Conducting Clinical Research Using Crowdsourced Convenience Samples

Exploring the Lived Experiences of Medication for Opioid use Disorder Treatment: A Qualitative Study among a Crowdsourced Convenience Sample

Given the effectiveness of medication for opioid use disorder (MOUD) and low engagement of treatment among people who use drugs (PWUD), it is important to better understand how to engage treatment clients with MOUD care. The current study aimed to achieve this goal by using qualitative methodology to characterize the MOUD treatment experiences. Participants (N = 52) were recruited for an online semi-structured interview. Qualitative analysis revealed varied treatment experiences, with the majority expressing irregular and intermittent MOUD treatment engagement. The therapeutic effects of MOUD in curbing withdrawal symptoms in conjunction with counseling services was frequently mentioned, as well as a preference for methadone maintenance treatment (MMT) to buprenorphine or naltrexone. Many participants described barriers to treatment and continuation of care, including failed drug screens for non-opioid drugs, perceived stigma, and physician-initiated discontinuation of treatment. The current study revealed that patients had favorable experiences with MOUD treatment, particularly when supplemented with counseling services.

A Pilot Study to Assess the Impact of a Multifactorial Explanation for Mental Illness on Prejudicial Attitudes Towards People With Mental Illness

Public stigma and prejudice toward people with psychiatric conditions is highly prevalent and damaging. Explanations for the origins of mental illness can influence attitudes toward people with these conditions. To date, studies exploring the effects of explanations for the origins of mental illness have focused on genetic or environmental explanations, and the impact of evidence-based multifactorial explanations for psychiatric illness on public attitudes remains unknown. Participants were recruited through Amazon Mechanical Turk to watch a 4-min video about the "mental illness jar model"-an evidence-based analogy that explains the complex interactions between genes and environment in the development of mental illness. Participants provided demographic information and completed questions regarding knowledge about the causes of mental illness, and the Prejudice towards People with Mental Illness (PPMI) scale both before and after watching the video. A total of 106 eligible participants completed the study. Watching the video had no significant effect on participants' knowledge about the causes of mental illness (p = 0.06), but there was a significant decrease in prejudicial attitudes toward mental illness (p = 0.0003), the effect size was small (-0.15). The use of this brief video (available at cogastudy.org) is a promising tool to decrease prejudicial attitudes toward mental illness that warrants further study.

Evaluating the psychometric properties of the 24-item and 12-item real relationship inventory-client forms

The current study assessed the psychometric properties of the long (24 items) and brief (12 items) versions of the Real Relationship Inventory-Client (RRI-C) in a United States sample. The RRI-C is the most used quantitative measure of the real relationship construct, yet its psychometric properties have not been explored outside its development studies. A sample of 700 adults in individual psychotherapy was recruited in the study and filled out a comprehensive battery of measures. Analytical techniques included confirmatory factor analysis (CFA), exploratory structural equation modeling (ESEM), multigroup CFA, multigroup factor analysis alignment, item response theory, internal reliability assessments, Bland-Altman regression analysis, and calculation of reliable change benchmark thresholds. Both RRI-C versions demonstrated a bifactor structure encompassing Genuineness and Realism dimensions. The bifactor ESEM model provided strong fit: χ2[210] =  482.464, CFI =  0.999, TLI =  0.998, RMSEA =  0.043, SRMR =  0.020 for the 24-item RRI-C; χ2[45] =  111.916, CFI =  0.999, TLI =  0.998, RMSEA =  0.046, SRMR =  0.028 for the 12-item RRI-C. McDonald's omega total was 0.97 and 0.95 respectively. The correlation between the total scores of the two versions was r =  0.98; the average discrepancy was 1.85 points higher for the comprehensive version with a slope of -0.013 (p =  0.12). Both versions showed functionally identical reliability and factor structure when therapy is online vs. in-person. Significant correlations were found between the RRI-C and the Working Alliance Inventory (r =  0.68 and r =  0.67 for the 24-item and 12-item versions, respectively, both p < .001) and the Session Evaluation Scale (r =  0.62 and r =  0.58, respectively, both p <  0.001). This study substantiates the sound psychometric properties of the 24-item and 12-item RRI-C.

