Brain injury has a tremendous effect on the United States. The medical system has a continuum of care available but many of these services are extremely expensive. Despite the effectiveness of residential post-acute brain injury rehabilitation (PABIR) resistance to provide adequate funding remains because of a dearth of randomized controlled trial (RCT) studies demonstrating effectiveness. Some research suggests observational trials are typically more representative of community samples and yield conclusions similar to RCT studies. This study uses a large multi-state naturalistic community-based sample of individuals who received residential PABIR. The purposes of this study were to (1) use logistic regression to identify a model that considered the relationships among the predictor variables to explain treatment outcome for individuals receiving residential PABIR and (2) better understand how self-awareness influences treatment outcome. The final model contained five independent variables (substance use at time of admit, functioning level at time of admit, change in awareness between discharge and admit, admit before or after 6 months post-injury (TPI), and length of stay (LOS) in the program less than or greater than 2 months). The model was statistically significant, ÷2 (5, N=434) = 194.751, p < .001, accounting for 36.2% (Cox & Snell R square) to 61.3% (Nagelkerke R square) of the variance in success rate, and correctly classified 89.4% of cases. Four of the five predictor variables (current substance use, change in awareness, LOS 2 months and TPI 6 months) made statistically significant contributions to the model. The strongest predictor of successful treatment outcome was change in awareness recording an odds ratio of 29.9 indicating that individuals who improved in self-awareness by at least one level were nearly 30 times more likely to be in the successful outcome group, controlling for other factors in the model. Participants were also more likely to be in the successful outcome group if they admitted within 6-months post-injury (5.5x) and stayed longer than 2-months (4.4x). Findings also suggest that active substance use at time of admission did not prevent people from being successful. Importance and implications of these findings are discussed.

In Ghana, prevalence of HIV among MSM is significantly higher than that of the general population. Substance use and transactional sex in the urban settings of Ghana have been identified as risk behaviors that exacerbate chances of transmission for this vulnerable group. This thesis draws upon the findings of two companion studies that were conducted in Kumasi, Ghana by Boston University researchers in 2012. The objectives of the studies were to gain a deeper understanding of the behaviors and attitudes regarding substance use and transactional sex among younger and older MSM in Kumasi, Ghana. In the first study 99 MSM between the ages of 15 to 29 years old participated, of whom 55 attended focus group discussions (FGDs) and 44 participated in in-depth interviews (IDIs). In the second study 44 participants aged 30 years or older participated including 20 in IDIs and 24 in FGDs. Condom use was found to be inconsistent across all ages and most commonly attributed to reduced caution while drinking alcohol. Transactional sex was high among both young and older MSM, but younger MSM were more likely to be on the ‘receiving’ end of the transaction with the older men providing money and gifts. For both groups the internet was identified as a key method to contact prospective sexual partners suggesting the need to include social media in future HIV prevention interventions.

Bakgrund Missbrukssyndrom är vanligt förekommande i samhället och innebär en skadlig användning av olika substanser t.ex. alkohol och droger. Användningen pågår trots negativa konsekvenser för personens livssituation och ökar risken för en instabil hälsa. Vilket leder till ett ökat behov av hälso- och sjukvård. Forskning har visat att personer med missbrukssyndrom upplevde utanförskap, stigmatisering och skam vid kontakt med sjukvården.  Syftet Att beskriva sjuksköterskors upplevelser av att möta personer med missbrukssyndrom och sjuksköterskans attityder i vårdmötet, samt att beskriva inkluderade artiklars undersökningsgrupper.  Metod En beskrivande litteraturstudie. Tio artiklar inkluderandes i resultatet. Artikelsökning gjordes i databaserna PubMed och Cinahl. Diskussion fördes mellan författarna för att sammanställa ett objektivt resultat.   Huvudresultat Sjuksköterskor hade skilda meningar om missbrukssyndrom var en sjukdom. Personer med missbrukssyndrom ansågs som oansvariga över sitt hälsotillstånd enligt sjuksköterskor. Sjuksköterskorna beskrev hur de upplevde patientgruppen som oberäknelig och manipulativ samt att den orsakade ökad arbetsbelastning. Vidare uppkom en känsla av frustration över den egna misstron och osäkerheten kring patientgruppen. Önskemål om utbildning uttrycktes. Enligt sjuksköterskorna var tålmodighet och att vara stödjande viktiga delar i vårdandet samt att inte spegla det egna tyckandet.   Slutsatser Beroende på om sjuksköterskor såg missbrukssyndromet som ett sjukdomstillstånd eller som självförvållat, framkom positiva eller negativa attityder och upplevelser. Kunskap och utbildning inom missbrukssyndrom behövs för att upprätthålla ett etiskt förhållningssätt i sjuksköterskans profession. / Background Substance-use disorder is common in society and involves harmful use of different substances, for example. alcohol and drugs. The use is in progress despite adverse consequences for the person's life situation and increases the risk of unstable health. Which leads to an increased need for healthcare. Research has shown that people with substance-use disorder experience exclusion, stigma and shame in contact with healthcare   Aim To describe nursing experience of meeting people with substance-use disorder and the nurse's attitudes in the healthcare meeting, as well as describing the survey articles of the included articles.   Method A descriptive literature study. Ten items are included in the result. Article search was made in the PubMed and Cinahl databases. Discussion was conducted between the authors to compile an objective result.   Results Nurses had different opinions about if substance-use disorder were a disease or not. Persons with substance-use disorder were considered irresponsible for their health status according to nurses. Nurses described how they experienced the patient group as erratic and manipulative and that caused increased workload. Furthermore, a sense of frustration arose over their own missile and the uncertainty surrounding the patient group. Requests for education were expressed. According to the nurses, patience and support were important parts of care and to not reflect their own opinion.   Conclusion Depending on whether nurses saw the substance-use disorder as a state of illness or as self-inflicted, positive or negative attitudes and experiences have emerged. Knowledge and education in substance-use disorder is necessary to maintain an ethical approach within the nurse's profession.

