1
|
Burnett DP, Trikalinos TA, Kiluk BD, Ray L, Misquith C, Magill M. A Descriptive Review and Meta-Regression Study of Demographic and Study Context Factors in US Clinical Trials of Cognitive Behavioral Interventions for Alcohol or Other Drug Use. Subst Use Misuse 2024:1-11. [PMID: 38946162 DOI: 10.1080/10826084.2024.2369167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Objectives. Cognitive-Behaviorally Based Interventions (CBIs) are evidence-based treatments for alcohol and other drug (AOD) use with potential variable effectiveness by population sub-groups. This study used evidence synthesis to examine treatment effect by demographic and study context factors in clinical trials of CBI for AOD. Methods. Studies were systematically identified, and their characteristics and outcome data were extracted and summarized. Standardized mean differences were calculated for within- and between-condition effects on substance use outcomes. Demographic and study context moderators were identified during data acquisition and several sensitivity analyses were conducted. Results. The sample included K = 29 trials and a total of 15 study-level moderators were examined. Information on participants' age, biological sex, and race were reported in at least 26 trials, but information on gender identity, sexual orientation, and ethnicity were reported infrequently or in non-inclusive ways. The mean between-condition effect size was small and moderately heterogenous (d = 0.158, 95% CI = 0.079, 0.238, I2 = 46%) and the mean within-condition effect size was large and showed high heterogeneity (dz = 1.147, 95% CI = 0.811, 1.482, - I2 = 96%). The specific drug targeted in the study and whether biological assay-based outcomes were used moderated between-condition CBI efficacy and the inclusion of co-occurring mental health conditions and study publication date moderated within-condition CBI effects. Conclusions. Results provide preliminary data on study context factors associated with effect estimates in United States based clinical trials of CBI for AOD.
Collapse
Affiliation(s)
- Don-Pierre Burnett
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | | | - Brian D Kiluk
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lara Ray
- Department of Psychology, University of California at Los Angeles, Los Angeles, California, USA
| | - Chelsea Misquith
- School of Public Health, Brown University, Providence, Rhode Island, USA
- University Library, Brown University, Providence RI
| | - Molly Magill
- School of Public Health, Brown University, Providence, Rhode Island, USA
| |
Collapse
|
2
|
Kissel HA, Lee GH, McFarland S, Berger D, Enneking E, Dunham J, Brumback T. Participant diversity in ACER: 2010-2022. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:1189-1204. [PMID: 38653579 DOI: 10.1111/acer.15324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 03/06/2024] [Accepted: 03/21/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Increasing diversity has become a priority for all fields working with human subjects due to historic exclusions and misrepresentations of participants with minoritized identities. To create a more representative and generalizable science of alcohol use, the Research Society on Alcohol (RSA) and its official journal, Alcohol: Clinical and Experimental Research (ACER), have increasingly incorporated diversity and inclusion into their posted values and programming. METHODS We analyzed the content of articles published in ACER from 2010 through 2022 (6 years before and after the formation of RSA's Diversity Committee) to assess the reporting of participants' demographic information and whether there has been increased inclusion of diverse samples in alcohol research over time. Our team screened 3292 abstracts for data extraction; studies were included if they were primary analyses of data collected from human subjects (n = 1043). RESULTS Reporting of all demographic variables increased over time, with significant increases in reporting for race/ethnicity, sexual orientation, gender identity, socioeconomic status (SES), income, and educational attainment. Demographic variables were also increasingly used in analyses. However, representation of research outside the United States diminished significantly over time. CONCLUSIONS We provide recommended journal article reporting standards for ACER to continue the positive progress in reporting demographics in alcohol research and facilitate meta-analyses examining demographic modulation and the impact of social determinants of health.
