Long-term Residential Research Articles

Long-Term Residential Exposure to Particulate Matter and Its Components, Nitrogen Dioxide and Ozone—A Northern Sweden Cohort Study on Mortality

This study aims to estimate the mortality risk associated with air pollution in a Swedish cohort with relatively low exposure. Air pollution models were used to estimate annual mean concentrations of particulate matter with aerodynamic diameter ≤ 2.5 µm (PM2.5), primary emitted carbonaceous particles (BC/pOC), sea salt, chemically formed particles grouped as secondary inorganic and organic aerosols (SIA and SOA) as well as ozone (O3) and nitrogen dioxide (NO2). The exposure, as a moving average was calculated based on home address for the time windows 1 year (lag 1), 1–5 years (lag 1–5) and 1–10 years (lag 1–10) preceding the death. During the study period, 1151 cases of natural mortality, 253 cases of cardiovascular disease (CVD) mortality and 113 cases of respiratory and lung cancer mortality were observed during 369,394 person-years of follow-up. Increased natural mortality was observed in association with NO2 (3% [95% CI −8–14%] per IQR) and PM2.5 (2% [95% CI −5–9%] for an IQR increase) and its components, except for SOA where a decreased risk was observed. Higher risk increases were observed for CVD mortality (e.g., 18% [95% CI 1–39%] per IQR for NO2). These findings at low exposure levels are relevant for future decisions concerning air quality policies.

Parent SMART (Substance Misuse in Adolescents in Residential Treatment): Pilot randomized trial of a technology-assisted parenting intervention

Adolescents in residential level of care for substance-related problems have high risk of relapse following discharge. Parent engagement lowers relapse risk, but there are myriad barriers to engaging parents in residential treatment and continuing care. Parent SMART (Substance Misuse in Adolescents in Residential Treatment) is a technology-assisted parenting intervention that was designed to circumvent barriers associated with traditional, office-based continuing care interventions to better engage parents. This pilot randomized trial assessed the acceptability, feasibility, and preliminary effectiveness of Parent SMART as an adjunctive intervention to adolescent residential treatment-as-usual (TAU). Sixty-one parent-adolescent dyads were randomized to Parent SMART+TAU or TAU-only. Thirty-seven dyads were recruited from a short-term facility and 24 dyads were recruited from a long-term facility. Those randomized to Parent SMART received a multi-component technology-assisted intervention combining an off-the-shelf online parenting program, coaching sessions, and a parent networking forum. Parent and adolescent assessments were conducted at baseline, 6, 12, and 24-weeks post-discharge. Feasibility (e.g., parental effectiveness) and acceptability (e.g., parental satisfaction, willingness to recommend the intervention) benchmarks were specified a priori as the primary hypotheses. Secondary effectiveness indicators were the proportion of days adolescent used alcohol, cannabis, and any substance. All acceptability and feasibility benchmarks were met or exceeded among dyads in both short- and long-term residential. Generalized linear mixed models showed no significant effects pooled across sites. Analyses by facility revealed two significant time by condition interactions. Adolescents in short-term residential whose parents received Parent SMART showed fewer drinking days and fewer school problems over time, relative to adolescents whose parents received TAU. Results indicate that Parent SMART was both acceptable and feasible, with preliminary indication of effectiveness among those in short-term residential. A fully-powered trial is warranted to reliably test the effectiveness of Parent SMART and understand possible mechanisms of improvement.

A System Dynamics Modelling of a Long-term Residential Electricity Consumption in Lomé, Togo

According to the Togolese Policy and Regulatory Overviews on Clean Energy, the residential sector in Lomé accounts for nearly 60 percent of the total electricity consumption. This fact is especially due to the current nature of the economy. A system dynamics model was built using Stella software to estimate both the current and long-term household electricity consumptions. These near (2030) and far future (2050) energy forecasts were carried out for Lomé, the capital city of Togo. Two different models were not only built, but also calibrated utilizing data from the past sixteen years as a benchmark. The first model was built based on the: 1) population, 2) Gross Domestic Product (GDP) growth, and 3) per capita electricity consumption. The second model was solely based on the: 1) number of households with electricity and 2) households accessing electricity. Results revealed that the population of Lomé under the current birth rate will be close to 3 million in 2030 and 5 million in 2050, with corresponding electricity consumption close to 860 GWh and 3 TWh, respectively. Therefore, growth in population, economy, and number of households with electricity will continue to drive the future electricity consumption in Lomé. This study could help investors and policy-makers to set the necessary investments by ensuring a timely, reliable, and resilient electricity supply at the turning of 2050 in the city of Lomé and the country at large.

