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Coughlin LN, Bonar EE, Bohnert AS, Blow FC, Bauermeister JA, Cross Y, Cunningham R, Young SD, Walton MA. Patterns of same-day alcohol and cannabis use in adolescents and young adults with risky alcohol use. ADDICTION RESEARCH & THEORY 2021; 30:89-95. [PMID: 36093415 PMCID: PMC9455920 DOI: 10.1080/16066359.2021.1936511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/16/2021] [Accepted: 05/26/2021] [Indexed: 06/14/2023]
Abstract
Same-day alcohol and cannabis use is relatively common in adolescents and young adults, constituting a higher-risk behavior relative to single-substance use. However, the association between quantity of alcohol and cannabis use on co-use days is understudied. We examined the association between the quantity of alcohol and same-day cannabis use with a multilevel regression analysis in a sample of youth (16-24 years old) with risky alcohol use. Participants reported one or more days of alcohol and cannabis over the past month (N = 468). Quantity of cannabis use was highest on heavy drinking days [M = 0.91 grams, SD = 0.68] followed by moderate drinking days (M = 0.78 grams, SD = 0.63), and lowest on days without alcohol use (M = 0.74 grams, SD = 0.64, p < 0.001). In multilevel modeling analyses, adjusted for clustering within individuals, greater quantity of drinking on a given day was associated with greater cannabis use (estimate = 0.03, p < 0.001). When using alcohol and cannabis on the same day, greater alcohol use was associated with greater cannabis use. Preventing days of heavy use of multiple substances, particularly among at-risk drinkers, may complement interventions addressing co-use generally to prevent substance-related consequences.
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Parker JN, Choi SK, Bauermeister JA, Bonar EE, Carrico AW, Stephenson R. HIV and STI testing among substance-using sexual and gender minority adolescents and young adults: Results from the baseline survey of a randomized control trial (Preprint). JMIR Public Health Surveill 2021; 8:e30944. [PMID: 35776441 PMCID: PMC9288102 DOI: 10.2196/30944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 03/01/2022] [Accepted: 05/10/2022] [Indexed: 12/28/2022] Open
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Stephenson R, Todd K, Gamarel KE, Bonar EE, Peitzmeier S. Addendum to: Development and Validation of a Scale to Measure Intimate Partner Violence Among Transgender and Gender Diverse Populations: Protocol for a Linear Three-Phase Study (Project Empower). JMIR Res Protoc 2021; 10:e28614. [PMID: 33979298 PMCID: PMC8225160 DOI: 10.2196/28614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/07/2021] [Indexed: 12/03/2022] Open
Abstract
[This corrects the article DOI: 10.2196/23819.].
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Bonar EE, Cunningham RM, Sweezea EC, Blow FC, Drislane LE, Walton MA. Piloting a brief intervention plus mobile boosters for drug use among emerging adults receiving emergency department care. Drug Alcohol Depend 2021; 221:108625. [PMID: 33631541 PMCID: PMC8026691 DOI: 10.1016/j.drugalcdep.2021.108625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/04/2021] [Accepted: 02/06/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE There are few efficacious prevention interventions for emerging adults (ages 18-25) drug use and concomitant risks (e.g., sexual risk behaviors). We developed and evaluated the feasibility and acceptability of an Emergency Department (ED)-initiated brief intervention (BI) combined with booster messaging as a clinician-extender primarily focusing on drug use, with a secondary focus on condomless sex. We examined descriptive outcomes of alcohol, drug use, and condomless sex. PROCEDURES We recruited N = 63 emerging adults who used drugs (primarily cannabis) from an ED (72.4 % participation rate). Their mean age was 21.7 years (SD = 2.3); 67 % were female and 52.4 % were Black/African American. Participants randomized to the intervention (N = 31) received a BI and 28 days of tailored booster messaging (based on drug use motives) daily, and the control condition received a community resource brochure. A post-test occurred at 1-month with a follow-up at 2-months. RESULTS The intervention was well-received (83.9 % allocated completed the BI) with 79 % overall liking the BI and 71 % finding it helpful to discuss substances. Mean ratings of booster messages were >4.0 (5-point scale); 77 % liked the daily messages and 91 % found them helpful. Descriptively, the intervention group evidenced absolute reductions over time on alcohol outcomes, cannabis use, and condomless sex. CONCLUSIONS This BI with booster messages was feasible and acceptable in the target population of emerging adults who use drugs (i.e., mostly cannabis). This intervention model, initiated during a healthcare visit and accompanied by a clinician-extender, should be tested in a future fully-powered trial.
