1
|
Redvers N, Larson S, Rajpathy O, Olson D. American Indian and Alaska Native recruitment strategies for health-related randomized controlled trials: A scoping review. PLoS One 2024; 19:e0302562. [PMID: 38687762 PMCID: PMC11060564 DOI: 10.1371/journal.pone.0302562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/08/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Significant health disparities exist among American Indian and Alaska Natives (AI/ANs), yet AI/ANs are substantially underrepresented within health-related research, including randomized controlled trials (RCTs). Although research has previously charted representation inequities, there is however a gap in the literature documenting best practice for recruitment techniques of AI/ANs into RCTs. Therefore, the aim of this review was to systematically gather and analyze the published literature to identify common strategies for AI/AN participant recruitment for RCTs in the US. METHODS A scoping review methodology was engaged with a systematic search operationalized within relevant databases to February 19, 2022, with an additional updated search being carried out up until January 1, 2023: PubMed, Embase, Web of Science, PsycINFO, CINAHL, and Google Scholar. A two-stage article review process was engaged with double reviewers using Covidence review software. Content analysis was then carried out within the included articles by two reviewers using NVivo software to identify common categories within the data on the topic area. RESULTS Our review identified forty-one relevant articles with the main categories of recruitment strategies being: 1) recruitment methods for AI/ANs into RCTs (passive advertising recruitment approaches, individual-level recruitment approaches, relational methods of recruitment); 2) recruitment personnel used within RCTs; and, 3) relevant recruitment setting. The majority of the included studies used a culturally relevant intervention, as well as a community-involved approach to operationalizing the research. CONCLUSION Increasing AI/AN representation in RCTs is essential for generating evidence-based interventions that effectively address health disparities and improve health outcomes. Researchers and funding agencies should prioritize the engagement, inclusion, and leadership of AI/AN communities throughout the RCT research process. This includes early community involvement in study design, implementation of culturally tailored recruitment strategies, and dissemination of research findings in formats accessible to AI/AN communities.
Collapse
Affiliation(s)
- Nicole Redvers
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Department of Indigenous Health, School of Medicine & Health Sciences, University of North Dakota, Grand Forks, ND, United States of America
| | - Sarah Larson
- Department of Indigenous Health, School of Medicine & Health Sciences, University of North Dakota, Grand Forks, ND, United States of America
| | - Olivia Rajpathy
- Department of Population Health, School of Medicine & Health Sciences, University of North Dakota, Grand Forks, ND, United States of America
| | - Devon Olson
- Library Resources, School of Medicine & Health Sciences, University of North Dakota, Grand Forks, ND, United States of America
| |
Collapse
|
2
|
Silva MA, Añez LM, Carroll KM, Jaramillo Y, Kiluk BD, Frankforter T, Ball SA, Gordon MA, Paris M. Computer-based training for cognitive behavioral therapy for Spanish-speaking substance users: adaptation and satisfaction. J Ethn Subst Abuse 2024; 23:251-271. [PMID: 35714996 PMCID: PMC10350903 DOI: 10.1080/15332640.2022.2086194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
There are few available culturally and linguistically adapted behavioral health interventions for substance use among Spanish-speaking adults. The authors describe the cultural adaptation of an innovative computer-based training for cognitive behavioral therapy program (CBT4CBT). Based in cognitive-behavioral skills training, CBT4CBT utilizes a telenovela to teach monolingual Spanish-speaking adults who have migrated to the United States to recognize triggers; avoid these situations; and cope more effectively with the consequences of substance use. Participants endorsed high levels of satisfaction with the program content and found the material to be easy to understand and relevant to their life experiences.
Collapse
Affiliation(s)
- Michelle A Silva
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Luis M Añez
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Kathleen M Carroll
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Yudilyn Jaramillo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Brian D Kiluk
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Tami Frankforter
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Samuel A Ball
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Melissa A Gordon
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Manuel Paris
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| |
Collapse
|
3
|
Crouch MC, Venner KL, Wendt DC, Burlew AK, Baukol P, Funaro MC, Sorrell T, Haeny AM. Lessons learned and future directions: A scoping review of American Indian and Alaska Native participants in the National Drug Abuse Treatment Clinical Trials Network. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 153:209081. [PMID: 37230391 PMCID: PMC10529616 DOI: 10.1016/j.josat.2023.209081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 02/09/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION American Indian and Alaska Native (AI/AN) populations are disproportionately affected by substance use disorders (SUDs) and related health disparities in contrast to other ethnoracial groups in the United States. Over the past 20 years, substantial resources have been allocated to the National Institute on Drug Abuse Clinical Trials Network (CTN) to disseminate and implement effective SUD treatments in communities. However, we know little about how these resources have benefitted AI/AN peoples with SUD who arguably experience the greatest burden of SUDs. This review aims to determine lessons learned about AI/AN substance use and treatment outcomes in the CTN and the role of racism and Tribal identity. METHOD We conducted a scoping review informed by the Joanna Briggs framework and PRISMA Extension for Scoping Reviews checklist and explanation. The study team conducted the search strategy within the CTN Dissemination Library and nine additional databases for articles published between 2000 and 2021. The review included studies if they reported results for AI/AN participants. Two reviewers determined study eligibility. RESULTS A systematic search yielded 13 empirical articles and six conceptual articles. Themes from the 13 empirical articles included: (1) Tribal Identity: Race, Culture, and Discrimination; (2) Treatment Engagement: Access and Retention; (3) Comorbid Conditions; (4) HIV/Risky Sexual Behaviors; and (5) Dissemination. The most salient theme was Tribal Identity: Race, Culture, and Discrimination, which was present in all articles that included a primary AI/AN sample (k = 8). Themes assessed but not identified for AI/AN peoples were Harm Reduction, Measurement Equivalence, Pharmacotherapy, and Substance Use Outcomes. The conceptual contributions used AI/AN CTN studies as exemplars of community-based and Tribal participatory research (CBPR/TPR). CONCLUSION CTN studies conducted with AI/AN communities demonstrate culturally congruent methods, including CBPR/TPR strategies; consideration/assessment of cultural identity, racism, and discrimination; and CBPR/TPR informed dissemination plans. Although important efforts are underway to increase AI/AN participation in the CTN, future research would benefit from strategies to increase participation of this population. Such strategies include reporting AI/AN subgroup data; addressing issues of cultural identity and experiences of racism; and adopting an overall effort for research aimed at understanding barriers to treatment access, engagement, utilization, retention, and outcomes for both treatment and research disparities for AI/AN populations.
Collapse
Affiliation(s)
- Maria C Crouch
- Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510, United States.
| | - Kamilla L Venner
- University of New Mexico, 1 University of New Mexico, MSC03 2220, Albuquerque, NM 87131-0001, United States
| | - Dennis C Wendt
- McGill University, 3700 McTavish St., Room 614, Montreal, QC H3A 1Y2, Canada
| | - Ann Kathleen Burlew
- University of Cincinnati, 2600 Clifton Ave., Cincinnati, OH 45220, United States
| | - Paulette Baukol
- Berman Center for Outcomes & Clinical Research, 701 Park Ave., Suite PP7.700, Minneapolis, MN 55415, United States
| | - Melissa C Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, 333 Cedar St, New Haven, CT 06510, United States
| | - Tanya Sorrell
- Rush University Medical Center, 1645 W Jackson Blvd, Westgate Building, Suite 600, Chicago, IL 60612, United States
| | - Angela M Haeny
- Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510, United States
| |
Collapse
|
4
|
Walker D, Pearson C, Day A, Bedard-Gilligan M, Saluskin K, Huh D, Kaysen D. A Community Engaged Approach in Adapting Motivational Interviewing and Skills Training for Native Americans With Experiences of Substance Misuse. Am J Health Promot 2023; 37:796-806. [PMID: 36869715 PMCID: PMC10311937 DOI: 10.1177/08901171231161467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
OBJECTIVE American Indian and Alaskan Natives (AIAN) are regenerating cultural knowledge and practices to adapt westernized evidence-based interventions to address health concerns such as substance use. This study describes the process of selecting, adapting, and implementing motivational interviewing plus cognitive behavior therapy (motivational interviewing + Skills Training; MIST) for use in a combined substance use intervention with a rural, Northwest tribal community. METHODS An established community and academic partnership worked together to make culturally mindful changes to MIST. The partnership incorporated community leaders/Elders (n = 7), providers (n = 9), and participants (n = 50) to implement an iterative process of adapting and implementing the adapted form of MIST. RESULTS Key adaptations included presenting concepts grounded in tribal values, providing examples from the community perspective, and incorporating cultural customs and traditions. Overall, the MIST adaptation was favorably received by participants, and the adaptation appeared feasible. CONCLUSIONS Adapted MIST appeared to be an acceptable intervention for this Native American community. Future research should evaluate the interventions efficacy in reducing substance use among this and other Native American communities. Future clinical research should consider strategies outlined in this adaptation as a potential process for working with Native American communities to implement culturally appropriate interventions.
