This document discusses a new pilot initiative where employee assistance programs (EAPs) will incorporate screening and brief intervention (SBI) for alcohol issues for all callers. The goal is to identify more individuals who could benefit from treatment for alcohol or drug problems. Early results show identifying rates increasing significantly, from under 1% to 18-22%, when EAPs add alcohol screening questions routinely. This has the potential to increase the number of employees referred to treatment by EAPs by 50-100%. Employers must be willing to add SBI and pay for it as part of their EAPs for the benefits to be realized.
the lookout for ways to get involved! - Ben Day, Mass-Care
This document summarizes the Fall 2011 issue of the Universal Health Care Education Fund newsletter. It discusses rallies held in Boston to advocate for single-payer healthcare. It also summarizes a survey finding that most Massachusetts physicians support a single-payer or public option approach. Additionally, it outlines Mass-Care's efforts to campaign against high deductibles for students and to organize for single-payer healthcare in major Massachusetts cities.
This document summarizes a report authored by Stephanie La Loggia and Karina Lungo under the auspices of the ASU Lodestar Center for Philanthropy and Nonprofit Innovation. The report provides data and research on the scope of the nonprofit sector in Arizona, including charitable giving trends, the economic impact of nonprofits, and information on Arizona's over 21,000 registered nonprofit organizations. Copyright for the report is held by Arizona State University.
the lookout for ways to get involved! - Ben Day, Mass-Care
This document summarizes the Fall 2011 issue of the Universal Health Care Education Fund newsletter. It discusses rallies held in Boston to advocate for single-payer healthcare. It also summarizes a survey finding that most Massachusetts physicians support a single-payer or public option approach. Additionally, it outlines Mass-Care's efforts to campaign against high deductibles for students and to organize for single-payer healthcare in major Massachusetts cities.
This document summarizes a report authored by Stephanie La Loggia and Karina Lungo under the auspices of the ASU Lodestar Center for Philanthropy and Nonprofit Innovation. The report provides data and research on the scope of the nonprofit sector in Arizona, including charitable giving trends, the economic impact of nonprofits, and information on Arizona's over 21,000 registered nonprofit organizations. Copyright for the report is held by Arizona State University.
The document summarizes key findings from a report on America's nonprofit community clinics, free clinics, and community health centers from 2006 to 2009. It finds that the total number of patients receiving services continues to rise, with a larger increase from 2008 to 2009 than previous years. The number of uninsured patients also continues to rise. While the proportion of uninsured patients decreased slightly, the proportion of Medicaid patients increased. Rates of chronic diseases like diabetes, hypertension, and asthma are increasing among patients at these safety net facilities.
Nonprofit community health centers and clinics that provide preventive and primary healthcare services for 24 million people – or one in 13 persons in the U.S. – report that the first year of the Affordable Care Act’s implementation had uneven effects, particularly between facilities in Medicaid expansion and non-expansion states.
The findings were released today by Direct Relief in The State of the Safety Net 2014, an annual report that examines issues and trends within the extensive network of nonprofit, community-based health centers and clinics, which are the principal point of access to healthcare and the medical home for persons with low incomes, without health insurance, and among the country’s most vulnerable. Such facilities include Federally Qualified Health Centers (FQHCs), nonprofit community-based health clinics, and free and charitable clinics.
This document summarizes the results of a survey of 639 Minnesota nonprofits conducted in December 2009. It finds that 60% of nonprofits reported increased demand for services due to high unemployment, but 61% also reported declining revenues. Small nonprofits and those relying on certain revenue streams faced more challenges. Many nonprofits cut staff or budgets to adapt. Stimulus funds helped some retain or hire staff. Nonprofits predict 2010 will be more difficult with further declines in revenues and increased demand. MCN is providing resources to help nonprofits with strategic planning during this difficult time.
The document discusses progress towards achieving universal healthcare in Massachusetts through a single-payer system. It notes that prominent political figures like Al Gore and Michael Dukakis now support single-payer. The advocacy group MASS-CARE has been educating the public and legislators through community events. However, the current healthcare reform law in Massachusetts is failing to cover many residents and imposing high costs on the middle class. True reform requires replacing the private insurance system with a single-payer Medicare for All approach.
This document is Direct Relief's annual report for fiscal year 2015. It summarizes their response to two major humanitarian crises during the year - the Ebola outbreak in West Africa and the Nepal earthquake. For Ebola, Direct Relief conducted emergency airlifts delivering over 100 tons of supplies to over 1,000 facilities in affected countries, making them one of the largest private providers of aid. For Nepal, they similarly organized large scale emergency response efforts. The report emphasizes that Direct Relief was able to mobilize these major responses because of existing partnerships in the affected regions.
The document outlines a program called the OzMed Drop Project created by the Ozaukee County Alcohol, Tobacco, and Other Drug Prevention Consortium to address the problem of prescription drug abuse. The program involves placing MedReturn Drug Collection Units in various law enforcement agencies throughout Ozaukee County, WI to allow residents to safely dispose of unused prescription drugs. Law enforcement representatives praise the program for reducing risks to youth and the environment by preventing access to unused medications. Similar prescription drug drop box programs have also been implemented in other counties.
Direct Relief’s annual report on Fiscal Year 2014: During this period—July 1, 2013, through June 30, 2014—Direct Relief responded to more requests for assistance, fulfilled its humanitarian mission more expansively, and provided more assistance to more people in need than ever before in the organization’s 66-year history.
As who lives in our rural communities changes, so too are the way these communities support themselves. As tax dollars shrink, the philanthropy community is finding itself being asked to play a bigger role.
The nonprofit sector in McLennan County employs over 19,000 people and provides essential services. It contributes $546 million to the local economy annually. Nonprofits make up 8% of the county's workforce and 11% of the private workforce. The sector is very diverse, with the largest portions being in education, human services, and arts/culture. It leverages substantial resources but also faces financial challenges, with many organizations operating at a deficit. Overall, the nonprofit sector improves quality of life in the county through employment, spending, and community services.
This document discusses harm reduction strategies and syringe exchange programs (SEPs). It provides evidence that SEPs are effective in preventing HIV and hepatitis C by allowing for safe disposal of used needles and connecting injection drug users to medical care. The document reviews how SEPs make communities safer by reducing improperly discarded syringes, protect first responders from needlestick injuries, and do not increase crime rates. SEPs are also cost-effective by saving millions in avoided healthcare costs from prevented infections. The discussion aims to increase support for SEPs by addressing common myths and concerns.