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Bonar EE, Wolfe JR, Drab R, Stephenson R, Sullivan PS, Chavanduka T, Hailu B, Guest JL, Bauermeister J. Training Young Adult Peers in a Mobile Motivational Interviewing-Based Mentoring Approach to Upstream HIV Prevention. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 67:237-248. [PMID: 33137221 PMCID: PMC7969398 DOI: 10.1002/ajcp.12471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Mentoring relationships are characterized by a sustained, high quality, and skill-building relationship between a protégé and mentor (Handbook of Youth Mentoring, Los Angeles, SAGE, 2014). Within prevention science, youth mentoring programs emphasize creating a specific context that benefits a young person. Program-sponsored relationships between youth and adults allow for creating a mentor-mentee partnership, but do not require the establishment of a strong bond in order to deliver prevention-focused activities and experiences (Handbook of Youth Mentoring, Los Angeles, SAGE, 2014). Motivational Interviewing (MI) is a counseling style used widely to promote health behavior change and in prevention interventions. As part of an upstream approach to HIV prevention, we combined mentoring and MI by training peer mentors to use MI skills in their interactions as part of a large RCT of a mobile life skills intervention for adolescent men who have sex with men (AMSM). Our training model developed for training peer mentors in MI skills resulted in peers reaching and exceeding established MI fidelity thresholds (e.g., mean percentage of complex reflections = 80%, mean reflection to question ratio = 2.2:1). We offer reflections on lessons learned and future directions for those researchers and practitioners who may benefit from adapting this blended approach for mentoring AMSM.
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Goldstick JE, Roche JS, Carter PM, Arterberry BJ, Bonar EE, Walton MA, Zimmerman M, Cunningham RM. Sex Differences in the Association Between Gaming and Serious Violence Among Predominantly African American Youth. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP2410-NP2422. [PMID: 29580195 PMCID: PMC6119504 DOI: 10.1177/0886260518764104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Video gaming, a remarkably popular hobby in the United States, has been consistently identified as a correlate of aggressive behavior, and this association is not limited to violent video gaming. Prior studies of sex differences in the association between video gaming and aggression have not controlled for other well-known violence correlates (e.g., substance use, community violence exposure, violence attitudes) or focused primarily on high-risk youth. In this study, we used data from an emergency department in Flint, Michigan (N = 409, 59.9% female, 93.4% African American) to identify sex differences in the association between video gaming and serious peer violence. Youth aged 14 to 20 years were recruited from October 2011 to March 2015, and self-administered computerized surveys including measures of demographics, violence perpetration, gaming frequency, substance use, community violence exposure, and violence attitudes. The primary outcome was an indicator of any serious violence perpetration (e.g., choking, burning, weapon violence) in the past 2 months. Using logistic regression, we estimated the association between gaming and serious violence perpetration, and how it varied by sex, while controlling for demographics, substance use, community violence exposure, and violence attitudes. Approximately 36.6% of males and 27.3% of females reported past 2-month serious violence. On adjusted analysis, hours spent gaming was associated with violence among females (odds ratio [OR] = 1.40, 95% confidence interval [CI] = [1.16, 1.78]), but not males (OR = 1.03, 95% CI = [0.89, 1.19]); in the model including both males and females, the interaction between hours gaming and sex was significant (p < .01). Our findings suggest video gaming is a stronger marker of severe violence perpetration in females than males among at-risk youth. Violence interventions among females may be improved by including content related to video gaming and identifying other prosocial activities for youth as an alternative to video gaming. Additional research is required to clarify the causal process underlying the identified associations, and to determine what aspects of video gaming are risk-enhancing.
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Coughlin LN, Nahum-Shani I, Philyaw-Kotov ML, Bonar EE, Rabbi M, Klasnja P, Murphy S, Walton MA. Developing an Adaptive Mobile Intervention to Address Risky Substance Use Among Adolescents and Emerging Adults: Usability Study. JMIR Mhealth Uhealth 2021; 9:e24424. [PMID: 33448931 PMCID: PMC7846447 DOI: 10.2196/24424] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/11/2020] [Accepted: 11/30/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Substance use among adolescents and emerging adults continues to be an important public health problem associated with morbidity and mortality. Mobile health (mHealth) provides a promising approach to deliver just-in-time adaptive interventions (JITAIs) to prevent escalation of use and substance use-related consequences. OBJECTIVE This pilot study aims to describe the iterative development and initial feasibility and acceptability testing of an mHealth smartphone app, called MiSARA, designed to reduce escalation in substance use. METHODS We used social media advertisements to recruit youth (n=39; aged 16-24 years, who screened positive for past-month binge drinking or recreational cannabis use) with a waiver of parental consent. Participants used the MiSARA app for 30 days, with feasibility and acceptability data reported at a 1-month follow-up. We present descriptive data regarding behavior changes over time. RESULTS The results show that most participants (31/39, 79%) somewhat liked the app at least, with most (29/39, 74%) rating MiSARA as 3 or more stars (out of 5). Almost all participants were comfortable with self-reporting sensitive information within the app (36/39, 92%); however, most participants also desired more interactivity (27/39, 69%). In addition, participants' substance use declined over time, and those reporting using the app more often reported less substance use at the 1-month follow-up than those who reported using the app less often. CONCLUSIONS The findings suggest that the MiSARA app is a promising platform for JITAI delivery, with future trials needed to optimize the timing and dose of messages and determine efficacy.