Development and validation of an 8-item version of the Real Relationship Inventory-Client form

OBJECTIVE

To develop and validate a very brief version of the 24-item Real Relationship Inventory-Client (RRI-C) form.

METHOD

Two independent samples of individual psychotherapy patients (Nsample1 = 700, Nsample2 = 434) completed the RRI-C along with other measures. Psychometric scale shortening involved exploratory factor analysis, item response theory analysis, confirmatory factor analysis (CFA), and multigroup CFA. Reliability and convergent and discriminant validity of the scale and subscales were also assessed.

RESULTS

The 8-item RRI-C (RRI-C-SF) preserves the two-factor structure: Genuineness (k = 4, α = .86) and Realism (k = 4, α = .87), which were correlated at r = .74. CFA provided the following fit indices for the bifactor model: X2/df = 2.16, CFI = .99, TLI = .96, RMSEA = .07, and SRMR = .03. Multigroup CFA showed that the RRI-C-SF was invariant across in-person and remote session formats. The RRI-C-SF demonstrated high reliability (α = .91); high correlation with the full-length scale (r = .96); and excellent convergent and discriminant validity with measures of other elements of the therapeutic relationship, personality characteristics, current mental health state, and demographic-clinical variables. Clinical change benchmarks were calculated to serve as valuable tools for both research and clinical practice.

CONCLUSION

The RRI-C-SF is a reliable measure that can be used for both research and clinical purposes. It enables a nuanced assessment of the genuineness and the realism dimensions of the real relationship.

Evaluating mobile-based data collection for crowdsourcing behavioral research

Online crowdsourcing platforms such as MTurk and Prolific have revolutionized how researchers recruit human participants. However, since these platforms primarily recruit computer-based respondents, they risk not reaching respondents who may have exclusive access or spend more time on mobile devices that are more widely available. Additionally, there have been concerns that respondents who heavily utilize such platforms with the incentive to earn an income provide lower-quality responses. Therefore, we conducted two studies by collecting data from the popular MTurk and Prolific platforms, Pollfish, a self-proclaimed mobile-first crowdsourcing platform, and the Qualtrics audience panel. By distributing the same study across these platforms, we examine data quality and factors that may affect it. In contrast to MTurk and Prolific, most Pollfish and Qualtrics respondents were mobile-based. Using an attentiveness composite score we constructed, we find mobile-based responses comparable with computer-based responses, demonstrating that mobile devices are suitable for crowdsourcing behavioral research. However, platforms differ significantly in attentiveness, which is also affected by factors such as the respondents' incentive for completing the survey, their activity before engaging, environmental distractions, and having recently completed a similar study. Further, we find that a stronger system 1 thinking is associated with lower levels of attentiveness and acts as a mediator between some of the factors explored, including the device used and attentiveness. In addition, we raise a concern that most MTurk users can pass frequently used attention checks but fail less utilized measures, such as the infrequency scale.

Patient Preferences for Utilization of Telemedicine in Aesthetic Surgery Consultations

PURPOSE

Telemedicine has been increasingly utilized by plastic surgeons since the start of the COVID-19 pandemic as it minimizes visit time, costs, and viral exposures. However, patient comfort level and preference for telemedicine visits in the aesthetic surgery perioperative period remains unknown. The purpose of this study was to evaluate patient comfort and preferences regarding perioperative telemedicine visits for aesthetic surgery.

METHODS

An IRB-approved cross-sectional survey was conducted in January 2022 on Amazon's Mechanical Turk (MTurk) platform to assess respondents' comfort and preferences regarding periprocedural telemedicine visits. Survey responses were compared using descriptive and multivariate analyses.