This article discusses the "millionaires tax" debate between Democrats and Republicans in New Jersey. Democrats want to introduce a bill to raise taxes on millionaires to generate additional revenue for schools, property tax relief, and police funding. However, Governor Christie opposes any tax increases. The tax push comes as Democrats are fighting with Christie over a bill cutting public worker pensions and benefits. The article also covers a controversial provision in the benefits bill regarding out-of-state health care that critics say favors one South Jersey political boss.
This report summarizes support services for victims of crime in Essex, identifies victims' needs, and proposes actions for the police and crime commissioner. It found that victims need clear and regular communication from services. Financial pressures have reduced resources, so agencies seek to collaborate. The report calls for increased independent domestic violence advisors, improved support for victims of hate crimes and homicides, and additional services for young victims.
The document describes the design process for a CD DigiPak and magazine advertisement created to accompany a music video by K-OS. Key elements were incorporated from the music video into both ancillary texts to create synergy across the projects. Research was conducted on real CD packaging and ads in the genre to inform the designs. Features like a custom font, character mascot, and elements from the video's setting were included to visually and thematically link the ancillary texts back to the original work. The goal was to create eye-catching, unique products that would stand out and gain more attention and sales.
The document describes the ways in which the author's media product challenges the conventions of a real magazine. It discusses design elements like the front cover, contents page, and double page spreads. For each section, it notes similarities between the author's magazine and a real magazine in terms of layout, fonts, and placement of images and text. It also explains ways the author represented a particular social group through choices of images, language, and content.
This document discusses innovations in treating addiction as a chronic condition rather than an acute problem. Over the past decade, experts have increasingly recognized addiction as a chronic disorder best addressed through long-term, diverse treatment and recovery support rather than brief interventions. This shift was pioneered by researchers, people in recovery, and providers and has led to new treatment models, payment systems, and a broader continuum of care including prevention, intervention, treatment, and recovery support.
The document summarizes key findings from a report on America's nonprofit community clinics, free clinics, and community health centers from 2006 to 2009. It finds that the total number of patients receiving services continues to rise, with a larger increase from 2008 to 2009 than previous years. The number of uninsured patients also continues to rise. While the proportion of uninsured patients decreased slightly, the proportion of Medicaid patients increased. Rates of chronic diseases like diabetes, hypertension, and asthma are increasing among patients at these safety net facilities.
Nonprofit community health centers and clinics that provide preventive and primary healthcare services for 24 million people – or one in 13 persons in the U.S. – report that the first year of the Affordable Care Act’s implementation had uneven effects, particularly between facilities in Medicaid expansion and non-expansion states.
The findings were released today by Direct Relief in The State of the Safety Net 2014, an annual report that examines issues and trends within the extensive network of nonprofit, community-based health centers and clinics, which are the principal point of access to healthcare and the medical home for persons with low incomes, without health insurance, and among the country’s most vulnerable. Such facilities include Federally Qualified Health Centers (FQHCs), nonprofit community-based health clinics, and free and charitable clinics.
This document summarizes the results of a survey of 639 Minnesota nonprofits conducted in December 2009. It finds that 60% of nonprofits reported increased demand for services due to high unemployment, but 61% also reported declining revenues. Small nonprofits and those relying on certain revenue streams faced more challenges. Many nonprofits cut staff or budgets to adapt. Stimulus funds helped some retain or hire staff. Nonprofits predict 2010 will be more difficult with further declines in revenues and increased demand. MCN is providing resources to help nonprofits with strategic planning during this difficult time.
The document discusses progress towards achieving universal healthcare in Massachusetts through a single-payer system. It notes that prominent political figures like Al Gore and Michael Dukakis now support single-payer. The advocacy group MASS-CARE has been educating the public and legislators through community events. However, the current healthcare reform law in Massachusetts is failing to cover many residents and imposing high costs on the middle class. True reform requires replacing the private insurance system with a single-payer Medicare for All approach.
This document is Direct Relief's annual report for fiscal year 2015. It summarizes their response to two major humanitarian crises during the year - the Ebola outbreak in West Africa and the Nepal earthquake. For Ebola, Direct Relief conducted emergency airlifts delivering over 100 tons of supplies to over 1,000 facilities in affected countries, making them one of the largest private providers of aid. For Nepal, they similarly organized large scale emergency response efforts. The report emphasizes that Direct Relief was able to mobilize these major responses because of existing partnerships in the affected regions.
The document outlines a program called the OzMed Drop Project created by the Ozaukee County Alcohol, Tobacco, and Other Drug Prevention Consortium to address the problem of prescription drug abuse. The program involves placing MedReturn Drug Collection Units in various law enforcement agencies throughout Ozaukee County, WI to allow residents to safely dispose of unused prescription drugs. Law enforcement representatives praise the program for reducing risks to youth and the environment by preventing access to unused medications. Similar prescription drug drop box programs have also been implemented in other counties.
Direct Relief’s annual report on Fiscal Year 2014: During this period—July 1, 2013, through June 30, 2014—Direct Relief responded to more requests for assistance, fulfilled its humanitarian mission more expansively, and provided more assistance to more people in need than ever before in the organization’s 66-year history.
As who lives in our rural communities changes, so too are the way these communities support themselves. As tax dollars shrink, the philanthropy community is finding itself being asked to play a bigger role.
The nonprofit sector in McLennan County employs over 19,000 people and provides essential services. It contributes $546 million to the local economy annually. Nonprofits make up 8% of the county's workforce and 11% of the private workforce. The sector is very diverse, with the largest portions being in education, human services, and arts/culture. It leverages substantial resources but also faces financial challenges, with many organizations operating at a deficit. Overall, the nonprofit sector improves quality of life in the county through employment, spending, and community services.
This document discusses harm reduction strategies and syringe exchange programs (SEPs). It provides evidence that SEPs are effective in preventing HIV and hepatitis C by allowing for safe disposal of used needles and connecting injection drug users to medical care. The document reviews how SEPs make communities safer by reducing improperly discarded syringes, protect first responders from needlestick injuries, and do not increase crime rates. SEPs are also cost-effective by saving millions in avoided healthcare costs from prevented infections. The discussion aims to increase support for SEPs by addressing common myths and concerns.
