C. Nathan Marti's research while affiliated with University of Texas at Austin and other places

Publications (160)

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Using the 2019 and 2020 National Health and Aging Trend Study, we examined the association between fall worry and changes in depression/anxiety symptoms among community-dwelling older adults age 70+ ( N = 3333). Past-month fall worry in 2020 included any fall worry (30.9%) and activity-limiting fall worry (34.0% of those with any fall worry). Chang...
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Objective To examine the associations between depression/anxiety severity and changes in severity and self-reported difficulty managing medications among a representative sample of community-residing US Medicare beneficiaries without a reported dementia diagnosis. Method We used the 2018 and 2019 National Health and Aging Trend Study (analysis sam...
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Measurement-based care (MBC) systematically tracks patient symptoms and informs treatment but is rarely used in psychotherapy. The authors compared standardized and tailored MBC implementation. Tailored implementation resulted in better Patient Health Questionnaire completion for depression in mental health clinics.
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Introduction Research has demonstrated disparities in depressive symptoms among people who are marginalized. However, more work should examine depressive symptoms through an intersectional lens, recognizing that multiple systems of privilege and oppression interlock to create unique struggles where multiple marginalized identities meet. Recent meth...
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Cannabis use has increased steadily among older adults, and they are a significant proportion of medical cannabis users. Using 2015–2019 National Survey on Drug Use and Health data (n = 44,007 age 50+), we examined whether the numbers of emergency department (ED) visits and nights hospitalized are associated with cannabis use status, use reason (no...
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Context Illicit opioid use and heroin treatment admissions among individuals age 50+ have increased. Little research has, however, examined correlates of illicit opioid overdose deaths in this age group before or during the COVID-19 pandemic or the healthcare services used in these cases. Methods The sample included illicit opioid (heroin, fentany...
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Objectives Given physical/social distancing due to COVID-19, we examined associations between self-reported loneliness and changes in contact with family/friends and mode of social participation among older adults. Methods Data came from the 2020 National Health and Aging Trend Study (NHATS) and its supplemental mail COVID-19 survey (N = 2,910 res...
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Background Increases in U.S. older adults’ nonprescription opioid and psychostimulant use call for examining their treatment admissions for these substances. Methods Using admissions age 55+ involving heroin (N=299,073) from the 2012-2019 Treatment Episode Data Set-Admissions, we examined trends and sociodemographic and clinical characteristics of...
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Background Although cigarette smoking during young adulthood is characterized by volatility, few studies examine if use of electronic nicotine delivery systems (ENDS) impacts transitions in cigarette use behaviors across this developmental period. The purpose of this longitudinal study was to examine the role of ENDS use on three transitions in cig...
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In this study using 2015–2018 Treatment Episode Data Set-Discharge (TEDS-D) cases age 55+ for heroin (N = 101,524) or prescription opioids (PO; N = 25,510) as the primary substance, we examined treatment completion rates and correlates. We fit separate logistic regression models for heroin and PO cases with treatment completion status (completed vs...
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We examined the role of depressive symptoms in the longitudinal trajectory of the number of tobacco products used across young adulthood, ages 18–30 years, and whether peer tobacco use exacerbated the effects of the depressive symptoms. Participants were 4534 initially 18–25-year-old young adults in the Marketing and Promotions Across Colleges in T...
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Background: Research shows significant associations of major depression with cannabis and binge alcohol use. However, despite increasing cannabis and binge alcohol use rates among the 50+ age group, research on this age group is scant. Methods: We used the 2015-2019 National Survey on Drug Use and Health data (n = 44,007 age 50+) and multinomial l...
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High rates of opioid overdose and suicide among the 50+ age group call for an examination of suicidal intent in overdose incidents. Using 2015–2020 National Poison Data System opioid poisoning cases aged 50+ (n = 83 153), we examined the types of opioids and other substances associated with suspected suicides compared to intentional misuse/abuse wi...
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Context Older adults are less likely than younger adults to receive naloxone therapy. Given high rates of prescription opioid use/misuse and increasing illicit opioid use among older adults, factors associated with naloxone administration for older opioid poisoning cases need examination. Methods We analyzed the 83,135 opioid-involved cases aged 5...
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The COVID-19 pandemic ushered in rapid telehealth/telemedicine adoption. In this study, we (1) examined rates and correlates of telehealth (video call) use among those aged 70+, and (2) tested the significance of access to information and communication technology (ICT) device ownership and knowledge of how to use the internet and devices as telehea...