Long-Term Residential Exposure to Environmental Noise and Cardiovascular Disease Onset: A Population-Based Cohort Study

Introduction: Cardiovascular effects of environmental noise are a growing concern. However, the evidence remains largely limited to the association between road traffic noise and hypertension and ischemic diseases especially myocardial infarction (MI).Objective: To examine associations between long-term residential exposure to total environmental noise and the onset of cardiovascular MI and strokes in adults of the Island of Montreal.Methods: An open cohort of 1,087,806 adults aged ≥ 45 years, free of MI and strokes before entering the cohort was created for the years 2000 to 2014 with the Quebec Integrated Chronic Disease Surveillance System, a systematic surveillance system from the second most populous province in Canada starting in 1996. The exposure to total environmental noise (LAeq24h) at cohort entry was estimated with a Land Use Regression (LUR) model. Onsets of MI and strokes were based on one hospital admission. Cox models were used to estimate associations.Results: We found positive associations between Laeq24h estimated and the occurrence of MI and strokes; hazard ratios adjusted for age, sex, year of entry, social and material deprivation indexes and traffic-related air pollutant (nitrogen dioxide) were respectively 1.10 (95% CI: 1.07-1.13) and 1.06 (95% CI: 1.03-1.09) per 10 dBA.Conclusion: These results suggest that total environmental noise is associated with the onset of MI and strokes. Future work should clarify if associations vary by noise sources, and if pre-existing diseases (e.g. hypertension) mediate such effects.

Long-Term Residential Exposure to Ultrafine Particles and C-Reactive Protein (CRP)

Background/Aim: Long-term exposure to ambient air pollution contributes to the burden of disease and particularly affects cardiovascular (CV) causes of death. We investigated the association between particle number concentration (PNC), a marker for ultrafine particles (UFP), and other air pollutants and high sensitivity C-reactive protein (hs-CRP) as a potential link between air pollution and CV disease. Methods: A cross-sectional analysis was performed on data of the second follow-up of the KORA S4 survey in Augsburg, Germany (2013-2014). Residential long-term exposure to PNC, particulate matter <10µm and <2.5µm in aerodynamic diameter (PM10 and PM2.5, respectively), PMcoarse (2.5-10µm), absorbance of PM2.5 (PM2.5abs), nitrogen dioxide (NO2) and nitrogen oxides (NOx) was estimated by land-use regression models. Associations between annual air pollution concentration and hs-CRP were modelled in 2,252 participants using linear regression adjusting for confounders. Possible effect-modifiers were examined by interaction terms. Two-pollutant models were calculated for pollutants with Spearman inter-correlation <0.70. Results: The results pointed to a positive association between PNC, PM10, PMcoarse, PM2.5abs, NO2 and NOx and hs-CRP. For PNC, an interquartile-range (IQR, 2,000 particles/cm3) increase was associated with a 3.63% [95% confidence interval (CI): -0.86%; 8.33%] increase in hs-CRP. Effect estimates were higher for women, non-obese and participants without history of CVD. Effect modification was also seen for participants without diabetes with the highest effect estimate of 14.71% [95% CI: 5.47%; 24.77%] for an IQR increase of 2.1 µg/m³ in PM10. In two-pollutant models, adjustment for PM2.5 strengthened the effect estimates for PNC and PM10 (increase per IQR 6.31% [95% CI: 0.42%; 12.53%] and 7.34% [95%CI: 0.40%; 14.77%], respectively). Conclusions: Our results highlight the role of UFP within the complex mixture of ambient air pollution and their inflammatory potential and help fill a research gap since studies on chronic exposure to ultrafine particles are still scarce.

Risk of Venous Thromboembolism in Patients Nursed at Home or in Long-Term Care Residential Facilities

Background. This study investigated the prevalence of and impact of risk factors for deep venous thrombosis (DVT) in patients with chronic diseases, bedridden or with greatly limited mobility, cared for at home or in long-term residential facilities. Methods. We enrolled 221 chronically ill patients, all over 18 years old, markedly or totally immobile, at home or in long-term care facilities. They were screened at the bedside by simplified compression ultrasound. Results. The prevalence of asymptomatic proximal DVT was 18% (95% CI 13–24%); there were no cases of symptomatic DVT or pulmonary embolism. The best model with at most four risk factors included: previous VTE, time of onset of reduced mobility, long-term residential care as opposed to home care and causes of reduced mobility. The risk of DVT for patients with reduced mobility due to cognitive impairment was about half that of patients with cognitive impairment/dementia. Conclusions. This is a first estimate of the prevalence of DVT among bedridden or low-mobility patients. Some of the risk factors that came to light, such as home care as opposed to long-term residential care and cognitive deficit as causes of reduced mobility, are not among those usually observed in acutely ill patients.

