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De Leon AN, Dvorak RD, Perrotte JK, Klaver SJ, Peterson R, Magri TD, Burr EK, Leary AV, Aguilar B. The role of sociocultural factors on alcohol self-efficacy and protective drinking behaviors among Hispanic/Latinx young adults. ETHNICITY & HEALTH 2024:1-25. [PMID: 38714915 DOI: 10.1080/13557858.2024.2345916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/16/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVES Hispanic/Latinx drinkers have been found to experience more adverse alcohol-related consequences than any other racial/ethnic group. Due to this, researchers have looked at the connection between drinking and cultural factors, alongside discrimination, to further analyze what sociocultural factors lead to negative outcomes when drinking. DESIGN Researchers used a sample of Hispanic/Latinx young adult drinkers (n = 710) with an average age of 22.43 (SD = 6.69), recruited through social media and assessed on several factors, including protective behavioral strategies (PBS), alcohol use severity, bicultural self-efficacy, discrimination, acculturation, and enculturation. RESULTS Utilizing an observed variable path analysis, results showed perceived discrimination to have a significant effect on all variables in the model (bicultural self-efficacy, acculturation, enculturation, PBS self-efficacy, PBS use, and alcohol use severity). Acculturation was positively associated with PBS self-efficacy, while enculturation was positively associated with PBS use. PBS self-efficacy was positively correlated with PBS use and negatively associated with alcohol use severity. There was a significant total indirect effect from perceived discrimination to alcohol use severity through various paths (i.e. PBS self-efficacy, acculturation, and bicultural self-efficacy), with the strongest path to occur through PBS self-efficacy. CONCLUSIONS Findings showcase the risk and protective effects of various sociocultural factors on drinking behaviors among young adults. PBS self-efficacy was found to have robust protective effects against alcohol use severity. Future research should continue to investigate these sociocultural and behavioral factors in order to develop efforts to mitigate hazardous alcohol use among Hispanic/Latinx young adult drinkers.
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Affiliation(s)
- Ardhys N De Leon
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Robert D Dvorak
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | | | - Samantha J Klaver
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Roselyn Peterson
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
| | - Tatiana D Magri
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Emily K Burr
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Angelina V Leary
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Bradley Aguilar
- Department of Psychology, University of Central Florida, Orlando, FL, USA
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Lee CS, Nalven T, Hai A, Pinedo M, Lopez V, Morris M, Delva J, Cano M. The relationship between discrimination, alcohol use severity, and PTSD symptoms among Latinx heavy drinkers. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 159:209263. [PMID: 38103830 PMCID: PMC10947868 DOI: 10.1016/j.josat.2023.209263] [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: 05/27/2023] [Revised: 11/01/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Discrimination is linked to alcohol use severity among Latinx adults, who also show high prevalence rates of PTSD compared to non-Latinx adults. We know little about whether PTSD symptoms affects the relationship between discrimination and alcohol use severity. We hypothesized that the association between discrimination and alcohol use severity might differ by level of PTSD symptom severity. METHODS This is a secondary cross-sectional analysis of data collected at baseline from a completed randomized clinical trial testing the relative efficacy of a culturally adapted motivational interview designed to address discrimination and drinking behavior against an unadapted motivational interview for Latinx adults. Eligible participants screened positive for the NIAAA Single Alcohol Screening Question for heavy drinking days, identified as Latinx, and were 18-65 years old. We assessed the Everyday Discrimination Scale, Primary Care PC-PTSD screener, Alcohol Use Disorder Identification Test, and the Short Acculturation Scale for Hispanics. The study analyzed the main and interactive effects of discrimination and PTSD symptoms on alcohol use severity, while controlling for age, sex, household income, and acculturation. RESULTS After controlling for covariates in model 2, the interaction of discrimination and PTSD symptoms was significantly related to alcohol use severity. Simple slopes analysis indicated that discrimination was positively related to alcohol use severity among those with high (1 SD above the mean) but not low (1 SD below the mean) levels of PTSD symptoms. CONCLUSIONS Evidence suggests that the experiences of discrimination were associated with alcohol use severity among those who reported more PTSD symptoms. Specifically, discrimination may have a stronger effect on alcohol use severity among Latinx adults who report more PTSD symptoms. Screening Latinx adults for heavy drinking days, discrimination, and PTSD symptoms is clinically important. Culturally adapted alcohol interventions that target discrimination may be particularly effective for Latinx individuals with more PTSD symptoms.
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Affiliation(s)
- Christina S Lee
- Boston University School of Social Work, 264 Bay State Road, Room 354, Boston, MA 02215, United States of America.