This mixed-methods dissertation considers the experiences of women who used substances during pregnancy. Retrospective interviews with 15 women, currently accessing inpatient substance abuse treatment, identify trends in women’s experiences prior to accessing these services. Women report being concerned about the impact of their substance use on the developing baby, seeking information, reducing substance use outside of accessing treatment services, and engaging in healthy behaviors to protect the baby from harm. Trends related to trying to reduce harm to the baby during pregnancy are then further explored through quantitative analyses. Data on harm reduction behaviors prior to accessing treatment were collected from an additional 54 women. A clinical and research tool for visually tracking patterns of maternal substance use over the course of pregnancy was developed. This tool identifies the high prevalence of women who decrease their substance use during pregnancy outside of accessing treatment services. Clinical use of this tool is considered. In addition, a questionnaire, designed to identify engagement in harm reduction and health promoting behaviors, was administered. Data suggests that harm reduction and health promotion behaviors are common and tend to begin early on in pregnancy. Women report beginning to decrease their substance use, on average, beginning at the end of the first trimester. The timing of beginning to reduce substance use is not associated with the timing of entering substance abuse treatment in relation to a given pregnancy. However, maternal mental health and perceived barriers to accessing services do predict when, in relation to pregnancy, women enter treatment. As a whole, this research suggests that continued use of substances during pregnancy is not due to indifference towards the developing baby. Instead, women report being concerned about their babies and being engaged in the process of positive self-change. There are public health and clinical implications to these findings. This research suggests the opportunity to build upon the motivation that women have to decrease their substance use. In addition, this research suggests the importance of focusing policy and intervention efforts on addressing perceived barriers to accessing treatment services.

abstract: ABSTRACT The relationships between adaptive and maladaptive aspects of gender roles in predicting substance use were examined in a sample of 955 (450 boys, 505 girls) Mexican American 7th and 8th grade adolescents participating in a school-based substance use intervention. The moderating effect of linguistic acculturation, the mediating effects of antisociality, depressive symptoms, and adaptive and avoidant coping on gender role-substance use relationships were examined. Correlational and path analyses supported the Functional Model of Gender Roles that considers these roles as adaptive or maladaptive social coping strategies. For boys, the path analyses yielded significant direct paths from aggressive masculinity to composite alcohol, cigarette, and marijuana use measures, with all other effects of gender roles on substance use operating through the mediators. Bootstrapped mediation tests yielded significant indirect paths, where for boys the positive relationships between assertive and aggressive masculinity with substance use and the negative relationship of affective femininity with substance use were mediated through antisociality, which is predictive of increased substance use. For girls, the positive relationship between aggressive masculinity with cigarette and alcohol use and the negative relationship of affective femininity with alcohol and cigarette use were also mediated by adaptive coping, which is predictive of decreased substance use. A different set of significant indirect paths through avoidant coping connected assertive masculinity and submissive femininity to alcohol use for boys. For boys, the paths from affective femininity to antisociality and adaptive coping were found to be moderated by linguistic acculturation, with the negative correlation of affective femininity with antisociality and positive correlation of this gender role with adaptive coping being stronger in boys low in acculturation. In turn, the pathway from this acculturation by affective femininity interaction to substance use was found to be mediated by antisociality. The present analyses confirmed the importance of gender roles and their interaction with acculturation in predicting substance use in Mexican American adolescents. The analyses also were important in delineating functional mechanisms through which these gender roles have their effects, with implications for the design of interventions to reduce substance use in this population. / Dissertation/Thesis / Ph.D. Social Work 2012