RESULTS

A total of 505 participants (54% male, 46% female; mean age 37.7±11.5 years) completed the survey. The majority of respondents reported feeling either very or somewhat comfortable having their initial consult via telemedicine for both aesthetic surgery (72%) and non-surgical aesthetic procedures (74%). Respondents were most comfortable having an initial telemedicine consult for head and neck procedures, and least comfortable having telemedicine consults for sensitive areas, including the breast and buttocks. Respondents were significantly more comfortable scheduling non-surgical procedures than surgical procedures after a telemedicine consult alone (65% vs 58%; p < 0.001).

CONCLUSIONS

Our data suggests that the majority of aesthetic surgery patients are comfortable with having initial consultations via telemedicine. Particularly in young patients seeking non-surgical aesthetic procedures, telemedicine consults alone may be substituted for in-office visits prior to procedural scheduling. However, for operations and procedures requiring physical examination of sensitive areas, including the breasts and gluteal regions, in-person visits remain the preferred modality.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Critical thinking about health and treatments in the United States: a cross-sectional assessment of parents and undergraduate college students

BACKGROUND

There is an urgent need to study and increase the public's ability to think critically about health and treatments. Unfortunately, we do not currently have a clear, in-depth understanding of critical thinking about health in the United States, especially its rates among parents and college students, two particularly important groups. This study assessed and characterized critical thinking about health with U. S. parents and college students. We also explored whether critical thinking about health varied as a function of sociodemographic determinants.

METHODS

Parents (N = 142) and college students (N = 145) in the U. S. completed an online test of critical thinking about health, and answered questions about their background.

RESULTS

Both parents and college students in the U. S. struggled to think critically about health and treatments based on various science literacy and evidence-based practice principles. Parents with higher educational attainment had lower critical thinking about health, and college students who reported a liberal political affiliation had higher critical thinking scores.

CONCLUSIONS

This investigation demonstrates a need to increase critical thinking about health among U. S. parents and college students so they can be empowered to make informed health choices.

Examining Food-Specific and General Inhibitory Control and Working Memory as Moderators of Relations Between Emotion Regulation Difficulties and Eating Pathology in Adults With Overweight/Obesity: A Preregistered, Cross-Sectional Study

OBJECTIVE

Empirical research and theory support the interaction of executive functions (e.g., inhibitory control, working memory) and emotion regulation in guiding goal-oriented behavior; however, applications to eating pathology (e.g., binge eating) are limited. Such research is scant with adults with overweight/obesity (AwO/O), a population reporting high levels of binge eating, emotion regulation difficulties, and deficits in inhibitory control and working memory. We tested interactions between emotion regulation and executive functioning in relation to eating pathology in AwO/O while considering stimuli-specific deficits (e.g., food-specific deficits) in behavioral task performance.

METHOD

AwO/O (N = 204; MBMI = 32.11; Mage = 38.30 [SD = 12.16]) completed a preregistered, online study assessing demographics and emotion regulation difficulties (Difficulties in Emotional Regulation Scale), inhibitory control (go/no-go task, food and general stimuli), working memory (N-Back Task, food and general stimuli), binge eating (Binge Eating Scale), and disordered eating (Eating Disorder Examination-Questionnaire).

RESULTS

There was limited evidence of moderation in models examining food-specific and general inhibitory control and working memory, emotion regulation difficulties, and binge eating. Preliminary support was found for emotion regulation difficulties to be more strongly associated with more disordered eating in AwO/O reporting more food-specific and general working memory deficits. Consistent, positive associations between emotion regulation difficulties and eating pathology were observed.

CONCLUSIONS

Among adults with AwO/O, emotion regulation difficulties are closely related to eating pathology, regardless of performance on working memory and inhibitory control tasks. Clinicians and researchers working with AwO/O may consider how emotion regulation difficulties and working memory deficits work together to influence disordered eating.