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Coughlin LN, Nahum-Shani I, Bonar EE, Philyaw-Kotov ML, Rabbi M, Klasnja P, Walton MA. Toward a Just-in-Time Adaptive Intervention to Reduce Emerging Adult Alcohol Use: Testing Approaches for Identifying When to Intervene. Subst Use Misuse 2021; 56:2115-2125. [PMID: 34499570 PMCID: PMC8785256 DOI: 10.1080/10826084.2021.1972314] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
JITAI: Just-in-time adaptive intervention; ROC: receiver operating characteristic; AUC: area under the curve; MRT: micro-randomized trial.
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Lin L(A, Fernandez AC, Bonar EE. Telehealth for Substance-Using Populations in the Age of Coronavirus Disease 2019: Recommendations to Enhance Adoption. JAMA Psychiatry 2020; 77:1209-1210. [PMID: 32609317 PMCID: PMC8108064 DOI: 10.1001/jamapsychiatry.2020.1698] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Stephenson R, Todd K, Gamarel KE, Bonar EE, Peitzmeier S. Development and Validation of a Scale to Measure Intimate Partner Violence Among Transgender and Gender Diverse Populations: Protocol for a Linear Three-Phase Study (Project Empower). JMIR Res Protoc 2020; 9:e23819. [PMID: 33242022 PMCID: PMC7728535 DOI: 10.2196/23819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Intimate partner violence (IPV) is approximately twice as prevalent among transgender and gender diverse individuals (those whose current gender identity does not match their sex assigned at birth) than among cisgender individuals (those whose gender aligns with their sex assigned at birth). However, most existing scales measuring IPV are not validated among transgender and gender diverse populations and do not consider the unique forms of IPV experienced by transgender and gender diverse individuals. OBJECTIVE This paper describes the protocol for Project Empower, a study that seeks to develop and validate a new scale to measure IPV as experienced by transgender and gender diverse adults. A new scale is necessary to improve the accuracy of IPV measurement among transgender and gender diverse populations and may inform the current tools used to screen and link to services for transgender and gender diverse people who experience or perpetrate IPV. METHODS The proposed new scale will be developed by a linear three-phase process. In Phase I, we will recruit a maximum of 110 transgender and gender diverse participants to participate in in-depth interviews and focus groups. Phase I will collect qualitative data on the experiences of IPV among transgender and gender individuals. After generating scale items from the qualitative data in Phase I, Phase II will conduct up to 10 cognitive interviews to examine understanding of scale items and refine wording. Phase III will then conduct a survey with an online recruited sample of 700 transgender and gender diverse individuals to validate the scale using factor analysis and examine the prevalence, antecedents, and linked health outcomes of IPV. This study will generate the first comprehensive IPV scale including trans-specific IPV tactics that has undergone robust mixed-methods validation for use in transgender and gender diverse populations, regardless of sex assigned at birth. RESULTS Project Empower launched in August 2019, with Phases I and II expected to be complete by late 2020. Phase III (survey of 700 transgender individuals) is expected to be launched in January 2021. CONCLUSIONS A scale that more accurately captures the forms of IPV experienced by transgender and gender diverse people not only has the potential to lead to more accurate measurements of prevalence but also can identify unique forms of violence that may form the basis of IPV prevention interventions. Additionally, identifying the forms of IPV experienced by transgender and gender diverse people has the potential to lead to the refinement of clinical screening tools used to identify and refer those who experience and perpetrate violence in clinical settings. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/23819.
