Showing papers by "Michael J. Fine published in 2004"

Health Disparities: The Importance of Culture and Health Communication

Abstract: The root causes of health disparities are numerous and relate to individual behaviors, provider knowledge and attitudes, organization of the health care system, and societal and cultural values. Disparities have been well documented,even in systems that provide unencumbered access to health care, such as the VA Healthcare System, suggesting that factors other than access to care (e.g., culture and health communication) are responsible. Efforts to eliminate health disparities must be informed by the influence of culture on the attitudes, beliefs, and practices of not only minority populations but also public health policymakers and the health professionals responsible for the delivery of medical services and public health interventions designed to close the health gap. There is credible evidence suggesting that cultural norms within Western societies contribute to lifestyles and behaviors associated with risk factors for chronic diseases (e.g., diabetes and cardiovascular disease). This is the context in which smoking cessation, increased physical activity, and dietary regulation are prime targets for intervention.

Self-reported changes in drug and alcohol use after becoming homeless.

Abstract: Objectives. We identified substance use patterns and factors associated with increased substance use after users become homeless. Methods. We carried out a 2-city, community-based survey that used population-proportionate sampling of 91 sites with random selection at each site. Results. Five hundred thirty-one adults were interviewed; 78.3% of them met Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition criteria for substance abuse or dependence. Most of those who met the criteria reported using drugs and alcohol less since they became homeless, commonly because they were in recovery. Factors independently associated with increased use were no health insurance (odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.02, 2.58), alcohol abuse or dependence (OR = 3.5; 95% CI = 1.85, 6.78), and selling plasma (OR = 2.6; 95% CI = 1.32, 5.14) or panhandling (OR = 3.0; 95% CI = 1.65, 5.55) to acquire drugs. Conclusions. Becoming homeless plays a role in self-reported substance use. Multi...

Substance-abusing urban homeless in the late 1990s: how do they differ from non-substance-abusing homeless persons?

Abstract: Much of our understanding of substance abuse and homelessness comes from data from the 1980s and may not necessarily reflect issues or trends prevalent during the 1990s. We report data from a two-city, community-based, populations-proportionate sample of 531 randomly selected homeless adults; the study was conducted in 1997 and compared substance-abusing to non-substance-abusing respondents. Most (78.3%) met criteria for substance abuse/dependence and were abusing either cocaine or alcohol and cocaine (68.5%). In the multiple logistic regression model, male gender (odds ratio [OR] 2.94, 95% confidence interval [CI] 1.70–5.09), less than a 12th grade education (OR 1.96, 95% CI 1.11–3.46), bustling or stealing for sustenance (OR 3.14, 95% CI 1.15–8.55), and identifying a need to learn how to manage one’s money (OR 2.41, 95% CI 1.45–3.98) were independently associated with substance abuse/dependence. Drug abuse/dependence and polysubstance use among urban homeless persons became a more prevalent issue in the late 1990s. These individuals have unique needs that will require tailored interventions.

ASAM Patient Placement Criteria Treatment Levels: Do They Correspond to Care Actually Received by Homeless Substance Abusing Adults?

Abstract: We report findings from a community-based two-city survey of homeless adults comparing the level of substance abuse treatment assigned to them using the ASAM Patient Placement Criteria with care actually received during the previous 12 months. Overall 531 adults were surveyed with 382 meeting DSM-IIIR criteria of being in need of treatment or having a demand for treatment. Of those with a treatment need, 1.5% met criteria for outpatient care, 40.3% intensive outpatient/ partial hospitalization care, 29.8% medically monitored care and 28.8% managed care levels. In contrast, of those receiving treatment (50.5%, 162 persons), almost all care received by this cohort was either inpatient or residential based (83.6%). Unsheltered homeless persons and those without insurance were significantly more likely to report not receiving needed treatment. Lack of treatment availability or capacity, expense, and changing one's mind while on a wait list were the most commonly cited reasons for no treatment.

Increased Costs of Diabetes Therapy Not Related to Glycemic Control at Three Veterans Affairs Medical Outpatient Clinics

Abstract: Our goal was to determine whether the type of primary care provider and the site of care influenced pharmaceutical costs and glycemic control at three Veterans Affairs outpatient clinics. Overall, we identified 4,265 veterans who received antihyperglycemic medications during 1997. We found that prescribing patterns, monthly total costs, and glycemic control differed according to hospital site. The primary care provider type and the intensity of treatment were associated with monthly medication costs, monthly total costs, and glycemic control; however, the costs of monthly medications and the total costs were not associated with improved glycemic control.