Increased BMI is associated with an altered decision-making process during healthy food choices in males and females

Unhealthy diets (rich in calories, sugar, fat, and sodium) are a major cause of obesity. Why individuals struggle to make healthy food choices remains unclear. This study examined how body mass index, biological sex, and eating context influence food attribute perception, the food choice process, and the percentage of healthy food choices. In an online study, males and females with and without obesity (n = 910) rated food images for healthiness and tastiness and made food choices after prompts directing them to choose foods they considered healthy (healthy prompt) or to choose as they would in their daily lives (typical prompt), which aimed to model healthy and typical eating contexts. When foods were classified as healthy or unhealthy using nutritional labeling information, all participants rated healthy foods with larger healthiness ratings, but females rated healthy foods as healthier and tastier than males. Still, participants with obesity had fewer healthy choices (i.e., choosing the food with the largest healthiness rating) regardless of sex and prompt. Further, tastiness differences were more relevant than healthiness differences during healthy food choices among participants with obesity, and more so after the typical prompt. On the contrary, healthiness differences were more relevant among participants with healthy weight regardless of prompt type. Our findings highlight the importance of eating contexts in how individuals use their perception of food attributes during healthy food choices and suggest that increasing the presence of healthy prompts and perceived tastiness of healthy foods may promote healthy food choices among individuals with obesity.

Online Search Strategies and Results From a Crowdsourced Survey on Asymptomatic Bacteriuria

IMPORTANCE

Despite the prevalence of asymptomatic bacteriuria (ASB), what proportion of the population is aware of this condition and the quality of internet resources are currently unknown.

OBJECTIVE

This study aimed to use an online crowdsourcing platform to explore general knowledge and internet search strategies, along with the quality of information, on ASB.

STUDY DESIGN

An online survey was administered through a crowdsourcing platform to women 50 years or older via Qualtrics, which is a sophisticated online survey tool. Participants completed a survey on ASB, and participants were asked how they would search the internet for information both on urinary test results and on ASB. Outcomes included survey responses, and qualitative data were coded and analyzed thematically. χ 2 Testing and regression modeling were used to look for variables associated with concern for ASB.

RESULTS

There were a total of 518 participants who passed attention check qualifications, and only 45 respondents (8.7%) had heard of ASB. Many were concerned about progress to a worsening infection (n = 387 [77.6%]). When controlling for confounders, education beyond a college degree was not associated with a lower concern for ASB when compared with those with a high school education or less (adjusted odds ratio, 0.63; 95% confidence interval, 0.25-1.55; P = 0.31). Medical providers were the target audience for a majority of the websites, and many of the patient-facing results were of poor quality.

CONCLUSIONS

Our national survey of women demonstrated a prevalent knowledge deficit surrounding ASB. We must seek to create high-quality, readily available, patient-facing information to increase awareness of ASB, allay concerns, and increase antibiotic stewardship.

Gender Stereotypes and Perceptions of Stranger Violence: Attributions of Blame and Motivation

Violence is a harmful, complex and gendered act that impacts individuals and communities financially, physically, socially and psychologically. Many studies have investigated how and why gender impacts perceptions of intimate partner violence (IPV), but little research has investigated its effect on stranger violence, despite being publicly perceived as causing greater fear and harm. Th is study examines the effects of gender attitudes and stereotypes on perceptions of stranger violence, specifically attributions of blame, affective response, alleged motivations and attitudes regarding the acceptability of violence (in general). Data was collected from 265 United Kingdom (UK) adults using an online survey posted on Amazon's Mechanical Turk (MTurk). Results indicate that like IPV, gender affects perceptions of stranger violence. Male and female perpetrators of stranger violence are perceived differently, and gender differences are evident between male and female participants. Practical implications of the findings are discussed.

Medical mistrust in racial minorities during the COVID-19 pandemic: Attitudes, actions and mental health outcomes

Numerous studies have demonstrated that minority groups had a higher level of medical mistrust than non-minority groups, and minority communities were criticized for noncompliance with the public health guidelines during the COVID-19 pandemic. This study explores racial minorities' attitudes and actual behavioral responses to the COVID-19 pandemic public health guidelines. A total of 221 adults responded to an online survey (mean age = 41.5; 48.0% female; 24.4% non-White). Study results indicate that racial minorities have lower trust in public health guidelines compared to non-minority groups but have taken more actions according to the public health guidelines. Analysis also uncovers the mediating roles of perceived pandemic severity and perceived public health action benefits, on the relation between minority status and public health compliance. This study contextualizes how racial minorities respond to public health crises in action, and the dissonance between that and their historical mistrust of medical authorities. This work highlights the importance of recognizing the minority's historical burden and fostering trust in government and professionals during public health crisis.