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McAfee J, Boehnke KF, Moser SM, Brummett CM, Waljee JF, Bonar EE. Perioperative cannabis use: a longitudinal study of associated clinical characteristics and surgical outcomes. Reg Anesth Pain Med 2020; 46:137-144. [PMID: 33208521 DOI: 10.1136/rapm-2020-101812] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite increases in cannabis use generally and for pain management, data regarding cannabis use in patients undergoing surgery are lacking. This study examined the prevalence of cannabis use among patients undergoing elective surgery and explored differences in clinical characteristics and surgical outcomes between cannabis users and non-cannabis users. METHODS This prospective study included 1335 adults undergoing elective surgery. Participants completed self-report questionnaires preoperative and at 3-month and 6-month postsurgery to assess clinical characteristics and surgical outcomes. RESULTS Overall, 5.9% (n=79) of patients reported cannabis use (53.2% medical, 19.0% recreational and 25.3% medical and recreational). On the day of surgery, cannabis users reported worse pain, more centralized pain symptoms, greater functional impairment, higher fatigue, greater sleep disturbances and more symptoms of anxiety and depression versus non-cannabis users (all p<0.01). Additionally, a larger proportion of cannabis users reported opioid (27.9%) and benzodiazepine use (19.0%) compared with non-cannabis users (17.5% and 9.2%, respectively). At 3 and 6 months, cannabis users continued to report worse clinical symptoms; however, both groups showed improvement across most domains (p≤0.05). At 6 months, the groups did not differ on surgical outcomes, including surgical site pain (p=0.93) or treatment efficacy (p=0.88). CONCLUSIONS Cannabis use is relatively low in this surgical population, yet cannabis users have higher clinical pain, poorer scores on quality of life indicators, and higher opioid use before and after surgery. Cannabis users reported similar surgical outcomes, suggesting that cannabis use did not impede recovery.
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Coughlin LN, Bonar EE, Bickel WK. Considerations for remote delivery of behavioral economic interventions for substance use disorder during COVID-19 and beyond. J Subst Abuse Treat 2020; 120:108150. [PMID: 33298296 PMCID: PMC7532990 DOI: 10.1016/j.jsat.2020.108150] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/10/2020] [Accepted: 09/22/2020] [Indexed: 12/24/2022]
Abstract
The response to the COVID-19 crisis has created direct pressure on health care providers to deliver virtual care, and has created the opportunity to develop innovations in remote treatment for people with substance use disorders. Remote treatments provide an intervention delivery framework that capitalizes on technological innovations in remote monitoring of behaviors and can efficiently use information collected from people and their environment to provide personalized treatments as needed. Interventions informed by behavioral economic theories can help to harness the largely untapped potential of virtual care in substance use treatment. Behavioral economic treatments, such as contingency management, the substance-free activity session, and episodic future thinking, are positioned to leverage remote monitoring of substance use and to use personalized medicine frameworks to deliver remote interventions in the COVID-19 era and beyond. With increased remote care, there is an opportunity for virtual treatment development. Treatments can capitalize on remote technology to increase effectiveness. Behavioral economic interventions are well positioned to fill this need. Remote behavioral economic interventions can add to current treatments.
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Patrick ME, Boatman JA, Morrell N, Wagner AC, Lyden GR, Nahum-Shani I, King CA, Bonar EE, Lee CM, Larimer ME, Vock DM, Almirall D. A sequential multiple assignment randomized trial (SMART) protocol for empirically developing an adaptive preventive intervention for college student drinking reduction. Contemp Clin Trials 2020; 96:106089. [PMID: 32717350 DOI: 10.1016/j.cct.2020.106089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 11/18/2022]
Abstract
College student alcohol use and associated negative consequences are clear public health problems with consequences including damage to self, others, and institutions. This paper describes the protocol of a research study designed to answer a number of important questions in the development of an adaptive preventive intervention (API) to reduce high-risk drinking among first-year college students. The API is designed to educate students and to motivate heavy-drinking college students to engage in existing resources to support reducing high-risk alcohol use, by leveraging technology-based intervention modalities. The primary outcome is a reduction in binge drinking, with secondary outcomes of reducing negative alcohol-related consequences and increasing health services utilization. Adaptive preventive interventions have the potential to reduce the acute and long-term negative health consequences of young adult alcohol use.
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Arterberry BJ, Goldstick JE, Walton MA, Cunningham RM, Blow FC, Bonar EE. Alcohol and cannabis motives: Differences in daily motive endorsement on alcohol, cannabis, and alcohol/cannabis co-use days in a cannabis-using sample. ADDICTION RESEARCH & THEORY 2020; 29:111-116. [PMID: 34248450 PMCID: PMC8262404 DOI: 10.1080/16066359.2020.1787390] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Same day use of alcohol and cannabis is prevalent among emerging/young adults and increases the risk for negative consequences. Although motives for alcohol and cannabis use are well-documented, specific motives on co-use days are under-investigated. We examined differences in motives on single substance use (i.e., alcohol or cannabis) versus co-use days in a sample of primarily cannabis-using emerging/young adults. METHODS Participants (N=97) aged 18-25 (Mage=22.2) were recruited from an urban Emergency Department (55.7% female, 46.4% African American, 57.7% public assistance) for a prospective daily diary study about risk behaviors. Participants received prompts for 28 daily text message assessments (up to 2716 surveys possible) of substance use and motives (social, enhancement, coping, conformity). We divided use days into three groups: alcohol use only (n=126), cannabis use only (n=805), and co-use (n=237). Using fixed effects regression modeling, we fit models to estimate within-person effects of alcohol and cannabis motives on day type (alcohol/cannabis co-use versus single use). RESULTS In adjusted models, greater cannabis-related enhancement and social motives were associated with increased likelihood of co-use days compared to cannabis-only days. In contrast, greater alcohol-related social motives were associated with co-use days versus alcohol-only days in unadjusted, but not in adjusted models. CONCLUSIONS Findings suggest that cannabis use motives associated with increasing positive affect may be most compelling for those engaging in alcohol/cannabis use on a given day. Intervention programs for alcohol/cannabis use should address alcohol and cannabis use motives in relation to increasing positive affect and engaging in social situations.
