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Recent Publications
The Relevance of the ACA for Improving Mental Health Care

David Mechanic and Mark Olfson

Provisions of the Affordable Care Act provide unprecedented opportunities for expanded access to behavioral health care and for redesigning the provision of services. Key to these reforms is establishing mental and substance abuse care as essential coverage, extending Medicaid eligibility and insurance parity, and protecting insurance coverage for persons with preexisting conditions and disabilities.
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Comparative Effectiveness of Clozapine and Standard Antipsychotic Treatment in Adults With Schizophrenia

T. Scott Stroup, Tobias Gerhard, Stephen Crystal, Cecilia Huang, and Mark Olfson

Objective: The authors compared the effectiveness of initiating treatment with either clozapine or a standard antipsychotic among adults with evidence of treatment-resistant schizophrenia in routine clinical practice.
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Abortion after Roe

Johanna Schoen

Abortion is--and always has been--an arena for contesting power relations between women and men. When in 1973 the Supreme Court made the procedure legal throughout the United States, it seemed that women were at last able to make decisions about their own bodies.
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Risk Factors for Family Time Burdens Providing and Arranging Health Care for Children with Special Health Care Needs: Lessons from Nonproportional Odds Models

Jane E. Miller, Colleen N. Nugent, and Louise B. Russell

We identify need, enabling, and predisposing factors for high family time burdens associated with the health care of chronically-ill children, using data from the U.S. 2009–2010 National Survey of Children with Special Health Care Needs (NS-CSHCN), a population-based survey of 40,242 children with special health care needs (CSHCN).
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Which Components of Medical Homes Reduce the Time Burden on Families of Children with Special Health Care Needs?

Jane E. Miller, Colleen N. Nugent, and Louise B. Russell

Objectives. To examine which components of medical homes affect time families spend arranging/coordinating health care for their children with special health care needs (CSHCNs) and providing health care at home. Data Sources.
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Lithium Treatment and Risk for Dementia in Adults with Bipolar Disorder: Population-Based Cohort Study

Tobias Gerhard, D. P. Devanand, Cecilia Huang, Stephen Crystal and Mark Olfson

The observational study in this article examines the association of lithium therapy and dementia risk in the largest and most diverse data-set of older adults diagnosed with bipolar disorder to date.
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Not Tonight: Migraine and the Politics of Gender and Health

Joanna Kempner

Pain. Vomiting. Hours and days spent lying in the dark. Migraine is an extraordinarily common, disabling, and painful disorder that affects over 36 million Americans and costs the US economy at least $32 billion per year.
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Improving the Quality of Geriatric Nursing Care: Enduring Outcomes from the Geriatric Nursing Education Consortium

Deanna Gray-Miceli, Laurie Dodge Wilson, Joan Stanley, Rachael Watman, Amy Shire, Shoshanna Sofaer, and Mathy Mezey

The nation’s aging demography, few nursing faculty with gerontological nursing expertise, and insufficient geriatric content in nursing programs have created a national imperative to increase the supply of nurses qualified to provide care for older adults.
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Happy Marriage, Happy Life? Marital Quality and Subjective Well-being in Later Life

Deborah Carr, Vicki A. Freedman, Jennifer C. Cornman, and Norbert Schwarz

The authors examined associations between marital quality and both general life satisfaction and experienced (momentary) well-being among older husbands and wives, the relative importance of own versus spouse's marital appraisals for well-being, and the extent to which the association between own marital appraisals and well-being is moderated by spouse's appraisals.
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Continuity and Change in Relationships with Neighbors: Implications for Psychological Well-being in Middle and Later Life

Emily Greenfield and Laurent Reyes

Objectives. There is growing enthusiasm for community initiatives that aim to strengthen neighbor relationships to promote well-being in later life. Nevertheless, few studies have examined the extent to which relationships with neighbors are associated with better psychological well-being among midlife and older adults.

