Building Xperience: a multilevel alcohol and drug prevention intervention

A combined intervention strategy to increase linkage to and retention in substance use treatment for individuals accessing hospital-based services: study protocol

Background

In 2020, New Mexico had the highest alcohol related death and the 11th highest drug overdose rate in the U.S. Towards the long-term goal of addressing this public health problem, we are implementing and evaluating an multi-level intervention designed to identify adults at risk of substance use disorder (SUD) and encourage linkage to and retention in treatment. The first level includes equipping the ED and medical inpatient units of a safety-net hospital with a method to screen individuals at risk of a SUD. The second level includes Seeking Safety (SS), a trauma-specific treatment for PTSD and SUD; and pharmacotherapy for SUD. Motivational Interviewing (MI) is used throughout both levels. Using the SPIRIT guidelines and checklist, this study protocol describes the multi-level intervention and the methodology we are using to assess feasibility and effectiveness.

Methods

We are using a Type 1 hybrid implementation design with a non-randomized approach (ISRCTN registration # ISRCTN33100750). We aim to enroll 110 adults ( ≧ 18 ) who screen positive for unhealthy use of alcohol, prescription medications (used nonmedically) and/or illicit drugs. Peer support workers are responsible for screening, using MI to increase engagement in screening and treatment and delivery of SS. Pharmacotherapy is provided by addiction clinical specialists. Treatment is provided post hospital discharge via telehealth to increase access to care. Participants are identified through (1) review of electronic health records for individuals with a chief or secondary complaint or mental health condition relating to alcohol and/or other drug use, (2) referrals from clinical staff and (3) screening in the ED and medical inpatient units. Feasibility is being measured through process data. Effectiveness will be determined by changes in two primary outcomes: (i) PTSD symptom severity; and (ii) substance use.

Discussion

Our study will expand on research related to the implementation of treatment strategies for patients presenting at EDs and admitted to medical inpatients units wherein there is a significant window of opportunity to link patients with follow-up behavioral and clinical services for alcohol and/or drug misuse. The challenges associated with implementation and strategies that have been helpful to address these challenges will further inform the field.

Normative Substance Use Antecedents among Sexual Minorities: A Scoping Review and Synthesis

Although sexual minority stress remains the dominant perspective for understanding disproportionate substance use among lesbian, gay and bisexual (LGB) populations, social norms are among the most predictive and commonly targeted substance use antecedents in other high-risk groups. This scoping review seeks to bring clarity to the body of norms-focused alcohol, tobacco, and other drug (ATOD) research conducted with LGBs over the past 20 years, identify intervention implications, and present priority directions for future research. Fifty-two peer-reviewed studies published between June 1999 and June 2019 were identified from searches of PubMed, PsycInfo, and Medline databases using combinations of terms related to: social norms; sexual orientation or sexual minority status; and, the use of alcohol, tobacco, and other drugs. A far greater number of studies focused on actual ATOD norms than perceived ATOD norms or discrepancies between actual or perceived norms, illuminating the need for additional research focused on these levels of analysis. Taken together, this literature suggests that: (1) perceived ATOD norms are reliable predictors of LGBs' ATOD use; (2) actual ATOD use norms are low among LGBs participating in representative, population-based survey studies; and, (3) LGBs over-estimate the ATOD use of peers. Thus, intervention strategies including personalized normative feedback, psychoeducation, and social branding may hold promise in reducing LGBs substance use. However, additional research is needed to increase our understanding of injunctive ATOD norms, identify meaningful LGB reference groups, elucidate environmental influences on ATOD norms, and examine relationships between stigma experiences, perceived norms, and ATOD use.

Youth Participatory Action Research for Youth Substance Use Prevention: A Systematic Review

Background: A growing body of research points to the efficacy of participatory methods in decreasing rates of alcohol, tobacco, and other drug use and other risky behaviors among youth. However, to date, no systematic review of the literature has been conducted on Youth Participatory Action Research (YPAR) for youth substance use prevention. This review draws on the peer-reviewed literature on YPAR in the context of youth substance use prevention published from January 1, 1998 through April 30, 2018. Methods: We summarize (1) the published evidence regarding YPAR for youth substance use prevention; (2) the level of youth engagement in the research process; (3) the methodologies used in YPAR studies for youth substance use prevention; and (4) where more research is needed. We used Reliability-Tested Guidelines for Assessing Participatory Research Projects to assess the level of youth engagement in the research process. Results: In all, we identified 15 unduplicated peer-reviewed, English-language articles that referenced YPAR, Community Based Participatory Research, youth, and substance use prevention. Conclusions: Our findings indicated that youth participation in research and social action resulted in increased community awareness of substance use and related solutions. This supports the premise of youth participation as an agent of community change by producing community-specific substance use data and prevention materials. Identified weaknesses include inconsistent levels of youth engagement throughout the research process, a lack of formalized agreements between youth and researchers with regard to project and data management, and a lack of outcome evaluation measures for assessing YPAR for youth substance use prevention.