Matching to Sufficient Treatment: Some Characteristics of Undertreated (Mismatched) Clients

ABSTRACT A previous study by the investigative team using Drug Abuse Outcome Study data supported the validity of a sufficient treatment matching paradigm, which defines successful placement as the least treatment intensity required to address the severity of a disorder. The least favorable outcomes were obtained in the under-treated clients who received insufficient treatment intensity. The purpose of the current study was to further clarify characteristics of the undertreated clients. Four groups, those matched and mismatched to long-term residential (LTR) and drug-free outpatient (ODF) treatment, were compared on several baseline variables. Results indicated that the severity levels of drug use, social and psychological problems, and motivation for those mismatched to ODF (undertreated) were significantly lower than the clients matched to LTR but generally higher than the clients matched to ODF and those mismatched to LTR (overtreated). These findings underscore the importance of identifying clients at risk for under-treatment and facilitating their entry into treatments of sufficient intensity. More generally, they highlight the need to develop a range of treatment options of sufficient intensity to meet severity differences among clients.

Physical Pain and Associated Clinical Characteristics in Treatment‐Seeking Patients in Four Substance Use Disorder Treatment Modalities

Physical pain among persons seeking treatment for substance use disorders (SUD) and characteristics associated with pain were examined in a secondary analysis of data from the Drug Abuse Treatment Outcome Study (DATOS), a multi-site treatment outcome study. Patients (N = 7,876) in four treatment modalities - long-term residential (LTR), short-term inpatient (STI), outpatient methadone treatment (OMT), and outpatient drug-free (ODF) - reported severity of physical pain experienced during the preceding 12 months. Moderate to severe physical pain was reported by 21.2% of LTR patients, 26.8% of STI patients, 33.6% of OMT patients, and 17.6% of ODF patients. Individuals with and without physical pain were compared across treatment modalities. Patients with pain were more likely to report weekly heroin use [aOR = 1.73 (1.44-2.08)], weekly narcotics use [aOR = 1.43 (1.18-1.74)] and greater depressive symptoms [aOR = 1.30 (1.21-1.38)]. These findings support the presence of a sizable proportion of SUD patients with pain who may benefit from pain assessment as part of their SUD treatment.

Long-Term Residential Exposure to Traffic and Peripheral Arterial Disease in the Heinz Nixdorf Recall Study

ISEE-363 Objective: Results from animal experiments suggest that long-term exposure to particulate matter (PM) accelerates atherogenesis. Two recent epidemiologic studies have shown an association between air pollution and different measures of atherosclerosis, namely coronary artery calcification and carotid intima-media thickness. We examined the relationship between long-term residential exposure to traffic, a major source of urban PM air pollution, and the prevalence of peripheral arterial disease. Material and Methods: We used baseline data from a population-based, prospective cohort study. Long-term traffic exposure was assessed by calculating distances between residences and major roads (mean daily vehicle count 10,000–130,000). Annual mean PM2.5 exposure values were derived from a small-scale dispersion model. The outcomes were the ankle brachial index (ABI) on a continuous scale, excluding participants with Moenckeberg's medial calcinosis (ABI >1.3), and the prevalence of peripheral arterial disease (PAD), defined as an ABI of less than 0.9 and/or a history of prior PAD treatment. We evaluated the association between proximity to major roads and ABI as well as prevalence of PAD with linear and logistic regression, controlling for background PM2.5 concentrations and individual level risk factors for atherosclerosis. Results: Mean ABI values and prevalence of PAD were dependent on age, sex, and smoking status in the 4616 participants with complete information on outcome and explanatory variables. Living within 50 m of a major road (reference >200 m) was associated with a 3.0% decrease in ABI (95% CI 0.8%–5.3%) in the unadjusted model and a 2.1% (0.0%–4.3%) decrease in the model adjusted for background PM2.5 and individual cardiovascular risk factors. Stronger associations were seen in elderly subjects (3.7%; 0.4%–7.1%), women (5.2%; 2.4%–8.0%), and smokers (8.1%; 3.6%–12.6%). The adjusted OR for PAD in the complete group was elevated by 1.87 (95% CI 1.10–3.20). Conclusions: This study provides epidemiologic evidence that long-term residential exposure to traffic is associated with atherosclerosis.