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More People Than Ever Before Are Receiving Behavioral Health Care In The United States, But Gaps And Challenges Remain

David Mechanic

The high prevalence of mental illness and substance abuse disorders and their significant impact on disability, mortality, and other chronic diseases have encouraged new initiatives in mental health policy including important provisions of the Affordable Care Act and changes in Medicaid.
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Facilitating Lewin’s Change Model with Collaborative Evaluation in Promoting Evidence Based Practices of Health Professionals

Julianne Manchester, Deanna L. Gray-Miceli, Judith A. Metcalf, Charlotte A. Paolini, Anne H. Napier, Constance L. Coogle, Myra G. Owens

Evidence based practices (EBPs) in clinical settings interact with and adapt to host organizational characteristics. The contextual factors themselves, surrounding health professions’ practices, also adapt as practices become sustained.
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Which Components of Medical Homes Reduce Time Burden for Families of Children with Special Health Care Needs?

Jane E. Miller, Colleen Nugent, and Louise B. Russell

Objectives To examine which components of medical homes affect time families spend arranging/coordinating health care for their children with special health care needs (CSHCNs) and providing health care at home.
Data Sources 2009–2010 National Survey of Children with Special Health Care Needs (NS-CSHCN), a population-based survey of 40,242 CSHCNs.
Study Design NS-CSHCN is a cross-sectional, observational study.

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Strategies Used by Older Asthmatics for Adherence

Taylor L. Brooks, Howard Leventhal, Michael S. Wolf, Rachel O’Conor, Jose Morillo, Melissa Martynenko, Juan P. Wisnivesky, and Alex D. Federman.

Taylor Brooks, Project L/EARN intern from the cohort of 2013, published a lead-author paper in the Journal of General Internal Medicine about collaborative research conducted under the guidance of her mentor Howard Leventhal and collaborators from Mt.
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Outpatient Psychotropic Medication Use in the US: A Comparison Based on Foster Care Status

Lynn A. Warner, Na Kyoung Song and Kathleen J. Pottick

Using data from the Client/Patient Sample Survey, a nationally representative study of outpatient mental health service utilization, the prevalence and correlates of psychotropic medication receipt for youth who live with families and in foster care are compared.
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Clinical Characteristics and Outpatient Mental Health Service Use of Transition-Age Youth in the USA

Kathleen J. Pottick, Lynn A. Warner, Ann Vander Stoep, and Nelson M. Knight

This study examines diagnostic and service utilization patterns of transition-age youth in outpatient care derived from the 2007 nationally representative Client/Patient Sample Survey.
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The Chicago Guide to Writing about Multivariate Analysis, 2nd Edition

Jane E. Miller

Social scientists, physicians, educators, policymakers, and others depend on the results of multivariate models to inform their decisions. Researchers use these advanced statistical techniques to analyze relationships among multiple variables, such as how exercise and weight relate to the risk of heart disease, or how unemployment and interest rates affect economic growth.
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Anxiety: A Short History (Johns Hopkins Biographies of Disease)

Allan V. Horwitz

More people today report feeling anxious than ever before—even while living in relatively safe and prosperous modern societies. Almost one in five people experiences an anxiety disorder each year, and more than a quarter of the population admits to an anxiety condition at some point in their lives.
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Mental Health and Social Policy: Beyond Managed Care, 6th edition

David Mechanic, Donna D. McAlpine, David A. Rochefort

Rooted in research findings that support an evidence-based orientation to treatment and recovery, the sixth edition of Mental Health and Social Policy takes a multidisciplinary approach to mental health and social policy.
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Can Family Relationships Explain the Race Paradox in Mental Health?

Dawne M. Mouzon

Biomedical research consistently finds that Blacks have worse physical health than Whites, an expected pattern given Blacks’ greater exposure to psychosocial stress, poverty, and discrimination.
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"Looking at Patients’ Choices through the Lens of Expected Utility: A Critique and Research Agenda," Medical Decision Making, July/August 2012.

Louise B. Russell and Alan Schwartz

The expected utility framework underlies much research in medical decision making. Because the framework requires decisions to be decomposed into probabilities of states and the values of those states, researchers have investigated the two components separately from each other and from patients’ actual decisions.
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"Effect of Non-Leisure Physical Activity on Mortality in U.S. Adults: Does Propensity Score Matching Make a Difference?"

Jeehyun Park and Louise B. Russell

Purpose To reanalyze results reported in 2008, using propensity score matching, to test the treatment effect of non-leisure physical activity on survival.