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Bonar EE, Schneeberger DM, Bourque C, Bauermeister JA, Young SD, Blow FC, Cunningham RM, Bohnert AS, Zimmerman MA, Walton MA. Social Media Interventions for Risky Drinking Among Adolescents and Emerging Adults: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e16688. [PMID: 32401225 PMCID: PMC7254293 DOI: 10.2196/16688] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/30/2020] [Accepted: 02/16/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Despite intervention efforts to date, the prevalence of risky drinking among adolescents and emerging adults remains high, increasing the risk for health consequences and the development of alcohol use disorders. Peer influences are particularly salient among this age group, including via social media. Thus, the development of efficacious early interventions for youth, delivered with a broad reach via trained peers on social media, could have an important role in addressing risky drinking and concomitant drug use. OBJECTIVE This paper describes the protocol of a randomized controlled trial (RCT) testing the efficacy of a social media intervention among adolescents and emerging adults who meet the criteria for risky drinking (using the Alcohol Use Disorders Identification Test-Consumption [AUDIT-C]), delivered with and without financial incentives for participation, compared with an attention placebo control condition (ie, entertaining social media content), on alcohol consumption and consequences. METHODS This RCT involved recruiting 955 youths (aged 16-24 years) via advertisements on Facebook and Instagram to self-administer a brief web-based screening survey. Those screening positive for past 3-month risky drinking (AUDIT-C positive: ages 16-17 years: ≥3 females and ≥4 males; and ages 18-24 years: ≥4 females and ≥5 males) were eligible for the RCT. After providing consent (a waiver of parental consent was obtained for minors), participants completed a web-based baseline survey and several verification procedures, including a selfie photo matched to Facebook profile photos. Participants were then randomized to join invitation-only secret Facebook groups, which were not searchable or viewable by parents, friends, or anyone not recruited by the study. The 3 conditions were social media intervention with incentives, social media intervention without incentives (SMI), and attention placebo control. Each condition lasted 8 weeks and consisted of bachelor's-level and master's-level therapist electronic coaches posting relevant content and responding to participants' posts in a manner consistent with Motivational Interviewing. Participants in the control condition and SMI condition did not receive payments but were blind to condition assignment between these 2 conditions. Follow-ups are ongoing and occur at 3, 6, and 12 months poststart of the groups. RESULTS We enrolled 955 participants over 10 waves of recruitment who screened positive for risky drinking into the RCT. CONCLUSIONS The findings of this study will provide the critical next step in delivering early alcohol interventions to the youth, capitalizing on social media platforms, which could have significant public health impact by altering alcohol use trajectories of adolescents and emerging adults engaged in risky drinking. TRIAL REGISTRATION ClinicalTrials.gov NCT02809586; https://clinicaltrials.gov/ct2/show/NCT02809586. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/16688.
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Bonar EE, Goldstick JE, Cunningham RM, Fernandez AC, Davis AK, Ilgen MA, Walton MA. Individual and Social Factors Related to Trajectories of Blackouts among Underage Drinkers in the Emergency Department. Alcohol Alcohol 2020; 54:370-377. [PMID: 30608570 DOI: 10.1093/alcalc/agy087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 11/19/2018] [Accepted: 11/23/2018] [Indexed: 12/19/2022] Open
Abstract
AIMS Alcohol-related blackouts can result in acute injuries and other negative outcomes. Among underage risky drinkers, we examined longitudinal trajectories of blackout frequency following an emergency department (ED) visit, and identified baseline characteristics associated with blackout trajectory membership. METHODS Participants (ages 14-20; N = 836) attending an ED who screened positive for risky drinking and enrolled in a randomized-controlled trial of brief alcohol interventions were assessed at baseline, 3-, 6-, and 12-months. We used group-based trajectory modeling to determine characteristic trajectories of blackout frequency over 12-months in relation to baseline characteristics: demographics, substance use, delinquency, depression/anxiety symptoms, sexual assault, dating violence, and peer and sibling influences. RESULTS We identified four groups: No/Low blackouts (n = 248; 29.7%), Declining blackouts (n = 92; 11.0%), Moderate blackouts (n = 337; 40.3%) and High blackouts (n = 159; 19.0%); group membership did not differ based on intervention receipt. In adjusted analyses, compared to the No/Low group all other groups had higher odds of having an alcohol-related baseline ED visit. Female sex, alcohol consumption, prescription drug misuse, sexual assault while incapacitated due to substances, and negative peer influences were positively associated with membership in the High group; College/Greek life involvement was also highest. Negative peer influences and being in high school (vs. College/Greek life) also distinguished the Moderate group. CONCLUSION Blackout frequency was largely stable over time and riskier trajectories were marked by risk factors such as negative peer influences and college/Greek life involvement. Findings may inform targeted interventions, particularly for women who were in higher risk trajectories.
