For some chronic conditions, increased drug utilization can provide a net economic return when it is driven by improved adherence with guidelines-based therapy.

Different changes in formulary administration may have dramatically different effects on utilization and spending and may in some instances lead enrollees to discontinue therapy. The associated changes in copayments can substantially alter out-of-pocket spending by enrollees, the continuation of the use of medications, and possibly the quality of care.

A single outpatient comprehensive geriatric assessment coupled with an adherence intervention can prevent functional and health-related quality-of-life decline among community-dwelling older persons who have specific geriatric conditions.

To develop viable strategies for preventing or curbing youth violence, we need to understand the scope of the problem and its co-occurrence with other behaviors that concern the public health and policy communities.1-3 Several studies provide estimates of general delinquency among youth,4-6 but research focusing only on violent behavior is sparse and is often based on special populations: youth in the criminal justice system,7 gangs,8 inner-city youth,6'9 high school students,'0"' or White middleclass males.'2 Because violent delinquents may differ from nonviolent delinquents in important ways,'3"4 we need to explicitly disentangle violence from other types of delinquent behavior and to assess its prevalence in more general populations.We also need to understand the degree to which violence and other problems are linked. Prior research indicates that general delinquency may occur as only one of a constellation of problem behaviors,2'4 5 but there is little agreement about how many youth "specialize" in a single high-risk behavior vs multiple problem behaviors. Dryfoos5 has suggested that as many as 25% of the nation's adolescents participate in multiple problem behaviors, including serious delinquency, school failure, substance use, and early sexual activity. In contrast, Elliot et al.4 estimated that less than 1% of 15-to 21 -year-olds were seriously delinquent in 1980, used two or more substances simultaneously, and suffered from mental health problems. And although most studies agree that more males than females are delinquent, substantial disagreement persists over the magnitude and nature of this difference.l'l8Our study examines the prevalence and behavioral context of multiple types of violent behavior in a sample of high school seniors and dropouts originally drawn from 30 middle and junior high schools in California and Oregon.Using liberal and stringent definitions of violence, we explore the correlation between violent behavior and other public health and criminal justice problems. We also examine gender differences in prevalence rates and estimate the extent to which youth engage in multiple problem behaviors.A key contribution of this study is that it overcomes the underreporting bias associated with prevalence rates that are derived from school-based samples of adolescents. I 19 Not only does our sample include a substantial proportion of school dropouts, but we have compensated for any remaining sample attrition by developing weights that allow us to represent the original 7th-grade cohort in the 30 schools. Hence, our estimates have been adjusted for nonresponse due to absenteeism, moving, dropping out of school, or refusal to respond to the survey. Methods Data SourceWe use a longitudinal database of more than 4500 high school seniors and dropouts (17-to 18-year-old adolescents) from urban, suburban, and rural communities in California and Oregon. The 30 middle schools they originally attended were chosen to represent a broad spectrum of communities, socioeconomic status, and racial and ethnic c...

OBJECTIVES. Although several studies have reported short-term gains for drug-use prevention programs targeted at young adolescents, few have assessed the long-term effects of such programs. Such information is essential for judging how long prevention benefits last. This paper reports results over a 6-year period for a multisite randomized trial that achieved reductions in drug use during the junior high school years. METHODS. The 11-lesson curriculum, which was tested in 30 schools in eight highly diverse West Coast communities, focused on helping 7th and 8th grade students develop the motivation and skills to resist drugs. Schools were randomly assigned to treatment and control conditions. About 4000 students were assessed in grade 7 and six times thereafter through grade 12. Program effects were adjusted for pretest covariates and school effects. RESULTS. Once the lessons stopped, the program's effects on drug use stopped. Effects on cognitive risk factors persisted for a longer time (many through grade 10), but were not sufficient to produce corresponding reductions in use. CONCLUSIONS. It is unlikely that early prevention gains can be maintained without additional prevention efforts during high school. Future research is needed to develop and test such efforts.