Collapse
Affiliation(s)
- Denise Walker
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Cynthia Pearson
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Angelique Day
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Michele Bedard-Gilligan
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | | | - David Huh
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University, CA, USA
| |
Collapse
|
5
|
Espinosa A, Conway FN, Ruglass LM, Sheffer CE. Differences among factors associated with tobacco product use among Black and White adolescents: A cross-sectional analysis of wave one of the PATH study 2013-2014. Tob Induc Dis 2023; 21:54. [PMID: 37153727 PMCID: PMC10158815 DOI: 10.18332/tid/161932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/04/2023] [Accepted: 03/06/2023] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION Tobacco use remains a primary cause of health disparities between Black and White Americans. Current approaches have not improved tobacco-related racial health disparities. This study aimed to identify differences in factors associated with tobacco product use among Black and White adolescents. METHODS This cross-sectional design used data from Wave One (2013-2014) of the Population Assessment of Tobacco and Health Study. Adolescents aged 12-17 years who identified as non-Hispanic Black or African American (n=1800) or non-Hispanic White (n=6495) were included. Primary outcomes were the ever use and current use of any tobacco products. Sociocultural, household environment, psychological, and behavioral factors were included. Logistic regressions, stratified by race, were used to determine significance. Dominance analysis was used to rank significant factors by their level of importance. RESULTS Although there were many Black-White commonalities, there were also important differences. Black adolescents in the Northeast were more likely to have ever used tobacco compared to those in the South (OR=0.6; 95% CI: 0.6-0.7, p<0.001) and Midwest (OR=0.6; 95% CI: 0.5-0.7, p<0.001). White adolescents in the Northeast were less likely to use tobacco products than in other regions. Peer influences (OR=1.9; 95% CI: 1.1-3.2, p<0.05) were uniquely associated with ever use among Black adolescents. Access to tobacco in the home (OR=2.0; 95% CI: 1.4-3.0, p<0.001) and thinking that tobacco use would help reduce stress (OR=1.3; 95% CI: 1.1-1.6, p<0.01) were uniquely associated with current use among Black adolescents. CONCLUSIONS There are significant Black-White differences in the factors associated with tobacco use. Factors uniquely associated with Black adolescent tobacco use should be considered in developing strategies to prevent adolescent tobacco use in Black communities.
Collapse
Affiliation(s)
- Adriana Espinosa
- Department of Psychology, The City College of New York, New York, United States
| | - Fiona N. Conway
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, United States
| | - Lesia M. Ruglass
- Department of Psychology, The City College of New York, New York, United States
| | - Christine E. Sheffer
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, United States
| |
Collapse
|
6
|
Jordan A, Quainoo S, Nich C, Babuscio TA, Funaro MC, Carroll KM. Racial and ethnic differences in alcohol, cannabis, and illicit substance use treatment: a systematic review and narrative synthesis of studies done in the USA. Lancet Psychiatry 2022; 9:660-675. [PMID: 35752192 DOI: 10.1016/s2215-0366(22)00160-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 10/17/2022]
Abstract
Reports from uncontrolled trials and surveys suggest that there are disparities in substance-use outcomes for minoritised racial and ethnic populations, yet few of these disparities have emerged from randomised clinical trials (RCTs). We conducted a systematic review of RCTs published in English of Black or Latinx adults with any non-nicotine substance use disorder that reported rates of treatment initiation, engagement, or substance-use outcome by race or ethnicity. Study quality was assessed by the Joanna Briggs Institute appraisal tool and a Yale internally validated quality assessment. Of the 5204 studies, 50 RCTs met the inclusion criteria, all done in the USA, 24 compared treatment initiation, engagement, or outcome across races or ethnicities and 26 compared these same factors within a race. Few RCTs have reported outcomes specifically for Black or Latinx populations, with nine reporting significant differences by race or ethnicity. Significant differences were found in all studies that evaluated the baseline differences in social determinants. This Review explains the need for optimisation of RCTs to inform the design, delivery, and dissemination of treatment to historically excluded communities.
Collapse
Affiliation(s)
- Ayana Jordan
- New York University Grossman School of Medicine, New York, NY, USA.
| | - Stephanie Quainoo
- Frank H Netter School of Medicine, Quinnipiac University, North Haven, CT, USA
| | - Charla Nich
- Department of Psychiatry, Yale University School of Medicine, Yale University, New Haven, CT, USA
| | - Theresa A Babuscio
- Department of Psychiatry, Yale University School of Medicine, Yale University, New Haven, CT, USA
| | - Melissa C Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA
| | - Kathleen M Carroll
- Department of Psychiatry, Yale University School of Medicine, Yale University, New Haven, CT, USA
| |
Collapse
|
7
|
Bhatt SR, Armstrong M, Parker T, Maviglia M, Kass R, Leeman L, Romo P, Ziedonis D. Psychedelic Therapies at the Crossroads of Trauma and Substance Use: Historical Perspectives and Future Directions, Taking a Lead From New Mexico. Front Pharmacol 2022; 13:905753. [PMID: 35833023 PMCID: PMC9273054 DOI: 10.3389/fphar.2022.905753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/02/2022] [Indexed: 12/04/2022] Open
Abstract
Post-traumatic stress disorder (PTSD), a common condition with potentially devastating individual, family, and societal consequences, is highly associated with substance use disorders (SUDs). The association between PTSD and SUD is complex and may involve adverse childhood experiences (ACEs), historical and multi-generational traumas, and social determinants of health as well as cultural and spiritual contexts. Current psychosocial and pharmacological treatments for PTSD are only modestly effective, and there is a need for more research on therapeutic interventions for co-occurring PTSD and SUD, including whether to provide integrated or sequential treatments. There is a current resurgence of interest in psychedelics as potential treatment augmentation for PTSD and SUDs with an appreciation of the risks in this target population. This paper reviews the historical perspective of psychedelic research and practices, as well as the intersection of historical trauma, ACEs, PTSD, and SUDs through the lens of New Mexico. New Mexico is a state with high populations of Indigenous and Hispanic peoples as well as high rates of trauma, PTSD, and SUDs. Researchers in New Mexico have been leaders in psychedelic research. Future directions for psychedelic researchers to consider are discussed, including the importance of community-based participatory approaches that are more inclusive and respectful of Indigenous and other minority communities.
Collapse
Affiliation(s)
- Snehal R. Bhatt
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, United States
- *Correspondence: Snehal R. Bhatt,
| | - Maya Armstrong
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Tassy Parker
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, United States
- College of Nursing, University of New Mexico, Albuquerque, NM, United States
- College of Population Health, University of New Mexico, Albuquerque, NM, United States
- Center for Native American Health, University of New Mexico, Albuquerque, NM, United States
- American Indian Health Research and Education, University of New Mexico, Albuquerque, NM, United States
| | - Marcello Maviglia
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, United States
- Center for Native American Health, University of New Mexico, Albuquerque, NM, United States
| | - Rebecca Kass
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Lawrence Leeman
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Paul Romo
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Douglas Ziedonis
- Executive Vice President, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| |
Collapse
|
8
|
Young AM, Lancaster KE, Bielavitz S, Elman MR, Cook RR, Leichtling G, Freeman E, Estadt AT, Brown M, Alexander R, Barrie C, Conn K, Elzaghal R, Maybrier L, McDowell R, Neal C, Lapidus J, Waddell EN, Korthuis PT. Peer-based Retention Of people who Use Drugs in Rural Research (PROUD-R 2): a multisite, randomised, 12-month trial to compare efficacy of standard versus peer-based approaches to retain rural people who use drugs in research. BMJ Open 2022; 12:e064400. [PMID: 35705346 PMCID: PMC9204453 DOI: 10.1136/bmjopen-2022-064400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 06/01/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Rural communities bear a disproportionate share of the opioid and methamphetamine use disorder epidemics. Yet, rural people who use drugs (PWUD) are rarely included in trials testing new drug use prevention and treatment strategies. Numerous barriers impede rural PWUD trial engagement and advancing research methods to better retain rural PWUD in clinical trials is needed. This paper describes the Peer-based Retention Of people who Use Drugs in Rural Research (PROUD-R2) study protocol to test the effectiveness of a peer-driven intervention to improve study retention among rural PWUD. METHODS AND ANALYSIS The PROUD-R2 study is being implemented in 21 rural counties in three states (Kentucky, Ohio and Oregon). People who are 18 years or older, reside in the study area and either used opioids or injected any drug to get high in the past 30 days are eligible for study inclusion. Participants are allocated in a 1:1 ratio to two arms, stratified by site to assure balance at each geographical location. The trial compares the effectiveness of two retention strategies. Participants randomised to the control arm provide detailed contact information and receive standard retention outreach by study staff (ie, contacts for locator information updates, appointment reminders). Participants randomised to the intervention arm are asked to recruit a 'study buddy' in addition to receiving standard retention outreach. Study buddies are invited to participate in a video training and instructed to remind their intervention participant of follow-up appointments and encourage retention. Assessments are completed by intervention, control and study buddy participants at 6 and 12 months after enrolment. ETHICS AND DISSEMINATION The protocol was approved by a central Institutional Review Board (University of Utah). Results of the study will be disseminated in academic conferences and peer-reviewed journals, online and print media, and in meetings with community stakeholders. TRIAL REGISTRATION NUMBER NCT03885024.