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Drislane LE, Waller R, Martz ME, Bonar EE, Walton MA, Chermack ST, Blow FC. Therapist and computer-based brief interventions for drug use within a randomized controlled trial: effects on parallel trajectories of alcohol use, cannabis use and anxiety symptoms. Addiction 2020; 115:158-169. [PMID: 31400240 PMCID: PMC6933089 DOI: 10.1111/add.14781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/11/2019] [Accepted: 08/02/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND AIMS Despite their high comorbidity, the effects of brief interventions (BI) to reduce cannabis use, alcohol use and anxiety symptoms have received little empirical attention. The aims of this study were to examine whether a therapist-delivered BI (TBI) or computer-guided BI (CBI) to address drug use, alcohol consumption (when relevant) and HIV risk behaviors, relative to enhanced usual care (EUC), was associated with reductions in parallel trajectories of alcohol use, cannabis use and anxiety symptoms, and whether demographic characteristics moderated reductions over time. DESIGN Latent growth curve modeling was used to examine joint trajectories of alcohol use, cannabis use and anxiety symptoms assessed at 3, 6 and 12 months after baseline enrollment. SETTING Hurley Medical Center Emergency Department (ED) in Flint, MI, USA. PARTICIPANTS The sample was 780 drug-using adults (aged 18-60 years; 44% male; 52% black) randomly assigned to receive either a TBI, CBI or EUC through the HealthiER You study. INTERVENTIONS AND COMPARATOR ED-delivered TBI and CBIs involved touchscreen-delivered and audio-assisted content. The TBI was administered by a Master's-level therapist, whereas the CBI was self-administered using a virtual health counselor. EUC included a review of health resources brochures in the ED. MEASUREMENTS Assessments of alcohol use (10-item Alcohol Use Disorders Identification Test), cannabis use (past 30-day frequency) and anxiety symptoms (Brief Symptom Inventory-18) occurred at baseline and 3-, 6- and 12-month follow-up. FINDINGS TBI, relative to EUC, was associated with significant reductions in cannabis use [B = -0.49, standard error (SE) = 0.20, P < 0.05) and anxiety (B = -0.04, SE = 0.02, P < 0.05), but no main effect for alcohol use. Two of 18 moderation tests were significant: TBI significantly reduced alcohol use among males (B = -0.60, SE = 0.19, P < 0.01) and patients aged 18-25 years in the TBI condition showed significantly greater reductions in cannabis use relative to older patients (B = -0.78, SE = 0.31, P < 0.05). Results for CBI were non-significant. CONCLUSIONS Emergency department-based therapist-delivered brief interventions to address drug use, alcohol consumption (when relevant) and HIV risk behaviors may also reduce alcohol use, cannabis use and anxiety over time, accounting for the overlap of these processes.
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Ong AR, Lee S, Bonar EE. Understanding disparities in access to naloxone among people who inject drugs in Southeast Michigan using respondent driven sampling. Drug Alcohol Depend 2020; 206:107743. [PMID: 31801107 DOI: 10.1016/j.drugalcdep.2019.107743] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 11/10/2019] [Accepted: 11/12/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Given the rising incidence of opioid overdose in the United States, naloxone access is critical for high-risk populations, such as persons who inject drugs (PWID). Yet not all PWID have access to this life-saving antidote. With PWID in Michigan recruited via respondent driven sampling in 2017, after the 2016 standing order expanding naloxone availability through local pharmacies, we explored possible access disparities. METHODS With 46 seeds recruited from agencies serving local PWID communities, we obtained a sample of N = 410 PWID from Southeast Michigan (n = 285 form urban Detroit, and 125 for suburban/rural areas outside Detroit). Participants completed questionnaires detailing socio-demographics, health history, substance use and treatment access, including naloxone. We used multiple logistic regression to examine the predictors of self-reported naloxone access based on participant characteristics (e.g., demographics, health status) and geography (urban vs. suburban/rural). RESULTS Self-reported naloxone access differed significantly by location (urban = 18.3 %; suburban/rural = 41.9 %). In multivariable analyses, naloxone access was significantly associated with race, household income, employment, health insurance, recent homelessness, prescription opioid usage, Hepatitis A and C status, Hepatitis A vaccination, Hepatitis C testing, access to drug treatment and services, and hospital as the usual place of care. CONCLUSION Despite recent policies to expand access, our results indicate that naloxone access among high-risk PWID is low. This warrants future research to identify effective channels to reduce barriers and increase naloxone access.