| | - Tessa Nalven
- Dept. of Psychology, University of Rhode Island, United States of America
| | - Audrey Hai
- Tulane University School of Social Work, United States of America
| | - Miguel Pinedo
- Dept of Health Sciences, University of Texas at Austin, United States of America
| | | | - Melanie Morris
- Boston University School of Social Work, United States of America
| | - Jorge Delva
- Boston University School of Social Work, United States of America
| | - Miguel Cano
- Dept. of Epidemiology, University of Texas Southwestern, United States of America
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Magill M, Figuereo V, Zelaya DG, Jackson K, Colby SM, Lee CS. Technical and relational process in MI sessions with a sample of Hispanic/Latinx adults who engage in heavy drinking: A latent growth mediation model. J Ethn Subst Abuse 2024:1-20. [PMID: 38193481 PMCID: PMC11231063 DOI: 10.1080/15332640.2024.2301718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
The current study tests the Motivational Interviewing (MI) technical and relational hypotheses in a sample of Hispanic/Latinx adults (N = 276) who engage in heavy alcohol consumption. MI causal theory hypothesizes that therapist use of MI consistent skills (i.e., technical hypothesis) and embodiment of the MI Spirit (i.e., relational hypothesis) will elicit client change talk, which is a putative mechanism of positive client outcome after the session. We tested these associations in a rigorous parallel process latent growth curve mediation modeling framework. The data are from a completed randomized clinical trial of a culturally-adapted (CAMI) versus un-adapted MI targeting hazardous alcohol use and consequences. Results. The unconditional growth models for the mediator (i.e., proportion of change talk relative to sustain talk) and two study outcomes (i.e., percent of heavy drinking days; alcohol-related consequences) showed a linear effect over a 12-month period with a slower rate of growth at later timepoints. Contrary to expectations, the latent growth mediation models did not show relationships between MI-consistent skills (i.e., technical predictor) or latent MI Spirit (i.e., relational indicator) and the slope factor for proportion change talk. The slope factor for proportion change talk was also not associated with the slope factors for percent heavy drinking and consequences over follow-up. Conclusions. In this novel population for MI process analysis, the technical and relational hypotheses were not supported. Studies that are exploratory may be needed to further investigate the causal model in populations that are not often represented in MI process research.
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Affiliation(s)
- Molly Magill
- Brown University School of Public Health, Providence, Rhode Island
| | - Victor Figuereo
- University of Pittsburgh School of Social Work, Pittsburgh, Pennsylvania
| | - David G Zelaya
- Brown University School of Public Health, Providence, Rhode Island
| | - Kristina Jackson
- Brown University School of Public Health, Providence, Rhode Island
| | - Suzanne M Colby
- Brown University School of Public Health, Providence, Rhode Island
| | - Christina S Lee
- Boston University School of Social Work, Boston, Massachusetts
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Rosales R, Lee CS, Cortés D, Caetano R, Rohsenow DJ, Lopez SR, Colby SM. Development and Evaluation of a Measure of Drinking Behavior in Response to Acculturation Stressors for Latinx Adults Entering Alcohol Treatment. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 155:208936. [PMID: 38434594 PMCID: PMC10906967 DOI: 10.1016/j.josat.2022.208936] [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] [Indexed: 03/05/2024]
Abstract
Introduction The current study presents the development of a scale to assess drinking behavior in response to acculturation and immigration stress. Methods The 19-item Measure of Immigration and Acculturation Stressors (MIAS) and a parallel assessment, a Measure of Drinking in Response to Immigration and Acculturation Stressors (MDRIAS), were administered at baseline, 6 months, and 12 months in a completed randomized controlled trial testing culturally adapted motivational interviewing to reduce heavy drinking and related problems in Latinx individuals who met criteria for heavy drinking (n=149). Results Exploratory factor analysis of the MIAS showed best fit for a four-factor solution (Relational Stress, Perceived Ethnic Discrimination, Attenuated Aspirations, and Sense of Alienation) with 15 items. The MIAS subscales and the four corresponding MDRIAS subscales were shown to have good reliability (i.e., internal consistency, intercorrelations, and test-retest) and criterion-related validity (i.e., concurrent, convergent, and predictive). Conclusions These findings suggest that the MIAS can be used to assess different types of immigration and acculturation stressors for Latinx adults and the MDRIAS can be used to assess drinking in response to those experiences. The MIAS and MDRIAS could be used in the future to adapt alcohol interventions to relevant stressors that contribute to Latinx adults' alcohol use.
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Affiliation(s)
- Robert Rosales
- Brown University School of Public Health, Department of Behavioral & Social Sciences, Center for Alcohol and Addictions Studies, 121 South Main Street, Providence, RI 02903
| | - Christina S Lee
- Boston University, School of Social Work, 264 Bay State Rd, Boston, MA 02215
| | - Dharma Cortés
- Health Equity Research Lab, Cambridge Health Alliance/Harvard Medical School, 1493 Cambridge Street, Cambridge, MA 02139
| | - Raul Caetano
- Pacific Institute for Research and Evaluation, Prevention Research Center, Berkeley, California
| | - Damaris J Rohsenow
- Brown University School of Public Health, Department of Behavioral & Social Sciences, Center for Alcohol and Addictions Studies, 121 South Main Street, Providence, RI 02903
| | - Steven R Lopez
- Department of Psychology, University of Southern California, SGM 501, 3620 S. McClintock Ave., Los Angeles, CA 90089
| | - Suzanne M Colby
- Brown University School of Public Health, Department of Behavioral & Social Sciences, Center for Alcohol and Addictions Studies, 121 South Main Street, Providence, RI 02903
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Dash GF, Bryan AD, Montanaro E, Feldstein Ewing SW. Long-Term RCT outcomes for adolescent alcohol and cannabis use within a predominantly Hispanic sample. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2023; 33:1038-1047. [PMID: 37127932 PMCID: PMC10530050 DOI: 10.1111/jora.12856] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 09/08/2022] [Accepted: 04/12/2023] [Indexed: 05/03/2023]
Abstract
Because adolescents are unlikely to seek, receive, or complete treatment for alcohol and/or cannabis misuse, it is important to enhance the lasting impact of clinical contacts when they do occur. Adolescents (N = 506; 72.5% Hispanic) were randomized to motivational interviewing (MI) versus alcohol and cannabis education (ACE). Latent growth models estimated change over time. Significant reductions in alcohol use were observed, with slightly greater reductions by 12-month follow-up for MI. Both interventions significantly reduced cannabis use, with no treatment group differences. When outcomes were examined comparing Hispanic to non-Hispanic participants, there were no significant differences in intervention efficacy by group. MI's inherently client-centered and culturally adaptive approach may contribute to its equitable degree of behavior change for youth across race/ethnic backgrounds.