A framework for integrating young peers in recovery into adolescent substance use prevention and early intervention

Substance use among adolescents is associated with a range of negative outcomes and risk-taking behaviors. Identifying and intervening early is essential to reducing associated risks in adolescence and adulthood. New approaches are needed to equip youth-serving systems with tools to identify and respond to substance use. Screening, Brief Intervention, and Referral to Treatment (SBIRT) has emerged as a promising public health framework and there is a growing research interest in effective adaptations for its use with adolescents. However, healthcare settings, schools, and other community-based settings are slow to adapt SBIRT, citing gaps in knowledge and capacity to deliver evidence-based substance use prevention and early intervention. Further, these settings and the surrounding communities often lack the treatment and other prevention and recovery support resources needed for youth who screen as high-risk. Integrating young adult peers with personal lived experience of substance use recovery may meet this practical need. By drawing upon their shared experiences and skills developed in recovery, young adult peers can provide developmentally appropriate screening and intervention support to youth - while also providing urgently needed skills and time to under resourced settings. This article describes the value of young adult peer roles in expanding youth substance use prevention and early intervention, and features Project Amp as an example. Project Amp was designed as an extended, four-session brief intervention for low to moderate risk adolescents, delivered by trained young adult peers. Project Amp draws on best practices from peer recovery support and prevention and early intervention approaches such as SBIRT.

Health Behaviors of Student Community Research Partners When Designing and Implementing a Healthy Lifestyle Intervention on College Campuses

Few studies work with college students as equal partners in all aspects of Community-Based Participatory Research (CBPR) and even less evaluate behaviors of those college partners. The current study aimed to examine health behaviors of students by designing and implementing a peer-led, social marketing campaign (Get Fruved) to promote healthier lifestyles on their campuses. Enrolled students (n = 376) were trained to either design and implement a health promotion intervention (Social Marketing and Environmental Interventionists; SMEI, n = 78), be peer mentors (PM; n = 205), or serve as control participants (n = 93). Students' behaviors (dietary, activity, and stress) and anthropometrics were assessed at baseline, 6 months, and 12 months. The population was predominately Caucasian, female, and between 19 and 20 years old. On average, fruit and vegetable consumption slightly decreased across all time points for each group with control at a larger decline. Students International Physical Activity Questionnaire (IPAQ) scores showed students met recommended amounts of activity throughout the intervention, with males reporting higher activity levels. Cohen's Perceived Stress Scale (PSS) analyses indicated 19 year olds had higher stress along with females had higher than males. Students involved in a CBPR approach to be trained, design, and implement a lifestyle intervention can achieve maintenance of health behaviors throughout a college year when compared to control students.

A Community Based Participatory Approach to Training Young Adults to Design and Implement a Social Marketing Framed Lifestyle Intervention on Their College Campus

Background: Using a Community-Based Participatory Research (CBPR) approach may increase the likelihood of relevance and acceptability of the designed intervention, especially on a college campus. Furthermore, recruiting and training college students to design a social marketing framed healthy lifestyle intervention for their peers will allow the intervention to be tailored to the needs of the campus. Objectives: To describe the process of online-course training college students to develop a campus-based, social marketing health promotion intervention. Methods: Four universities recruited current college students (18+ y.o.) to develop a social marketing and environmental intervention (SMEI), which was completed during a 16-week, online/in-person hybrid semester course. Researchers and Extension professionals trained students to design 24 weeks of intervention events that would be implemented the upcoming year. Results: Seventy-eight students enrolled in the study and social marketing and environmental intervention course among the four intervention states (Florida = 30, South Dakota = 8, Tennessee = 13, West Virginia = 27); students were predominately Caucasian (65.8%), females (84.0%), and sophomore status in college (64.9%). Throughout the semester, students assessed their campus environments, set priorities, and developed weekly events and resources needed to implement the intervention on their campuses. By the end of the semester, with researcher support, students had designed 24 weeks of intervention events (marketing, recruiting, and implementation) focusing on nutrition/food/diet, physical activity, stress management, sleep, and time management. These events and resources were catalogued into a digital toolkit of instructions and activities for each week of intervention events. Conclusion: Using a Community-Based Participatory Research approach with college students interested in health allows for the development of an intervention that stems from grass roots efforts and is tailored to the acceptability and needs of their peers.

The critical role of communications in a multilevel obesity-prevention intervention: Lessons learned for alcohol educators

OBJECTIVE

Multilevel interventions to prevent underage drinking are more effective than individual-level strategies, and messaging campaigns are key to such approaches. Recognizing the benefits of translating best practices across public health domains, this paper details the communications campaign from Shape Up Somerville (SUS), an exemplar for multilevel community-based approaches to address pediatric obesity, highlighting lessons learned for alcohol educators.