Collapse
Affiliation(s)
- Heather A Kissel
- Department of Psychological Sciences, Northern Kentucky University, Highland Heights, Kentucky, USA
| | - Ga Hee Lee
- Department of Psychological Sciences, Northern Kentucky University, Highland Heights, Kentucky, USA
| | - Sara McFarland
- Department of Psychological Sciences, Northern Kentucky University, Highland Heights, Kentucky, USA
| | - Dexton Berger
- Department of Psychological Sciences, Northern Kentucky University, Highland Heights, Kentucky, USA
| | - Elizabeth Enneking
- Department of Psychological Sciences, Northern Kentucky University, Highland Heights, Kentucky, USA
| | - Jenna Dunham
- Department of Psychological Sciences, Northern Kentucky University, Highland Heights, Kentucky, USA
| | - Ty Brumback
- Department of Psychological Sciences, Northern Kentucky University, Highland Heights, Kentucky, USA
| |
Collapse
|
3
|
Jiang TE, Edwards KA, Dildine TC, You DS, Nguyen T, Pascual AP, Falasinnu T. Trends in Patient Representation in Low Back Pain Pharmacological Randomized Clinical Trials, 2011 to 2020: A Systematic Review. THE JOURNAL OF PAIN 2024; 25:104456. [PMID: 38185211 PMCID: PMC11128353 DOI: 10.1016/j.jpain.2023.12.013] [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: 08/22/2023] [Revised: 11/17/2023] [Accepted: 12/28/2023] [Indexed: 01/09/2024]
Abstract
Low back pain (LBP) significantly affects global health, with associated detrimental outcomes such as physical impairment, emotional distress, and exacerbated mental health symptoms. This study evaluated the representation of marginalized groups, including racialized, gender minority, pregnant/lactating, and elderly individuals in randomized controlled trials for pharmacological interventions treating LBP from 2011 to 2020. We searched Embase, MEDLINE, and CINAHL in December 2021, and 139 studies were eligible. Most trials (n = 113, 81%) reported participant sex; however, no study collected data on sexual and gender minorities, and the majority (n = 99, 71%) excluded pregnant/lactating individuals. Most trials (n = 105, 76%) reported no data on participant race or ethnicity. We limited within-country analyses of race and ethnicity to US-based trials because US-based trials were more likely to report race and/or ethnicity (48%) compared to non-US-based trials (8%). Black participants were the only racialized group whose composition was comparable to US Census estimates. About half (n = 73, 53%) of all trials had an upper age limit for eligibility (range: 40-85 years old) and 24% (n = 33) excluded adults aged >65 years. Our findings confirm that trials for pharmacological LBP interventions underreport demographic data, and the trials that include this data have unrepresentative samples. There is an urgent need for more inclusive and representative patient samples to ensure generalizability and equitable benefits. Standardizing demographic data reporting and integrating community-based participatory research methods can help foster inclusive research practices. This review was registered with prospective register of systematic reviews (PROSPERO), ID 296017. PERSPECTIVE: This systematic review investigates patient representation in pharmacological-based clinical trials for low back pain, LBP, the most prevalent pain condition worldwide. Improvements in reporting demographic data and recruiting diverse participant populations-across different racialized, gender and sexual minority, and age groups-will help clinical research generalizability and provide equitable benefits.
Collapse
Affiliation(s)
- Tiffany E Jiang
- Department of Epidemiology and Population Sciences, Stanford University School of Medicine, Stanford, California; Yale School of Medicine, New Haven, Connecticut
| | - Karlyn A Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California; The Center for Research on Health Care, University of Pittsburgh Division of General Internal Medicine, Pittsburgh, Pennsylvania
| | - Troy C Dildine
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Dokyoung S You
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Thy Nguyen
- Department of Epidemiology and Population Sciences, Stanford University School of Medicine, Stanford, California
| | - Alissa P Pascual
- Department of Human Biology, Stanford University, Stanford, California
| | - Titilola Falasinnu
- Department of Epidemiology and Population Sciences, Stanford University School of Medicine, Stanford, California; Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
4
|
Carlini LE, Fernandez AC, Mellinger JL. Sex and gender in alcohol use disorder and alcohol-associated liver disease in the United States: A narrative review. Hepatology 2024:01515467-990000000-00864. [PMID: 38683562 DOI: 10.1097/hep.0000000000000905] [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: 11/24/2023] [Accepted: 04/05/2024] [Indexed: 05/01/2024]
Abstract
Over the last 20 years, there has been an alarming increase in alcohol use and AUD prevalence among women, narrowing the historical gender gap. Concurrently, there has also been a significant rise in alcohol-associated liver disease (ALD) prevalence, severity, and mortality among women. Despite this, there are no recent reviews that have sought to evaluate both sex and gender differences at the intersection of AUD and ALD. In this narrative review, we address the escalating rates of ALD and AUD in the United States, with a specific focus on the disproportionate impact on women. Sex and gender play an important and well-known role in the pathogenesis and epidemiology of ALD. However, sex and gender are also implicated in the development and prevalence of AUD, as well as in the treatment of AUD, all of which have important consequences on the approach to the treatment of patients with ALD and AUD. A better understanding of sex and gender differences in AUD, ALD, and the intersection of the 2 is essential to enhance prevention, diagnosis, and management strategies. These data underscore the urgent need for awareness and preventive efforts to mitigate the potential long-term health consequences.