Overview of 5-year followup outcomes in the drug abuse treatment outcome studies (DATOS)

Followup results from the Drug Abuse Treatment Outcome Studies (DATOS) 1-year and 5-year followups were used to describe the long-term outcomes of drug treatment and to further clarify the relationship between treatment duration and post-treatment outcomes in four treatment modalities: outpatient methadone, long-term residential (LTR), outpatient drug free (ODF), and short-term inpatient. Methods replicating those used in earlier analyses of the DATOS 1-year followup of 2,966 patients admitted to treatment in 1991–1993 and those of the Treatment Outcome Prospective Study patients admitted in 1979–1981 were employed. DATOS is a non-experimental longitudinal study conducted within the natural settings of 96 treatment programs in the U.S.A. The study followed patients during and after treatment at specified periods of time. Prevalence of drug use and behaviors were evaluated for the year prior to treatment; and the post-treatment time frames defined by the 1- and 5-year followups. In addition, the multivariate analytic technique of generalized estimating equations was used to examine the relationship of treatment duration and outcomes across both followups while also controlling for patient characteristics and pretreatment levels of behaviors. The 5-year stratified followup sample included 1,393 of the same individuals in the 1-year followup sample. Analyses were restricted to patients participating in both followups. Reductions in prevalence of cocaine use in the year after treatment (compared to the preadmission year) by patients were associated with longer treatment durations (particularly 6 months or more in LTR and ODF). In addition, reductions in illegal activity and increases in full-time employment were related to treatment stays of 6 months or longer for patients in LTR. The DATOS results from the 1-year and 5-year post-treatment followup combined suggest the stability of outcomes of substance abuse treatment. While results are generally consistent with the full 1-year followup, reduced sample size and bias of the sample toward patients with longer treatment retention may have attenuated the findings.

Patient and program factors in obtaining supportive services in DATOS

This study examined patient and program factors that influenced the receipt of scheduled supportive services in the Drug Abuse Treatment Outcome Studies (DATOS). Patients ( N = 2,932) in 21 long-term residential (LTR) programs, 27 outpatient methadone treatment (OMT), and 25 outpatient drug-free programs were interviewed at admission and at 3 months during treatment. A hierarchical regression analysis was used to examine the relationship between patient-level and program-level factors associated with receiving supportive services in seven categories (medical, psychological, family, legal, educational, vocational, and financial). LTR patients received more services on average than outpatients (especially OMT), but patients overall received few services in the first 3 months of treatment. The patient-level likelihood of receiving services was related to being female and to having higher problem severity at intake. At the program level, outpatient clientele with higher problem severity received more services if they entered a program whose other enrolled patients were less troubled on average.

Treatment Retention of Crack and Cocaine Users in a National Sample of Long Term Residential Clients

Clients entering treatment with cocaine problems are difficult to engage and retain in treatment. Crack users, a subset of cocaine users, are especially difficult to treat. This study investigated whether type of cocaine used (crack or non-crack) was related to retention in treatment. The sample consisted of 900 clients in 13 long-term residential (LTR) programs participating in the national Drug Abuse Treatment Outcome Studies (DATOS). Clients met the DSM-HI-R criteria for cocaine dependence and were at least weekly users of cocaine (including crack). Hierarchical logistic model regression analysis was used to test the relationship between type of cocaine preference and retention. Crack users had lower retention rates than non-crack cocaine users, even after adjusting for covariates. Higher retention was also related to being older, a high school graduate, unmarried, not depressed, alcohol dependent, more motivated for treatment, and having fewer arrests. New strategies to improve retention for crack use...

Patient histories, retention, and outcome models for younger and older adults in DATOS

Structural equation modeling with multiple groups was used to examine relationships among pretreatment patient characteristics, treatment retention, and treatment outcomes among younger and older adults in the Drug Abuse Treatment Outcome Studies. Separate models were tested for 551 patients treated in long-term residential (LTR) programs and 571 patients treated in outpatient drug-free (ODF) programs. There was a stronger positive relationship between treatment retention and abstinence at follow-up for younger adults in both treatment modalities. Prior treatment history had a negative effect on self-efficacy to resist drug use for older adults in LTR. Negative reference group influence was reduced for all groups following treatment, however, it was more strongly related to abstinence for younger adults in LTR and for older adults in ODF. Clinical implications of age-related differences in these relationships are discussed.

Retention and patient engagement models for different treatment modalities in DATOS

A model to explain treatment retention in terms of process components — therapeutic involvement and session attributes for the 1st month — and patient background factors were tested in long-term residential (LTR), outpatient drug free (ODF), and outpatient methadone (OMT) treatments. The data was collected in the national Drug Abuse Treatment Outcome Studies (DATOS), and included 1362 patients in LTR, 866 in ODF, and 981 in OMT programs. Structural equation models showed there were positive reciprocal effects between therapeutic involvement and session attributes in all three modalities, and these variables had direct positive effects on treatment retention. Motivation at intake was a strong determinant of therapeutic involvement. Other patient background factors were significantly related to retention, including pretreatment depression, alcohol dependence, legal pressure, and frequency of cocaine use.