METHODS

All elements of SUS, including the communications strategy, were developed collaboratively with local partners. Communication initiatives included community-engaged brand development to unify diverse intervention components; school-based communications to promote new opportunities for healthy eating and physical activity; and media partnerships to promote healthy behaviors community-wide.

RESULTS

The overall SUS intervention was effective in reducing prevalence of overweight/obesity among first- to third-graders in Somerville relative to control communities. Process evaluation showed that communications successfully reached diverse community segments and raised awareness of and receptivity to changes.

CONCLUSIONS AND PRACTICE IMPLICATIONS

Communications campaigns are essential components of multilevel interventions addressing public health challenges including obesity and underage drinking. Such communications should be developed collaboratively with the target audience and stakeholders, designed to engage community members at multiple levels through multiple channels within a systems framework, and sustained through local partnerships.

Lines in the sand: Social representations of substance use boundaries in life narratives

This study identifies social representations in interviews about alcohol and substance use in the discourse of 129 young adults, who were interviewed for 2.5 to 3.5 hours each for their life histories and use or non-use of alcoholic beverages and drugs. Respondents spontaneously delineated their substance use boundaries, creating a continuum of behaviors with boundary points separating acceptable from unacceptable behaviors. They used signaling expressions to indicate go and stop signs and movement along the substance use continuum and reported negotiating substance use boundaries both internally and with peers. A ubiquitous narrative element was the cautionary tale, in which a negative exemplar goes too far with alcohol and/or drugs, providing an example of the possible negative outcomes of transgressing boundaries. In general, the narratives revealed complex relationships to alcohol and other drugs that may be useful in refining messages for more effective communication in prevention and intervention programs.

Youth as partners, participants or passive recipients: a review of children and adolescents in community-based participatory research (CBPR)

Community-based participatory research (CBPR) is an orientation to research that places value on equitable collaborations between community members and academic partners, reflecting shared decision making throughout the research process. Although CBPR has become increasingly popular for research with adults, youth are less likely to be included as partners. In our review of the literature, we identified 399 articles described by author or MeSH keyword as CBPR related to youth. We analyzed each study to determine youth engagement. Not including misclassified articles, 27 % of percent of studies were community-placed but lacked a community partnership and/or participatory component. Only 56 (15 %) partnered with youth in some phase of the research process. Although youth were most commonly involved in identifying research questions/priorities and in designing/conducting research, most youth-partnered projects included children or adolescents in several phases of the research process. We outline content, methodology, phases of youth partnership, and age of participating youth in each CBPR with youth project, provide exemplars of CBPR with youth, and discuss the state of the youth-partnered research literature.

Formative research for a community-based message-framing intervention

OBJECTIVE

To inform a community-based message framing intervention encouraging physical activity and fruit and vegetable consumption among medically underserved adults.

METHOD

Key informant interviews, focus groups, and a survey were conducted with limited-literacy Hispanics in the northeastern United States.

RESULTS

Barriers to healthy lifestyle behaviors exist at individual, community, and policy levels. A strong degree of networking among local organizations and elected officials exists that can be used to encourage healthy lifestyle initiatives.

CONCLUSIONS

Community-based health communication interventions must address neighborhood realities, the literacy levels of the target population, and existing networks of providers and consumers.

Intervention mapping as a participatory approach to developing an HIV prevention intervention in rural African American communities

Southeastern states are among the hardest hit by the HIV epidemic in this country, and racial disparities in HIV rates are high in this region. This is particularly true in our communities of interest in rural eastern North Carolina. Although most recent efforts to prevent HIV attempt to address multiple contributing factors, we have found few multilevel HIV interventions that have been developed, tailored or tested in rural communities for African Americans. We describe how Project GRACE integrated intervention mapping (IM) methodology with community-based participatory research (CBPR) principles to develop a multilevel, multigenerational HIV prevention intervention. IM was carried out in a series of steps from review of relevant data through producing program components. Through the IM process, all collaborators agreed that we needed a family-based intervention involving youth and their caregivers. We found that the structured approach of IM can be adapted to incorporate the principles of CBPR.

Relationships of adolescents' perceptions of parental and peer behaviors with cigarette and alcohol use in different neighborhood contexts

This study examined the relationships of adolescents' perceptions of parental and peer behaviors with cigarette and alcohol use in different neighborhood contexts. The sample included 924 adolescents (49% boys, 51% girls) 12-14 years of age whose addresses were matched with 1990 census block groups. Six neighborhood types were identified through a cluster analysis. The findings suggest that parental smoking was associated with increased adolescent smoking in suburban white middle socioeconomic status (SES) neighborhoods. Peer smoking was associated with increased adolescent smoking in rural neighborhoods. Parental monitoring was associated with decreased adolescent drinking in urban white high-SES neighborhoods and parental drinking was associated with increased adolescent drinking in urban white middle-SES neighborhoods, respectively. Peer drinking was associated with increased adolescent drinking in urban neighborhoods. This study demonstrates the importance of examining parental and peer influences on adolescent smoking and drinking in different neighborhood contexts.