Collapse
Affiliation(s)
- Lauren E Carlini
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Anne C Fernandez
- Department of Psychiatry, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Jessica L Mellinger
- Department of Internal Medicine and Psychiatry, Michigan Medicine, Ann Arbor, Michigan, USA
| |
Collapse
|
5
|
Goldstein SC, Newberger NG, Schick MR, Ferguson JJ, Collins SE, Haeny AM, Weiss NH. A systematic meta-epidemiologic review on nonabstinence-inclusive interventions for substance use: inclusion of race/ethnicity and sex assigned at birth/gender. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024:1-15. [PMID: 38411974 DOI: 10.1080/00952990.2024.2308087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/16/2024] [Indexed: 02/28/2024]
Abstract
Background: Minoritized racial/ethnic and sex assigned at birth/gender groups experience disproportionate substance-related harm. Focusing on reducing substance-related harm without requiring abstinence is a promising approach.Objectives: The purpose of this meta-epidemiologic systematic review was to examine inclusion of racial/ethnic and sex assigned at birth/gender in published studies of nonabstinence-inclusive interventions for substance use.Methods: We systematically searched databases (PubMed and PsycINFO) on May 26, 2022 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Articles were eligible for inclusion if they: 1) reported in English language, 2) had a primary goal of investigating a nonabstinence-inclusive intervention to address substance use, 3) used human subjects, and 4) only included adults aged 18 or older. Two coders screened initial articles and assessed eligibility criteria of full text articles. A third consensus rater reviewed all coding discrepancies. For the remaining full-length articles, an independent rater extracted information relevant to study goalsResults: The search strategy yielded 5,759 records. 235 included articles remained. Only 73 articles (31.1%) fully reported on both racial/ethnic and sex assigned at birth/gender, and only seven articles (3.0%) reported subgroup analyses examining treatment efficacy across minoritized groups. Nine articles (3.8%) mentioned inclusion and diversity regarding both racial/ethnic and sex assigned at birth/gender in their discussion and four articles (1.7%) broadly mentioned a lack of diversity in their limitationsConclusion: Findings highlight that little is known about nonabstinence-inclusive interventions to address substance use for individuals from minoritized racial/ethnic and sex assigned at birth/gender groups.
Collapse
Affiliation(s)
- Silvi C Goldstein
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Noam G Newberger
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Melissa R Schick
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | | | - Susan E Collins
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Department of Psychology, Washington State University, Pullman, WA, USA
| | - Angela M Haeny
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| |
Collapse
|
6
|
Contreras-Pérez ME, Wagner E, Hospital M, Morris S, Colby S, Magill M. Outcomes of a Brief Motivational Intervention for Heavy Alcohol Use in Racial or Ethnic Minority Compared to White Emerging Adults. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2024; 21:75-89. [PMID: 37766623 DOI: 10.1080/26408066.2023.2263454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
PURPOSE This study used secondary data from a randomized controlled trial of a Brief Motivational Intervention (BMI) to examine whether Non-White participants had different treatment results compared to White participants. METHODS The outcome variables of this study were divided into primary outcomes (heavy drinking and consequences associated with alcohol use) and secondary outcomes (cognitive variables such as motivation to change alcohol use, and behavioral variables, including protective behavioral strategies). Linear regression analyses were conducted with the PROCESS macro for SPSS, to test if race or ethnicity moderated the relationship between BMI and each treatment outcome. Data was collected at two time points, six weeks and three months after treatment. RESULTS This study showed that race or ethnicity did not moderate treatment results for the four outcome variables. Additional within-group effect sizes were calculated for all racial and ethnic categories, showing that Hispanic/Latine and Black participants had larger effect sizes in all the outcome variables. DISCUSSION The discussion examines the potential strength of Motivational Interviewing due to its client-centered spirit, which naturally allows for incorporating values and identity-based factors, such as culture, into the session. CONCLUSION The results suggest similar BMI outcomes among White and Non-White emerging adults who engage in heavy drinking, potentially due to its client-centered approach. This is a preliminary study, and the results are therefore tentative.