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Coughlin LN, Bonar EE, Bohnert KM, Jannausch M, Walton MA, Blow FC, Ilgen MA. Changes in urban and rural cigarette smoking and cannabis use from 2007 to 2017 in adults in the United States. Drug Alcohol Depend 2019; 205:107699. [PMID: 31707265 PMCID: PMC6951810 DOI: 10.1016/j.drugalcdep.2019.107699] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/23/2019] [Accepted: 10/13/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Rural-urban differences in cigarette and cannabis use have traditionally shown higher levels of cigarette smoking in rural areas and of cannabis use in urban areas. To assess for changes in this pattern of use, we examined trends and prevalence of cigarette, cannabis, and co-use across urban-rural localities. METHODS Urban-rural trends in current cigarette and/or cannabis use was evaluated using 11 cohorts (2007-2017) of the National Survey on Drug Use and Health (NSDUH; N = 397,542). We used logistic regressions to model cigarette and cannabis use over time, adjusting for demographics (age, gender, race/ethnicity, income, education), in addition to assessing patterns of cannabis use among cigarette smokers and nonsmokers. RESULTS Despite decreases in cigarette smoking overall, between 2007 and 2017, the urban-rural disparity in cigarette smoking increased (AOR = 1.17), with less reduction in rural as compared to urban cigarette smokers. Cannabis use increased in general (AOR = 1.88 by 2017), with greater odds in urban than rural regions. Cannabis use increased more rapidly in non-cigarette smokers than smokers (AOR = 1.37 by 2017), with 219% greater odds of cannabis use in rural non-cigarette smokers in 2017 versus 2007. CONCLUSIONS Rurality remains an important risk factor for cigarette smoking in adults and the fastest-growing group of cannabis users is rural non-cigarette smokers; however, cannabis use is currently still more prevalent in urban areas. Improved reach and access to empirically-supported prevention and treatment, especially in rural areas, along with dissemination and enforcement of policy-level regulations, may mitigate disparities in cigarette use and slow the increase in rural cannabis use.
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Young SD, Padwa H, Bonar EE. Social Big Data as a Tool for Understanding and Predicting the Impact of Cannabis Legalization. Front Public Health 2019; 7:274. [PMID: 31637226 PMCID: PMC6787761 DOI: 10.3389/fpubh.2019.00274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 09/10/2019] [Indexed: 11/13/2022] Open
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Dora-Laskey AD, Goldstick JE, Buckley L, Bonar EE, Zimmerman MA, Walton MA, Cunningham RM, Carter PM. Trajectories of Driving after Drinking among Marijuana-Using Youth in the Emergency Department: Substance Use, Mental Health, and Peer and Parental Influences. Subst Use Misuse 2019; 55:175-187. [PMID: 31502499 PMCID: PMC6980673 DOI: 10.1080/10826084.2019.1660675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: The psychosocial correlates and longitudinal trajectories of driving after drinking (DAD) among youth remain understudied in at-risk populations. Objectives: We investigated the relationships of DAD trajectories and negative peer and parental influences, substance use, and mental health among predominantly marijuana-using youth seeking emergency department (ED) treatment. Methods: Data were from a 2-year prospective cohort study of drug-using patients (97.4% used marijuana) ages 14-24 seeking ED care for assault injury, or as part of a non-assaulted comparison group. Validated surveys measured DAD behaviors and correlates at baseline, 6, 12, 18, and 24 months. Latent class growth analysis identified characteristic DAD trajectory groups; baseline predictors were analyzed descriptively and using multinomial logistic regression. Results: Three DAD trajectory groups were identified among driving-age youth (n = 580): no DAD (NDAD; 55.2%), low-steady (LDAD; 29.0%), and high-declining (HDAD; 15.9%). In unadjusted analyses, HDAD youth were older, but otherwise similar to other groups demographically. Compared to NDAD, LDAD and HDAD group members had higher rates of drug and alcohol use disorders (p < .001). Further, HDAD group members had higher rates of anxiety symptoms and were more likely to be diagnosed with PTSD or depression than NDAD or LDAD youth (p < .05). Negative peer and parent influences were significantly higher in progressively more severe trajectory groups (p < .01). Adjusted effects from the multinomial model were analogous for peer and parental influences and substance use disorders, but not mental health. Conclusion: DAD is strongly associated with negative social influences and substance use disorders among marijuana-using youth, reinforcing their importance when developing interventions.