Methods McCullagh's ordinal logit model was used to estimate propensity scores, separately for adults aged 35–59 and 60–74 years at baseline in the National Health and Nutrition Examination Survey I Epidemiologic Followup Study, for three levels of non-leisure activity.

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Child Support and Young Children's Development

Lenna Nepomnyaschy, Katherine Magnuson, and Lawrence Berger

This study examines the influence of nonresident fathers’ formal and informal cash child support on children’s cognitive skills and behavior at 5 years of age. Taking advantage of the panel structure of the Fragile Families and Child Wellbeing Study, the analyses control for child outcomes at age 3, as well as for a variety of child and family sociodemographic and psychosocial characteristics.
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Seizing Opportunities Under The Affordable Care Act For Transforming The Mental And Behavioral Health System

David Mechanic

The Affordable Care Act, along with Medicaid expansions, offers the opportunity to redesign the nation’s highly flawed mental health system. It promotes new programs and tools, such as health homes, interdisciplinary care teams, the broadening of the Medicaid Home and Community-Based Services option, co-location of physical health and behavioral services, and collaborative care.
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Racial Differences in End-of-Life Planning: Why Don’t Blacks and Latinos Prepare for the Inevitable?

Deborah Carr

The extent to which ethnic disparities in advance care planning reflect cultural and religious attitudes and experience with the painful deaths of loved ones was evaluated. Data are from a sample of 293 chronically ill older adults who are seeking care at one of two large medical centers in urban New Jersey.
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Perceived Weight Discrimination Amplifies the Link Between Central Adiposity and Nondiabetic Glycemic control (HbA1c)

Vera Tsenkova, Deborah Carr, Dale Schoeller, and Carol Ryff

BACKGROUND: While the preclinical development of type 2 diabetes is partly explained by obesity and central adiposity, psychosocial research has shown that chronic stressors such as discrimination have health consequences as well.

PURPOSE: We investigated the extent to which the well-established effects of obesity and central adiposity on nondiabetic glycemic control (indexed by HbA(1c)) were moderated by a targeted psychosocial stressor linked to weight: perceived weight discrimination.

METHODS: The data came from the nondiabetic subsample (n?=?938) of the Midlife in the United States (MIDUS II) survey.

RESULTS: Body mass index (BMI), waist-to-hip ratio, and waist circumference were linked to significantly higher HbA(1c) (p?
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Familial Instability and Young Children’s Physical Health

Sharon Bzostek and Audrey Beck

This paper uses recent longitudinal data about a cohort of young children born in the United States to mostly unmarried parents to examine the association between increasingly-complex patterns of family instability and physical health in early childhood.
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Forbidden Knowledge: Controversy as a Form of Social Control in the Production of Nonknowledge

Joanna Kempner, Charles L. Bosk, and Jon F. Merz

Sociologists, philosophers, and historians of science tend to focus their attention on the production of knowledge. More recently, scholars have begun to investigate more fully the structures and processes that impede the production of knowledge.
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Racial and Ethnic Disparities in Depression Care in Community-Dwelling Elderly in the United States

Ayse Akincigil, Mark Olfson, Michele Siegel, Karen A. Zurlo, James T. Walkup, and Stephen Crystal

Objectives. We investigated racial/ethnic disparities in the diagnosis and treatment of depression among community-dwelling elderly.

Methods. We performed a secondary analysis of Medicare Current Beneficiary Survey data (n?=?33?708) for 2001 through 2005.

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How Much Time Do Adults Spend on Health-related Self-care? Results from the American Time Use Survey

Daniel E. Jonas, Yoko Ibuka, and Louise B. Russell

The authors report that time spent on health-related self-care is disproportionately distributed across the population, with a larger amount of time reported by those in poor health (3.6 hours/week) and the nonworking disabled (3.2 hours/week).
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Stigma, Reflected Appraisals, and Recovery Outcomes in Mental Illness.