Collapse
Affiliation(s)
- April M Young
- Epidemiology, University of Kentucky, Lexington, Kentucky, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
| | - Kathryn E Lancaster
- Division of Epidemiology, Ohio State University College of Public Health, Columbus, Ohio, USA
| | | | - Miriam R Elman
- Oregon Health & Science University, Portland, Oregon, USA
| | - Ryan R Cook
- Oregon Health & Science University, Portland, Oregon, USA
| | | | - Edward Freeman
- Department of Epidemiology, University of Kentucky, Lexington, Kentucky, USA
| | | | | | - Rhonda Alexander
- Department of Epidemiology, University of Kentucky, Lexington, Kentucky, USA
| | - Caiti Barrie
- Oregon Health & Science University, Portland, Oregon, USA
| | - Kandi Conn
- Department of Epidemiology, University of Kentucky, Lexington, Kentucky, USA
| | - Rhody Elzaghal
- Oregon Health & Science University, Portland, Oregon, USA
| | - Lisa Maybrier
- Department of Epidemiology, University of Kentucky, Lexington, Kentucky, USA
| | | | - Cathy Neal
- The Ohio State University, Columbus, Ohio, USA
| | - Jodi Lapidus
- Oregon Health & Science University, Portland, Oregon, USA
| | - Elizabeth N Waddell
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
| | | |
Collapse
|
9
|
Biondi BE, Vander Wyk B, Schlossberg EF, Shaw A, Springer SA. Factors associated with retention on medications for opioid use disorder among a cohort of adults seeking treatment in the community. Addict Sci Clin Pract 2022; 17:15. [PMID: 35255967 PMCID: PMC8899775 DOI: 10.1186/s13722-022-00299-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 02/22/2022] [Indexed: 12/03/2022] Open
Abstract
Background Medication treatment for opioid use disorder (OUD) (MOUD; buprenorphine and methadone) reduces opioid use and overdose. Discontinuation of MOUD can quickly lead to relapse, overdose and death. Few persons who initiate MOUD are retained on treatment, thus it is critical to identify factors associated with retention. Methods Evaluated data was from an ongoing prospective cohort study of adults aged 18 or older with DSM-5 moderate to severe OUD seeking MOUD in the community and followed for 6 months. Participants were considered retained on MOUD through 6 months if they reported taking MOUD at every study interview without discontinuation. A high dose of MOUD was defined as a methadone dose > 85 mg or buprenorphine dose ≥ 16 mg. Multivariable logistic regression was conducted to assess factors associated with 6-month MOUD retention. Results A total of 118 participants (73% male, 58% white, 36% with HIV) were included. Buprenorphine was initiated by 58% and 42% started methadone. MOUD retention was 49% and 58% among buprenorphine and methadone, respectively, at 6-months. In adjusted models, a high MOUD dose (OR = 4.71, 95% CI 2.05–10.84) and higher pain interference (OR = 1.59, 95% CI 1.15–2.19) was associated with MOUD retention. Conclusions Adequate dosing of MOUD leads to improved retention on MOUD. Further, persons with high pain interference at baseline had higher odds of retention on MOUD. Both methadone and buprenorphine have analgesic effects, thus those with high pain interference could have dual benefits of MOUD for treating OUD and pain. Interventions should be tailored to improve adequate MOUD dosing to improve retention on MOUD.
Collapse
Affiliation(s)
- Breanne E Biondi
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Brent Vander Wyk
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT, USA
| | - Esther F Schlossberg
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, Yale AIDS Program, New Haven, CT, USA
| | - Albert Shaw
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, Yale AIDS Program, New Haven, CT, USA
| | - Sandra A Springer
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, Yale AIDS Program, New Haven, CT, USA. .,Center for Interdisciplinary Research On AIDS, Yale University School of Public Health, New Haven, CT, USA. .,Department of Internal Medicine, Section of Infectious Disease, Yale AIDS Program, 135 College Street, Suite 323, New Haven, CT, 06510, USA.
| |
Collapse
|
10
|
Ahuja M, Haeny AM, Sartor CE, Bucholz KK. Perceived racial and social class discrimination and cannabis involvement among Black youth and young adults. Drug Alcohol Depend 2022; 232:109304. [PMID: 35124388 DOI: 10.1016/j.drugalcdep.2022.109304] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/09/2021] [Accepted: 12/10/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The current study examines the association of perceived racial and social class discrimination with cannabis involvement among Black youth and young adults. METHODS This secondary analysis used data from the Missouri Family Study (MOFAM), a high-risk longitudinal family study of alcohol use disorder, oversampled for Black families. Offspring (n = 806) and their mothers were interviewed by telephone. Cox proportional hazards regression analyzes were used to examine associations of racial and social class discrimination (experienced by offspring and their mothers) with offspring cannabis involvement. Two stages of cannabis involvement were analyzed: timing of 1) initiation and 2) transition from initiation to first cannabis use disorder (CUD) symptom. RESULTS The study found that offspring report of experiencing racial (HR: 1.28, CI: 1.01-1.62) and social class discrimination (HR: 1.45, CI: 1.14-1.84) were associated with cannabis initiation in our fully adjusted model. Mothers' report of discrimination predicted a lower hazard of cannabis initiation among offspring (HR: 0.79, CI: 0.64-0.98). Offspring social class discrimination (HR: 2.45, CI: 1.71-3.51) predicted an increased hazard of transition from initiation to first CUD symptom, while offspring racial discrimination (HR: 0.57, CI: 0.39-0.85) was associated with lower hazard of transition in our fully adjusted model. CONCLUSIONS As rates for cannabis use among Black youth are disproportionately rising, there is a critical need to identify pathways to its use among Black youth. These findings suggest racial and social class discrimination may be important targets in efforts to prevent cannabis involvement among Black youth and emerging adults.
Collapse
Affiliation(s)
- Manik Ahuja
- Department of Health Services Management and Policy, East Tennessee State University, Johnson City, TN, United States.
| | - Angela M Haeny
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Carolyn E Sartor
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States; Department of Psychiatry, Washington University School of Medicine, United States
| | - Kathleen K Bucholz
- Department of Psychiatry, Washington University School of Medicine, United States
| |
Collapse
|
11
|
Burlew K, McCuistian C, Szapocznik J. Racial/ethnic equity in substance use treatment research: the way forward. Addict Sci Clin Pract 2021; 16:50. [PMID: 34353373 PMCID: PMC8340520 DOI: 10.1186/s13722-021-00256-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/19/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Opioid use and opioid-related overdose continue to rise among racial/ethnic minorities. Social determinants of health negatively impact these communities, possibly resulting in poorer treatment outcomes. Research is needed to investigate how to overcome the disproportionate and deleterious impact of social determinants of health on treatment entry, retention, drug use and related outcomes among racial/ethnic minorities. The current commentary provides recommendations that may help researchers respond more effectively to reducing health disparities in substance use treatment. We begin with recommendations of best research practices (e.g., ensuring adequate recruitment of racial/ethnic minorities in research, central components of valid analysis, and adequate methods for assessing effect sizes for racial/ethnic minorities). Then, we propose that more NIDA research focuses on issues disproportionately affecting racial/ethnic minorities. Next, techniques for increasing the number of underrepresented racial/ethnic treatment researchers are suggested. We then recommend methods for infusing racial/ethnic expertise onto funding decision panels. This commentary ends with a case study that features NIDA's National Drug Abuse Treatment Clinical Trials Network (CTN). CONCLUSIONS The proposed recommendations can serve as guidelines for substance use research funders to promote research that has the potential to reduce racial/ethnic disparities in substance use treatment and to increase training opportunities for racial/ethnic minority researchers.
Collapse
Affiliation(s)
- Kathleen Burlew
- Department of Psychology, University of Cincinnati, Mail Location #210375, Cincinnati, OH, 45213, USA.
| | - Caravella McCuistian
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA, 94118, USA
| | - José Szapocznik
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 3380 Devon Road, Miami, FL, 33133-5902, USA
| |
Collapse
|
12
|
Wieland ML, Njeru JW, Alahdab F, Doubeni CA, Sia IG. Community-Engaged Approaches for Minority Recruitment Into Clinical Research: A Scoping Review of the Literature. Mayo Clin Proc 2021; 96:733-743. [PMID: 33004216 DOI: 10.1016/j.mayocp.2020.03.028] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/15/2020] [Accepted: 03/31/2020] [Indexed: 01/14/2023]
Abstract
Underrepresentation of racial and ethnic minority populations in clinical research persists in the United States, highlighting the unmet ideals of generalizability and equity of research findings and products. Previous systematic reviews exploring various facets of this phenomenon concluded that community engagement with minority groups may effectively promote recruitment and retention, but the ways in which community-engaged approaches have been used for recruitment have not been examined. We performed a scoping review of the literature to identify studies of community-engaged recruitment processes. The search resulted in 2842 articles, of which 66 met inclusion criteria. These articles demonstrated a relatively large literature base of descriptive studies conveying details of community engagement approaches to enhance recruitment of minority research participants. We summarize key aspects of current practices across the spectrum of community engagement. A gap in the literature is the relative lack of the comparative studies among different engagement strategies.