Collapse
Affiliation(s)
- María Eugenia Contreras-Pérez
- Community-Based Research Institute, Florida International University, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
- Robert Stempel School of Social Work, Florida International University, Miami, Florida, USA
| | - Eric Wagner
- Community-Based Research Institute, Florida International University, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
- Robert Stempel School of Social Work, Florida International University, Miami, Florida, USA
| | - Michelle Hospital
- Community-Based Research Institute, Florida International University, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
- Department of Biostatistics, Florida International University, Miami, Florida, USA
| | - Staci Morris
- Community-Based Research Institute, Florida International University, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
- Robert Stempel School of Social Work, Florida International University, Miami, Florida, USA
| | - Suzanne Colby
- Department of Psychiatry & Human Behavior, Center for Alcohol and Addiction Studies, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Molly Magill
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island, USA
| |
Collapse
|
7
|
Koch AR, Craemer KA, Garland CE, Fox WB, Jones CT, Qualls AC, Sterr JC, Geller SE. Federally Funded Randomized Controlled Trials Increase Analysis and Reporting of Study Outcomes by Sex, Race, and Ethnicity. J Womens Health (Larchmt) 2024; 33:14-19. [PMID: 37930690 DOI: 10.1089/jwh.2023.0307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Background: We previously examined National Institutes of Health (NIH)-funded randomized controlled trials (RCTs) published in 2004, 2009, and 2015 and found low compliance with NIH policies on inclusion, analysis, and reporting results for female and minoritized subgroups, with no improvement over time. We conducted a fourth wave of data collection using RCTs published in 2021, comparing current results with previous years. Materials and Methods: The authors used PubMed to find 657 RCTs published in print in 14 leading US medical journals in 2021. Of those, 93 (14.2%) were eligible for analysis. We reviewed all parts of eligible studies and any published commentary. Fisher's exact statistics compared proportions of studies analyzing or reporting results for subgroups in 2021 compared with RCTs studied in previous waves. Posthoc analysis compared eligible RCTs about the Covid-19 pandemic to eligible RCTs on other topics. Results: Twenty-five of 93 studies (26.9%) analyzed or reported outcomes by race or ethnicity, an increase over previous years (p < 0.01). Among 79 RCTs with participants of both sexes, the median proportion of female participants was 43%. Moreover, 34 (43.0%) reported an outcome by sex, included sex as a covariate in statistical analysis, or reported results by sex, also an increase over previous waves (p < 0.01). Eleven eligible studies (11.8%) were on a SARS-CoV-2 topic; there was no difference between SARS-CoV-2 RCTs and RCTs on other topics. Conclusions: Analysis and reporting by sex, race, and ethnicity for NIH-funded RCTs published in 2021 significantly increased from previous waves, despite no corresponding increase in enrollment.
Collapse
Affiliation(s)
- Abigail R Koch
- Center for Research on Women and Gender, University of Illinois Chicago, Chicago, Illinois, USA
| | - Katherine A Craemer
- Center for Research on Women and Gender, University of Illinois Chicago, Chicago, Illinois, USA
| | - Caitlin E Garland
- Center for Research on Women and Gender, University of Illinois Chicago, Chicago, Illinois, USA
| | - William B Fox
- University of Illinois College of Medicine Rockford, Rockford, Illinois, USA
| | - Cyndra T Jones
- University of Illinois College of Medicine Rockford, Rockford, Illinois, USA
| | - Ashley C Qualls
- University of Illinois College of Medicine Rockford, Rockford, Illinois, USA
| | - Julia C Sterr
- University of Illinois College of Medicine Rockford, Rockford, Illinois, USA
| | - Stacie E Geller
- Center for Research on Women and Gender, University of Illinois Chicago, Chicago, Illinois, USA
- Department of Obstetrics and Gynecology, University of Illinois Chicago, Chicago, Illinois, USA
| |
Collapse
|
8
|
Firdaus I, Kleiboer AM, Huizink AC, Kaag AM. The Moderating Role of Sex in the Relation between Cue-Induced Craving and Resting-State Functional Connectivity in the Salience Network of Non-Clinically Diagnosed Drinkers. Eur Addict Res 2023; 29:294-304. [PMID: 37423204 PMCID: PMC10614227 DOI: 10.1159/000531090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 04/18/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION Previous research indicates a relation between craving and increased connectivity in the resting-state salience network. However, the link between cue-induced craving and connectivity in the salience network remains unclear. Further investigation is needed to understand the effect of sex on the relationship between cue-induced craving and the salience network. We investigated the role of sex in the association between the resting-state functional connectivity (RSFC) salience network and subjective cue-induced craving. METHODS Twenty-six males (mean age = 25.3) and 23 females (mean age = 26.0), with a score of 12 or higher on the alcohol use disorder identification test, were included in the current study. No significant difference in age was observed between males and females. Participants underwent a resting-state MRI scan for 6 min. Following the MRI scan, participants completed an alcohol cue-exposure task for 5.5 min to assess cue-induced craving using the desire to drink alcohol questionnaire. We applied independent component analysis methods to determine functional connectivity within the salience network. Subsequently, we investigated how cue-induced craving is related to the salience network's RSFC and if this relationship is moderated by sex. RESULTS The association between the salience network and cue-induced craving was not statistically significant nor did we find a moderating effect for sex. CONCLUSION The null findings in the study may be explained by a lack of power. Alternatively, alcohol use sex disparities may be more prevalent in the recreational/impulsive stage, whereas participants in our study were in the later stage of addiction.
Collapse
Affiliation(s)
- Insan Firdaus
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annet M Kleiboer
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anja C Huizink
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anne Marije Kaag
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|