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Context Rates of prescription opioid (PO) prescribing and filling remain high, and illicit opioid (IO) use has increased among late middle-aged and older adults. Research on PO and IO poisoning and their impacts among these age groups is needed. Methods Data came from 2015 to 2020 poison control center cases aged 50+ (N = 83,135). We used χ² tests...
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Aims To examine the longitudinal trajectory of young Texan (USA) adults’ Electronic Nicotine Delivery Systems (ENDS) use from 2014-2019, and to determine if there are changes in the trajectory among younger and older young adults post-2017, when vape pods surged in popularity in the United States. Design Nine-wave longitudinal study, with 6 months...
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Background: Despite increasing rates of nonmedical and/or medical cannabis use in the 50+ age group, scant research exists on the associations between cannabis use and prescription medication use. In this study, we examined associations of use of prescription tranquilizers, sedatives, stimulants, and pain relievers, tobacco products, any/binge/hea...
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Objectives Lonely and socially isolated homebound older participants of a randomized trial comparing behavioral activation (BA) vs. friendly visiting, both delivered by lay counselors using tele-videoconferencing, were reassessed at one-year to determine whether benefits at 12 weeks were maintained over time. Methods The study reinterviewed 64/89...
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This report provides a review of randomized controlled trials that tested whether an eating disorder prevention program significantly reduced future onset of eating disorders, which is important because eating disorders are common and result in marked functional impairment. We identified 15 trials involving 5080 participants (mean ages ranging from...
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Context/Objectives A significant proportion of individuals aged 50+ in the U.S. use cannabis for medical or recreational purposes, sometimes with adverse effects. Given differences in cannabis use among men and women, we examined sex differences in (1) cannabis forms used, (2) exposure reasons, and (3) medical outcomes in older-adult poison control...
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Increasing numbers of older adults use cannabis and cannabis-derived products that can have adverse effects. This study examined management site and level of healthcare services for older adult poison control center cases involving cannabis products. Using the American Association of Poison Control Centers’ (PCC) National Poison Data System, 2016–2...
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Purpose The present study examined the longitudinal associations between exposure to tobacco advertisements in magazines popular among young adults and changes in the number of tobacco products used by young adults. Methods Participants were 4,824 students from 24 Texas colleges participating in a longitudinal study. Tobacco advertisements in 11 m...
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Objectives Research has shown ample evidence for reciprocity between depression and disability. We examined whether decreases in disability among low‐income, homebound older adults who received brief depression treatments were mediated by improvement in depressive symptoms and vice versa and whether the mediation effects varied by treatment modalit...
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Importance Older adults who are homebound and have low income have limited access to psychosocial treatments because of their homebound state and geriatric mental health workforce shortages. Objective To evaluate clinical effectiveness of a brief, aging service–integrated, videoconferenced behavioral activation (tele-BA) treatment delivered by lay...
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This study examined differences by race/ethnicity and state in poisoning deaths of undetermined intent (UnD) versus suicide classification and the potential impact of state variations on UnD rates for Blacks and Hispanics. We used data from the 2005-2015 U.S. National Violent Death Reporting System (N = 29,567 aged 15+) and weighted coarsened exact...
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Objectives Older (aged 50+) cannabis users are growing in numbers, but research on poison control center (PCC) cases has not focused on them. In this study, we examined: (1) changing trends in cannabis forms reported in PCC cases; (2) demographic and clinical factors associated with different cannabis forms; and (3) associations between cannabis fo...
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Sexual minority (SM) youth are at high risk for intimate partner violence (IPV) and suicidal ideation/attempts compared to their heterosexual peers. We examined whether SM identity enhanced the relationship between experiences of IPV and suicidal ideation/attempts. Weighted logistic regression models were run using the 2017 Youth Risk Behavior Surv...
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Objectives To examine experiences and perspectives of low-income homebound older adults (N = 90) who participated in tele-delivered behavioral activation (Tele-BA) treatment for depression by bachelor’s-level lay counselors. Methods We used the 11-item Treatment Evaluation Inventory (TEI) to measure participants’ acceptability of Tele-BA. We used...
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Objective: The authors assessed central nervous system (CNS) polypharmacy among low-income, racially diverse homebound older adults with depression (N=277) and its associations with the participants' ratings of depressive symptoms and pain. Methods: CNS-active and other psychotropic and analgesic medications intake was collected from patients' m...
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Objectives: To investigate the psychometric properties of the 10-item Social Engagement and Activities Questionnaire (SEAQ) to assess social-group, interpersonal interaction, and solitary activities among low-income, depressed homebound older adults (n = 269). Methods: We used principal component analysis (PCA) to evaluate the underlying dimensions...