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Affiliation(s)
- Genevieve F. Dash
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA
| | - Angela D. Bryan
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Erika Montanaro
- Department of Psychological Sciences, University of North Carolina Charlotte, Charlotte, North Carolina, USA
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Ali F, Kaura A, Russell C, Bonn M, Bruneau J, Dasgupta N, Imtiaz S, Martel-Laferrière V, Rehm J, Shahin R, Elton-Marshall T. Identifying barriers and facilitators to COVID-19 vaccination uptake among People Who Use Drugs in Canada: a National Qualitative Study. Harm Reduct J 2023; 20:99. [PMID: 37516836 PMCID: PMC10387201 DOI: 10.1186/s12954-023-00826-6] [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: 04/22/2023] [Accepted: 07/16/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND People Who Use Drugs (PWUD) have lower vaccination uptake than the general population, and disproportionately experience the burden of harms from vaccine-preventable diseases. We conducted a national qualitative study to: (1) identify the barriers and facilitators to receiving COVID-19 vaccinations among PWUD; and (2) identify interventions to support PWUD in their decision-making. METHODS Between March and October 2022, semi-structured interviews with PWUD across Canada were conducted. Fully vaccinated (2 or more doses) and partially or unvaccinated (1 dose or less) participants were recruited from a convenience sample to participate in telephone interviews to discuss facilitators, barriers, and concerns about receiving COVID-19 vaccines and subsequent boosters, and ways to address concerns. A total of 78 PWUD participated in the study, with 50 participants being fully vaccinated and 28 participants partially or unvaccinated. Using thematic analysis, interviews were coded based on the capability, opportunity, and motivation-behavior (COM-B) framework. RESULTS Many partially or unvaccinated participants reported lacking knowledge about the COVID-19 vaccine, particularly in terms of its usefulness and benefits. Some participants reported lacking knowledge around potential long-term side effects of the vaccine, and the differences of the various vaccine brands. Distrust toward government and healthcare agencies, the unprecedented rapidity of vaccine development and skepticism of vaccine effectiveness were also noted as barriers. Facilitators for vaccination included a desire to protect oneself or others and compliance with government mandates which required individuals to get vaccinated in order to access services, attend work or travel. To improve vaccination uptake, the most trusted and appropriate avenues for vaccination information sharing were identified by participants to be people with lived and living experience with drug use (PWLLE), harm reduction workers, or healthcare providers working within settings commonly visited by PWUD. CONCLUSION PWLLE should be supported to design tailored information to reduce barriers and address mistrust. Resources addressing knowledge gaps should be disseminated in areas and through organizations where PWUD frequently access, such as harm reduction services and social media platforms.
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Affiliation(s)
- Farihah Ali
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada.
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada.
| | - Ashima Kaura
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
| | - Cayley Russell
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada
| | - Matthew Bonn
- Canadian Association of People Who Use Drugs, Dartmouth, NS, Canada
| | - Julie Bruneau
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montreal, QC, H2X 0A9, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, 2900 Boul, Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada
| | - Nabarun Dasgupta
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Sameer Imtiaz
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
| | - Valérie Martel-Laferrière
- Centre de Recherche du Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, Montreal, Canada
| | - Jürgen Rehm
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada
- Department of Psychiatry, Dalla Lana School of Public Health, & Institute of Medical Science (IMS), Toronto, Canada
- 1 King's College Circle, University of Toronto, Toronto, ON, M5S 1A8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 1001 Queen St. West, Toronto, ON, M6J 1H4, Canada
- Institut Für Klinische Psychologie Und Psychotherapie, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research (ZIS), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | | | - Tara Elton-Marshall
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
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Hai AH, Lee CS, Zhou C, Delva J. Culturally adapted motivational interviewing's effects on drinking in response to immigration and acculturation stressors among Latinx adults with heavy drinking problems. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 150:209061. [PMID: 37156426 DOI: 10.1016/j.josat.2023.209061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/13/2022] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Abstract
INTRODUCTION Culturally adapted motivational interviewing (CAMI) is a form of motivational interviewing that was adapted to address immigration- and acculturation-related stressors among Latinx adults who met criteria for hazardous drinking. This study hypothesized that (1) receiving CAMI was associated with reduced immigration/acculturation stress and related drinking and that (2) these associations differed by participants' acculturation and perceived discrimination levels. METHODS This study employed a single group pre-post study design using data from a randomized controlled trial. Participants were Latinx adults who received CAMI (N = 149). The study assessed immigration/acculturation stress with the Measure of Immigration and Acculturation Stressors (MIAS) and measured related drinking with the Measure of Drinking Related to Immigration and Acculturation Stressors (MDRIAS). The study team conducted linear mixed modeling for repeated measures to examine outcome changes between the baseline and the 6-month and 12-month follow-ups and moderation effects. RESULTS Compared to baseline, the study found significant decreases in the total MIAS and MDRIAS scores and subscale scores at 6- and 12-month follow-ups. Moderation analysis results showed that lower acculturation levels and higher levels of perceived discrimination were significantly associated with larger decreases at follow-up in total MIAS and MDRIAS scores and several subscale scores. CONCLUSIONS Findings provide preliminary support for CAMI's efficacy in reducing immigration and acculturation stress and related drinking among Latinx adults with heavy drinking problems. The study observed more improvements among the less acculturated and more discriminated participants. Larger studies with more rigorous designs are needed.