The LIMB-Q: Reliability and Validity of a Novel Patient-Reported Outcome Measure for Patients with Lower Extremity Trauma

BACKGROUND

The LIMB-Q is a novel patient-reported outcome measure for patients with lower extremity trauma. The aim of this study was to perform a psychometric validation of the LIMB-Q based on the Rasch measurement theory.

METHODS

An international, multisite convenience sample of patients with lower extremity traumatic injuries distal to the midfemur was recruited from clinical sites in the United States and the Netherlands and online platforms (in English; Trauma Survivors Network patient support group and the Prolific academic research platform). A cross-sectional survey of the LIMB-Q was conducted with test-retest reliability analysis performed 1 to 2 weeks after initial completion in a subgroup of patients.

RESULTS

The LIMB-Q was field-tested in 713 patients. The mean age was 41 years (SD, 17 years; range, 18 to 85 years), the mean time from injury was 7 years (SD, 9 years; range, 0 to 58 years), and there were various injury and treatment characteristics (39% fracture surgery only, 38% flap or graft, 13% amputation, 10% amputation and flap or graft). Out of 382 items tested, 164 were retained across 16 scales. Reliability was demonstrated with person separation index values of 0.80 or greater in 14 scales (0.78 to 0.79 in the remaining 2 scales), Cronbach alpha values 0.83 or greater, and intraclass correlation coefficient values 0.70 or greater. Each scale was unidimensional, measurement invariance was confirmed across clinical and demographic factors, test-retest analysis showed adequate reliability, and construct validity was demonstrated.

CONCLUSION

The LIMB-Q is a patient-reported outcome measure with 16 independently functioning scales (6 to 15 items per scale) developed and validated specifically for patients with lower extremity trauma with fractures, reconstruction, or amputation.

Cross-Cultural Adaptation and Psychometric Validation of the Suicide Cognitions Scale-Revised (SCS-R) in Spanish Adolescents in Residential Care

The Suicide Cognitions Scale (SCS) has demonstrated considerable promise as a risk screening tool, although it has yet to be validated for use with adolescents or in Spanish-speaking populations. The aim of this study was to develop a Spanish version of the 16-item SCS-Revised (SCS-R) and to examine its psychometric properties in a sample of adolescents. Participants were 172 adolescents aged between 12 and 18 years (M = 15.32, SD = 1.57) and currently in residential care. They completed the Spanish SCS-R and a series of other psychological measures. The psychometric properties of the SCS-R were examined through factor analyses and testing of convergent/discriminant validity and construct validity. Factor analyses supported a bifactor structure, indicating that SCS-R items were primarily measuring a common underlying latent variable. SCS-R scores were positively correlated with multiple indicators of psychopathology and other suicide risk factors (e.g., depression, hopelessness) but negatively correlated with protective factors (e.g., believing that one's mental pain will eventually end). Importantly, SCS-R scores differentiated adolescents in residential care who had previously attempted suicide from those who had only thought about suicide. Scores also differentiated adolescents who had previously attempted suicide from those who had previously only engaged in non-suicidal self-injury. This constitutes further evidence that the SCS-R measures a construct that distinguishes suicidal thought from action and is specific to suicidal forms of self-harm. Overall, the results suggest that the Spanish SCS-R is a potentially useful tool for identifying adolescents at risk of attempting suicide in residential care.

Dropout in a Longitudinal Survey of Amazon Mechanical Turk Workers With Low Back Pain: Observational Study

BACKGROUND

Surveys of internet panels such as Amazon's Mechanical Turk (MTurk) are common in health research. Nonresponse in longitudinal studies can limit inferences about change over time.

