusionsThe findings indicate a high prevalence of DMS, particularly among some population groups. Characterizing DMS may be a valuable tool for identifying populations at risk within the health care system and optimizing the overall patient care experience. Implementing relevant policies remains an essential strategy for mitigating the prevalence of DMS and reducing health care disparities.

Survival outcomes and molecular drivers of testicular cancer in hispanic men

ObjectiveTo examine survival outcomes and molecular drivers in testis cancer among Hispanic men using a large national sample and molecular database. MethodsWe reviewed the SEER registry for testicular cancer from 2000 to 2020. Cox proportional hazards models were used to examine the relationship between race/ethnicity and cancer-specific survival (CSS) by tumor type (seminoma vs. nonseminomatous germ cell tumors [NSGCT]). All models were adjusted for demographic, socioeconomic, and treatment variables. We accessed somatic mutations for testicular cancers through AACR Project GENIE v13.1 and compared mutational frequencies by ethnicity. ResultsOur cohort consisted of 43,709 patients (23.3% Hispanic) with median follow-up 106 months (interquartile range: 45-172). Compared to Non-Hispanic Whites (NWH), Hispanics presented at a younger age but with more advanced disease. Hispanics experienced worse CSS for NSGCT (HR 1.7, 95% CI: 1.5-2.0, P < 0.01) but not seminoma. Somatic mutation data was available for 699 patients. KIT and KRAS mutations occurred in 24.2% and 16.9% of seminoma patients (n = 178), respectively. TP53 and KRAS mutations occurred in 12.1% and 7.9% of NSGCT patients (n = 521), respectively. No differences in mutational frequencies were observed between ethnic groups. There was significant heterogeneity in primary ancestral group for Hispanic patients with available data (n = 53); 14 (26.4%) patients had primary Native American ancestry and 30 (56.6%) had primary European ancestry. ConclusionsCancer-specific survival is worse for Hispanic men with non-seminoma of the testicle. Somatic mutation analysis suggests no differences by ethnicity, though genetic ancestry is heterogeneous among patients identifying as Hispanic.

Further Evidence of Feasibility, Validity, and Reliability of Quality of Life-Aged Care Consumers: Evidence From Home-Based Care Settings

ObjectivesThe Quality of Life-Aged Care Consumers (QOL-ACC) is an aged-care-specific preference-based instrument currently being rolled out in residential care across Australia as part of the aged care Quality Indicator program. This study aimed to provide a comprehensive assessment of the feasibility, reliability, and construct validity of the QOL-ACC in a large national sample of older adults receiving aged care services at home. MethodsOlder adults receiving in-home aged care services completed a survey including the QOL-ACC, Quality of Care Experience-ACC, adult social care outcome tool, EQ-5D-5L, and 2 global single item measures of health and quality of life. Feasibility was assessed by missing responses (≤5%) and ceiling/floor effects (≤15%). Construct validity was assessed by exploring the relationship between the QOL-ACC and other instruments (convergent validity) and its ability to discriminate varying levels of self-rated health and quality of life (known-group validity). ResultsA total of 802 respondents (mean age, 74.5 ± 6.3 years; 56.0% females) completed the survey. The QOL-ACC had no missing responses, no floor effects, and very low ceiling effect (3.5%) and demonstrated moderate correlation with adult social care outcome tool (r = 0.59, P < .001), EQ-5D-5L (r = 0.65, P < .001), EQ-VAS (r = 0.53, P < .001), and a lower correlation with the QCE-ACC (r = 0.41, P < .001). Respondents with poor self-rated health and quality of life had significantly lower preference-weighted scores on the QOL-ACC. ConclusionsThe QOL-ACC demonstrated adequate feasibility, reliability, and construct validity in a large population of older people accessing government-subsidized aged care services at home. Further studies will explore the responsiveness of the QOL-ACC to aged-care-specific interventions both in home and residential aged care settings.