Fred E. Markowitz, Beth Angell, and Jan S. Greenberg

Drawing on modified labeling theory and the reflected appraisals process and using longitudinal data from 129 mothers and their adult children with schizophrenia, we estimate models of the effects of mothers’ stigmatized identity appraisals of their mentally ill children on reflected and self-appraisals, and how appraisals affect outcomes (symptoms, self-efficacy, life satisfaction).
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Creating an Age of Depression: The Social Construction and Consequences of the Major Depression Diagnosis

Allan Horwitz

One type of study in the sociology of mental health examines how social and cultural factors influence the creation and consequences of psychiatric diagnoses. Most studies of this kind focus on how diagnoses emerge from struggles among advocacy organizations, economic and political interest groups, and professionals.
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Parental eligibility and take-up of SCHIP: The roles of parental health and employment

Jane E. Miller, Dorothy Gaboda, Colleen Nugent, Theresa Simpson, and Joel C. Cantor

In 2000, New Jersey’s State Children’s Health Insurance Program (NJ FamilyCare) expanded coverage to parents of eligible children from families with income below 200% of the Federal Poverty Level who were not covered by other health insurance.
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'Quicker and Sicker' under Medicare’s Prospective Payment System for Hospitals: New Evidence on an Old Issue from a National Longitudinal Survey

Xufeng Qian, Louise B. Russell, Elmira Valiyeva, and Jane E. Miller

Medicare’s prospective payment system for hospitals (PPS), introduced in the U.S. in 1983, replaced cost reimbursement with a system of fixed rates which created incentives for hospitals to control costs.
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The Race and Class Privilege of Motherhood: New York Times Presentations of Pregnant Drug-Using Women

Kristen W. Springer

Prior research has examined race and class bias embedded in media presentations of pregnant drug users; however, this past research is limited in identifying biases because it focuses on single substances—primarily crack cocaine.
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The Myth of Meritocracy
and African American Health

Naa Oyo Kwate and Ilan H. Meyer

Recent theoretical and empirical studies of the social determinants of health inequities have shown that economic deprivation, multiple levels of racism, and neighborhood context limit African American health chances and that African Americans' poor health status is predicated on unequal opportunity to achieve the American Dream.

President Obama's election has been touted as a demonstration of American meritocracy—the belief that all may obtain the American Dream—and has instilled hope in African Americans.

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Witnessing Domestic Abuse in Childhood as an Independent Risk Factor for Depressive Symptoms in Young Adulthood

David Russell, Kristen W. Springer and Emily A. Greenfield

OBJECTIVE: This study addresses the relationship between retrospective reports of witnessing domestic abuse in childhood and levels of depressive symptoms in young adulthood. We examine whether the association between having witnessed violence in childhood and depression is independent of having been the direct target of sexual and/or physical abuse, as well as other characteristics and experiences linked with family violence.

METHODS: We used two waves of data collected from a sample of 1,175 young adults (ages 20-24) in Miami, Florida.

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Advances in Families and Health Research in the 21st Century

Deborah Carr and Kristen W. Springer

We review research on families and health published between 2000 and 2009 and highlight key themes and findings from innovative, methodologically rigorous studies. Whereas research in prior decades focused primarily on whether family structure affects child and adult health, contemporary research examines the contextual and processual factors that shape for whom, for which outcomes, and under what conditions families affect mental and physical health.
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Economic Dependence in Marriage and Husbands' Health: Testing Three Possible Mechanisms

Kristen Springer

Prior research suggests that midlife husbands have worse health when they earn less than their wives; however, the mechanism(s) for this relationship have not been evaluated. In this study, the author analyzes 1,319 heterosexual married couples from the Health and Retirement Study to explore three theoretically grounded mechanisms.
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Do Wives' Work Hours Hurt Husbands' Health? Reassessing the Care Work Deficit Thesis

Kristen W. Springer

Prior research suggests that wives’ full-time employment harms husbands’ health because employed wives have less time to promote their husbands’ salubrious behavior (“care work deficit thesis” (CWDT)).
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Understanding Recent Changes in Suicide Rates Among the Middle-aged: Period or Cohort Effects?

Julie A. Phillips, Ashley V. Robin, Colleen N. Nugent, and Ellen L. Idler

The suicide rate for middle-aged persons, a group considered relatively protected from suicide and with historically stable suicide rates, took a sharp upward jump between 1999 and 2005 according to a new study by Julie Phillips and colleagues.
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Antipsychotic Medication Use in Medicaid Children and Adolescents: Report and Resource Guide From a 16-State Study

Prepared by the Publication Committee

State Medicaid Mary Ellen Foti, M.D.; Gordon Harper, M.D.; Robert Moon, M.D.; George Oestreich, Pharm.D., M.P.A.; Roger Snow, M.D., M.P.H., Jeffery Thompson, M.D., M.P.H.