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Affiliation(s)
- Audrey Hang Hai
- School of Social Work, Tulane University, 127 Elk Place, New Orleans, LA 70112, USA.
| | - Christina S Lee
- Center for Innovation in Social Work & Health, School of Social Work, Boston University, 264 Bay State Rd, Boston, MA 02215, USA.
| | - Carmen Zhou
- School of Public Health, Boston University, 715 Albany Street, Boston, MA 02118, USA.
| | - Jorge Delva
- School of Social Work, Boston University, 264 Bay State Rd, Boston, MA 02215, USA.
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Magill M, Walthers J, Figuereo V, Torres L, Montanez Z, Jackson K, Colby SM, Lee CS. The role of the relational context and therapists' technical behaviors in brief motivational interviewing sessions for heavy alcohol consumption: Findings from a sample of Latinx adults. J Subst Abuse Treat 2023; 144:108898. [PMID: 36270197 DOI: 10.1016/j.jsat.2022.108898] [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: 05/07/2022] [Revised: 08/07/2022] [Accepted: 10/10/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Motivational interviewing (MI) theory and process research highlights the role of therapist technical and relational behaviors in predicting client in-session statements for or against behavior change (i.e., change and sustain talk, respectively). These client statements, in turn, have been shown to predict intervention outcomes. The current study examines sequential associations between therapist behaviors and client change and sustain talk in a sample of Latinx individuals who engage in heavy alcohol consumption. DATA Data are from a completed randomized clinical trial of a culturally adapted (CAMI) versus unadapted MI targeting alcohol use and consequences among Latinx individuals. METHOD The study collected observational coding data with the Motivational Interviewing Skill Code (MISC 2.5, i.e., therapist behaviors and global ratings) and the Client Language Assessment - Proximal/Distal (CLA-PD, i.e., client language). Frequentist and Bayesian sequential analyses examined the relationship among nine different categories of therapist behaviors and three different categories of client language (i.e., change talk, sustain talk, neutral). We examined odds ratios and conditional probabilities for the direction, magnitude, and significance of the association between the use of MI technical behaviors and subsequent client statements about change. The study compared these same transitional associations between low/average (i.e., <4) and high (i.e., ≥4) MI Spirit sessions. RESULTS The pattern of results was replicated across both analytic frameworks. Questions and reflections about change talk versus sustain talk versus neutral statements showed greater odds of predicting the intended client response (i.e., change talk, sustain talk, neutral, respectively) compared to other possible client responses. Conditional probabilities for these transitions were high, ranging from 0.55 to.88. The magnitude of certain technical transitions significantly differed between low/average and high MI Spirit sessions. CONCLUSIONS Analyses supported the hypothesized associations between therapist use of technical MI behaviors and client change language within this Latinx sample. Analyses of MI Spirit as a moderator of these transitions showed partial support.
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Affiliation(s)
- Molly Magill
- Brown University School of Public Health, Center for Alcohol and Addiction Studies, United States of America.
| | - Justin Walthers
- Brown University School of Public Health, Center for Alcohol and Addiction Studies, United States of America
| | - Victor Figuereo
- University of Pittsburgh School of Social Work, United States of America
| | | | | | - Kristina Jackson
- Brown University School of Public Health, Center for Alcohol and Addiction Studies, United States of America
| | - Suzanne M Colby
- Brown University School of Public Health, Center for Alcohol and Addiction Studies, United States of America
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Price MA, Hollinsaid NL. Future Directions in Mental Health Treatment with Stigmatized Youth. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022; 51:810-825. [PMID: 36007234 PMCID: PMC9835015 DOI: 10.1080/15374416.2022.2109652] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Stigma refers to societally-deemed inferiority associated with a circumstance, behavior, status, or identity. It manifests internally, interpersonally, and structurally. Decades of research indicate that all forms of stigma are associated with heightened risk for mental health problems (e.g., depression, PTSD, suicidality) in stigmatized youth (i.e., children, adolescents, and young adults with one or more stigmatized identities, such as youth of Color and transgender youth). Notably, studies find that stigmatized youth living in places with high structural stigma - defined as laws/policies and norms/attitudes that hurt stigmatized people - have a harder time accessing mental health treatment and are less able to benefit from it. In order to reduce youth mental health inequities, it is imperative for our field to better understand, and ultimately address, stigma at each of these levels. To facilitate this endeavor, we briefly review research on stigma and youth mental health treatment, with an emphasis on structural stigma, and present three future directions for research in this area: (1) directly addressing stigma in treatment, (2) training therapists in culturally responsive care, and (3) structural interventions. We conclude with recommendations for best practices in broader mental health treatment research.
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Affiliation(s)
- Maggi A. Price
- School of Social Work, Boston College, Boston, MA
- Department of Psychology, Harvard University, Cambridge, MA
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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.