This article discusses the "millionaires tax" debate between Democrats and Republicans in New Jersey. Democrats want to introduce a bill to raise taxes on millionaires to generate additional revenue for schools, property tax relief, and police funding. However, Governor Christie opposes any tax increases. The tax push comes as Democrats are fighting with Christie over a bill cutting public worker pensions and benefits. The article also covers a controversial provision in the benefits bill regarding out-of-state health care that critics say favors one South Jersey political boss.
This report summarizes support services for victims of crime in Essex, identifies victims' needs, and proposes actions for the police and crime commissioner. It found that victims need clear and regular communication from services. Financial pressures have reduced resources, so agencies seek to collaborate. The report calls for increased independent domestic violence advisors, improved support for victims of hate crimes and homicides, and additional services for young victims.
The document describes the design process for a CD DigiPak and magazine advertisement created to accompany a music video by K-OS. Key elements were incorporated from the music video into both ancillary texts to create synergy across the projects. Research was conducted on real CD packaging and ads in the genre to inform the designs. Features like a custom font, character mascot, and elements from the video's setting were included to visually and thematically link the ancillary texts back to the original work. The goal was to create eye-catching, unique products that would stand out and gain more attention and sales.
The document describes the ways in which the author's media product challenges the conventions of a real magazine. It discusses design elements like the front cover, contents page, and double page spreads. For each section, it notes similarities between the author's magazine and a real magazine in terms of layout, fonts, and placement of images and text. It also explains ways the author represented a particular social group through choices of images, language, and content.
This document discusses innovations in treating addiction as a chronic condition rather than an acute problem. Over the past decade, experts have increasingly recognized addiction as a chronic disorder best addressed through long-term, diverse treatment and recovery support rather than brief interventions. This shift was pioneered by researchers, people in recovery, and providers and has led to new treatment models, payment systems, and a broader continuum of care including prevention, intervention, treatment, and recovery support.
The document discusses a music video created by a student to promote an artist. Feedback was gathered from friends in the target age range of 12-28 by sending the YouTube link online and asking specific questions. Most enjoyed the shots, editing, and effects used and found it enjoyable overall, though some felt some clips were repeated or didn't match the music. The video received over 500 views in two weeks, primarily from males aged 18-34 and females 13-17, meeting the target audience and making the video a success.
The document provides an evaluation of a music magazine media product created by the author. The author discusses how their magazine incorporates various conventions of real music magazines, including having a masthead, focal image, cover lines, barcode/website/price, and article layout. The author also discusses how their magazine represents a particular social group through images and language that depict urban youth culture. Finally, the author analyzes their target audience and choice of distributor based on their magazine's focus on grime music.
During his media coursework, the author used a variety of hardware and software technologies throughout the research, planning, construction, and evaluation stages of his project. He analyzed music videos online, contacted artists, edited videos, created album artwork, and shared his work online. Key technologies used included computers, cameras, phones, and editing/design software like Final Cut Pro, Photoshop, and WordPress.
Three large employee assistance programs (EAPs) - Aetna, OptumHealth, and ValueOptions - piloted adding screening and brief intervention protocols for risky drinking to their services. This led to identifying 50-100% more employees with alcohol issues. Aetna identified risky drinking in 40% of clients screened and increased clinical follow-ups. OptumHealth identified risky drinking in 20.1% of clients compared to 7.5% previously and increased referrals to treatment. ValueOptions screened over 3,000 people and identified risky drinking in 7% leading to further screening, where 12% were found to have elevated risk.
1) The document discusses drug and alcohol abuse among employees, which costs companies through decreased productivity, increased health claims, and absenteeism. Approximately 14 million U.S. workers abuse drugs or alcohol.
2) While employee assistance programs (EAPs) have helped address substance abuse issues for decades, identifying and treating meaningful percentages of affected employees remains challenging. EAPs provide counseling and aim to improve workplace productivity, but only reach about 90% of the workforce.
3) The document provides industry-specific data on substance abuse prevalence and notes construction, food services, and accommodations have higher rates, while utilities, education and public administration have lower rates. More men than women struggle with substance abuse.
The document provides an evaluation of the student's music magazine media product. It describes how the magazine follows conventions of real media products through elements like the masthead, focal image on the cover, main cover line, additional cover lines around the image, barcode and pricing on the back, contents page layout, and double page article spread layout. It also analyzes how the magazine represents its target social group through images, language, and content choices.
EAPs Think Big To Identify More Problem Drinking 10 21 10Tracy McPherson
The BIG initiative aims to increase the number of problem drinkers identified by Employee Assistance Programs (EAPs) by 100% by October 2011. Three pilot studies found that implementing screening and brief intervention protocols increased identification of problem drinking by 50% or more. Preliminary data suggests businesses can save up to $1,400 per employee identified through EAP screening. The BIG initiative has trained over 1,500 EAP counselors and aims to expand screening to include other issues like tobacco, drugs, depression and anxiety.
Valuing Voices_Gold Coast Consumer Perspectives of Dual Diagnosis and Addicti...Zoe Elizabeth Gill
This document summarizes a project that collected consumer perspectives on dual diagnosis and addiction services on the Gold Coast. It involved interviewing 10 consumers about their experiences and identifying gaps in services. The interviews were analyzed for themes. The goals were to give consumers a voice, provide feedback to services to improve, and identify service priorities. An ABCD community development model guided the project, which focused on recruiting consumers, using them as a primary resource, identifying additional resources, generating ideas for community initiatives, and implementing ideas.
Raisers' Ask - South Asia's Fundraising MagazineRanjini Victor
Raisers’ Ask is a magazine that aims at equipping fundraisers in South Asia with information and good practices to guide their fundraising. It shares skills in the form of articles, case studies and tutorials, besides experiences and perspectives in communication, fundraising, governance, donor relations and technology. It also seeks to provide research based on which fundraisers can make decisions..
This document discusses a report by Euro RSCG Worldwide on health and wellness in modern times. It provides context about Euro RSCG Worldwide as a leading integrated marketing agency and introduces the "Prosumer Reports" publication series. The document highlights some key findings from the report, including that everything about how people regard, prevent, and treat health is changing; the globalization of health issues and solutions; and aging populations increasing healthcare costs. It also lists contents covered in the report around topics like proactive health consumers, measuring wellness, the importance of control and finance in health, the role of diet and brain health, and implications for marketing.