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Objective To test the acceptability and effectiveness of a lay-coach-facilitated, videoconferenced, short-term behavioral activation (Tele-BA) intervention for improving social connectedness among homebound older adults. Methods We employed a two-site, participant-randomized controlled trial (RCT) with 89 older adults (averaging 74 years old) who...
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Background Due to other marketing restrictions, one venue where tobacco companies concentrate their marketing efforts to reach young adults is bars/nightclubs. Objective This study examined the relationship between exposure to tobacco marketing in bars/nightclubs and number of alternative tobacco/nicotine products used 6 months later among college...
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Objectives: To examine (1) correlates of religious coping, and (2) associations of religious coping at baseline with evaluation of treatment acceptability and depressive symptom severity outcomes of short-term psychotherapeutic depression treatments among 277 low-income homebound older adults (70% female; 41% non-Hispanic White, 30% African America...
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Background and objectives: Fall incidents and associated medical costs are increasing among older adults. This study examined longitudinal associations between older adults' falls status and depression at 2 time periods to further clarify bidirectional relationships. Methods: We used the National Health and Aging Trends Study (NHATS) Waves 5 and...
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Background: Fall injuries and related healthcare use among older adults are increasing in the United States. This study examined chronic illnesses, sensory and memory problems, and injury characteristics that were associated with ED visits and hospitalizations among older adults who received medical attention for fall injuries within a 91-day refe...
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Objectives Late-life depression, falls, and fall worry are public health problems. While previous research confirms the cross-sectional relationship between depression and fall worry, few longitudinal studies have examined whether changes in fall worry are associated with changes in depressive illness and vice versa. This study examined longitudina...
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Many trials have provided support for dissonance-based eating disorder prevention programs. This meta-analytic review characterized the average intervention effects and tested whether various intervention, participant, and facilitator features correlated with larger effects to guide implementation of optimally effective versions of this program. We...
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Aims: To examine bi-directional associations between self-reported exposure to electronic nicotine delivery system (ENDS) marketing and ENDS use, over four six-month follow-up surveys, among young adults. Design: The Marketing and Promotions Across Colleges in Texas project (M-PACT) is a cohort study that examined exposure to tobacco marketing a...
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Significant differences in health across racial/ethnic and socioeconomic groups in the US signal increasing numbers of low‐income homebound older adults in a rapidly ageing society. The purpose of this study was to examine physical and psychiatric conditions and their association with incidence of self‐reported falls and hospitalisations among larg...
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Objective: Depression is the most prominent mental health disorder among youth and has a profound impact with respect to morbidity and mortality if not addressed. The Treatment for Adolescent Depression Study (TADS) is one of the largest randomized controlled trials that compared the effectiveness of four treatments: cognitive-behavioral therapy (...
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Introduction In violent deaths, forensic autopsy is often regarded as the means for making the final medical diagnosis of the cause and manner of death; however, without other corroborative evidence (e.g., suicide note, prior history of suicide attempt/intent disclosure), drug intoxication and other poisoning deaths, especially among individuals wi...
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Purpose: Given increasing youth suicide rates and liberalization of marijuana-use laws, this study examined post-mortem marijuana toxicology test results among suicide decedents aged 15–19 (youth) compared to those aged 20–29 (young adults). Methods: Data were from the 2005–2015 National Violent Death Reporting System (N = 6002 decedents aged 15–19...
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Background: Opioid use disorder (OUD) and overdose deaths among the US population continue to increase. This study examined associations of OUD and other substance use disorders with substance abuse treatment use and perceived treatment need among US adults aged 18+ who misused opioids. Methods: The 2015-2016 National Survey on Drug Use and Heal...
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Objective: To examine cross-sectional and longitudinal associations between (a) activity-limiting fall worry (ALW) and (b) self-reported health-related restrictions and social engagement among older adults. Method: The National Health and Aging Trends Study Waves 5 (T1) and 6 (T2) provided data (n = 6,279). Binary and multinomial logistic regressio...
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Objectives: To examine intraindividual change in polytobacco and individual tobacco and nicotine product use across young adulthood. Method: Participants were 2711 students from 24 Texas colleges participating in a 6-wave online study, with 6 months between each wave. Participants were aged 18 to 25 years at baseline in fall 2014 or spring 2015...