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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
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Ewing SF, Bryan AD, Dash GF, Lovejoy TI, Borsari B, Schmiege SJ. Randomized controlled trial of motivational interviewing for alcohol and cannabis use within a predominantly Hispanic adolescent sample. Exp Clin Psychopharmacol 2022; 30:287-299. [PMID: 33749294 PMCID: PMC9113520 DOI: 10.1037/pha0000445] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hispanic youth represent one of the fastest-growing minority groups. Yet, we know little about Hispanic adolescents' response to empirically-supported interventions for adolescent addiction, including motivational interviewing (MI). This randomized controlled trial (RCT) compared MI to an active educational treatment for adolescent alcohol and cannabis use (alcohol and cannabis education; ACE). Adolescents who regularly use substances (N = 448; n = 347 Hispanic; n = 101 non-Hispanic white; ages 13-18) were randomized to two 1-hr individual sessions of MI or ACE. We examined 6-month outcomes and mechanisms of change across Hispanic and non-Hispanic white youth. Treatment response was comparable across ethnicities (Hispanic vs. non-Hispanic white youth). Additionally, adolescents in the MI condition showed greater reductions in alcohol use compared to those in ACE, with support for motivation and self-efficacy as mechanisms of treatment response. Direct effects of MI on cannabis use were not observed; however, a significant indirect effect of motivation was observed for reductions in cannabis use. Data support the efficacy of MI in reducing adolescent alcohol use, through the vehicle of enhanced motivation and self-efficacy. While consistent treatment response was observed for adolescent alcohol use across ethnicities (Hispanic vs. non-Hispanic white), further exploration into potential underexplored mechanisms of Hispanic adolescents' treatment response is requisite to strengthening prevention and intervention programming for Hispanic adolescents' cannabis use. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | - Angela D. Bryan
- University of Colorado Boulder, Department of Psychology and Neuroscience, Boulder, CO
| | - Genevieve F. Dash
- University of Missouri, Department of Psychological Sciences, Columbia, MO
| | - Travis I. Lovejoy
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR
| | - Brian Borsari
- Mental Health Service, San Francisco VA Health Care System/ Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA
| | - Sarah J. Schmiege
- University of Colorado Anschutz Medical Campus, Department of Biostatistics and Informatics, Aurora, CO
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12
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Rimayanti MU, O'Halloran PD, Shields N, Morris R, Taylor NF. Comparing process evaluations of motivational interviewing interventions for managing health conditions and health promotions: A scoping review. PATIENT EDUCATION AND COUNSELING 2022; 105:1170-1180. [PMID: 34509340 DOI: 10.1016/j.pec.2021.08.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/21/2021] [Accepted: 08/24/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore how process evaluations were conducted alongside randomised controlled trials (RCTs) involving motivational interviewing (MI) as an intervention to manage health conditions. METHODS A scoping review was conducted. We searched 7 databases (to May 2021) for studies that incorporated at least one aspect of process evaluation of RCTs using MI to manage a health condition. Two reviewers screened the studies for eligibility and extracted data according to Medical Research Council framework. RESULTS Of the 123 studies included, 85% lacked a theoretical framework for process evaluation. Most studies reported fidelity, but dose was underreported. Sixty-five studies reported mechanism of impact, but only twelve used participant experiences to understand how MI works. Only thirty used true mediation analysis. Context (n = 33) was the least reported aspect of process evaluation. CONCLUSION Process evaluations of MI to manage health conditions often consist of fragmented reports of implementation, mechanisms, and context. Using validated measures of fidelity, reporting dose, and using mediation analysis alongside qualitative exploration of participant and stakeholder insights will improve our understanding of how MI works. PRACTICE IMPLICATIONS Robust and comprehensive process evaluations will inform MI researchers to design more rigorous trials and for clinicians to implement more effective interventions for their clients.
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Affiliation(s)
- Made U Rimayanti
- College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, Australia.
| | - Paul D O'Halloran
- College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, Australia.
| | - Nora Shields
- College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, Australia.
| | - Rebecca Morris
- College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, Australia; Allied Health Clinical Research Office, Eastern Health, Box Hill, VIC, Australia.
| | - Nicholas F Taylor
- College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, Australia; Allied Health Clinical Research Office, Eastern Health, Box Hill, VIC, Australia.
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13
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Surace A, Zelaya DG, Guy AA, Mastroleo NR, Durst A, Pantalone DW, Monti PM, Mayer KH, Kahler CW. Examining the Impact of Race on Motivational Interviewing Implementation and Outcomes with HIV+ Heavy Drinking Men Who Have Sex with Men. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3930. [PMID: 35409611 PMCID: PMC8997518 DOI: 10.3390/ijerph19073930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 11/16/2022]
Abstract
Motivational interviewing (MI)-based interventions focus on changing behavior through building client motivation. It is unknown how racial mismatch between clients and providers may impact MI implementation and subsequent behavior. We used a mixed methods approach to examine differences in Motivational Interviewing Skill Code (MISC) coded sessions and post-session outcomes between a sample of HIV-positive cisgender men who have sex with men (MSM) participants of an MI-based intervention to reduce heavy drinking who identified as persons of color (POC; n = 19) and a matched sample of White participants (n = 19). We used quantitative methods to analyze how providers implemented the intervention (i.e., MISC codes) and post-session drinking. We used qualitative analyses of session transcripts to examine content not captured by MISC coding. Quantitative analyses showed that providers asked fewer open-ended questions and had a lower ratio of complex reflections to simple reflections when working with POC participants, but no significant differences were observed in drinking post-intervention between participants. Qualitative analyses revealed that participants discussed how racial and sexual orientation discrimination impacted their drinking. Allowing clients to share their experiences and to explore individually meaningful reasons for behavioral change may be more important than strict adherence to MI techniques.
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Affiliation(s)
- Anthony Surace
- Center of Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI 02903, USA; (D.G.Z.); (A.A.G.); (A.D.); (P.M.M.); (C.W.K.)
| | - David G. Zelaya
- Center of Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI 02903, USA; (D.G.Z.); (A.A.G.); (A.D.); (P.M.M.); (C.W.K.)