The Destruction From The 2004 Indian Ocean Tsunami And...Casey Hudson
The document discusses how international aid organizations in Haiti have unintentionally gained political power due to Haiti's reliance on aid after disasters like the 2010 earthquake and cholera outbreak. It notes that the IMF recently stalled an economic aid package for Haiti because elections were postponed, resulting in an interim government with little experience managing aid. Overall, the document examines the politics involved in Haiti's relationship with international aid organizations.
The document provides an overview of the state of the cooperative movement globally and in the Philippines. Some key points:
1) Cooperatives employ over 100 million people worldwide and help secure livelihoods for nearly half the world's population.
2) In the Philippines, there are over 18,000 registered cooperatives with over 7 million members and total paid-up assets of over 35 billion pesos as of 2010.
3) The prospects for growth of the cooperative movement in the Philippines are bright due to government support, increasing assets and membership, and potential for cooperation among cooperatives. However, challenges remain such as competition, some unions within cooperatives, and a need for more participative management practices.
The document discusses the relationship between businesses and the communities in which they operate. It analyzes why it is in the interest of businesses to respond to community problems and needs, such as avoiding public backlash and maintaining a "license to operate." It also examines how businesses can build strong relationships with communities through various forms of corporate engagement like economic development initiatives, crime reduction programs, and disaster relief efforts. Finally, it evaluates how companies can direct their citizenship activities strategically to further their own business objectives.
Flavio fabiani case study reconciling business communication with sustainab...Flavio Fabiani
This document presents a case study for a green action plan aimed at reconciling business communication with sustainable development. The plan seeks to address public skepticism of companies' ethical initiatives by discouraging misleading practices like greenwashing. The objectives are to restore trust in genuinely sustainable businesses and support a transition to greener manufacturing. While sustainability reporting is growing in the EU, the communication industry has been slow to adopt it. The action plan aims to correct this issue and increase transparency.
Are charities learning from how businesses are tackling issues around trust, reputation and sustainability, does it matter, and if it does, what can they do about it? Our latest report shows nice ways charities can ensure their methods match their mission.
The document discusses the differing views of Mahatma Gandhi and Bhagat Singh on the use of violence as a tool in politics. While Gandhi was strictly against violence and advocated for non-violent civil disobedience, Bhagat Singh felt some degree of violence was justified when protesting an oppressive regime like the British colonial rule of India. The conclusion emphasizes that writing about these two influential Indian independence leaders provides useful insights into their diverging philosophies on this complex issue during the colonial period.
6. unep fi presentation.ukraine. may 2011csrcentre
This document discusses corporate social responsibility (CSR) and sustainability issues that are important for investors. It notes that over $432 billion of financial stimulus packages have been tagged as "green" and sustainability is becoming a new investment criteria for many large institutional investors. The document outlines some of the initiatives and indexes that have been developed related to CSR and sustainability reporting. It also discusses how environmental issues can transform into material financial risks for companies if not properly managed. The document concludes by discussing the information that investors are looking for from companies regarding their environmental, social and governance performance.
The article discusses envisioning what the nutrition industry could look like 10 years in the future. It begins by assessing progress made since 2002 in areas like self-regulation and addressing adulteration issues. The author proposes creating an "idealized redesign" of the entire supplement industry with a clearly articulated shared vision to guide coordinated progress. The vision outlined includes the industry being fully self-policing, the perception of supplements changing to view them as safe and contributing to public health, and reforms moving towards prevention and addressing root causes of diseases. The goal is for stakeholders to provide feedback and develop their own visions to define and progress the industry.
This document provides instructions on how to analyze the financial statements of Procter & Gamble using ratio analysis. It discusses collecting secondary financial data for P&G and limiting the analysis to only using ratio analysis techniques to evaluate P&G's financial status and performance based on its income statement, balance sheet, and statement of cash flows from previous years. The conclusion will describe an evaluation of P&G and help substantiate decisions based on the financial analysis.
Wearables and health apps have grown rapidly over the past year. An upcoming event will explore how digital technologies like wearables and apps can help reinvent healthcare delivery by providing data insights, remote care, and improving efficiency, quality and costs. The event will discuss the expanding potential and challenges of using these technologies in an integrated healthcare system.
7th december,2020 daily global regional local rice e newsletterRiceplus Magazine
This document summarizes a daily global, regional, and local rice e-newsletter. It provides information on rice news headlines around the world, as well as details on subsidies provided to government entities in the Philippines. The newsletter is published by RicePlus, and includes sections on the editorial board members, rice news headlines from around the world, and a longer article on subsidies provided to state-owned entities in the Philippines.
7th december,2020 daily global regional local rice e newsletterRiceplus Magazine
This document summarizes a daily global, regional, and local rice e-newsletter. It provides information on rice news headlines around the world, as well as details on subsidies provided to government entities in the Philippines. The newsletter is published by RicePlus, and includes sections on the editorial board members, rice news headlines from around the world, and a longer featured news article on subsidies in the Philippines.
Fundations Writing Paper Grade 2 Fun Phonics WritTrina Simmons
The document provides instructions for creating an account and submitting requests for writing assistance on the HelpWriting.net website. It involves a 5-step process: 1) Create an account with a password and email, 2) Complete a request form providing instructions and deadlines, 3) Review bids from writers and select one, 4) Review the completed paper and authorize payment, 5) Request revisions to ensure satisfaction and receive a refund for plagiarized work. The purpose is to outline the simple process for obtaining original, high-quality content writing assistance.
3. September 13, 2010 Alcoholism & Drug Abuse Weekly
3
out is on dealing with the present- situation: the need to reintroduce al- lems — underground, said Go-
ing problem.” Typically, EAPs are cohol issues to the EAP of today, plerud. When companies have poli-
focused on problem-solving and so- said Goplerud. cies of disciplining or firing employ-
lutions. “You aren’t going to be “As EAPs became professional- ees who test positive for drugs or al-
dealing with serious addiction in an ized by the carveouts, they were cohol, those employees won’t even
EAP, but there could be some brief staffed by people with good mental talk to the EAP.
