No abstract

Since 2009, the U.S. Veterans Administration has made concentrated efforts to end homelessness among veterans. As part of these efforts, the Iowa City, Iowa, VA Health Care System in collaboration with local community providers deployed a supportive housing program aimed at homeless veterans. Called the Lodge program, it is intended to serve a Mid-Western mid-size city and its surrounding rural communities. This article presents qualitative findings from a mixed-method, two-year formative evaluation of the Lodge's implementation. Primary barriers to the effectiveness of the Lodge program were regulations hindering cooperation between service programs, followed by problems regarding information sharing and client substance abuse. Facilitators included personal communication and cooperation between individuals within and among service groups. The feasibility of implementing a Lodge program in a more rural community than Iowa City was also discussed.

BackgroundTobacco use remains prevalent among Veterans of military service and those residing in rural areas. Smokers frequently experience tobacco-related issues including risky alcohol use, post-cessation weight gain, and depressive symptoms that may adversely impact their likelihood of quitting and maintaining abstinence. Telephone-based interventions that simultaneously address these issues may help to increase treatment access and improve outcomes.MethodsThis study was a two-group randomized controlled pilot trial. Participants were randomly assigned to an individually-tailored telephone tobacco intervention combining counseling for tobacco use and related issues including depressive symptoms, risky alcohol use, and weight concerns or to treatment provided through their state tobacco quitline. Selection of pharmacotherapy was based on medical history and a shared decision interview in both groups. Participants included 63 rural Veteran smokers (mean age = 56.8 years; 87 % male; mean number of cigarettes/day = 24.7). The primary outcome was self-reported 7-day point prevalence abstinence at 12 weeks and 6 months.ResultsTwelve-week quit rates based on an intention-to-treat analysis did not differ significantly by group (Tailored = 39 %; Quitline Referral = 25 %; odds ratio [OR]; 95 % confidence interval [CI] = 1.90; 0.56, 5.57). Six-month quit rates for the Tailored and Quitline Referral conditions were 29 and 28 %, respectively (OR; 95 % CI = 1.05; 0.35, 3.12). Satisfaction with the Tailored tobacco intervention was high.ConclusionsTelephone-based treatment that concomitantly addresses other health-related factors that may adversely affect quitting appears to be a promising strategy. Larger studies are needed to determine whether this approach improves cessation outcomes.Trial registrationClinicalTrials.gov identifier number NCT01592695 registered 11 April 2012.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3493-z) contains supplementary material, which is available to authorized users.

The purpose of this research was to identify risk factors for future substance abuse (SA) and/or substance dependence (SD) among young boys with attention deficit/hyperactivity disorder (ADHD). The prevalence of childhood ADHD among adult substance abusers has been well documented and stimulant medication therapy is considered to be a protective factor. However, this population remains at high risk for developing SA disorder in adulthood. Thus, since stimulant therapy alone does not eliminate the risk of future SA, it is important to determine other factors that contribute to this problem in this population. The specific questions addressed in this research were 1) What risk factors predict SA problems in later life for adolescent boys who were diagnosed with ADHD? ; 2) Do boys diagnosed with ADHD and receiving stimulant medication have the same risk factors for SA as undiagnosed/unmedicated (normal) boys? and 3) Is the medication effect at reducing SA in later years dependent or independent of the response to the pharmacological treatment for behavioral symptoms of ADHD? This study evaluated data collected in a longitudinal study (1968 to present) of boys diagnosed with ADHD at the University of Iowa Hospital outpatient psychiatric clinic. Longitudinal regression and odds-ratios were used to measure the strength of correlation of risk factors to adult SD outcomes in three groups: diagnosed medicated boys, diagnosed unmedicated boys and a comparison group of undiagnosed, unmedicated (normal) boys. It was hypothesized that specific risk factors could be identified in the two groups of diagnosed boys (medicated and unmedicated). It was further hypothesized that poor response to medication would predict higher rates of adult substance abuse. and thus be an indicator for early prevention/intervention need for the poor responders. Results indicated that few of the evidence-based risk factors identified for the general adolescent population were significant predictors of adult SD for these adolescents diagnosed with ADHD. Other identified risk factors did not appear to be influenced by the effects of the medication. Response to stimulant medication was not related to the outcome of adult substance dependence, indicating that the protective factor exists regardless of medication response.