- Department of Global Health and Population, Harvard Medical School, Boston, MA 02115, USA;
| | - Arryn A. Guy
- Center of Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI 02903, USA; (D.G.Z.); (A.A.G.); (A.D.); (P.M.M.); (C.W.K.)
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI 02903, USA
| | | | - Ayla Durst
- Center of Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI 02903, USA; (D.G.Z.); (A.A.G.); (A.D.); (P.M.M.); (C.W.K.)
| | - David W. Pantalone
- The Fenway Institute, Fenway Health Boston, Boston, MA 02215, USA;
- Department of Psychology, University of Massachusetts, Boston, MA 02125, USA
| | - Peter M. Monti
- Center of Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI 02903, USA; (D.G.Z.); (A.A.G.); (A.D.); (P.M.M.); (C.W.K.)
| | - Kenneth H. Mayer
- Department of Global Health and Population, Harvard Medical School, Boston, MA 02115, USA;
- Department of Psychology, University of Massachusetts, Boston, MA 02125, USA
- Department of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Christopher W. Kahler
- Center of Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI 02903, USA; (D.G.Z.); (A.A.G.); (A.D.); (P.M.M.); (C.W.K.)
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14
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Self KJ, Borsari B, Ladd B, Nicolas G, Gibson CJ, Jackson K, Manuel JK. Cultural adaptations of motivational interviewing: A systematic review. Psychol Serv 2022; 20:7-18. [PMID: 35130010 PMCID: PMC10161132 DOI: 10.1037/ser0000619] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Motivational interviewing (MI; Miller & Rollnick, 2012) has expanded from treating substance use disorders to other health concerns across a range of racial-ethnic groups and ages. The spirit of MI lends itself well to working with culturally diverse populations by eliciting the client's values and goals in a collaborative and client-centered approach in pursuit of behavior change. Additionally, MI has been further adapted for use with racial-ethnic minority groups to enhance its effectiveness with specific populations. The aim of this review was to investigate existing cultural adaptations of MI (CAMI), their effectiveness, and to provide directions for future cultural adaptations in both research and clinical settings. This systematic review identified studies of CAMI over the past 20 years using MEDLINE/Pubmed and Embase. The final dataset consisted of 25 peer review studies. In the randomized controlled trial (RCT) studies that utilized a control condition (n = 17), 10 studies showed that the CAMI condition performed significantly better on at least the primary outcome measure than the control condition. All 10 studies adapted Context, Content, and Concepts-three of the dimensions of cultural adaptation defined by the ecological validity framework used in this study (Bernal et al., 1995). (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Kyle J. Self
- San Francisco VA Health Care System
- University of Miami
| | - Brian Borsari
- San Francisco VA Health Care System
- University of California, San Francisco
| | - Ben Ladd
- Washington State University Vancouver
| | | | - Carolyn J. Gibson
- San Francisco VA Health Care System
- University of California, San Francisco
| | | | - Jennifer K. Manuel
- San Francisco VA Health Care System
- University of California, San Francisco
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15
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Pachankis JE, Soulliard ZA, Morris F, Seager van Dyk I. A Model for Adapting Evidence-Based Interventions to Be LGBQ-Affirmative: Putting Minority Stress Principles and Case Conceptualization into Clinical Research and Practice. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2021.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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16
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Venner K, Hernandez-Vallant A, Hirchak KA, Herron J. A scoping review of cultural adaptations of substance use disorder treatments across Latinx communities: Guidance for future research and practice. J Subst Abuse Treat 2022; 137:108716. [DOI: 10.1016/j.jsat.2021.108716] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 10/26/2021] [Accepted: 12/14/2021] [Indexed: 11/24/2022]
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Hatzenbuehler ML, Pachankis JE. Does Stigma Moderate the Efficacy of Mental- and Behavioral-Health Interventions? Examining Individual and Contextual Sources of Treatment-Effect Heterogeneity. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2021. [DOI: 10.1177/09637214211043884] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In this article, we argue that stigma may be an important, but heretofore underrecognized, source of heterogeneity in treatment effects of mental- and behavioral-health interventions. To support this hypothesis, we review recent evidence from randomized controlled trials and spatial meta-analyses suggesting that stigma may predict not only who responds more favorably to these health interventions (i.e., individuals with more stigma experiences), but also the social contexts that are more likely to undermine intervention effects (i.e., communities with greater structural stigma). By highlighting the potential role of personal and contextual stigma in shaping response to interventions, our review paves the way for additional research.
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Affiliation(s)
| | - John E. Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University
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18
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Hai AH, Lee CS, Abbas BT, Bo A, Morgan H, Delva J. Culturally adapted evidence-based treatments for adults with substance use problems: A systematic review and meta-analysis. Drug Alcohol Depend 2021; 226:108856. [PMID: 34274617 DOI: 10.1016/j.drugalcdep.2021.108856] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND This systematic review/meta-analysis aimed to synthesize empirical evidence from randomized controlled trials on the efficacy of culturally adapted interventions (CAIs) for substance use and related consequences for adults of color. METHODS Six electronic databases were searched to identify eligible studies. Two reviewers independently screened studies, extracted data, and assessed risks of bias. We used robust variance estimation in meta-regression to synthesize effect size estimates and conduct moderator analyses. RESULTS Twenty-two studies met the inclusion criteria and were included in the review. The overall effect size was 0.23 (95 % Confidence Interval [CI] = 0.12, 0.35). The subgroup effect sizes for comparing CAIs with inactive controls and with active controls were 0.31 (CI = 0.14, 0.48) and 0.14 (CI=-0.02, 0.29), respectively. The effect sizes for alcohol use, illicit drug use, unspecified substance use outcomes, and substance use related consequences were 0.25 (CI = 0.08, 0.43), 0.35 (CI =-0.30, 1.00), 0.22 (CI=-0.17, 0.62), and 0.02 (CI=-0.11, 0.16), respectively. Moderator analysis showed that CAIs' effects might not vary significantly by treatment model, dose, country, follow-up assessment timing, participant age, or gender/sex. CONCLUSIONS Research on substance use interventions that are culturally adapted for people of color is growing, and more high-quality studies are needed to draw definitive conclusions about CAIs' treatment effects. Our study found CAIs to be a promising approach for reducing substance use and related consequences. We call for more efficacy/effectiveness and implementation research to further advance the development and testing of evidence-based CAIs that meet the unique needs and sociocultural preferences of diverse populations.