counseling.” health training, but probably not a “One of our transportation com-
About 11 percent of the people lot of substance abuse training,” he panies that’s piloting used to have a
in the Aetna pilot who screened said. In addition, by the 1990s EAPs very punitive attitude towards alco-
positive as potentially at risk for al- were responding to the marketplace hol or drug use,” said Goplerud. “If
cohol problems were identified as by offering “broad brush” programs the EAP or the health plan or drug
“very high risk, possibly alcohol de- designed to help people with every- testing caught you, they fired you,”
pendent,” said Goplerud. “This is thing from weight loss and smoking he said. That policy hasn’t been in
where SBI becomes very relevant cessation to finding a nursing home existence for a decade, but there is
for the treatment world, because it for a worker’s elderly parents. “Fi- still a problem with trust, because
will identify everyone with prob- nally, EAPs have increasingly be- 41 percent of the callers to the EAP
lems, a good proportion of whom come a commodity, something say they don’t drink at all. “That’s an
are going to need specialty sub- workplaces think they have to have, unbelievable rate,” said Goplerud.
stance abuse treatment.” but they want to do it as cheaply as “If you don’t truly trust your EAP
possibly. To do a good job on alco- not to rat on you, you’re not going
Barriers to SBI hol and drug problems, it costs to talk to someone you don’t know
In the early days — about 50 money.” The EAP premium for one from Adam about something that
years ago — EAPs were mainly fo- employee for a year is about 80 could lead to retaliation.”
cused on alcoholism, and run by cents, said Goplerud. For EAPs to be successful, em-
people who were in recovery them- Another barrier for EAPs trying ployees must trust them, or they
selves, said Goplerud. They were to do SBI is lack of trust on the part won’t share information about
concentrated in unions, with mem- of employees. But the drug-free drinking, agreed Derr. “You want to
bers helping one another. The mar- workplace program which started in create a culture where the EAP is
ketplace and the carveouts them- the 1980s drove some people — es- the first resource people go to,” he
selves are to blame for the current pecially those with alcohol prob- said. •
Study shows link between moderate drinking and longevity
For some time researchers have Longer than Non-Drinkers,” for ex- – notably, social isolation. But even
reported that people who don’t ample, did not take into considera- when adjusting for these factors, ab-
drink die at a younger age than peo- tion the cautions expressed by the stainers still died earlier than mod-
ple who drink moderately. A new authors Charles J. Holahan, Ph.D. erate drinkers.
study by researchers who have been and colleagues. “Overall, our findings are con-
looking at this phenomenon sheds “Even among moderate drinkers, sistent with an interpretation that an
light on the role of confounding fac- higher levels of alcohol consump- important part of the survival effect
tors — people who used to be tion and heavy episodic drinking for moderate drinking compared to
heavy drinkers, for example — but may adversely affect safety and abstention among older adults is ex-
still concludes that, in fact, moder- quality of life,” they wrote, noting plained by the effect of confounding
ate drinking does seem to increase that consuming more than two factors associated with alcohol ab-
longevity, compared to heavy drink- drinks a day has been associated stention,” the authors wrote. “How-
ing, light drinking, and abstaining. with an increased risk of falls, a ever, even after taking account of all
The study, “Late Life Alcohol higher risk of alcohol use problems, of these traditional and nontradition-
Consumption and 20-Year Mortali- and potential adverse interactions al covariates, moderate alcohol con-
ty,” created a stir in the lay press with medications. sumption continued to show a sig-
when it was published online Au- Current abstainers in the study nificant, though attenuated, associa-
gust 24 in Alcoholism: Clinical and included former problem drinkers, tion with lower mortality risk.”
Experimental Research. But the people with health problems such The study looked at alcohol
headlines that blared “Live Longer as obesity and smoking, and so- consumption and mortality among
with Three Glasses of Alcohol” and ciodemographic and behavioral fac- 1,824 older adults over a 20-year pe-
“Consume Lots of Alcohol, Live tors linked to increased risk of death Continues on next page
Alcoholism & Drug Abuse Weekly DOI: 10.1002/adaw A Wiley Periodicals, Inc. publication. wileyonlinelibrary.com
4. 4 Alcoholism & Drug Abuse Weekly September 13, 2010
Continued from previous page abstainers and heavy drinkers both ular moderate drinking.”
riod. Prior to adjusting for con- showed increased mortality risks Participants were enrolled be-
founding factors, abstainers had compared to moderate drinkers, of tween the ages of 55 and 65; life-
more than twice the mortality risk 49 and 42 percent. After adjusting, time abstainers were excluded. The
compared to moderate drinkers. there was no longer any difference researchers defined four categories
Heavy drinkers had a 70-percent in- in mortality risk between moderate of average daily alcohol consump-
creased risk compared to moderate and light drinkers. tion at baseline: abstainer, light (up
drinkers, and light drinkers had a Citing previously published re- to one drink a day), moderate (be-
23-percent increased risk. search, the authors suggested that tween one to less than three drinks
The researchers found that at health-protective effects of moder- a day), and heavy (3 or more drinks
baseline, abstaining older adults ate alcohol consumption may be re- per day). This resulted in a total of
were significantly more likely than lated to reductions in cardiovascular 345 (19 percent of the sample) ab-
moderate drinkers to have prior disease. The adverse health effects stainers, 595 (32 percent) light
drinking problems, current obesity of heavy drinking compared to drinkers, 560 (31 percent) moderate
and smoking, to have depressive moderate drinking are due mainly drinkers, and 324 (18 percent)
symptoms, not to be physically ac- to non-cardiovascular diseases: heavy drinkers.
tive, not to have close or quality head and neck cancer, cirrhosis, The researchers concluded by
friends, and not to be married. After pancreatitis, and hypertension, as saying that more research is needed
controlling for all of these factors, well as injuries. The authors stress to further explore the reasons for
the mortality risk for abstainers that “any health-protective effects of the link between moderate drinking
compared to moderate drinkers alcohol appear to be limited to reg- and longevity. •
dropped by one third, approaching
the same risk as that of heavy For the study, which is available online, go to
drinkers. Still, even after adjusting, http://onlinelibrary.wiley.com/doi/10.1111/j.1530-0277.2010.01286.x/full.
TEDS: Admissions age 50 and over growing, in financial straits
Older adults admitted to treat- group has dropped, from 32 percent clear depiction, in graphs, of the
ment are in increasingly difficult fi- in 1992 to 24 percent in 2008. drastic economic situation of pa-
nancial situations, with more than The percentage of older adults tients age 50 and older, showing
half of them either on unemploy- admitted to treatment with no in- also that homelessness grew among
ment assistance or having no in- come at all has been steadily in- this group. The report urges treat-
come at all, according to a report re- creasing, from 11 percent in 1992 to ment providers to pay special atten-
leased last week by the Substance 20 percent in 2000 to 29 percent in tion to the financial needs of these
Abuse and Mental Health Services 2008. The percentage on a retire- patients. “These findings suggest
that this population may need fi-
nancial assistance with the costs as-
‘These findings suggest that this population sociated with substance abuse treat-
ment,” the report states. “Additional
may need financial assistance with the costs case management programs and
associated with substance abuse treatment.’ services may be needed to help in-
dividuals in this age group who are
SAMHSA currently in treatment or transition-
ing out of treatment find housing
and employment.”
