CONCLUSION: Antidepressants are no more effective than placebo in the management of back pain. Further randomized controlled trials of antidepressants are needed before they can be routinely prescribed for treatment of back pain. PURPOSE: Older adults vary greatly in their expectations regarding aging, with some expecting to maintain high function, and others expecting to experience functional decline. Whether having low expectations regarding aging causes older adults to seek less health care for modifiable age-associated conditions is unknown. We set out to determine whether older adults with low expectations regarding aging are less likely to think that they should seek health care for age-associated conditions associated with functional decline. METHODS: We surveyed by mail a random sample of 588 English-speaking patients aged 65 and older cared for by 20 UCLA network physicians. We measured expectations regarding aging using a recently developed and validated 38-item Expectations Regarding Aging (ERA) Survey, which includes 10 domains of expectations such as physical health, cognitive function, and mental health. Additionally, to identify beliefs regarding care-seeking, we asked participants if they felt it was``very",``somewhat", or``not at all ''important to seek health care for 13 ageassociated conditions such as falling, urinary incontinence and pain. Participants also reported on their chronic medical conditions, ability to perform activities of daily living, level of depressive symptoms, religiosity, and generic physical and mental health status. We then constructed a multiple linear regression model to assess the independent relationship between ERA Survey scores and beliefs regarding care-seeking, adjusting for potential confounders. RESULTS: Surveys were returned by 72% (n = 429) of those surveyed; 54% were women; the mean age was 76 years; 80% were Caucasian, 9%Latino, 6%African American; 59%reported > 2 medical conditions, and 21%reported disability. After controlling for all covariates including age, comorbidity, activities of daily living, religiosity and generic physical and mental health status, having lower expectations regarding aging was associated significantly with lower beliefs regarding care-seeking for age-associated conditions (p = .01). CONCLUSION: In this community-based sample of older adults, having lower expectations regarding aging was independently associated with placing less importance on seeking health care for age-associated, potentially modifiable conditions. These results suggest that older adults with low expectations regarding aging may not receive health care for modifiable conditions, and thus may experience preventable functional decline. METHODS: For 1984 indigent patients, adherence was modeled using multivariable linear regression with an alpha of 0.01 for statistical significance. DA was defined as either mean DA for all drugs taken by each patient or minimum DA based on the lowest adherence drug using prescription refill data from a closed pharmacy system. Additional data were drawn from a clinical data repository. RESULTS: Based on mean DA, 31%of patients took < 80% of prescribed doses. Based on minimum DA, 52% of patients took < 80% of prescribed doses for at least one drug. Increasing age, ethnicity (white), and greater medication supply per prescription were independently associated with higher mean and minimum DA. Number of drugs taken had a positive mean but negative minimum DA association. Gender, number of primary care visits, dosage schedule, and copayment were not independently associated with DA. The model explained only 6% of the variance in mean DA. CONCLUSION: In an indigent population with HBP, DM or HC, DA was associated with ethnicity, age, and quantity of drug supplied. However these factors explained only a small amount of the substantial DA variability. To target DA efforts, better predictors must be developed to identify patients most in need of adherence intervention. Prescription refill claims data could serve this purpose. Cook County Hospital, Chicago, IL PURPOSE: Because of its high prevalence and cost, preventing emergency departments (ED) visits and hospitalizations for congestive heart failure (CHF) has become the focus of extensive`d isease management ''activities. As part of a national chronic disease improvement collaborative, we sought to better understand and improve the care for patients with CHF. Because virtually all admissions in our public hospital system are the result of an emergency department visit, and our finding that approximately one in three ED visits of patients in our CHF cohort resulted in a hospital admission (unpublished data), we sought to better characterize the frequency and patterns of ED visits in this patient population. METHODS: We assembled two cohorts of patients with the diagnosis of congestive heart failure ± -1) an outpatient cohort attending one of four outpatient sessions at an public hospital general medical clinic over a three month period (7/99 ± 10/99) who had CHF listed on their PURPOSE: Low levels of functional health literacy (FHL) are common among public hospital patients with chronic conditions. Identifying patients with low FHL may improve care at the risk of disclosing a stigmatizing issue. We evaluated the acceptability and utility of FHL screening among type 2 diabetes patients (DM2). METHODS: This study was a randomized controlled trial of FHL screening. We measured FHL for all patients with the short Test of Functional Health Literacy in Adults. We enrolled 155 patients who had low FHL (scores < 23), DM2, spoke English or Spanish, and were cared for by one of 61 primary care physicians (PCPs) at a public hospital. PCPs in the intervention group were alerted prior to the visit when the patient had low FHL ; control PCPs were not. We surveyed patients regarding the acceptability of FHL screening. We surveyed PCPs regarding their satisfaction with the visit, communication techniques, and self-rated effectiveness. We also asked intervention PCPs to report their prior estimates of the patient' s FHL and the extent to which knowledge of the patient' s FHL would impact future diabetes care. Post-visit survey data were available for both patients (141) and physicians (152). Post-visit differences between intervention and control patients and physicians were examined, controlling for the clustering of patients by physicians. RESULTS: Nearly all patients (95%) felt that FHL screening was useful; of these, 99%felt it was important to share this information with their PCP. After adjusting for clustering, PCPs who received FHL feedback felt less trained and confident in caring for their patient than control physicians(p=.02), were more likely to involve patient' s family or friend in decisionmaking (p=.03), or use pictures and diagrams to promote understanding (p=.08). However, intervention and control PCPs had similar self-rated effectiveness (p = 0.66). Intervention PCPs accurately estimated the FHL of patients with inadequate FHL only 30%of the time. Intervention PCPs believed that FHL screening was clinically useful (63%of visits), would result in improved medication adherence (63%), and would improve future DM2 care (58%). CONCLUSION: Patients with DM2 and low FHL found FHL screening acceptable. PCPs, despite working in a setting with high prevalence of FHL problems, frequently overestimated patients' FHL. FHL feedback was associated with greater feelings of PCP inadequacy and use of recommended communication strategies, but no differences in physician self-rated effectiveness. Most PCPs believed FHL screening was clinically useful. Further research should explore the impact of FHL screening combined with provider communication training on patient-centered measures and clinical outcomes. RESULTS: Only 2.2%of the sample reported eating a vegetarian diet was 43%(116) of selfreported vegetarians reported eating some meat (beef, pork, poultry or fish) during the 24-hour food recall surveys. Overall, reports of vegetarian diet were more likely in women (67.8%of vegetarians v. 49.0%of controls; p < .001) and``other ''races (12.6%of vegetarians vs. 7.7%of controls; p < .05). Medical history was strongly associated with reporting a vegetarian diet. Among those who were vegetarian, 22.3%, 16.3%and 6.7%reported a history of high cholesterol, heart disease and stroke compared to 16.6%, 9.2%and 1.7%of controls, respectively (all comparisons significant at p < .01). Self-report of other risk behaviors was also significantly associated with reporting a vegetarian diet; 16.7%and 59.5%of vegetarians reported current smoking and current vigorous exercise at least two times per week compared to 23.2%and 50.9%of controls, respectively. No differences were seen between vegetarian and non-vegetarian subjects with respect to age, body mass index, household income, education level, region of country and self-reported health status. CONCLUSION: In conclusion, self-report of a vegetarian diet is uncommon among U.S. adults and is strongly associated with gender, chronic medical conditions, and the self-report of other health-promoting behaviors.