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Affiliation(s)
- Audrey Hang Hai
- Center for Innovation in Social Work & Health, School of Social Work, Boston University, 264 Bay State Rd, Boston, MA, 02215, USA.
| | - Christina S Lee
- Center for Innovation in Social Work & Health, School of Social Work, Boston University, 264 Bay State Rd, Boston, MA, 02215, USA
| | - Bilal T Abbas
- Department of General Internal Medicine, Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, USA
| | - Ai Bo
- Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, 2400 E. Hartford Avenue, Milwaukee, WI, 53211, USA
| | - Henry Morgan
- Sociology Department, Vassar College, 124 Raymond Avenue, Poughkeepsie, NY, 12604, USA
| | - Jorge Delva
- Center for Innovation in Social Work & Health, School of Social Work, Boston University, 264 Bay State Rd, Boston, MA, 02215, USA
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Comparison of Patient Versus Trained Observer Assessments of Healthcare Providers' Use of Motivational Interviewing Techniques for Patients Experiencing Depression and Anxiety in the Dominican Republic. J Clin Psychol Med Settings 2021; 29:206-219. [PMID: 34143354 PMCID: PMC8211715 DOI: 10.1007/s10880-021-09781-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 11/17/2022]
Abstract
In settings with limited mental health system capacity, integrated care and the improvement of patient-provider communication surrounding common mental disorders is critical to advancing treatment outcomes. We trained primary care providers in the Dominican Republic in motivational interviewing (MI) to improve communication with patients experiencing depression and anxiety. Providers were randomized to an intervention group, which received MI training, or a control group. To evaluate the training’s effectiveness, patients assessed their clinical encounters using the Motivational Interviewing Measure of Staff Interaction (MIMSI). Trained research assistants (RAs) rated a sub-set of those interactions using an adapted MIMSI instrument. Overall, patients (n = 36) perceived their interactions with providers (n = 10) very positively; however, the RAs’ ratings strongly indicated that providers’ application of MI behaviors was insufficient. Patients generally could not distinguish between intervention and control providers. Findings underscore the need to carefully consider optimal training delivery and cultural influences surrounding the implementation of MI mental health interventions in settings where directive communication is highly valued.
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20
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Lee CS, Magill M, Figuereo VJ, Jackson K, Colby SM. Examining client self-exploration in motivational interviewing: Preliminary psychometrics of an observational rating measure. J Subst Abuse Treat 2021; 129:108345. [PMID: 34080540 DOI: 10.1016/j.jsat.2021.108345] [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: 07/16/2020] [Revised: 01/08/2021] [Accepted: 02/15/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE We examine in-session self-exploration among Latinx heavy drinkers who received a motivational interview (MI) to reduce heavy drinking. The goals of this study are to report the validity and reliability of an adaptation of the Global Client Rating for Self-Exploration from the Motivational Interviewing Skill Code (MISC SE). METHOD The study measured the MISC SE as three subscales (Emotional, Cognitive, New Learning/Developing Discrepancy SE) to assess underlying processes that might allow for higher predictive validity in relation to behavioral change (drinking) outcomes. The study created a dichotomous variable, Personally Relevant Vulnerable Making (PR-VM), to distinguish the disclosure of particularly sensitive material related to drinking behavior. The study used the measure of Everyday Discrimination as a criterion variable for the PR-VM measure. The study collected observationally rated data for n = 158 participants. RESULTS Subscales showed moderate correlations with the MISC SE (r = 0.421 to 0.574, p < .001). The MISC SE was not associated with number of drinking days or percent heavy drinking days at 3-month follow-up. Cognitive and New Learning/Developing Discrepancy SE were associated with fewer drinking days (r = -0.247 to -0.266, p < .005), and Cognitive SE was associated with percent heavy drinking days (r = -0.169, p < .05), Subscale interrater reliability was comparable to the MISC SE (ICC = 0.72 to 0.86). The study observed higher mean scores on the Everyday Discrimination scale when session PR-VM was present than when not present (t (df = 118) = -3.02, p < .005). CONCLUSIONS The subscale adaptation of the SE measure may provide a sensitive approach to understanding how self-exploration relates to behavior change in the context of MI.
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Affiliation(s)
- Christina S Lee
- Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215, United States of America.
| | - Molly Magill
- Department of Psychiatry & Human Behavior, Center for Alcohol and Addiction Studies, Alpert Medical School of Brown University, Providence, RI 02903, United States of America.
| | - Victor J Figuereo
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, United States of America.
| | - Kristina Jackson
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Alpert Medical School of Brown University, Providence, RI 02903, United States of America.
| | - Suzanne M Colby
- Department of Psychiatry & Human Behavior, Center for Alcohol and Addiction Studies, Alpert Medical School of Brown University, Providence, RI 02903, United States of America.