Administration (SAMHSA). Between ment or pension declined as well, These patients also have fewer
2000 and 2008, the percentage of from 10 percent in 1992 to 7 percent social supports, with a greater pro-
adults age 50 or over who are on in 2000 to 4 percent in 2008. And portion having never married. Pa-
unemployment rose from 18 per- fewer are on public assistance; in tients who had never married more
cent to 31 percent. In 1992, 19 per- 1992 16 percent of this age group than doubled between 1992 (13.2
cent of this population was on un- was on public assistance, compared percent) and 2008 (30.3 percent).
employment, reflecting the better to 11 percent in 2000 and 8 percent And even among those had married,
economic times of the 1990s. At the in 2008. more were divorced or widowed.
same time, wages or salary as a The Treatment Episode Data Set “This finding draws attention to a
principal source of income for this (TEDS) report from SAMHSA gives a possible need for additional social
It is illegal under federal copyright law to reproduce this publication or any portion of it without the publisher’s permission Alcoholism & Drug Abuse Weekly DOI: 10.1002/adaw
5. September 13, 2010 Alcoholism & Drug Abuse Weekly
5
support for these admissions as they ic, indicating “the need for gender Distributing print or PDF copies of
progress through and transition out and culturally appropriate services.” Alcoholism & Drug Abuse Weekly
of treatment.” The number of older adults is a copyright violation.
The report also showed an in- admitted to treatment has doubled, If you need additional copies,
crease in the number of admissions from 102,700 in 1992 to 231,200 in please contact Sandy Quade at
who were female, Black, or Hispan- 2008. • 860-339-5023 or
squadepe@wiley.com
Go to http://oas.samhsa.gov/2k10/240/240OlderAdm2k10Web.pdf for the for special discounted rates.
complete report.
Recovery from page 1
Gil Kerlikowske, director of the Of-
fice of National Drug Control Policy,
The recovery movement and methadone
and H. Westley Clark, M.D., J.D., di- in Pennsylvania
rector of the Center for Substance Opioid treatment programs (OTPs) are getting some support from
Abuse Treatment, will be at the the recovery movement in Pennsylvania, where a group of legislators are
Philadelphia walk as well. trying to severely limit methadone maintenance treatment (see ADAW,
June 28). “We’ve met with some of the prime sponsors to give our input
Teams and express our concern about this,” said Beverly Haberle, executive
Many recovery month activities director of PRO-ACT.
are sponsored by organizations that The Pennsylvania Drug and Alcohol Coalition tried to come up with
are engaged in recovery activity,
a response in support of medication-assisted treatment and OTPs at its
said Pat Taylor, executive director
last meeting, said Haberle, who serves on the coalition. But reaching a
of Faces & Voices of Recovery,
consensus was difficult because “some factions within the field are
which is coordinating the events
anti-medication,” she told ADAW. “The goal was to present something
on a national basis. “The impact at
the community level is a much from the entire coalition that everyone could agree on.”
broader network supporting recov- Pat Taylor, executive director of Faces & Voices of Recovery, which
ery month activity,” she told ADAW. strongly supports the concept that people in medication-assisted
Teams of people walk, sometimes treatment, including with methadone, are in recovery, noted that Reckitt
for a family, or honoring a recov- Benckiser (maker of Suboxone) and Alkermes (maker of Vivitrol) are
ery. There are also teams like sponsors of the September 25 recovery walk to be held in Philadelphia.
“Teachers for Recovery” and There will be representatives from OTPs marching as well, and, she
“Lawyers for Recovery.” hopes, patients. “Usually there is a recovery speaker at every rally who
The Philadelphia walk is also represents medication-assisted treatment as well,” she told ADAW. “But
going to have an “honor guard” — there is still a lot of work to do to help people understand that being
people with at least 10 years of re- in medication-assisted treatment is being in recovery.”
covery. The honor guard will lead
the walk, and then will part and let
the rest of the walkers through, people trying to break away from stages of recovery, who themselves
symbolizing hope for people newly their old drinking and drug-using are just learning how to define it,”
in recovery, said Haberle. “Our goal “friends, places and things.” she said. “We have to talk about re-
is to have 500 people in the honor currence, not relapse.” It’s important
guard, representing 5,000 years of Stages of recovery to make the movement “safe” for
recovery.” The recovery movement in- people newly in recovery, as well as
Some providers bring everyone cludes people who are no longer for people in long-term recovery
in treatment with them to the walk, using alcohol or other drugs, people who still are rooted in the AA belief
said Haberle. “It’s very reinforcing who are on medication-assisted treat- in anonymity.
for them, to see that long-term re- ment such as methadone or Vivitrol, The involvement of many
covery is possible.” And because of and even people who have cut back young people who have four or five
the many family-oriented events on their use of alcohol and drugs. years of recovery in Faces & Voices
that take place around the walk, “From PRO-ACT’s perspective, peo- of Recovery, and the recovery
they can also see that the recovery ple are in recovery when they say month activities, has contributed to
movement gives them social oppor- they’re in recovery,” said Haberle. a year-round focus on support and
tunities — particularly important for “We have people in the early Continues on next page
Alcoholism & Drug Abuse Weekly DOI: 10.1002/adaw A Wiley Periodicals, Inc. publication. wileyonlinelibrary.com
6. 6 Alcoholism & Drug Abuse Weekly September 13, 2010
Continued from previous page work — which is often unromantic events being held across the coun-
advocacy, said Taylor. The increas- and hard — involved in organizing, try this month. “Rally for Recovery is
ing participation in the walks is also such as the billboards that must be meant to focus attention on one
a reflection of the more sophisticat-
ed organizing ability of groups that
are involved, she said, adding that ‘It’s more than people coming together to put
every month there is a telephone
call for people involved in the a face and voice on recovery — it’s advocacy.’
movement to share information. Pat Taylor
“It’s more than people coming
together to put a face and voice on
recovery – it’s advocacy,” said Tay- put up along the highway to publi- day, so we’re really pleased to be
lor. Work on getting the parity bill cize the walk (PRO-ACT did that able to partner with PRO-ACT in
passed helped strengthen the advo- this year). terms of this being a national hub
cacy component, which this year is There are over 1,000 recovery event,” said Taylor. •
focused on making sure that recov-
ery support services are included in For people who want to participate via the web, Faces & Voices of Recovery
health reform. launched a new online rally last week.