State Mental Health Molly Finnerty, M.D.; Elsie Freeman, M.D.; Penny Knapp, M.D.; Nina Jo Muse, M.D.; Joseph Parks, M.D.

Rutgers CERTs Stephen Crystal, Ph.D.; Tobias Gerhard, Ph.D.

AHRQ Nancy Wilson, M.D., M.P.H.

Medicaid Medical Directors Learning Network/Rutgers CERTs June 2010

The Resource Guide on improving quality in the management of antipsychotic use among Medicaid children, and its accompanying data dictionary and compendium of State practices, were motivated principally by the desire of the consortium to provide information that would be useful for State officials, across the nation, in their efforts to improve quality of mental health care for their Medicaid populations.

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How an Age of Anxiety Became an Age of Depression

Allan Horwitz

Context: During the 1950s and 1960s, anxiety was the emblematic mental health problem in the United States, and depression was considered to be a rare condition. One of the most puzzling phenomena regarding mental health treatment, research, and policy is why depression has become the central component of the stress tradition since then.

Methods: This article reviews statistical trends in diagnosis, treatment, drug prescriptions, and textual readings of diagnostic criteria and secondary literature.

Findings: The association of anxiety with diffuse and amorphous conceptions of “stress” and “neuroses” became incompatible with professional norms demanding diagnostic specificity.

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Trends in Antipsychotic Drug Use by Very Young, Privately Insured Children

Mark Olfson, Stephen Crystal, Cecilia Huang and Tobias Gerhard

Objective This study describes recent trends and patterns in antipsychotic treatment of privately insured children aged 2 through 5 years.

Method A trend analysis is presented of antipsychotic medication use (1999–2001 versus 2007) stratified by patient characteristics.

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Race Disparities in Low Birth Weight in the U.S. South and the Rest of the Nation

Lenna Nepomnyaschy

There are well-documented and as yet unexplained disparities in birth outcomes by race in the USA. This paper examines the sources of disparities in low birth weight between blacks and whites in the US, by focusing on differences in disparities between two very distinct geographic areas, the Deep South and the rest of the country.
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Felt Obligation to Help Others as a Protective Factor Against Losses in Psychological Well-being Following Functional Decline in Middle and Later Life

Emily A. Greenfield

This study examined felt obligation to help others in two domains (close others and society) as protective factors against losses in psychological well-being following functional decline.
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Perceived Need for Mental Health Care Among Community-Dwelling Older Adults

Melissa M. Garrido, Robert L. Kane, Merrie Kaas, and Rosalie A. Kane

Only half of older adults with a mental disorder use mental health services, and little is known about the causes of perceived need for mental health care (MHC). We used logistic regression to examine relationships among depression, anxiety, chronic physical illness, alcohol abuse and/or dependence, sociodemographics, and perceived need among a national sample of community-dwelling individuals 65 years of age and older (the Collaborative Psychiatric Epidemiology Surveys data set).
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Completing Costs: Patients’ Time

Louise B. Russell

Every patient knows that taking care of one’s health and seeking medical care takes time, sometimes lots of it. Yet those who study the medical system rarely recognize the burden time requirements can be for patients.
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Will More Prevention Lower Medical Spending?

Louise B. Russell

Many people believe that prevention reduces medical spending, despite four decades of studies showing that it rarely does. Preventive interventions are often worth the additional cost, but each must be evaluated on its own merits.

Professor Louise Russell provides additional information on this topic:

Louise Russell, “Prevention Will Reduce Medical Costs: A Persistent Myth,” The Health Care Cost Monitor, June 17, 2009.

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Childhood Physical Abuse and Midlife Physical Health: Testing a Multi-Pathway Life Course Model

Kristen W. Springer

Although prior research has established that childhood abuse adversely affects midlife physical health, it is unclear how abuse continues to harm health decades after the abuse has ended.
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Violence from Parents in Childhood and Obesity in Adulthood: Using Food in Response to Stress as a Mediator of Risk

Emily A. Greenfield and Nadine F. Marks

Guided by a life course perspective and concepts from models of stress and coping, this study tested the extent to which self-reported profiles of physical and psychological violence in childhood from parents were associated with greater odds of obesity in adulthood.
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"Race" and "Ethnicity" in Biomedical Research: How Do Scientists Construct and Explain Differences in Health?