Collapse
Affiliation(s)
- Mark L Wieland
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN.
| | - Jane W Njeru
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN
| | - Fares Alahdab
- Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, MN
| | - Chyke A Doubeni
- Center for Health Equity and Community Engagement Research and Department of Family Medicine, Mayo Clinic, Rochester, MN
| | - Irene G Sia
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN
| |
Collapse
|
13
|
Chartier KG, Martinez P, Cummings C, Riley BP, Karriker-Jaffe KJ. Recruiting for diversity: a pilot test of recruitment strategies for a national alcohol survey with mail-in genetic data collection. J Community Genet 2021; 12:459-468. [PMID: 33398649 DOI: 10.1007/s12687-020-00502-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 12/21/2020] [Indexed: 12/14/2022] Open
Abstract
We assessed the feasibility and acceptability of collecting a saliva sample for DNA through the mail from a national sample of drinkers and examined whether targeted messaging would increase the response rates of Black/African American and Hispanic/Latino participants. We invited respondents from two prior national population surveys to participate in a brief telephone survey regarding recent alcohol use and to mail in a self-administered saliva sample. Blacks/African Americans, Hispanics/Latinos, and Whites had similar rates of consenting to participate. A higher proportion of respondents with a college education and a family history of alcohol problems consented. The differences in participation between respondents receiving targeted and general messaging were not statistically significant. This study provides preliminary evidence for the feasibility of recruiting diverse participants into a genetic study of alcohol use disorder.
Collapse
Affiliation(s)
- Karen G Chartier
- School of Social Work and Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA.
| | | | - Cory Cummings
- School of Social Work, Monmouth University, West Long Branch, NJ, USA
| | - Brien P Riley
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | | |
Collapse
|
14
|
Miguel AQC, Jordan A, Kiluk BD, Nich C, Babuscio TA, Mari JJ, Carroll KM. Sociodemographic and clinical outcome differences among individuals seeking treatment for cocaine use disorders. The intersection of gender and race. J Subst Abuse Treat 2019; 106:65-72. [PMID: 31540613 DOI: 10.1016/j.jsat.2019.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 08/16/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Most published treatment trials for cocaine use disorders (CUD) have been conducted with samples composed predominantly of White men and underrepresent women and racial/ethnic minorities. Because of the high prevalence of men and White individuals in CUD treatment trials, results from studies that have compared treatment outcomes by gender and race or ethnicity separately may not be representative of women or racial/ethnic minorities. METHODS With a sample pooled from seven randomized clinical trials of treatment for CUD (n = 629), baseline characteristics and treatment outcome responses were compared with 4 subgroups of individuals created based on the intersection of gender and race (White men, Black men, White women and Black women). RESULTS At baseline, sociodemographic status, pattern, frequency and severity of cocaine use, psychiatric comorbidities, employment and legal problems significantly differed across groups. Treatment outcome indicators collected during treatment and through follow-up, consistently indicated poorer outcomes among the sample of White women, but were similar for the other groups. CONCLUSIONS Men and women with CUD from both racial groups enter treatment with different psychosocial issues (e.g., history of violence/trauma, financial problems, co-occurring psychiatric disorders) and substance use problems (e.g. types of substances) that may impact treatment outcomes and indicate a need for culturally-informed care to deliver more effective treatment for CUD. Poorer overall outcomes among White women may reflect the need for a more focused treatment approach for this group; and highlight the importance of evaluating gender and race in treatment trials to better address health disparities.
Collapse
Affiliation(s)
- André Q C Miguel
- Department of Psychiatry, Yale University School of Medicine, Temple Medical Building, Suite 6C, 40 Temple Street, New Haven, CT 06510, USA; Department of Psychiatry, Federal University of Sao Paulo, Rua Major Maragliano 241, Vila Mariana, São Paulo, SP 04017-030, Brazil.
| | - Ayana Jordan
- Department of Psychiatry, Yale University School of Medicine, Temple Medical Building, Suite 6C, 40 Temple Street, New Haven, CT 06510, USA.
| | - Brian D Kiluk
- Department of Psychiatry, Yale University School of Medicine, Temple Medical Building, Suite 6C, 40 Temple Street, New Haven, CT 06510, USA.
| | - Charla Nich
- Department of Psychiatry, Yale University School of Medicine, Temple Medical Building, Suite 6C, 40 Temple Street, New Haven, CT 06510, USA.
| | - Theresa A Babuscio
- Department of Psychiatry, Yale University School of Medicine, Temple Medical Building, Suite 6C, 40 Temple Street, New Haven, CT 06510, USA.
| | - Jair J Mari
- Department of Psychiatry, Federal University of Sao Paulo, Rua Major Maragliano 241, Vila Mariana, São Paulo, SP 04017-030, Brazil.
| | - Kathleen M Carroll
- Department of Psychiatry, Yale University School of Medicine, Temple Medical Building, Suite 6C, 40 Temple Street, New Haven, CT 06510, USA.
| |
Collapse
|
15
|
The Importance of Successful Recruitment and Retention Strategies to Reduce Health Disparities. Ann Am Thorac Soc 2019; 15:1138-1140. [PMID: 30272497 DOI: 10.1513/annalsats.201808-516ed] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
16
|
Roviš D, Vasiljev V, Jenko-Pražnikar Z, Petelin A, Drevenšek G, Peruč D, Černelič-Bizjak M. Mental health and drug use severity: the role of substance P, neuropeptide Y, self-reported childhood history of trauma, parental bonding and current resiliency. J Ment Health 2019; 30:88-96. [PMID: 31347421 DOI: 10.1080/09638237.2019.1644492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Many risk factors lead to opioid use and drug-related problems. One of the challenges to understand behavioural factors, drug problems and psychopathology is to identify biological markers that are suitable for research on broad substance abuse and dependence involving human participants. AIMS The study has examined the relationships between the self-reported childhood history of trauma, parental bonding, psychopathology, impulsivity, current resiliency, two neuropeptides, possible markers of behaviour and emotion regulation, and severity of drug-related problems. METHODS One hundred and sixty-seven individuals with a history of opioid use completed questionnaires. Serum neuropeptide Y (NPY) and substance P (SP) levels were analysed. Moderating and mediating relationships between variables were examined using structural equation modelling (SEM). RESULTS Antisocial features, depression, impulsivity, SP, NPY, emotional neglect and resilience are associated with severity of drug-related problems. SP is associated with antisocial personality traits. CONCLUSIONS The novelty of this study is the proposed possible link between biochemical markers, antisocial features and behavioural and emotional regulation. Serum NPY and SP levels have a potential to be used as a biomarker in opioid users before and in the treatment process to account for interactions between biological vulnerabilities and childhood risk factors in predicting behavioural adjustment and more severe drug-related problems.
Collapse
Affiliation(s)
- Darko Roviš
- Department of Social Medicine and Epidemiology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Vanja Vasiljev
- Department of Social Medicine and Epidemiology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Zala Jenko-Pražnikar
- Department of Nutritional Counselling - Dietetics, Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| | - Ana Petelin
- Department of Nutritional Counselling - Dietetics, Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| | - Gorazd Drevenšek
- Department of Psychology, Faculty of Mathematics, Natural Sciences and Information Technologies, University of Primorska, Koper, Slovenia
| | - Dolores Peruč
- Department of Social Medicine and Epidemiology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Maša Černelič-Bizjak
- Department of Nutritional Counselling - Dietetics, Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| |
Collapse
|
17
|
Kim M, Byrne AM, Jeon J. Predictors of treatment participation rate of substance use disorders among Whites and African Americans. J Ethn Subst Abuse 2019; 20:211-224. [PMID: 31113296 DOI: 10.1080/15332640.2019.1612300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Low treatment participation impedes successful treatment completion and reduces treatment effectiveness. This study explored relationships among treatment participation rate and individuals' symptom severities and employment statuses. A sample of 106 individuals with substance use disorders was recruited for cross-sectional investigation. Individuals who were employed at baseline or had lower symptom severities of baseline alcohol, drug use, and psychiatric issues had significantly higher treatment participation rates. Service providers should pay more attention to individuals' symptom severities and employment to encourage treatment participation. Integrated interventions including vocational services and illness management and recovery intervention could be provided to reduce individuals' symptom severities and increase employability. Implications of participation in substance abuse treatment are discussed.