Widespread, bipartisan aversion exists to neighbors owning AR-15s or storing guns insecurely

Over 45,000 gun deaths occur annually in the United States, a country with more than 100 million gun owners and more than 350 million guns. Nevertheless, passing legislation to reduce gun violence is difficult because the issue is intensely polarized. Polls asking about general gun policies (e.g., AR-15 restrictions) demonstrate that, at least in the abstract, Americans disagree vehemently about whether civilians should be able to keep and bear arms. It is possible, however, that a hidden consensus exists in America, which has thus far escaped attention-specifically, that when the focus is on their immediate environments and daily lives, even traditionally pro-gun groups may exhibit aversion to certain types of gun ownership and storage practices. To test this, we conducted two preregistered survey experiments with a large national sample. The first was a conjoint analysis where respondents chose between neighbors (n = 33,596 choices) who randomly varied on seven attributes, including gun ownership (none, pistol, AR-15). No group of respondents, not even traditionally pro-gun groups (e.g., Republicans), exhibited a significant preference for living near gun owners, and every group was averse to AR-15-owning neighbors. The second experiment, per debates about safe-storage laws, was a picture-based factorial vignette that randomized a neighbor's gun storage practices (n = 2,098). Every group of respondents was averse to interacting with a neighbor who stored guns outside of a locked safe. Our findings demonstrate that there is widespread agreement that certain types of gun ownership and storage practices are undesirable for communities.

Perception of hallucinogen use risks and associated hallucinogen use in the United States: results from a large national sample

ABSTRACT Background Our research hypothesis suggests that individuals who perceived hallucinogens as a high-risk substance may have lower odds of using hallucinogens. Methods Data were extracted from three waves (2017–2019) of the National Survey of Drug Use and Health. Two measurements evaluating perception of hallucinogen use risks were selected: risk trying LSD once or twice (unweighted n = 61,982) and risk using LSD once or twice a week (unweighted n = 23,734). Multivariable logistic regressions were estimated following propensity score matching. Results Respondents who thought trying LSD once or twice may bring moderate to great risks to human health were less likely to use LSD (adjusted odds ratio [AOR] = 0.19, 95% CI: 0.17, 0.21; p < .01) and other types of hallucinogens (AOR = 0.26, 95% CI: 0.24, 0.27; p < .01). Respondents who thought using LSD once or twice per week may bring moderate to great risks to human health also were less likely to use LSD (AOR = 0.27, 95% CI: 0.24, 0.31; p < .01) and other types of hallucinogens (AOR = 0.36, 95% CI: 0.31, 0.40; p < .01). Conclusions The empirical evidence from this research suggests that perceptions of hallucinogen use risks were associated with the actual hallucinogen use.

Pharmacokinetic correlates of clinical response in a naturalistic sample of escitalopram-treated patients

ABSTRACT Objective We assessed pharmacokinetic correlates of treatment response to escitalopram using a large therapeutic drug monitoring database. Methods A large naturalistic sample of patients receiving escitalopram was analyzed. Responders were defined as ‘very much improved’ or ‘much improved’ based on the Clinical Global Impression – Improvement score, CGI-I. We compared responders (n = 83) vs. non-responders (n = 388) with the primary outcome being the escitalopram plasma concentration and concentration corrected by the daily dose (C/D ratio). Effects of age, sex, body-mass-index (BMI), and C/D ratio were assessed in a multivariate logistic regression model predicting response. Results There were no statistically significant differences in clinical and demographic characteristics between responders vs. non-responders. There were also no differences between escitalopram daily doses or plasma concentrations, while C/D ratios were significantly higher in non-responders than in responders (1.6 ± 1.7 vs. 1.2 ± 0.9 (ng/mL)/(mg/day), p = 0.007); C/D ratios (odds ratio 0.52, 95% confidence interval 0.34–0.80, p < 0.003) were associated with response to escitalopram, after controlling for age, sex, and BMI. Conclusions Patients with low clearance of escitalopram as reflected upon high C/D ratios may be less likely respond to escitalopram. Identifying these patients during dose titration may support clinical decision-making, including switching to a different antidepressant instead of increasing daily dose.