Costs and benefits of treatment for cocaine addiction in DATOS

Our objective was to examine the cost of long-term residential (LTR) and outpatient drug-free (ODF) treatments for cocaine-dependent patients participating in the Drug Abuse Treatment Outcome Studies (DATOS), calculate the tangible cost of crime to society, and determine treatment benefits. Subjects were 502 cocaine-dependent patients selected from a national and naturalistic nonexperimental evaluation of community-based treatment. Financial data were available for programs from 10 US cities where the subjects received treatment between 1991 and 1993. Treatment costs were estimated from the 1992 National Drug Abuse Treatment Unit Survey (NDATUS), and tangible costs of crime were estimated from reports of illegal acts committed before, during, and after treatment. Sensitivity analyses examined results for three methods of estimating the costs of crime and cost-benefit ratios. Results showed that cocaine-dependent patients treated in both LTR and ODF programs had reductions in costs of crime from before to after treatment. LTR patients had the highest levels and costs of crime before treatment, had the greatest amount of crime cost reductions in the year after treatment, and yielded the greatest net benefits. Cost-benefit ratios for both treatment modalities provided evidence of significant returns on treatment investments for cocaine addiction.

Effects of readiness for drug abuse treatment on client retention and assessment of process

Aims. This study examined client motivation as a predictor of retention and therapeutic engagement across the major types of treatment settings represented in the third national drug abuse treatment outcome study (DATOS) conducted in the United States. Design. Sequential admissions during 1991‐93 to 37 programs provided representative samples of community‐based treatment populations. Based on this naturalistic non‐experimental evaluation design, hierarchical linear model (HLM) analysis for nested data was used to control for systematic variations in retention rates and client attributes among programs within modalities. Setting. The data were collected from long‐term residential (LTR), outpatient methadone (OMT) and outpatient drug‐free (ODF) programs located in 11 large cities. Participants. A total of 2265 clients in 18 LTR, 981 clients in 13 OMT and 1791 clients in 16 ODF programs were studied. Measurements. Pre‐treatment variables included problem recognition and treatment readiness (two stages of motivation), socio‐demographic indicators, drug use history and dependence, criminality, co‐morbid psychiatric diagnosis and previous treatment. Retention and engagement (based on ratings of client and counselor relationships) served as outcome criteria. Findings. Pre‐treatment motivation was related to retention in all three modalities, and the treatment readiness scale was the strongest predictor in LTR and OMT. Higher treatment readiness also was significantly related to early therapeutic engagement in each modality. Conclusions. Indicators of intrinsic motivation‐especially readiness for treatment‐were not only significant predictors of engagement and retention, but were more important than socio‐demographic, drug use and other background variables. Improved assessments and planning of interventions that focus on stages of readiness for change and recovery should help improve treatment systems.

Effects of readiness for drug abuse treatment on client retention and assessment of process.

This study examined client motivation as a predictor of retention and therapeutic engagement across the major types of treatment settings represented in the third national drug abuse treatment outcome study (DATOS) conducted in the United States. Sequential admissions during 1991-93 to 37 programs provided representative samples of community-based treatment populations. Based on this naturalistic non-experimental evaluation design, hierarchical linear model (HLM) analysis for nested data was used to control for systematic variations in retention rates and client attributes among programs within modalities. The data were collected from long-term residential (LTR), outpatient methadone (OMT) and outpatient drug-free (ODF) programs located in 11 large cities. A total of 2265 clients in 18 LTR, 981 clients in 13 OMT and 1791 clients in 16 ODF programs were studied. Pre-treatment variables included problem recognition and treatment readiness (two stages of motivation), socio-demographic indicators, drug use history and dependence, criminality, co-morbid psychiatric diagnosis and previous treatment. Retention and engagement (based on ratings of client and counselor relationships) served as outcome criteria. Pre-treatment motivation was related to retention in all three modalities, and the treatment readiness scale was the strongest predictor in LTR and OMT. Higher treatment readiness also was significantly related to early therapeutic engagement in each modality. Indicators of intrinsic motivation--especially readiness for treatment--were not only significant predictors of engagement and retention, but were more important than socio-demographic, drug use and other background variables. Improved assessments and planning of interventions that focus on stages of readiness for change and recovery should help improve treatment systems.