Collapse
Affiliation(s)
- Min Kim
- Human Resource Evaluation, Incheon National University, Incheon, South Korea
| | | | - Jihye Jeon
- Incheon National University, Yeonsu-gu, Incheon, South Korea
| |
Collapse
|
18
|
A feasibility study exploring self-care and parenting for adults recovering from addictive substances. Arch Psychiatr Nurs 2019; 33:155-163. [PMID: 30927985 DOI: 10.1016/j.apnu.2018.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 10/16/2018] [Accepted: 11/17/2018] [Indexed: 11/23/2022]
Abstract
Little information is available on parental self-care while in recovery from addictive substances, and its relationship to parenting and recovery outcomes. We evaluated the feasibility of obtaining self-care and parenting outcomes for adults in long-term recovery from addictive substances, and explored potential contributing factors. Nineteen mothers and fathers who self-reported at least two years of sobriety participated in this study. Feasibility challenges included recruitment and scheduling interviews, given multiple work and personal demands on participants' schedules. Possible associations of self-care to parental efficacy (PE), parenting behaviors, resilience, and total recovery years were examined as indicators to parental functioning. The exploratory analyses showed a significant moderate correlation between PE and parenting behaviors (r = 0.45, p < 0.05) as well as total years in recovery and age (r = 0.43, p < 0.05); total years in recovery differed significantly when compared by race (χ2 (1) = 5.63; p = 0.018) and education (χ2 (1) = 3.94; p = 0.048). There was also a significant inverse relationship between total years in recovery and PE (r = -0.43, p < 0.05) and parental self-care (r = -0.59, p < 0.01). Recruiting parents (especially minorities) in long-term recovery was very challenging indicating that recruitment through community organizations was not feasible without a site champion. Preliminary findings showed statistically significant correlations among self-care, parental efficacy, age, and total years in recovery. As researchers and clinicians, it is necessary to determine the role and impact of self-care for future intervention development, however, recruitment strategies need to be modified to ensure sufficiently large study samples.
Collapse
|
19
|
Saraiya T, Smith KZ, Campbell ANC, Hien D. Posttraumatic stress symptoms, shame, and substance use among Asian Americans. J Subst Abuse Treat 2019; 96:1-11. [PMID: 30466541 PMCID: PMC7534512 DOI: 10.1016/j.jsat.2018.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/29/2018] [Accepted: 10/08/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND To examine the association between posttraumatic stress symptoms (PTSS) and substance use among Asian Americans and the influence of a culturally-relevant moderator, shame. METHODS From 2016 to 2017, 199 participants from Amazon Mechanical Turk and a university subject pool completed an online survey. Chi-square and Kruskal-Wallis tests explored demographic and clinical differences among three Asian American ethnic subgroups (East Asians, South Asians, and Southeast Asians). Generalized linear models assessed the association between PTSS and substance use (alcohol, tobacco, and other drugs) and the moderation of this relationship by shame. RESULTS Ethnic subgroups significantly differed on all three substance use variables. The severity in PTSS was significantly associated with hazardous drug use (IRR = 1.03, (1.01, 1.05), p = .003). The association between PTSS and days of tobacco use and binge drinking was significantly moderated by shame. Low levels of shame increased the effect of PTSS on binge drinking (IRR = 1.05, (1.00, 1.10), p = .035) and tobacco use (IRR = 1.15, (1.11, 1.19), p < .001). High levels of shame had no effect of PTSS on binge drinking (IRR = 1.01, (0.99, 1.03), p = .54) and a reduced effect on tobacco use (IRR = 1.07, (1.05, 1.09), p < .001). CONCLUSIONS Among Asian Americans, the association of PTSS and substance use depends on shame. Lower levels of shame are a risk factor, increasing the effect of PTSS on substance use. Culturally-modified addiction treatments should assess for shame among Asian Americans and attend to ethnic sub-group diversity in substance use.
Collapse
Affiliation(s)
- T Saraiya
- The City College of New York, The City University of New York, 160 Convent Avenue, New York, NY 10031, USA; Derner School of Psychology, Adelphi University, 158 Cambridge Avenue, Garden City, NY 11530, USA.
| | - K Z Smith
- Columbia University Medical Center, Department of Psychiatry and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - A N C Campbell
- Columbia University Medical Center, Department of Psychiatry and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - D Hien
- The City College of New York, The City University of New York, 160 Convent Avenue, New York, NY 10031, USA; Center of Alcohol Studies, Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey, 607 Allison Road, Piscataway Township, NJ 08854, USA.
| |
Collapse
|
20
|
Neale J, Tompkins CNE, McDonald R, Strang J. Improving recruitment to pharmacological trials for illicit opioid use: findings from a qualitative focus group study. Addiction 2018; 113:1066-1076. [PMID: 29356208 PMCID: PMC5969063 DOI: 10.1111/add.14163] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/20/2017] [Accepted: 01/12/2018] [Indexed: 11/29/2022]
Abstract
AIM To explore potential study participants' views on willingness to join clinical trials of pharmacological interventions for illicit opioid use to inform and improve future recruitment strategies. DESIGN Qualitative focus group study [six groups: oral methadone (two groups); buprenorphine tablets (two groups); injectable opioid agonist treatment (one group); and former opioid agonist treatment (one group)]. SETTINGS Drug and alcohol services and a peer support recovery service (London, UK). PARTICIPANTS Forty people with experience of opioid agonist treatment for heroin dependence (26 males, 14 females; aged 33-66 years). MEASUREMENTS Data collection was facilitated by a topic guide that explored willingness to enrol in clinical pharmacological trials. Groups were audio-recorded and transcribed. Transcribed data were analysed inductively via Iterative Categorization. FINDINGS Participants' willingness to join pharmacological trials of medications for opioid dependence was affected by factors relating to study burden, study drug, study design, study population and study relationships. Participants worried that the trial drug might be worse than, or interfere with, their current treatment. They also misunderstood aspects of trial design despite the researchers' explanations. CONCLUSIONS Recruitment of participants for clinical trials of pharmacological interventions for illicit opioid use could be improved if researchers became better at explaining clinical trials to potential participants, dispelling misconceptions about trials and increasing trust in the research process and research establishment. A checklist of issues to consider when designing pharmacological trials for illicit opioid use is proposed.
Collapse
Affiliation(s)
- Joanne Neale
- National Addiction CentreKing's College London, LondonUK,Centre for Social Research in HealthUniversity of New South Wales, SydneyAustralia
| | | | | | - John Strang
- National Addiction CentreKing's College London, LondonUK
| |
Collapse
|
21
|
Gryczynski J, Carswell SB, O'Grady KE, Mitchell SG, Schwartz RP. Gender and ethnic differences in primary care patients' response to computerized vs. in-person brief intervention for illicit drug misuse. J Subst Abuse Treat 2017; 84:50-56. [PMID: 29195593 DOI: 10.1016/j.jsat.2017.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 10/17/2017] [Accepted: 10/17/2017] [Indexed: 12/19/2022]
Abstract
This study is a secondary analysis from a randomized clinical trial of computerized vs. in-person brief intervention (BI) for illicit drug misuse among adult primary care patients (N=359; 45% Female; 47% Hispanic) with moderate-risk illicit drug misuse as measured by the World Health Organization's Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). This study examined differences in response to the two brief intervention strategies (both based on motivational interviewing) on the basis of gender and ethnicity, comparing non-Hispanic males, non-Hispanic females, Hispanic males, and Hispanic females. Participants were assessed at baseline, 3-, 6-, and 12-month follow-up with the ASSIST. Trajectories in Global Continuum of Illicit Drug Risk Scores were examined using a generalized linear mixed model. There were significant differences in response to computerized vs. in-person BI over time on the basis of gender-ethnic subgroups (Gender×Ethnicity×Condition×Time interaction; p=0.03), with Hispanic males tending to respond more favorably to the computerized BI and Hispanic females tending to respond more favorably to the in-person BI. There was no clear differentiation in response to the two BIs among non-Hispanic males, while among non-Hispanic females the pattern of change converged following baseline differences. Consideration of gender and ethnic differences in future studies of BI is warranted.
Collapse
Affiliation(s)
- Jan Gryczynski
- Friends Research Institute, 1040 Park Avenue, #103, Baltimore, MD 21201, United States.
| | - Steven B Carswell
- Friends Research Institute, 1040 Park Avenue, #103, Baltimore, MD 21201, United States
| | - Kevin E O'Grady
- Friends Research Institute, 1040 Park Avenue, #103, Baltimore, MD 21201, United States
| | - Shannon Gwin Mitchell
- Friends Research Institute, 1040 Park Avenue, #103, Baltimore, MD 21201, United States
| | - Robert P Schwartz
- Friends Research Institute, 1040 Park Avenue, #103, Baltimore, MD 21201, United States
| |
Collapse
|
22
|
Raynor PA, Pope C, York J, Smith G, Mueller M. Exploring Self-Care and Preferred Supports for Adult Parents in Recovery from Substance Use Disorders: Qualitative Findings from a Feasibility Study. Issues Ment Health Nurs 2017; 38:956-963. [PMID: 29028365 DOI: 10.1080/01612840.2017.1370520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Very little is known about the self-care behaviors (SCB) that adult parents employ and the preferred supports they utilize to maintain their recovery from substance use disorders (SUD) while also parenting their children. This study used a qualitative descriptive approach to explore perceptions of self-care and parenting to inform future self-care interventions for parents in early recovery. Nineteen mothers and fathers of at least one child between the ages of 6-18 were interviewed by telephone about parental self-care practices while in recovery from SUD, recovery management, and preferred supports in the community. Participants described the experience of parenting as challenging, with variations in the level of support and resources. Self-care included meaningful connection with recovery support and children, taking care of physical health, maintaining spirituality, healthy eating, exercise, journaling, continuing education, staying busy, sponsorship, establishing boundaries, self-monitoring, abstinence, and dealing with destructive emotions. Participants reported SCB as being a critical component of their ongoing recovery and their parenting practices, though differences in SCB by gender and for minorities require further exploration. Parental gains were perceived as benefits of SCB that minimized the negative impact of prior parental drug use on their children.