Catherine Lee

Social and biomedical scientists, journal editors, and public health officials continue to debate the merits of the use of race and ethnicity in health-related research. As biomedical research focuses on issues of racial or ethnic health disparities, it remains unclear how biomedical scientists investigate race or ethnicity and health.
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How Much Time Do Patients Spend on Outpatient Visits? The American Time Use Survey

Louise B. Russell, Yoko Ibuka and Deborah Carr

Background: In Crossing the Quality Chasm, the Institute of Medicine recommended that patient-centered care should not waste patients’ time and should recognize the involvement of family and friends.
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Preventing Chronic Disease: An Important Investment, But Don’t Count On Cost Savings

Louise B. Russell

Over the four decades since cost-effectiveness analysis was first applied to health and medicine, hundreds of studies have shown that prevention usually adds to medical costs instead of reducing them.
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Effects of Leisure and Non-Leisure Physical Activity on Mortality in U.S. Adults over Two Decades

Alejandro Arrieta, PhD and Louise Russell, PhD

PURPOSE: To estimate the effects of the components of total physical activity, leisure-time and nonleisure activity, on all-cause mortality over two decades in a large, nationally representative sample of U.S.
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Initiation and Change of Psychotropic Medication Regimens among Adolescents in Inpatient Care

Lynn A. Warner, Cynthia A. Fontanella, and Kathleen J. Pottick

Objective: The purpose of this study was to compare clinical and service utilization profiles of adolescents admitted to inpatient treatment with and without a psychotropic medication regimen, and estimate correlates of medication use separately for the two groups.

Method: Comprehensive data on clinical characteristics and service utilization of 517 adolescents enrolled in Medicaid who were admitted to three inpatient hospitals (one for-profit and two nonprofit) in a mid-Atlantic state were used.

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Mental Health and Social Policy

David Mechanic

The fifth edition of Mental Health and Social Policy takes a multidisciplinary approach to mental health and social policy. It covers mental health issues and includes important new epidemiological studies, controlled clinical trials, and other investigations that inform the new thrust for evidence-based mental health services.
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Health-Related Activities in the American Time Use Survey

Louise B. Russell, Yoko Ibuka, and Katharine G. Abraham

The Bureau of Labor Statistics' American Time Use Survey (ATUS), launched in 2003, offers the first comprehensive look at how individuals spend their time. Health services researchers can use it to study time spent on a variety of health-related activities.
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The Truth about Health Care: Why Reform Is Not Working in America

David Mechanic

The United States spends significantly more per person on health care than any other country but the evidence shows that care is often poor and inappropriate. Despite expenditures upwards of 1.9 trillion dollars -- a cost that grows substantially every year --health care services remain fragmented and uncoordinated, and more than 46 million people are uninsured.
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Focus on Economic Outcomes in Later Life

Stephen Crystal and Dennis Shea (Volume Editors)

In this latest volume of annual reviews, leading scholars focus on the economics of aging, with a particular emphasis on the economic future of the baby boom generation. Key themes include the influence of early advantages on later-life economic outcomes (the cumulative advantage/cumulative disadvantage hypothesis); the relationship between inequalities in economic status and inequalities in health status and access to health; and the consequences of societal choices concerning retirement income systems and policies for financing acute and long-term health care.
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Effective Health Behavior in Older Adults

K. Warner Schaie, Howard Leventhal, and Sherry L. Willis (Editors)

Based on the edited proceedings of a conference held at Pennsylvania State University in 1999, the chapters are oriented to examining health behaviors and societal mechanisms that facilitate or discourage the assumption of individual responsibility for these behaviors.
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The Self-Regulation of Health and Illness Behaviour

Linda D. Cameron and
Howard Leventhal (Editors)

Over the past two decades self-regulation theory has emerged to offer a whole new perspective on human behaviour. With its focus on the ways in which individuals direct and monitor their activities and emotions to attain their goals, the theory provides a dynamic framework for understanding the complexities of behaviour in response to emotionally provocative events, such as illness and stressful experiences.
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