xv, 83 p. A print copy of this title is available through the UO Libraries. Search the library catalog for the location and call number. / Peer influences on adolescence substance use have been widely demonstrated. In particular, social interactions that are centered around and reinforcing of antisocial values, known as deviant peer contagion, are predictive of a variety of antisocial outcomes, including substance use. However, much less is known about the interpersonal dynamics between friends that are associated with resilience to peer contagion. Recent work has associated self-regulation with resilience to the effects of associating with deviant and substance-using peers. Limited resource models of self-regulation have proposed that social interactions may tax regulatory resources to the point that self-regulation becomes impaired. Youth with more limited regulatory resources may demonstrate increased susceptibility to influence from peers. However, in friendship interactions, self-regulatory behaviors are highly dependent on the self-regulation of the partner. Therefore, the present study examined dyadic regulation in friendship interactions consistent with the idea of a dyadic process. In addition to investigating the construct validity of dyadic regulation, it was hypothesized that dyadic regulation would moderate the impact of peer contagion on problematic substance use. Furthermore, consistent with a limited resource model, it was predicted that adolescents with declining dyadic regulation over the course of an interaction would be more susceptible to peer contagion. Problematic substance use and interaction patterns within friendships were assessed in a sample of 711 (355 male, 356 female) ethnically diverse 16- and 17-year-old adolescents. Using videotaped observations of friendship interactions, dyadic regulation was assessed by rating responsiveness, self-focused intrusions, attention, and conversational turn-taking. Deviant peer contagion was assessed through the proportion of the interaction spent discussing deviant topics. Contrary to the hypothesized self-regulatory resilience model, those dyads that were more highly regulated while discussing deviant topics demonstrated the highest levels of problematic tobacco use. Consistent with a limited resource model of regulation, however, dyads with decreasing regulation over the course of an interaction appeared to be the most vulnerable to deviant peer contagion, demonstrating greater problematic marijuana use. These results are encouraging of further investigation in this area and may have implications for direct interventions targeting risk for substance use as well as reducing iatrogenic effects in group interventions. / Adviser: Thomas J. Dishion

Intimate partner violence (IPV) is a serious public health concern in the United States and around the world, with adolescents and emerging and young adults most at-risk for IPV. Early experiences of IPV have far-reaching, immediate negative effects on individual health and developmental outcomes. There is a small body of research on the impact of IPV on young adults’ vocational outcomes and the links between these two factors. This study utilized prospective, longitudinal data collected nationally from 1,386 individuals to examine how IPV experiences during adolescence impact IPV experiences, depression, and substance use problems during emerging adulthood and vocational outcomes during young adulthood. It was hypothesized that (a) IPV victimization during adolescence will be associated with vocational outcomes during young adulthood; (b) IPV experiences, depression and substance use problems during emerging adulthood would mediate the relationship between IPV victimization during adolescence and vocational outcomes during young adulthood; (c) there would be a positive association between depression and substance use problems during emerging adulthood; and (d) there would be a positive association between educational attainment and employment status during young adulthood. Path analyses were performed using a Structural Equation Modeling framework to test study hypotheses. Study findings revealed that adolescent IPV victimization significantly predicted emerging adult IPV victimization, reciprocal IPV and depression, and young adult educational attainment. Emerging adult depression and reciprocal IPV mediated adolescent IPV victimization and young adult vocational outcomes. Depression and substance use problems during emerging adulthood and educational attainment and employment status during young adulthood were significantly associated. The present study provides support for the developmental cascading risks of IPV on individuals’ development over time. This study adds to the dearth of empirical research showing a relationship between early IPV experiences and vocational development for young adult men and women and the importance of assessing for different types of IPV experiences and the differential impact on mental health and vocational outcomes, for women and men, across time. These findings support the importance of identifying key mediating factors and time points that may be targeted to interrupt the accumulation of IPV risk from adolescence into young adulthood.