And that energy pays off in the Go to www.facesandvoicesofrecovery.org/rally.
Employment closes the marijuana gateway, researchers find
The gateway from marijuana use ployed, were not any more likely illicit drug use in adolescence, our
to harder drugs is stress related to to use other illicit substances as results indicate that the effect may
unemployment, not the marijuana it- young adults. be short-lived, subsiding by age 21,”
self, according to research published “Employment in young adult- the researchers said. “Interestingly,
in the September issue of the Jour- hood can protect people by closing age emerges as a protective status
nal of Health and Social Behavior. the marijuana gateway,” said Karen above and beyond the other life sta-
According to the study, marijuana Van Gundy, associate professor of tuses and conditions considered here.
does not have a “gateway effect” in sociology at the University of New We find that respondents ‘age out’
and of itself, and the strongest pre- Hampshire and lead author of the of marijuana’s gateway effect regard-
dictor of whether someone will use study. “Over-criminalizing youth less of early teen stress exposure or
harder drugs — whether or not they marijuana use might create more se- education, work, or family statuses.”
used marijuana — is race/ethnicity. rious problems if it interferes with The article has implications for
For the study, researchers from later employment opportunities.” drug policy, the authors conclude,
the University of New Hampshire Furthermore, once young adults urging policymakers “to consider
used survey data from 1,286 young reach age 21, the gateway effect dis- stress and life-course approaches in
adults who attended Miami-Dade appears completely. “While marijuana their pursuit of solutions to the
public schools in the 1990s. Within use may serve as a gateway to other ‘drug problem.’” •
the final sample, 26 percent of the
respondents are black, 44 percent
are Hispanic, and 30 percent are
non-Hispanic white. Not graduating
Briefly Noted links to an increased risk for addic-
tion to painkillers. The study, con-
from high school or attending col- ducted by Joseph Boscarino, Ph.D.,
lege was associated with higher Study identifies risk factors an epidemiologist and senior inves-
rates of both marijuana and harder for addiction to painkillers tigator at Geisinger’s Center for
drug use. Those who used marijua- A study published in the Sep- Health Research, suggests that these
na as teenagers were more likely to tember issue of Addiction has iden- risk factors may also indicate an in-
use other illicit drugs as young tified four risk factors for painkiller creased risk for drug addiction even
adults if they were unemployed fol- addiction in patients with chronic in patients without a history of
lowing high school. pain: age (65 years or younger), a chronic pain. “These findings sug-
However, employment elimi- history of drug abuse and depres- gest that patients with pre-existing
nated those differences — people sion, and the use of psychiatric risk factors are more likely to be-
who used marijuana as teenagers, medications. Researchers also stud- come addicted to painkillers, pro-
but went on to college or were em- ied — and found — possible genetic viding the foundation for further
It is illegal under federal copyright law to reproduce this publication or any portion of it without the publisher’s permission Alcoholism & Drug Abuse Weekly DOI: 10.1002/adaw
7. September 13, 2010 Alcoholism & Drug Abuse Weekly
7
clinical evaluation,” said Boscarino. Noting that 61 percent of the city’s gram. The Army is hiring seven
“By assessing patients in chronic voters approved Proposition T, more counselors to work at Fort
pain for these risk factors before which would provide “treatment on Carson. Last year, Fort Carson was
prescribing painkillers, doctors will demand,” Avalos criticized the “tug the subject of an investigation fol-
be better able to treat their patients’ of war” between Mayor Gavin lowing a spate of homicides, and
pain without the potential for future Newsom and the Board of Supervi- one finding – that soldiers who
drug addiction.” For the study, re- sors. “The mayor’s cuts and the needed substance abuse help would
searchers accessed electronic health board’s restorations to substance have to leave the service in order to
records of Geisinger patients with abuse treatment are like a never- get it – led to calls to remove barri-
back pain and related conditions ending cycle, repeated year after ers to such assistance (see ADAW,
who were prescribed opioid pain- year in a downward spiral exacer- July 27, 2009).
killers for more than 90 days. A bated by the ongoing budget
sample (705) of these patients were deficit,” he said. Before proposing Study of compound shows link
interviewed, and their DNA was col- the fee, the city commissioned a between alcohol and eating
lected and studied. The researchers study which found that alcohol A compound that suppresses al-
looked at a gene located on chro- costs the city $17.7 million in am- cohol craving in humans also de-
mosome 15 that has been implicat- bulance, treatment, prevention, and creases sugar consumption by ro-
ed in alcohol, cocaine and nicotine, hospital services. It does not in- dents, according to a study by re-
but did not find a clear link to opi- clude law enforcement costs. searchers at the Ernest Gallo Clinic
oid addiction, they said. and Research Center of the Univer-
California treatment program sity of California, San Francisco. The
Alcohol lobby vs. San Francisco as will focus on veterans compound, ezlopitant, blocks the
fee fight continues Victory Village, owned by the action of a neurotransmitter that
A proposal to pay for substance Oroville Economic and Community plays a role in the reward system,
abuse treatment in San Francisco by Development Corporation, is according to researchers. The rats
adding a fee, to be paid by whole- launching a program to treat veter- were less motivated to drink sugar
salers and distributors, equivalent ans with substance abuse problems water when on ezlopitant. “This
to 3 to 5 cents a drink, has public in Northern California. The residen- finding suggests a possible link be-
support but is opposed by the alco- tial program will provide substance tween the neurochemical pathways
hol lobby. The Alcohol Cost Recov- abuse treatment as well as mental for addiction and compulsive eat-
ery Fee proposed by John Avalos, health counseling, medical care, job ing,” said principal investigator Sele-
chair of the San Francisco Board of training, and other services. Mike na Bartlett, director of the Pre-Clini-
Supervisors budget committee, Anderson, a drug and alcohol coun- cal Development Group at the Gallo
would be on wholesalers and dis- selor, will run the program, which Center. The study was published
tributors, not local bars and restau- will serve 48 veterans and include September 1 in PLoS One.