Collapse
Affiliation(s)
- Phyllis A Raynor
- a University of South Carolina, College of Nursing , Columbia , South Carolina , USA
| | | | | | | | | |
Collapse
|
23
|
Graves D, Sheldon JP. Recruiting African American Children for Research: An Ecological Systems Theory Approach. West J Nurs Res 2017; 40:1489-1521. [PMID: 28436265 DOI: 10.1177/0193945917704856] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
With health disparities still pervasive and persistent in the United States, medical researchers and social scientists continue to develop recruitment strategies to increase the inclusion of racial/ethnic minority groups in research and interventions. Effective methods for recruiting samples of African American participants for pediatric research may be best understood when situated within an overarching conceptual model-one that serves to organize and explain effective recruitment strategies. A theoretical framework well suited for this purpose is Bronfenbrenner's ecological systems theory, which views individuals as influencing and being influenced by (both directly and indirectly) a series of interconnected social systems. Based on the ecological systems theory and on previous research from multiple domains (e.g., medicine, psychology, public health, social work), in the current article, we review strategies for effective recruitment of African American children and adolescents for research.
Collapse
|
24
|
Blanchard JW, Tallbull G, Wolpert C, Powell J, Foster MW, Royal C. Barriers and Strategies Related to Qualitative Research on Genetic Ancestry Testing in Indigenous Communities. J Empir Res Hum Res Ethics 2017; 12:169-179. [PMID: 28434393 DOI: 10.1177/1556264617704542] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Conducting genetics-related research with populations that have historically experienced considerable harm and little benefit from genetics research poses unique challenges for understanding community-based perceptions of new genetic technologies. This article identifies challenges and strategies for collecting qualitative data on the perceptions of direct-to-consumer (DTC) Genetic Ancestry tests (GAT) among diverse Indigenous communities. Based on a 3-year project related to perceptions, attitudes, and values associated with genetic ancestry testing among diverse Indigenous communities in Oklahoma, the engagement process revealed specific opportunities to improve the process of qualitative data collection related to GAT, and more broadly, to conduct genetics-related research with Indigenous communities in culturally and methodologically appropriate ways. Priority areas include issues related to participant recruitment and tribal advisory boards, challenges of self-identification as a recruitment mechanism, and the necessity of including Indigenous researchers in all aspects of the research process.
Collapse
|
25
|
Susukida R, Crum RM, Stuart EA, Ebnesajjad C, Mojtabai R. Assessing sample representativeness in randomized controlled trials: application to the National Institute of Drug Abuse Clinical Trials Network. Addiction 2016; 111:1226-34. [PMID: 26825855 PMCID: PMC4899104 DOI: 10.1111/add.13327] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/23/2015] [Accepted: 01/28/2016] [Indexed: 11/28/2022]
Abstract
AIMS To compare the characteristics of individuals participating in randomized controlled trials (RCTs) of treatments of substance use disorder (SUD) with individuals receiving treatment in usual care settings, and to provide a summary quantitative measure of differences between characteristics of these two groups of individuals using propensity score methods. Design Analyses using data from RCT samples from the National Institute of Drug Abuse Clinical Trials Network (CTN) and target populations of patients drawn from the Treatment Episodes Data Set-Admissions (TEDS-A). Settings Multiple clinical trial sites and nation-wide usual SUD treatment settings in the United States. PARTICIPANTS A total of 3592 individuals from 10 CTN samples and 1 602 226 individuals selected from TEDS-A between 2001 and 2009. Measurements The propensity scores for enrolling in the RCTs were computed based on the following nine observable characteristics: sex, race/ethnicity, age, education, employment status, marital status, admission to treatment through criminal justice, intravenous drug use and the number of prior treatments. Findings The proportion of those with ≥ 12 years of education and the proportion of those who had full-time jobs were significantly higher among RCT samples than among target populations (in seven and nine trials, respectively, at P < 0.001). The pooled difference in the mean propensity scores between the RCTs and the target population was 1.54 standard deviations and was statistically significant at P < 0.001. CONCLUSIONS In the United States, individuals recruited into randomized controlled trials of substance use disorder treatments appear to be very different from individuals receiving treatment in usual care settings. Notably, RCT participants tend to have more years of education and a greater likelihood of full-time work compared with people receiving care in usual care settings.
Collapse
Affiliation(s)
- Ryoko Susukida
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Rosa M. Crum
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe St. Baltimore, MD 21287
| | - Elizabeth A. Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Cyrus Ebnesajjad
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Ramin Mojtabai
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe St. Baltimore, MD 21287
| |
Collapse
|
26
|
Peavy KM, Garrett S, Doyle S, Donovan D. A comparison of African American and Caucasian stimulant users in 12-step facilitation treatment. J Ethn Subst Abuse 2016; 16:380-399. [PMID: 27294812 DOI: 10.1080/15332640.2016.1185657] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Engagement in 12-step meetings and activities has been shown to be a powerful aid to recovery from substance use disorders. However, only limited attention has been given to ethnic and racial differences in attitudes toward 12-step and involvement. This study utilized data from a large multisite trial testing the effectiveness of a 12-step facilitation therapy with stimulant-dependent treatment seekers. We compared baseline differences and treatment outcomes between African American and Caucasian participants. A select few baseline differences were found (i.e., African Americans reported higher levels of spirituality than Caucasians; African American participants indicated more perceived benefits of 12-step involvement; Caucasians were more likely to endorse future involvement in 12-step). There were no outcome differences (e.g., substance use outcomes, 12-step meeting attendance). The tested intervention produced similar outcomes for both groups, indicating that it may be useful across racial categories.
Collapse
Affiliation(s)
- K Michelle Peavy
- a Alcohol & Drug Abuse Institute , University of Washington , Seattle , Washington.,b Evergreen Treatment Services , Seattle , Washington
| | - Sharon Garrett
- a Alcohol & Drug Abuse Institute , University of Washington , Seattle , Washington
| | - Suzanne Doyle
- a Alcohol & Drug Abuse Institute , University of Washington , Seattle , Washington
| | - Dennis Donovan
- a Alcohol & Drug Abuse Institute , University of Washington , Seattle , Washington
| |
Collapse
|
27
|
Sahker E, Toussaint MN, Ramirez M, Ali SR, Arndt S. Evaluating racial disparity in referral source and successful completion of substance abuse treatment. Addict Behav 2015; 48:25-9. [PMID: 25935719 DOI: 10.1016/j.addbeh.2015.04.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 02/27/2015] [Accepted: 04/14/2015] [Indexed: 11/18/2022]
Abstract
Health disparity is a significant problem in the United States, and particularly for substance abuse treatment programs. A better understanding of racial differences in treatment pathways associated with successful treatment completion is needed to reduce the existing health disparities. Referral source is a strong predictor of treatment success and most research on health disparities has focused on the criminal justice referrals. However, little research has examined other types of referral sources, and the interaction with race. The current study sought to compare the effect of referral sources on national substance abuse successful treatment completion rates between Black clients (n=324,625) and White clients (n=1,060,444) by examining the interaction of race on referral source and successful treatment completion. Race significantly moderated the difference between referral source and successful treatment completion (Wald χ(2)=1477.73, df=6, p<0.0001). Employment referral was associated with the greatest percentage of successful treatment completion for Black clients. Criminal justice referral was associated with the greatest percentage of successful treatment completion for White clients. Results from the present study support a reevaluation of incentives leading to successful treatment completion with a multicultural perspective.
Collapse
Affiliation(s)
- Ethan Sahker
- Iowa Consortium for Substance Abuse Research and Evaluation, 100 MTP4, University of Iowa, Iowa City, IA 52245-5000, USA; Department of Psychological and Quantitative Foundations, Counseling Psychology Program, College of Education, University of Iowa, 361 Lindquist Center, Iowa City, IA 52242, USA
| | - Maisha N Toussaint
- Department of Epidemiology, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA 52242, USA
| | - Marizen Ramirez
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, 145 N. Riverside Drive, 100 CPHB, Iowa City, IA 52242, USA
| | - Saba R Ali
- Department of Psychological and Quantitative Foundations, Counseling Psychology Program, College of Education, University of Iowa, 361 Lindquist Center, Iowa City, IA 52242, USA
| | - Stephan Arndt
- Iowa Consortium for Substance Abuse Research and Evaluation, 100 MTP4, University of Iowa, Iowa City, IA 52245-5000, USA; Department of Psychiatry, Carver College of Medicine, University of Iowa, 451 Newton Road, 200 Medicine Administration Building, Iowa City, IA 52242, USA; Department of Biostatistics, College of Public Health, University of Iowa, 145 N. Riverside Drive, 100 CPHB, Iowa City, IA 52242, USA.
| |
Collapse
|
28
|
Association of race and age with treatment attendance and completion among adult marijuana users in community-based substance abuse treatment. J Addict Med 2015; 8:143-9. [PMID: 24603621 DOI: 10.1097/adm.0000000000000030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES African American youth who use marijuana are less likely to attend and complete treatment than white youth. Limited information is available on racial and age variation in treatment attendance and completion among adults who use marijuana. METHODS The current research examined differences in community-based substance abuse treatment attendance and completion between adult African American and white marijuana users in 2 independent samples from the US southeastern (N = 160; 70.6% African American) and mid-Atlantic (N = 450; 34.7% African American) regions. OUTCOMES Attended at least 3 treatment sessions, successful treatment completion, number of days in treatment, and percentage of positive urine drug screens. Adjusted regression models examined the association of race, age, and the interaction of race and age with treatment attendance and completion. RESULTS In the southeastern sample, successful treatment completion was significantly associated with the interaction of race and age (adjusted odds ratio = 1.35, 95% confidence interval = 1.08-1.69); whereas younger African Americans were less likely to complete treatment than older African Americans, age was unrelated to treatment completion among whites. In the mid-Atlantic sample, African Americans were significantly less likely to attend at least 3 treatment sessions (adjusted odds ratio = 0.37, 95% confidence interval = 0.23-0.58), and younger adult marijuana users were retained for fewer days in treatment (adjusted β = 0.13, 95% confidence interval = 0.27-2.48). Among African Americans, 37.9% (SD = 38.0) of urine drug screens tested positive for at least 1 illicit drug, and among whites, 34.2% (SD = 37.8%) tested positive; the percentage of positive urine drug screens was not associated with race or age. CONCLUSIONS Among marijuana-using adults, treatment attendance and completion differ by race and age, and improvements in treatment completion may occur as some African Americans mature out of young adulthood.