Being a mother is often described as a difficult but rewarding experience. Maternal parenting reward (PR) may serve an important function, helping to facilitate responsive maternal care and healthy infant development. However, it should not be taken for granted that the rewards of parenting will emerge naturally for women, particularly women who were abused by their own caregivers in childhood, within family systems that enabled or perpetuated the abuse. Despite an abundance of research on the neurobiological correlates of PR, surprisingly little is known about mothers’ self-reported experience of PR, both in general and in relation to early adversity. The aims of this survey-based dissertation were to develop and psychometrically evaluate a PR self-report measure, and to determine the extent to which childhood abuse predicts short-term (family betrayal) and long-term (maternal depression, posttraumatic stress, and problematic substance use) sequelae of abuse that are associated with diminished PR. In Study 1, with 203 mothers of young children, the final 14-item questionnaire assessed PR in a way that was not confounded with social desirability or maternal demographic characteristics, and was distinct from the related constructs of parenting pleasure and satisfaction. On average, mothers reported being highly rewarded by parenting, though there were individual differences in PR within and across mothers. In Study 2, with 270 mothers of young children, maternal history of childhood psychological and sexual abuse by caregivers each predicted diminished PR indirectly. Childhood psychological abuse was strongly associated with family betrayal, or actions and inactions by the family of origin that enabled or perpetuated abuse, which in turn predicted recent maternal depression and posttraumatic stress, each of which predicted diminished PR. The association between childhood sexual abuse and diminished PR was mediated by increased maternal posttraumatic stress symptoms only, not by family betrayal or alcohol use problems related to posttraumatic stress, as hypothesized. Although alcohol use problems predicted diminished PR at the bivariate level, they did not predict PR in the full model. Maternal childhood abuse by caregivers is indirectly associated with disruptions to the social rewards of attachment, with potential intergenerational consequences for the mother-infant relationship and infant development. / 10000-01-01

Emerging adulthood is a unique developmental stage during which significant transitions in living environment, social networks, personal responsibilities, and identity development occur. Stress resulting from such transitions relates to increases in health risk behaviors. As such, emerging adults (EAs) have a high prevalence of substance use disorders and sexually transmitted infections. However, EAs are less likely to seek treatment. Therefore, brief methods of intervention, such as Motivational Interviewing (MI) and the Family Check-up (FCU), might be useful approaches for working with this unique population. MI and the FCU are linked with decreases in health risk behaviors. The FCU comprises three sessions: an initial interview, an ecological assessment, and a feedback session. MI techniques are used during the feedback session. Only a few studies have investigated treatment fidelity of the FCU and no studies have examined the use of MI techniques within the FCU. The current study aims to assess treatment fidelity of the FCU, specifically measuring the extent to which therapists adhere to principles of MI during FCU feedback sessions. The current study also aims to determine if a positive relationship exists between therapists’ MI-adherence and client change talk (CT), and to determine if MI-adherence and client CT predict post-intervention health risk behaviors among the 134 EAs who participated in the FCU. Measures of health risk behaviors were collected pre- and post-intervention. MI-adherence was measured with the Motivational Interviewing Treatment Integrity (MITI 4) and client change language was measured using the Client Language Easy Rating Scale (CLEAR) and the Motivational Interviewing Skills Code 2.1 (MISC 2.1) self-exploration code. Four therapists were assessed for treatment fidelity. Results indicate overall fair treatment fidelity. Significant differences between therapists were observed. MI-adherence was positively related to client CT, but not client self-exploration. Several indicators of MI-adherence predicted decreases in EA post-intervention health risk behaviors. Client CT predicted a decrease in EA post-intervention marijuana quantity and client self-exploration predicted increases in marijuana quantity and number of sexual partners. These results have important implications for FCU training and implementation, and indicate that MI-adherence might be a mechanism of change within the FCU intervention.

abstract: A secondary data analysis was conducted to investigate the direct and indirect effects of family traditionalism, family cohesion, and parent involvement on alcohol, cigarette, and marijuana use in a sample of pre-adolescent youth (N = 635) and their parents (N = 462). Aim one hypothesized that family cohesion and family traditionalism would be indicators of a higher order construct, operationalized as familismo. Aims two and three hypothesized that family traditionalism, family cohesion, and parent involvement would be protective against youth substance use. Finally, aim four hypothesized that acculturation would decrease the protective effects of family traditionalism and family cohesion on substance use. Using second order confirmatory factor analysis, aim one found that family cohesion and family traditionalism were indicators of a second order structure. Regarding aims two and three, a consistent significant association was found between family cohesion and parent involvement across alcohol, cigarette, and marijuana use outcomes. As well, family cohesion was significantly and inversely associated with past 30-day alcohol use amount ( = -.21, p < 0.05), lifetime alcohol use ( = -.19, p < 0.05), and lifetime marijuana use ( = -.31, p < 0.001). Counter to what was hypothesized, a significant positive relationship between family traditionalism and past 30-day alcohol use amount was found. No significant indirect effects were found. Specific to aim four, significant moderation effects were found between family cohesion and acculturation on alcohol and cigarette use. Higher acculturated youth had greater past 30-day alcohol and cigarette use amount compared to low acculturated youth; as family cohesion increased, alcohol and cigarette use for both low and high-acculturated youth decreased. This study has important implications for social work and future research specific to culture, family, and youth substance use. This study may assist direct social work practitioners, school personnel, and other professionals that work with Latino youth and families in the tailoring of services that are culturally sensitive and relevant to this population and provides further understanding regarding the impact of culture and family on Latino youth substance use. Findings and limitations are discussed specific to social work practice, policy, and research. / Dissertation/Thesis / Doctoral Dissertation Social Work 2015