***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Relationships between depression , alcohol and illicit drug use , adherence behaviors , and blood pressure ( BP ) were examined in 190 urban hypertensive Black men enrolled in an ongoing hypertension control clinical trial . More than one fourth ( 27.4 % ) of the sample scored greater than 16 on the Center for Epidemiological Studies - Depression Scale ( CES-D ) , indicating a high risk of clinical depression . Depression was significantly associated with an increased likelihood of meeting Diagnostic and Statistical Manual of Mental Disorders ( 4th ed . ) criteria for alcohol abuse or dependence ( odds ratio = 5.2 ; 95 % confidence interval = 1.897–14.214 ) . The level of depression was significantly correlated with poor medication ( r = .301 ) and poor dietary compliance ( r = .164 ) . Both alcohol intake and illicit drug use were significantly correlated with poor dietary compliance ( r = .195 and .185 , respectively ) and smoking ( r = .190 and .269 , respectively ) . Although no direct relationship between depression and the level of BP was substantiated by multivariate analysis , findings of descriptive analyses revealed statistically significant associations among depression , substance use , poor adherence , and poor BP outcomes . Given the harsh environment in which a large number of young urban Black men live , the high prevalence of substance abuse might be an attempt to fight off depression . Further in- depth investigation is needed to identify the role of depression and BP control in urban young Blacks in order to construct effective interventions that address their unique needs BACKGROUND The prevalence , morbidity and mortality of hypertension are strikingly higher for African Americans than for Whites . Poor adherence to the antihypertensive medication regimen is a major cause of inadequate blood pressure control . In this study , we assess the relationship of antihypertensive medication adherence to sociodemographic , clinical and cognitive characteristics of urban African American adults . METHOD Data were drawn from a larger r and omized controlled trial assessing the effect of a behavioral intervention to improve medication adherence and blood pressure control among hypertensive African American patients followed in an urban primary care network . Medication adherence was assessed at baseline using the Medication Event Monitoring System (MEMS)--a  method regarded as the gold st and ard for assessing medication adherence in clinical research . Information on potential correlates of medication adherence ( sociodemographic , clinical and cognitive ) was obtained at baseline by computer-assisted interview . We assessed the cross sectional association of these factors to medication adherence in baseline data . RESULTS Medication adherence was significantly associated with systolic blood pressure ( r=.253 , P<.04 ) and self-reported medication adherence ( r=.285 , P<.03 ) . The relationship of education to medication adherence varied significantly by sex ( P<.05 for interaction ) . Specifically , lower educational attainment was related to higher adherence among men , but lower adherence among women . CONCLUSION Identifying correlates of low antihypertensive medication adherence and their interactions , as in this study , will help health providers to better recognize patients at higher risk for worse hypertension-related outcomes . This knowledge can also inform interventions which target a higher-risk subset of hypertensive patients Barriers to high blood pressure ( HBP ) care and control have been reported in the literature for > 30 years . Few reports on barriers , however , have focused on the young black man with HBP , the age/sex/race group with the highest rates of early severe and complicated HBP and the lowest rates of awareness , treatment , and control . In a r and omized clinical trial of comprehensive care for hypertensive young urban black men , factors potentially associated with care and control were assessed at baseline for the 309 enrolled men . A majority of the men encountered a variety of barriers including economic , social , and lifestyle obstacles to adequate BP care and control , including no current HBP care ( 49 % ) , risk of alcoholism ( 62 % ) , use of illicit drugs ( 45 % ) , social isolation ( 47 % ) , unemployment ( 40 % ) , and lack of health insurance ( 51 % ) . Having health insurance  ( odds ratio = 7.20 , P = .00 ) and a negative urine drug screen  ( odds ratio = .56 , P = .04 ) were significant predictors of being in HBP care . Low alcoholism risk and employment were identified as significant predictors of compliance with HBP medication-taking behavior . Men currently using illicit drugs  were 2.64 times less likely to have controlled BP compared with their counterparts who did not use illicit drugs , and men currently taking HBP medication  were 63 times more likely have controlled BP compared with men not taking HBP medication . Comprehensive interventions are needed to address socioeconomic and lifestyle issues as well as other barriers to care and treatment , if HBP care is to be salient and effective in this high risk group Many studies have documented the negative effects of depression on adherence to recommended treatment ; however , little is known about the mechanism underlying this relationship . Using the Kenny and Baron analytic framework of mediation , the authors assessed whether self-efficacy mediated the relationship between depression and medication adherence in 167 hypertensive African Americans followed in a primary care practice . Depressive symptoms are associated with poor medication adherence ( β = .013 , p = .036 ) and low self-efficacy ( β = —.008 , p = .023 ) . Self-efficacy is negatively associated with medication adherence at follow-up ( β = —.612 , p < .001 ) . The relationship between depressive symptoms and medication adherence becomes nonsignificant when controlling for self-efficacy ( β = .010 , p = .087 ) . Implication s for further examination into the mediating role of self-efficacy and the deleterious effect of depression on medication adherence are discussed BACKGROUND Poor medication adherence is a significant problem in hypertensive African Americans . Although motivational interviewing ( MINT ) is effective for adoption and maintenance of health behaviors in patients with chronic diseases , its effect on medication adherence remains untested in this population . METHODS This r and omized controlled trial tested the effect of a practice -based MINT counseling vs. usual care ( UC ) on medication adherence and blood pressure ( BP ) in 190 hypertensive African Americans ( 88 % women ; mean age 54 years ) . Patients were recruited from two community-based primary care practice s in New York City . The primary outcome was adherence measured by electronic pill monitors ; the secondary outcome was within-patient change in office BP from baseline to 12 months . RESULTS Baseline adherence was similar in both groups ( 56.2 and 56.6 % for MINT and UC , respectively , P = 0.94 ) . Based on intent-to-treat analysis using mixed-effects regression , a significant time x group interaction with model-predicted posttreatment adherence rates of 43 and 57 % were found in the UC and MINT groups , respectively ( P = 0.027 ) , with a between-group difference of 14 % ( 95 % confidence interval , -0.2 to -27 % ) . The between-group difference in systolic and diastolic BP was -6.1 mm Hg ( P = 0.065 ) and -1.4 mm Hg ( P = 0.465 ) , respectively , in favor of the MINT group . CONCLUSIONS A practice -based MINT counseling led to steady maintenance of medication adherence over time , compared to significant decline in adherence for UC patients . This effect was associated with a modest , nonsignificant trend toward a net reduction in systolic BP in favor of the MINT group 
    Output:
    
Factors that were associated with medication adherence were self-efficacy , depression , patient-provider communication , and healthcare system related .