American journal of public health
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The National Research Council and the Institute of Medicine have called for making the healthy mental, emotional, and behavioral development of young people a national priority. The Substance Abuse and Mental Health Services Administration (SAMHSA) in the US Department of Health and Human Services is uniquely positioned to help develop national mental health policies that promote mental health and prevent mental illnesses. ⋯ I also describe how SAMHSA works to achieve these goals. Ultimately, true health reform will not succeed without a comprehensive, committed focus on the mental health needs of all Americans.
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We evaluated changing patterns of tobacco use following a period of forced tobacco abstinence in a US military cohort to determine rates of harm elimination (e.g., tobacco cessation), harm reduction (e.g., from smoking to smokeless tobacco use), and harm escalation (e.g., from smoking to dual use or from smokeless tobacco use to smoking or dual use). ⋯ When considering a harm reduction strategy with smokeless tobacco, the tobacco control community should balance anticipated benefits of harm reduction with the risk of harm escalation and the potential for adversely affecting public health.
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We examined refusal rates for sensitive demographic questions to determine whether questions on sexual orientation are too sensitive for routine use on public health surveys. We compared the percentage of active refusals in New Mexico for a sexual orientation question and 6 other sensitive demographic questions. In 2007 and 2008, refusal rates for sexual orientation questions were similar to rates for questions on race/ethnicity and weight and significantly lower than rates for questions on household income. Perceptions that sexual orientation is too controversial a topic to be included on state surveys may be unfounded.
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We describe age and gender trends in long-term use of prescribed opioids for chronic noncancer pain in 2 large health plans. ⋯ Risks and benefits of long-term opioid use are poorly understood, particularly among older adults. Increased surveillance of the safety of long-term opioid use is needed in community practice settings.
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We aimed to determine the percentage of suicide attempts attributable to individual Axis I and Axis II mental disorders by studying population-attributable fractions (PAFs) in a nationally representative sample. ⋯ Our results provide new insight into the relationships between mental disorders and suicide attempts in the general population. Although many mental illnesses were associated with an increased likelihood of suicide attempt, elevated rates of suicide attempts were mostly attributed to the presence of 4 disorders.