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Based on 2005 to 2014 data from the National Violent Death Reporting System, this study examined mental health treatment status of suicide decedents in correctional settings, focusing on those with prior/recent suicide ideation/plans/attempts. Of all decedents (N = 1,727), 30% had prior/recent suicidal ideation/plans/attempts, and of them, 64% had...
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Opioid misuse and adverse health outcomes are serious problems among the 50+ age group. Using data from the 2015–2016 National Survey of Drug Use and Health (N = 17,608 respondents aged 50+), we examined emergency department (ED) visits and hospitalizations among those who reported (1) no opioid use in the past year (61.4%); (2) opioid use but no m...
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Identifying predictors of increases in weight (or in fat mass) is important for understanding the genesis of obesity and for the design of prevention programs. We examined the predictive utility of 6 variables that have been predictive of weight gain in past research: depression, disinhibition, family history of overweight, body dissatisfaction, se...
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Background Given the rapid increase in prescription and illicit drug poisoning deaths in the 50+ age group, we examined precipitating/risk factors and toxicology results associated with poisoning deaths classified as suicides compared to intent-undetermined death (UnD) among decedents aged 50+. Methods Data were from the 2005–2015 US National Viol...
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This study used Texas state vital statistics records, 2006-2015, to examine firearm use rates among 28,010 suicide decedents by residential location (urbanized vs. all others). Firearms were responsible for 44% of all teenage suicides and 76%-90% and 50%-60% of suicides of men and women aged 60+ years, respectively, and firearm use rates remained s...
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Background: Despite increasing marijuana use rates over the past decade, the longitudinal association between marijuana use and other substance use problems among adults is unclear. Objectives: To examine associations of self-reported changes in marijuana use and marijuana use frequency with self-reported other substance use problems over a 12-m...
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Background: This study examined blood alcohol content (BAC) among suicide decedents aged 50+ and its associations with suicide precipitating/risk factors, means, and other drug toxicology. Methods: The National Violent Death Reporting System, 2005-2015, provided data (N = 56,118 for all suicide decedents and N = 29,115 with alcohol test results)...
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Background US suicide rates among older women have substantially increased over the past decade. We examined potential differences in sociodemographic and risk/precipitating factors among older female suicide decedents who died by drug overdose versus firearms, hanging/suffocation, and other means, and postmortem toxicology results by suicide means...
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Background Studies indicate that use of electronic nicotine delivery systems (ENDS) predicts subsequent cigarette use, but these are limited by a focus primarily on adolescents or examination of cigarette initiation/onset. Little is known about the impact of ENDS use in current (past 30-day) cigarette use or in changes in current use across young a...
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Objective: The purpose of this study is to examine differences between current and non-current cigarette users, focusing on sociodemographic factors, non-cigarette tobacco product use, parental and friend use, and alcohol and marijuana use; and to identify predictors of cigarette use at six-month follow-up. Participants: Participants included young...
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Background Recent data suggest that lower perceived risks of e-cigarettes are associated with e-cigarette use in young adults; however, the temporality of this relationship is not well-understood. We explore how perceptions of harmfulness and addictiveness of e-cigarettes influence e-cigarette initiation, and specifically whether this association v...
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Background Compared to their non-using age peers, older marijuana users are known to have lower marijuana risk perceptions. We examined associations of older marijuana users’ risk perceptions with their marijuana use patterns and substance use disorders. Methods Data are from 2013 to 2015 National Survey of Drug Use and Health ( N = 24,057 respond...
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Despite increasing marijuana use among the 50+ age group, little research has been done on marijuana’s impact on older adults’ driving under the influence (DUI). Using the 2013 to 2014 National Survey on Drug Use and Health data, this study examined the association of older adults’ self-reported DUI with marijuana use, marijuana abuse/dependence, a...
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Background: This study examined factors associated with marijuana use initiation among never users, prior-to-past year user who return to use, and users who continue use over a 12-month follow-up period. Methods: Two waves (W1 and W2) of the Population Assessment of Tobacco and Health (PATH) Study provided data (N=26,204 aged 18+). Multivariable...
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This study compared bone mineral density (BMD) of the spine obtained by dual-energy X-ray absorptiometry (DEXA), nutritional status, biochemical markers, and gastrointestinal (GI) symptoms in 4–8 year old boys with Autism Spectrum Disorder (ASD) with a group of age-matched, healthy boys without ASD. Boys with ASD had significantly lower spine BMD c...
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Using 2005–2014 National Violent Death Reporting System data, we examined firearm suicides among youth (age < 21 years; N = 3116). Rates of firearm versus other suicide means were consistent during the study period. Young firearm suicide decedents were less likely than those who used other means to have been identified as having mental health probl...
