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BackgroundAntipsychotic medications often have a variety of side effects, however, it is not well understood how the presence of specific side effects correlate with adherence in a real-world setting. The aim of the current study was to examine the relationship between these variables among community-dwelling patients with schizophrenia.MethodsData were analyzed from a 2007-2008 nationwide survey of adults who self-reported a diagnosis of schizophrenia and were currently using an antipsychotic medication (N = 876). The presence of side effects was defined as those in which the patient reported they were at least "somewhat bothered". Adherence was defined as a score of zero on the Morisky Medication Adherence Scale. To assess the relationship between side effects and adherence, individual logistic regression models were fitted for each side effect controlling for patient characteristics. A single logistic regression model assessed the relationship between side effect clusters and adherence. The relationships between adherence and health resource use were also examined.ResultsA majority of patients reported experiencing at least one side effect due to their medication (86.19%). Only 42.5% reported complete adherence. Most side effects were associated with a significantly reduced likelihood of adherence. When grouped as side effect clusters in a single model, extra pyramidal symptoms (EPS)/agitation (odds ratio (OR) = 0.57, p = 0.0007), sedation/cognition (OR = 0.70, p = 0.033), prolactin/endocrine (OR = 0.69, p = 0.0342), and metabolic side effects (OR = 0.64, p = 0.0079) were all significantly related with lower rates of adherence. Those who reported complete adherence to their medication were significantly less likely to report a hospitalization for a mental health reason (OR = 0.51, p = 0.0006), a hospitalization for a non-mental health reason (OR = 0.43, p = 0.0002), and an emergency room (ER) visit for a mental health reason (OR = 0.60, p = 0.008).ConclusionsAmong patients with schizophrenia, medication side effects are highly prevalent and significantly associated with medication nonadherence. Nonadherence is significantly associated with increased healthcare resource use. Prevention, identification, and effective management of medication-induced side effects are important to maximize adherence and reduce health resource use in schizophrenia.

This paper applies Census microdata from 1980 and 1990 to assess the determinants of housing tenure choice among racial and ethnic groups in the Los Angeles metropolitan area. Like previous research, our results indicate that endowment differences (income, education, and immigrant status) largely explain the homeownership gap between Latinos and whites. In contrast to previous work, we find that Asians are as likely to choose homeownership as are whites, and that status as an immigrant did not portend lower homeownership rates among Asians. However, the endowment-adjusted homeownership choice differential between whites and blacks remains sizable; further, that gap more than doubled between 1980 and 1990, to a full 11 percentage points.

This paper develops a new measure of the quality of business environment that complements existing measures of the quality of life. An annual panel of these measures is constructed and analyzed for 37 cities from 1977 to 1995. Findings indicate that many cities attractive to firms are unattractive to households, and vice versa. In addition, the size of a city's workforce increases with improvements in the quality of the business environment. In contrast, cities most likely to be dominated by retirees are those that are less attractive to firms. Additional specifications support theoretical arguments that retirees are drawn to cities in which local attributes are capitalized into lower wages rather than higher rents. © 2004 President and Fellows of Harvard College and the Massachusetts Institute of Technology.

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