Collapse
|
29
|
Clinical trials and American Indians/Alaska Natives with substance use disorders: identifying potential strategies for a new cultural-based intervention. JOURNAL OF PUBLIC MENTAL HEALTH 2014. [DOI: 10.1108/jpmh-01-2014-0003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to address a significant public mental health disparity affecting American Indians/Alaska Natives (AI/ANs): the shortage of clinical trials research analyzing the benefits of AI/AN traditional-based treatments, e.g. drumming.
Design/methodology/approach
– A total of four focus groups were conducted among outpatient and inpatient AI/AN substance abuse patients and providers serving AI/ANs. The purpose of these focus groups was to obtain insights relating to the recent challenges of conducting a clinical trial within the outpatient treatment setting seeking to analyze the benefits of a new substance abuse treatment intervention utilizing drumming for AI/ANs [Drum-assisted Recovery Therapy for Native Americans (DARTNA)] and to obtain recommendations to successfully conduct a similar study within an inpatient treatment setting.
Findings
– The most prevalent barriers to conducting a clinical trial within an outpatient setting were transportation and child care issues. Recommendations were obtained with regard to optimizing recruitment and retention for a future study within an inpatient setting.
Originality/value
– This research offers the field rare information that helps toward identifying strategies to successfully conduct clinical trials investigating the benefits of culturally-appropriate treatments for AI/ANs with substance use disorders.
Collapse
|
30
|
Heller C, Balls-Berry JE, Nery JD, Erwin PJ, Littleton D, Kim M, Kuo WP. Strategies addressing barriers to clinical trial enrollment of underrepresented populations: a systematic review. Contemp Clin Trials 2014; 39:169-82. [PMID: 25131812 DOI: 10.1016/j.cct.2014.08.004] [Citation(s) in RCA: 179] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 08/01/2014] [Accepted: 08/02/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Underrepresentation of racial and ethnic minorities in clinical trials remains a reality while they have disproportionately higher rates of health disparities. OBJECTIVE The purpose of this study was to identify successful community-engaged interventions that included health care providers as a key strategy in addressing barriers to clinical trial enrollment of underrepresented patients. DESIGN A systematic review of the literature on interventions addressing enrollment barriers to clinical trials for racial and ethnic minorities was performed in Ovid MEDLINE, EBSCO Megafile, and EBSCO CINAHL. The systematic review identified 360 studies, and 20 were selected using the inclusion criteria. An iterative process extracted information from the eligible studies. RESULTS The 20 selected studies were analyzed and then grouped by first author, nature of the clinical research initiative, priority populations, key strategies, and study outcomes. Nine of the studies addressed cancer clinical trials and 11 related to chronic medical conditions, including diabetes, hypertension management, and chronic kidney disease. The key strategies employed were categorized according to their presumed impact on barriers incurred at distinct steps in study recruitment: clinical trial awareness, opportunity to participate, and acceptance of enrollment. The strategies were further categorized by whether they would address barriers associated with minority perceptions of the research process and barriers related to how studies were designed and implemented. CONCLUSION Multiple and flexible strategies targeting providers and participants at provider sites and within communities might be needed to enroll underrepresented populations into clinical trials.
Collapse
Affiliation(s)
- Caren Heller
- Weill Cornell Medical College, Department of Medicine, Division of Medical Ethics, United States
| | - Joyce E Balls-Berry
- Mayo Clinic, Department of Health Sciences Research, Division of Epidemiology, United States; Mayo Clinic, Center for Clinical and Translational Science Office for Community Engagement in Research, United States.
| | - Jill Dumbauld Nery
- University of California San Diego, Clinical and Translational Research Institute, United States
| | | | | | - Mimi Kim
- NC TraCS Institute, The University of North Carolina at Chapel Hill, United States; Center for Biobehavioral Health Disparities, United States
| | - Winston P Kuo
- Interferon Expression Signature Diagnostics, Cambridge, MA 02139, United States; Harvard Catalyst, Laboratory for Innovative Translational Technologies, Harvard Medical School, Boston, MA 02115, United States
| |
Collapse
|
31
|
McCallum GB, Versteegh LA, Morris PS, Mckay CC, Jacobsen NJ, White AV, D'Antoine HA, Chang AB. Mobile phones support adherence and retention of indigenous participants in a randomised controlled trial: strategies and lessons learnt. BMC Public Health 2014; 14:622. [PMID: 24943961 PMCID: PMC4067523 DOI: 10.1186/1471-2458-14-622] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 06/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ensuring adherence to treatment and retention is important in clinical trials, particularly in remote areas and minority groups. We describe a novel approach to improve adherence, retention and clinical review rates of Indigenous children. METHODS This descriptive study was nested within a placebo-controlled, randomised trial (RCT) on weekly azithromycin (or placebo) for 3-weeks. Indigenous children aged ≤24-months hospitalised with acute bronchiolitis were recruited from two tertiary hospitals in northern Australia (Darwin and Townsville). Using mobile phones embedded within a culturally-sensitive approach and framework, we report our strategies used and results obtained. Our main outcome measure was rates of adherence to medications, retention in the RCT and self-presentation (with child) to clinic for a clinical review on day-21. RESULTS Of 301 eligible children, 76 (21%) families declined participation and 39 (13%) did not have access to a mobile phone. 186 Indigenous children were randomised and received dose one under supervision in hospital. Subsequently, 182 (99%) children received dose two (day-7), 169 (93%) dose three (day-14) and 180 (97%) attended their clinical review (day-21). A median of 2 calls (IQR 1-3) were needed to verify adherence. Importantly, over 97% of children remained in the RCT until their clinical endpoint at day-21. CONCLUSIONS In our setting, the use of mobile phones within an Indigenous-appropriate framework has been an effective strategy to support a clinical trial involving Australian Indigenous children in urban and remote Australia. Further research is required to explore other applications of this approach, including the impact on clinical outcomes. TRIAL REGISTRATION ACTRN12608000150347 (RCT component).
Collapse
Affiliation(s)
- Gabrielle B McCallum
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Glover M, Kira A, Johnston V, Walker N, Thomas D, Chang AB, Bullen C, Segan CJ, Brown N. A systematic review of barriers and facilitators to participation in randomized controlled trials by Indigenous people from New Zealand, Australia, Canada and the United States. Glob Health Promot 2014; 22:21-31. [PMID: 24842989 DOI: 10.1177/1757975914528961] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
ISSUE Many randomized controlled trials (RCTs) are conducted each year but only a small proportion is specifically designed for Indigenous people. In this review we consider the challenges of participation in RCTs for Indigenous peoples from New Zealand, Australia, Canada and the United States and the opportunities for increasing participation. APPROACH The literature was systematically searched for published articles including information on the barriers and facilitators for Indigenous people's participation in health-related RCTs. Articles were identified using a key word search of electronic databases (Scopus, Medline and EMBASE). To be included, papers had to include in their published work at least one aspect of their RCT that was either a barrier and/or facilitator for participation identified from, for example, design of intervention, or discussion sections of articles. Articles that were reviews, discussions, opinion pieces or rationale/methodology were excluded. Results were analysed inductively, allowing themes to emerge from the data. KEY FINDINGS Facilitators enabling Indigenous people's participation in RCTs included relationship and partnership building, employing Indigenous staff, drawing on Indigenous knowledge models, targeted recruitment techniques and adapting study material. Challenges for participation included both participant-level factors (such as a distrust of research) and RCT-level factors (including inadequately addressing likely participant barriers (phone availability, travel costs), and a lack of recognition or incorporation of Indigenous knowledge systems. IMPLICATION The findings from our review add to the body of knowledge on elimination of health disparities, by identifying effective and practical strategies for conducting and engaging Indigenous peoples with RCTs. Future trials that seek to benefit Indigenous peoples should actively involve Indigenous research partners, and respect and draw on pertinent Indigenous knowledge and values. This review has the potential to assist in the design of such studies.
