Publications

PURPOSE

The aim of the article was to examine flavors of alternative tobacco products most commonly used by young adults (YAs).

METHODS

California YA (N = 365; mean age = 20.0 years) were surveyed in 2018 about the first and usual flavors of alternative tobacco products used. Flavor categories were fruit, candy, menthol, mint, coffee, spice, alcohol, wintergreen, and tobacco.

RESULTS

Fruit and mint were the most common flavors used (pod-based e-cigarettes: 35.4% and 29.3%; other e-cigarettes: 52.7% and 23.1%; hookah: 45.4% and 18.5%; cigars/cigarillos: 22.4% and 6.9%, respectively). For other e-cigarettes and hookah, candy was also popular (20.5% and 14.8%, respectively). For pod-based and other e-cigarettes, menthol was widely used (13.4% and 17.0%, respectively). Approximately half of the ever-flavor users reported they "usually" used the same flavors across products (menthol users: 52.2%; fruit users: 51.7%; mint users: 44.0%; and candy users: 43.8%).

CONCLUSIONS

YA are clearly using flavors, specifically fruit, mint, candy, and menthol, in their tobacco products.

Aiming to increase care access, the national Primary Care-Mental Health Integration (PC-MHI) initiative of the Veterans Health Administration (VHA) embedded specialists, care managers, or both in primary care clinics to collaboratively care for veterans with psychiatric illness. The initiative's effects on health care use and cost patterns were examined among 5.4 million primary care patients in 396 VHA clinics in 2013-16. The median rate of patients who saw a PC-MHI provider was 6.3 percent. Each percentage-point increase in the proportion of clinic patients seen by these providers was associated with 11 percent more mental health and 40 percent more primary care visits but also with 9 percent higher average total costs per patient per year. At the mean, 2.5 integrated care visits substituted for each specialty-based mental health visit that did not occur. PC-MHI was associated with improved access to outpatient care, albeit at increased total cost to the VHA. Successful implementation of integrated care necessitates significant investment and multidisciplinary partnership within health systems.

BACKGROUND/OBJECTIVE

Offering depression collaborative care services in primary care (PC) settings can reduce use of nonintegrated mental health care resources and improve mental health care access, particularly for vulnerable PC patients. Tests of effects on depression care quality, however, are needed. We examined overall quality of depression care and tested whether increasing clinic engagement in Veterans Affairs (VA)'s Primary Care-Mental Health Integration (PC-MHI) services was associated with differences in depression care quality over time.

METHODS

We conducted a retrospective longitudinal cohort study of 80,136 Veterans seen in 26 Southern California VA PC clinics (October 1, 2008-September 30, 2013). Using multilevel regression models adjusting for year, clinic, and patient characteristics, we predicted effects of clinic PC-MHI engagement (ie, percent of PC patients receiving PC-MHI services) on 3 VA-developed longitudinal electronic population-based depression quality measures among Veterans newly diagnosed with depression (n=12,533).

RESULTS

Clinic PC-MHI engagement rates were not associated with significant depression care quality differences. Across all clinics, average rates of follow-up within 84 or 180 days were, 66.4% and 74.5%, respectively. Receipt of minimally appropriate treatment was 80.5%. Treatment probabilities were significantly higher for vulnerable PC patients (homeless: 4.5%, P=0.03; serious mental illness: 15.2%, P<0.001), than for otherwise similar patients without these characteristics.

CONCLUSIONS/POLICY IMPLICATIONS

Study patients treated in PC clinics with greater PC-MHI engagement received similarly high quality depression care, and even higher quality for vulnerable patients. Findings support increasing use of PC-MHI models to the extent that they confer some advantage over existing services (eg, access, patient satisfaction) other than quality of care.