Delays to institutionalization were compared between elderly individuals who differed in the amounts ("dosages") of adult day services (ADS) they attended. A Kaplan-Meier survival analysis revealed higher dosages of ADS to be associated with greater delays to institutionalization. Retrospective data from financial and service utilization systems and from the Resident Assessment Instrument for Home Care (RAI-HC) were then used to fit a Cox regression model that was adjusted for potential selection biases. This model also found systematically lower hazards for institutionalization at higher ADS dosages. The ADS effect did not appear to be an artifact of increased utilization of additional home health services. Results suggest a beneficial effect of ADS on delay to institutionalization that cannot be attributed to home support, respite, or case management services.
This study evaluates the effects of a school-based smoking prevention program after 1 year, using school (22 middle/elementary schools, 15 high schools) as both the unit of randomization and the unit of analysis. The multigrade level (grades 6 through 9) intervention was designed to address comprehensively the social influence factors that encourage smoking. Teacher survey data indicated that treatment schools had a median of 10 classroom sessions devoted to tobacco/drug use education, 5 of which were the sessions designed for this evaluation, and control schools had also dedicated a median of 10 classroom sessions to tobacco/drug education. Thus, the study evaluated the incremental effects of the social influence intervention compared to "standard-care" curricula. Among those who reported smoking one or more cigarettes in the month prior to the intervention, there was a significant treatment effect on rate of smoking at one year, but no grade level, gender, or interaction effects. The 1-year covariate-adjusted smoking rate among pretest smokers in the treatment schools was 76.6 cigarettes per month, compared to 111.6 cigarettes per month in control schools, a 31.4% difference. These effects were not accounted for by differential subject attrition. The analyses for nonsmokers, however, showed no significant effects, and the program did not affect self-reported alcohol or marijuana use. Taken together with the results of other prevention studies, these results point to the need for the development and evaluation of new initiatives to prevent substance use.
Findings replicate and extend results from previous research that reported a decreased reliance on costly health care services by seniors who attend adult day programs.
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