rants. Yet “big alcohol” has stepped 30 housing units and 16,000 square
in to oppose it, said Avalos. Two feet of retail space. The nonprofit Co-occurring SA, bipolar disorder
San Francisco lobby firms have corporation is buying the property linked to violent crime
been brought into the fray to “whip and rehabilitating it for $6 million, Although guidelines don’t rec-
up local opposition to the fee and according to news reports. About ommend routine risk assessment for
foment fear among bar and restau- 3,000 homeless veterans live in violence for violence in patients
rant owners and local merchants' Northern California. with bipolar disorder, if there is co-
organizations,” he said. “They claim occurring substance abuse there
the fee will be passed through as a Alcohol abuse counseling to be may be need for such an assess-
50 cents-to-$1 increase on a serv- offered anonymously at Fort Carson ment, according to research pub-
ing, and have dressed up the fee as In an effort to encourage sol- lished in the current issue of the
a major job and business killer. Yet diers to seek help for alcohol prob- Archives of General Psychiatry. The
according to the controller’s chief lems, a new Army program will goal of the study was to see if there
economist, the fee will decrease allow them to be treated anony- is a link between violent crime
consumer spending on alcohol by mously, the Associated Press report- (convictions for homicide, assault,
less than 1 percent and have very ed earlier this month. Some other robbery, arson, any sexual offense,
minimal impact on the economy.” posts already offer anonymous illegal threats, or intimidation) and
counseling. Under the new pro- bipolar disorder, and it found no
Renew your subscription today. gram, soldiers will no longer have such link exists. But when there was
888-378-2537
to notify supervisors before they go substance abuse as well, the risk in-
to the Army's Substance Abuse Pro- Continues on next page
Alcoholism & Drug Abuse Weekly DOI: 10.1002/adaw A Wiley Periodicals, Inc. publication. wileyonlinelibrary.com
8. 8 Alcoholism & Drug Abuse Weekly September 13, 2010
Continued from previous page
creased (adjusted odds ratio of 6.4), Coming up…
according to the research, which
was written by Seena Fazel, M.D., The 2010 Annual Conference and Training Institute of the Substance Abuse
and colleagues. Program Administrators Association will be held October 17-21 in Las Vegas. Go
to www.swiftpage6.com/CampResource/2Y0RJSUNHVITLMSO/1/text.pdf for
more information.
In the States The American Association for the Treatment of Opioid Dependence, Inc.
(AATOD) will hold its 2010 National Conference, “Building Partnerships:
‘Don’t share Rx medication’ bags Advancing Treatment & Recovery,” on October 23-27 in Chicago. For more
distributed in West Virginia information, visit www.aatod.org.
This month Take Care West Vir- The Association for Medical Education and Research in Substance Abuse will
ginia, a statewide prescription drug hold its annual conference November 4-6 in Bethesda, Md. For more
abuse prevention campaign, will information, go to www.amersa.org/conf.asp.
help pharmacies distribute medica-
Therapeutic Communities of America will hold its national conference
tion bags that say “Don’t share Rx
November 7-10 in Washington, D.C. For more information, go to http://
medication.” The campaign is “aimed
registration.sitesolutionsworldwide.com/synergy/v_1_/home/?id=267&info=1
at changing social/culture norms
or call Site Solutions Worldwide at (866) 374-6338.
about sharing prescription drugs,”
said Andy Whisman, senior evalua- The American Academy of Addiction Psychiatry will hold its annual meeting
tion specialist at the W.Va. Preven- December 2-5 in Boca Raton, Fla. For more information, go to
tion Resource Center, which is run- http://www2.aaap.org/meetings-and-events/annual-meeting.
ning the campaign. Almost all of the
state’s 55 counties are participating in
the Take Care W.Va. message, and so questioned why the state was pay- py — one for counselors, and one
are most pharmacies. The campaign ing for Suboxone without counsel- for physicians — both based on
is supported with funding from the ing, noting that medication alone is TIP 49.
following grants: 2009 Drug Free not enough to treat addiction. But For the Quick Guide for Coun-
W.Va. Grant, W.Va.’s federal Strategic Medicaid in Kentucky doesn’t pay selors Based on TIP 49: Incorporat-
Prevention Framework State Incen- for substance abuse treatment at all, ing Alcohol Pharmacotherapies Into
tive Grant (SPF SIG), and W.Va.’s except for pregnant women. In Medical Practice, go to http://
federal Projects of Regional & Na- most cases, Suboxone is being pre- kap.samhsa.gov/products/tools/cl-
tional Significance (PRNS) Grant. scribed by primary care or other guides/pdfs/QGC_49.pdf.
physicians, and not by addiction For the Quick Guide for Physi-
Suboxone costs, abuse worry treatment programs. cians Based on TIP 49: Incorporat-
Kentucky officials ing Alcohol Pharmacotherapies Into
Last year Medicaid spent almost
$11 million on Suboxone for Ken-
Resources Medical Practice, go to http://
kap.samhsa.gov/products/tools/cl-
tucky residents, but didn’t pay for guides/pdfs/QGP_49.pdf.
any of the recommended counsel- SAMHSA issues guides on alcohol These quick reference tools
ing or other treatment, the Louisville pharmacotherapy provide guidance for the use of
Courier-Journal reported last week. The Substance Abuse and Men- acamprosate, disulfiram, oral nal-
In addition, law enforcement offi- tal Health Services Administration trexone, and extended-release in-
cials in the state are concerned (SAMHSA) has issued new Quick jectable naltrexone in the treatment
about illegal sales of the medication. Guides on alcohol pharmacothera- of alcohol use disorders.
One prescribed tablet costs $7.50
but sells on the street for $20, ac-
cording to the report. The $11 mil-
lion covers about 1,800 patients a
In case you haven’t heard…
month. While the state’s Medicaid Three-year old Ardi Rizal from Indonesia, who became famous for being addicted
Commissioner thinks Suboxone is a to nicotine, has been treated for one month and is now in recovery, according to
good medication, she said there the National Commission for Child Protection. He became addicted after his father
need to be tighter controls, partly gave him one cigarette; his parents kept giving them to him to prevent temper
because of the increased costs, and tantrums that resulted from craving. Viewers who saw a video of the boy smoking
partly because of the drug abuse were shocked. He had been smoking since the age of 11 months and could even
problem. Drug treatment officials blow smoke rings.
Alcoholism & Drug Abuse Weekly DOI: 10.1002/adaw A Wiley Periodicals, Inc. publication. wileyonlinelibrary.com