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Introduction: This study examined: (1) associations of suicide intent disclosure with depressed mood and health problems; (2) age-group differences in those associations; and (3) relationship between disclosure and suicide means among suicide decedents aged ≥50 years (N=46,857). Methods: Data came from the National Violent Death Reporting System...
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Background and Objectives In light of high late-life suicide rates, we compared older suicide decedents with and without physical health problems as a suicide precipitant with respect to their clinical characteristics and suicide means. We also examined health-related concerns noted in summary coroner/medical examiner or law enforcement (CME/LE) re...
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Introduction: An increasing body of research indicates that use of electronic nicotine delivery systems (ENDS) predicts cigarette initiation. However, no studies examine if risk for cigarette initiation varies for exclusive ENDS users versus users of ENDS and other tobacco products. This study examined if: a) cigarette-naïve young adults (i.e., ne...
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Marijuana and pain reliever use for medical and nonmedical purposes has been increasing among older adults. Using the 2012–2013 U.S. National Survey on Alcohol and Related Conditions (NESARC-III), this study examined: (1) the association between past-year nonmedical marijuana and pain reliever use among adults aged 50+ years (N = 14,715); and (2) s...
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Objective: To examine 1) temporal trends between 2005 and 2014 in the three most frequently used suicide means (firearms, hanging/suffocation, alcohol/drug/medicine overdose) by decedents aged 50+ years and 2) associations of suicide means with sociodemographic and precipitating factors. Methods: The National Violent Death Reporting System, 2005...
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Using the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions data, we examined the associations of ten types of adverse childhood experiences (ACEs) with (1) lifetime suicide attempts and (2) number and age of attempts among U.S. adults aged 18+. In a case-control design, suicide attempters (5.14% of the full sample) were mat...
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Background Autism spectrum disorder (ASD) affects approximately 1 in 68 children in the USA. An ASD blood biomarker may enable early diagnosis and/or identification of new therapeutic targets. Serum samples from ASD and typically developing (TD) boys (n = 30/group) were screened for differences in 110 proteins using a multiplex immunoassay. Result...
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Background: Despite increasing marijuana use among older adults, little research has been done on marijuana's effects on their healthcare use. Objectives: To examine whether (1) marijuana use is associated with the likelihood of emergency department (ED) visits through increased injury risk, and (2) marijuana use patterns are associated with inj...
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Objective: We aimed to determine the potential for reductions in the prevalence of young people's e-cigarette and tobacco use if characterizing flavors were not present. Methods: Two parallel cross-sectional surveys of 2483 youth (TATAMS: Texas Adolescent Tobacco and Marketing Surveillance System) and 4326 young adults (M-PACT: Marketing and Pro...
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Objective: Community mental health therapists often endorse an eclectic orientation, but few studies reveal how therapists utilize elements of evidence-based psychotherapies. This study aimed to characterize treatment as usual patterns of practice among therapists treating depressed adults in community mental health settings. Method: Therapists (N...
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The purpose of this study is to investigate how the use of flavored e-cigarettes varies between youth (12–17years old), young adults (18–29years old), and older adults (30+ years old). Cross-sectional surveys of school-going youth (n=3907) and young adult college students (n=5482) in Texas, and young adults and older adults (n=6051) nationwide were...
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Background Given growing numbers of older adults with mental and substance use disorders (MSUDs), this study examined the association between ten types of adverse childhood experiences (ACEs) and lifetime MSUDs among those aged 50+. Methods Data (N = 14,738 for the 50+ age group) came from the 2012 to 2013 National Epidemiologic Survey on Alcohol...
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Objectives: Motor vehicle traffic (MVT) injury is the second most frequent type of injury among older emergency department (ED) patients. We examined the role of substance use disorders (SUD) in ED visit outcomes among older MVT injury patients either as drivers, passengers, or pedestrians. Methods: Using the 2012 U.S. National Emergency Departm...
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Forehand and Kotchick (1996) issued a wake-up call to the field to develop culturally responsive interventions. Since that time, 11 meta-analyses on culturally adapted interventions have been conducted. To reconcile the differences of the previous meta-analyses, a new meta-analysis was conducted that included 13,998 participants, 95% of whom were n...
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Deaf women face heightened rates of intimate partner violence (IPV) compared with hearing women, yet limited research has focused on IPV among this population. Empirical studies are warranted to examine the unique experiences and resource needs of Deaf women, along with barriers excluding Deaf participants from IPV research and service provision. O...