Collapse
Affiliation(s)
- Marewa Glover
- Centre for Tobacco Control Research, University of Auckland, New Zealand
| | - Anette Kira
- Centre for Tobacco Control Research, University of Auckland, New Zealand
| | - Vanessa Johnston
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Natalie Walker
- National Institute for Health Innovation, University of Auckland, New Zealand
| | - David Thomas
- Menzies School of Health Research, Charles Darwin University and the Lowitja Institute, Darwin, Australia
| | - Anne B Chang
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Chris Bullen
- National Institute for Health Innovation, University of Auckland, New Zealand
| | - C J Segan
- Centre for Health Policy, Programs and Economics, University of Melbourne, Australia
| | - Ngiare Brown
- Menzies School of Health Research, Charles Darwin University and the Lowitja Institute, Darwin, Australia
| |
Collapse
|
33
|
Amaro H. Implementing mindfulness-based relapse prevention in diverse populations: challenges and future directions. Subst Use Misuse 2014; 49:612-6. [PMID: 24611858 DOI: 10.3109/10826084.2014.856624] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Hortensia Amaro
- School of Social Work and Department of Preventive Medicine, University of Southern California , Los Angeles, CA , USA
| |
Collapse
|
34
|
Valera P, Cook S, Macklin R, Chang Y. Conducting Health Disparities Research with Criminal Justice Populations: Examining Research, Ethics, and Participation. ETHICS & BEHAVIOR 2014; 24:164-174. [PMID: 25045243 PMCID: PMC4101906 DOI: 10.1080/10508422.2013.826581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study explored the challenges of informed consent and understanding of the research process among Black and Latino men under community supervision (e.g., parole and/or probation). Between February and October 2012, we conducted cognitive face-to-face interviews using open-ended questions on the significant areas of research participation (i.e., the informed consent process, confidentiality, compensation, what is meant by human subject and clinical trials) among 259 men aged 35 to 67 under community supervision in Bronx, New York. Content analysis of the open-ended questions revealed limited knowledge concerning the understanding of research participation. The study participants appeared to generally understand concepts such as compensation after research participation and confidentiality. Participants demonstrated a lack of understanding of certain aspects of the research process-informed consent, human subject, Institutional Review Board, and clinical trials. These findings are informative to researchers conducting studies with criminal justice populations and Institutional Review Boards reviewing research studies.
Collapse
Affiliation(s)
- Pamela Valera
- Department of Sociomedical Sciences Columbia University Mailman School of Public Health
| | - Stephanie Cook
- Department of Health Behavior and Health Education University of Michigan School of Public Health
| | - Ruth Macklin
- Department of Epidemiology & Population Health Albert Einstein School of Medicine
| | - Yvonne Chang
- Department of Sociomedical Sciences Columbia University Mailman School of Public Health
| |
Collapse
|
35
|
Bertrand K, Richer I, Brunelle N, Beaudoin I, Lemieux A, Ménard JM. Substance abuse treatment for adolescents: how are family factors related to substance use change? J Psychoactive Drugs 2013; 45:28-38. [PMID: 23662329 DOI: 10.1080/02791072.2013.763560] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Parental involvement in adolescents' substance abuse treatment is highly recommended, even though the mechanisms explaining how this favors youths' recovery are not well understood. The present study examines the association between (1) changes in adolescents' substance use and parenting practices, as measured by adolescent self-disclosure and parental warmth; (2) changes in mothers' mental health and their parenting practices, and (3) parental use of services offered by substance abuse treatment centres, parenting practices and adolescent substance use. In total, 147 adolescents and 69 mothers participated in this study. Participants were assessed upon adolescent admission into treatment, as well as at three- and six-month follow-up. Results show an association between improved maternal mental health and greater parental warmth, as perceived by adolescents. In addition, greater parental use of treatment services was found to be associated with greater adolescent self-disclosure and greater reduction of adolescent substance use. Finally, greater adolescent self-disclosure and parental warmth were both associated with lower adolescent substance use. These findings underscore the need to facilitate parents' access to and involvement in treatment of adolescents. The parent-adolescent relationship and the mental health of parents are essential aspects to consider for interventions.
Collapse
Affiliation(s)
- Karine Bertrand
- Department of Community Health Sciences, Université de Sherbrooke, Longueuil, Quebec, Canada.
| | | | | | | | | | | |
Collapse
|
36
|
Weinberger AH, Mazure CM, Morlett A, McKee SA. Two decades of smoking cessation treatment research on smokers with depression: 1990-2010. Nicotine Tob Res 2013; 15:1014-31. [PMID: 23100459 PMCID: PMC3693502 DOI: 10.1093/ntr/nts213] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 08/22/2012] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Adults with depression smoke at higher rates than other adults leaving a large segment of this population, who already incur increased health-related risks, vulnerable to the enormous harmful consequences of smoking. Yet, the impact that depression has on smoking cessation is not clear due to the mixed results of past research. The primary aims of this review were to synthesize the research examining the relationship of depression to smoking cessation outcomes over a 20-year period, to examine the gender and racial composition of these studies, and to identify directions for future research. METHODS Potential articles published between January 1, 1990 and December 31, 2010 were identified through a MEDLINE search of the terms "clinical trial," "depression," and "smoking cessation." 68 studies used all three terms and met the inclusion criteria. RESULTS The majority of studies examined either a past diagnosis of major depression or current depression symptoms. Within the few studies that examined the interaction of gender and depression on smoking cessation, depression had a greater impact on treatment outcomes for women than men. No study reported examining the interactive impact of race and depression on treatment outcomes. CONCLUSIONS Although attention to the relationship of depression and smoking cessation outcomes has increased over the past 20 years, little information exists to inform a treatment approach for smokers with Current Major Depressive Disorder, Dysthymia, and Minor Depression and few studies report gender and racial differences in the relationship of depression and smoking cessation outcomes, thus suggesting major areas for targeted research.
Collapse
Affiliation(s)
- Andrea H Weinberger
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA.
| | | | | | | |
Collapse
|
37
|
Burlew AK, Copeland VC, Ahuama-Jonas C, Calsyn DA. Does cultural adaptation have a role in substance abuse treatment? SOCIAL WORK IN PUBLIC HEALTH 2013; 28:440-60. [PMID: 23731430 PMCID: PMC4220306 DOI: 10.1080/19371918.2013.774811] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The changing ethnic composition of the nation and increasing requirements to use evidence-based treatments (EBTs) challenge mental health professionals to adapt treatments and interventions to be appropriate for their clients. This article applies the available information on cultural adaptation to substance abuse. The authors' review suggests that the most common approaches for adapting substance use interventions include some combination of either community involvement in the adaptation, existing research and literature, and/or consultation from experts to adapt EBTs. The challenges facing the development of culturally adapted interventions include the need for additional research to determine which specific EBTs warrant adaptation, the responsibility of maintaining the balance between fidelity and adaptation, and the challenge of intragroup diversity.
Collapse
Affiliation(s)
- A Kathleen Burlew
- Department of Psychology, University of Cincinnati, Cincinnati, OH 45221, USA.
| | | | | | | |
Collapse
|
38
|
Montgomery L, Petry NM, Carroll KM. Moderating effects of race in clinical trial participation and outcomes among marijuana-dependent young adults. Drug Alcohol Depend 2012; 126:333-9. [PMID: 22743160 PMCID: PMC3501540 DOI: 10.1016/j.drugalcdep.2012.05.033] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 05/28/2012] [Accepted: 05/30/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Few studies have examined clinical trial participation rates and treatment outcomes among underserved young adults who are dependent on marijuana, the most commonly abused illicit drug. METHOD The present study was a secondary analysis of a trial of court-referred marijuana-dependent young adults (ages 18-25) randomized to one of four treatment conditions: Motivational Enhancement Therapy/Cognitive Behavioral Therapy (MET/CBT), MET/CBT+Contingency Management (CM), Drug Counseling (DC) or DC+CM. African American (N=81) participants were compared to White (N=31) participants with respect to rates of participation in phases of treatment and substance use outcomes. In addition, the interaction of race and treatment condition was examined to ascertain if the interventions yielded different effects based on race. RESULTS Among those who started treatment, African American young adults were significantly less likely to complete the treatment and posttreatment phases of the clinical trial than their White counterparts. Irrespective of treatment type, substance use outcomes (i.e., percentage of marijuana-negative specimens and longest duration of continuous abstinence) did not vary by race. However, there was a significant interaction effect between treatment type and race; African American young adults did not benefit differentially from any specific type of treatment, but CM was effective in reducing proportion of marijuana positive samples among White young adults. CONCLUSIONS Findings suggest that clinical trial treatment and posttreatment completion rates vary by race in this population, as does response to specific treatment types. More treatment research focusing specifically on African American marijuana-dependent young adults is warranted.
Collapse
Affiliation(s)
- LaTrice Montgomery
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States.
| | | | | |
Collapse
|
39
|
Greenfield BL, Venner KL. Review of Substance Use Disorder Treatment Research in Indian Country: Future Directions to Strive toward Health Equity. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2012; 38:483-92. [DOI: 10.3109/00952990.2012.702170] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|