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21
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Lee CS, O'Connor BM, Todorova I, Nicholls ME, Colby SM. Structural racism and reflections from Latinx heavy drinkers: Impact on mental health and alcohol use. J Subst Abuse Treat 2021; 127:108352. [PMID: 34134869 DOI: 10.1016/j.jsat.2021.108352] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/12/2020] [Accepted: 02/24/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Discrimination and social inequity increase risk for alcohol use disorders among Latinxs. An alcohol intervention trial that led to significant reductions in alcohol-related consequences also produced significant reductions in mental health symptoms for Latinx heavy drinkers. In the current qualitative study, we explore this trial's mental health effect by examining participants' perspectives on the social context of immigration, i.e., structural barriers, and associations among the immigrant experience, stigma, depressive/anxiety symptomatology, and alcohol consumption. METHODS Study participants were eligible if they completed the clinical trial, exhibited levels of depressive and anxiety symptoms that exceeded the range for clinical depression (≥18, CES-D) and anxiety (≥12, BAI) at baseline, and demonstrated significant declines in depression and anxiety symptoms 12 months following their completion of the trial. The study coded 24 participant transcripts using ATLAS.ti and thematic analysis. RESULTS Participants reported their responses to structural barriers (e.g., a lack of educational supports, difficulties accessing safety net programs). Reported experiences of exclusion and discrimination were associated with depressive and anxiety symptoms. Stigmatization processes included feeling isolated and contributed to poor mental health. Participants reported drinking to cope with low mood. CONCLUSIONS Structural barriers are exclusionary because they limit full participation and communicate who does/does not belong along race/ethnic lines, i.e., structural racism. Feeling stigmatized for being different was associated with feelings of anxiety and depression among our immigrant participants. Future interventions must focus on stressors associated with the constraints of being an immigrant. Understanding how structural barriers and structural racism impact health behavior can enrich the design and impact of interventions for socially disadvantaged Latinx individuals.
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Affiliation(s)
- Christina S Lee
- Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215, USA.
| | | | - Irina Todorova
- Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA 02115, USA.
| | - Mariana E Nicholls
- Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA 02115, USA
| | - Suzanne M Colby
- Department of Psychiatry & Human Behavior, Center for Alcohol & Addiction Studies, Alpert Medical School of Brown University, 121 South Main St., Providence, RI 02912, USA
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22
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Lee CS, Rosales R, Colby SM, Martin R, Cox K, Rohsenow DJ. Addressing social stressors in a brief motivational interview improve mental health symptoms for Latinx heavy drinkers. J Clin Psychol 2020; 76:1832-1850. [PMID: 32469106 PMCID: PMC7487011 DOI: 10.1002/jclp.22976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Depressive and anxiety symptoms co-occur with hazardous drinking among Latinxs. This secondary analysis of a clinical trial to reduce hazardous drinking (motivational interviewing adapted to address social stressors [CAMI] vs. motivational interviewing [MI]) examined effects on anxiety/depressive symptoms. Discrimination and acculturation were examined as moderators. METHODS Latinx (n = 296) hazardous drinkers (2+ occasions/month of heavy drinking; 4/5 drinks/occasion, females/males) were randomized to CAMI/MI. Generalized estimating equations analyzed how treatment conditions and interactions were related to depressive and anxiety symptoms after controlling for covariates. RESULTS Baseline symptoms (anxiety, depression) exceeded clinical thresholds (Anxiety ≥8, M = 14.62, SD = 13.52; Depression ≥ 12, M = 18.78, SD = 12.57). Cultural adaptation of motivational interviewing (CAMI) showed significantly lower anxiety and depressive symptoms (6/12 months, respectively) than MI. CAMI with high baseline discrimination reported significantly less depression than MI (12 months). CONCLUSIONS Explicitly addressing social stressors may be a beneficial adjunct to treatment for Latinx drinkers.
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Affiliation(s)
- Christina S. Lee
- Department of Clinical Practice, Boston University School of Social Work, 264 Bay State Road, Boston, MA, 02215
| | - Robert Rosales
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA
| | - Suzanne M. Colby
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA
| | - Rosemarie Martin
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA
| | - Koriann Cox
- Department of Applied Psychology, Northeastern University, 360 Huntington Avenue, Boston, 02115
| | - Damaris J. Rohsenow
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA
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After the Affordable Care Act: the Effects of the Health Safety Net and the Medicaid Expansion on Latinxs' Use of Behavioral Healthcare in the US. J Behav Health Serv Res 2020; 48:183-198. [PMID: 32514810 DOI: 10.1007/s11414-020-09715-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This study investigated the association between the implementation of the Affordable Care Act (ACA) and Latinxs' use of behavioral health services in the US. Organizational responses from the 2010, 2014, and 2016 National Mental Health Service Survey were used to examine the number and proportion of outpatient Latinx admissions over time, as well as the role of Medicaid expansion and health safety net funding on Latinxs' admissions. Findings showed that there was an increase in Latinx admissions post-ACA (2014). However, 2 years post-implementation (2016), Latinx admissions were at levels lower than prior to the healthcare reform. Despite this overall decrease, behavioral health safety net organizations, particularly those located in states that adopted the expansion of Medicaid, served more Latinxs than behavioral health service organizations outside the safety net. Policy and practice implications to strengthen behavioral safety net organizations that serve Latinxs are discussed.
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