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Arterberry BJ, Davis AK, Walton MA, Bonar EE, Cunningham RM, Blow FC. Predictors of empirically derived substance use patterns among sexual minority groups presenting at an emergency department. Addict Behav 2019; 96:76-81. [PMID: 31048112 DOI: 10.1016/j.addbeh.2019.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 04/19/2019] [Accepted: 04/20/2019] [Indexed: 11/28/2022]
Abstract
AIM Minority sexual orientation (i.e., Lesbian, Gay, Bisexual; LGB) is a risk indicator for mental health and substance use problems. Findings are inconsistent across studies investigating LGB substance use and risk factors, possibly due to heterogeneity in LGB subgroups. To inform models of substance use risk, we identified empirical patterns of substance use and related risk behaviors among LGB individuals. METHOD LGB participants (N = 343; Mage = 35.5, SD = 11.8; 71.4% = Female; 80.5% = White) were screened in an Emergency Department as part of a randomized controlled trial of an alcohol brief intervention. We conducted latent class analyses using the AUDIT-C (12 month; frequency, quantity, & binge) and ASSIST (12 month; illicit or misused prescription substance). Multinomial regression was performed to test predictors of class membership including depression symptoms, driving after alcohol or marijuana, and sexually transmitted infection (STI) history. RESULTS A 3-class model fit best and included "low use alcohol, marijuana, and tobacco users," (Low use; n = 244) "hazardous alcohol, tobacco and marijuana users," (Hazardous; n = 74) and "high-risk polysubstance users" (HPU; n = 25). The Low use class comprised the largest proportion of the sample across age, race/ethnicity, and sexual orientation. Compared to the Low use class, higher likelihood of depression symptoms, driving after alcohol or marijuana use, and STI was found for both Hazardous and HPU classes. CONCLUSION Researchers and clinicians should consider substance use patterns within the LGB population to inform interventions that address a variety of complex needs such as allocating more support for LGB individuals endorsing high-risk polysubstance use.
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Sexton MB, Davis AK, Buchholz KR, Winters JJ, Rauch SAM, Yzquibell M, Bonar EE, Friday S, Chermack ST. Veterans with recent substance use and aggression: PTSD, substance use, and social network behaviors. ACTA ACUST UNITED AC 2019; 11:424-433. [DOI: 10.1037/tra0000367] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Waller R, Bonar EE, Fernandez AC, Walton MA, Chermack ST, Cunningham RM, Blow FC. Exploring the components of an efficacious computer brief intervention for reducing marijuana use among adults in the emergency department. J Subst Abuse Treat 2019; 99:67-72. [PMID: 30797396 PMCID: PMC6538032 DOI: 10.1016/j.jsat.2019.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To examine the efficacious components of a computer-delivered brief intervention (CBI) for reducing marijuana use among adults presenting to a low-income urban emergency department (ED), which a prior report found to decrease marijuana use at a 6-month follow-up. METHOD Participants were 237 ED patients reporting recent drug use (46% male; 54% African-American; mean age, 30.7) who were randomized to receive a CBI consisting of an interactive program guided by a virtual health counselor. The primary outcome was past 30-day marijuana use at 6-month follow-up assessed using the Timeline Follow-Back (TLFB). Intervention components related to change in marijuana use at 6 month follow-up examined in the current study included participant responses to items within five CBI domains that were rooted in motivational interviewing: goals for change, strengths, evoking-change (concerns about use and benefits of change), challenges, and tools for change. RESULTS The evoking-change domain was related to significant reductions in marijuana use at 6 months (B = -2.91, SE = 1.10, p < .01). Within this domain, items focused on concerns about family and friends were related to reductions in marijuana use of up to 5.5 fewer days of marijuana use in the past month (B = -5.49, SE = 1.63, p < .01). CONCLUSIONS An ED-based brief intervention, delivered by computer, was effective in reducing marijuana use. Intervention components focused on perceived concerns about use and benefits of change in relation to family and friends were critical domains within a CBI associated with reductions in marijuana use at 6-month follow-up.
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Chermack ST, Bonar EE, Goldstick JE, Winters J, Blow FC, Friday S, Ilgen MA, Rauch SA, Perron BE, Ngo QM, Walton MA. A randomized controlled trial for aggression and substance use involvement among Veterans: Impact of combining Motivational Interviewing, Cognitive Behavioral Treatment and telephone-based Continuing Care. J Subst Abuse Treat 2019; 98:78-88. [DOI: 10.1016/j.jsat.2019.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 12/24/2018] [Accepted: 01/02/2019] [Indexed: 11/30/2022]
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