OBJECTIVE

This study aimed to (1) describe the patterns of survey responses and nonresponse among MTurk members with back pain, (2) identify factors associated with survey response over time, (3) assess the impact of nonresponse on sample characteristics, and (4) assess how well inverse probability weighting can account for differences in sample composition.

METHODS

We surveyed adult MTurk workers who identified as having back pain. We report participation trends over 3 survey waves and use stepwise logistic regression to identify factors related to survey participation in successive waves.

RESULTS

A total of 1678 adults participated in wave 1. Of those, 983 (59%) participated in wave 2 and 703 (42%) in wave 3. Participants who did not drop out took less time to complete previous surveys (30 min vs 35 min in wave 1, P<.001; 24 min vs 26 min in wave 2, P=.02) and reported having fewer health conditions (5.88 vs 6.6, P<.001). In multivariate models predicting responding at wave 2, lower odds of participation were associated with more time to complete the baseline survey (odds ratio [OR] 0.98, 95% CI 0.97-0.99), being Hispanic (compared with non-Hispanic, OR 0.69, 95% CI 0.49-0.96), having a bachelor's degree as their terminal degree (compared with all other levels of education, OR 0.58, 95% CI 0.46-0.73), having more pain interference and intensity (OR 0.75, 95% CI 0.64-0.89), and having more health conditions. In contrast, older respondents (older than 45 years age compared with 18-24 years age) were more likely to respond to the wave 2 survey (OR 2.63 and 3.79, respectively) and those whose marital status was divorced (OR 1.81) and separated (OR 1.77) were also more likely to respond to the wave 2 survey. Weighted analysis showed slight differences in sample demographics and conditions and larger differences in pain assessments, particularly for those who responded to wave 2.

CONCLUSIONS

Longitudinal studies on MTurk have large, differential dropouts between waves. This study provided information about the individuals more likely to drop out over time, which can help researchers prepare for future surveys.

Orthopaedic Surgery and Indusry: What our Potential Patients Believe

PURPOSE

Physician and surgeon involvement in industry has received considerable attention in recent decades. In this study, we outline the perspective of the general US population regarding (1) disclosure, (2) ownership, and (3) compensation between physicians/surgeons and industry. We hypothesize that the general population would be largely supportive of the physician/surgeon-industry relationship.

METHODS

An online, survey-based, descriptive study was conducted through a crowdsourcing platform, Amazon Mechanical Turk. Survey respondents were presented with a seven-item questionnaire inquiring about the physician/surgeon and industry relationship. An "attention check" question was included; those who failed this question were excluded. Descriptive statistics were used to assess the data and a McNemar chi-squared test for paired, dichotomous data.

RESULTS

A total of 993 respondents were included. Survey responses are summarized in Table 1. 70.6% of respondents stated that it was "important" or "extremely important" to disclose that the patient be informed whether implants used in surgery had been developed by the operating surgeon. 71.1% of respondents reported that it was "important" or "extremely important" to disclose partial ownership within industry. Seventy-one percent of respondents stated it was "important" or "extremely important" to disclose royalty payments pertaining to surgical implants. 95.6% of respondents suggested that it was acceptable for surgeons to accept free airfare and lodging, and 95.2% of respondents stated that it was acceptable for the surgeon to be compensated for time away from practice to learn about new equipment.

DISCUSSION

In our survey of 993 respondents, we found that relationships with industry are considered acceptable if appropriate disclosure is given to patients. We also found that although respondents suggested that physicians and surgeons may be influenced by a free meal, compensation for trips to try new equipment and time spent away from practice is considered appropriate.

LEVEL OF EVIDENCE

2c, Ecological studies.

Using survey experiment pretesting to support future pandemic response

The world could witness another pandemic on the scale of COVID-19 in the future, prompting calls for research into how social and behavioral science can better contribute to pandemic response, especially regarding public engagement and communication. Here, we conduct a cost-effectiveness analysis of a familiar tool from social and behavioral science that could potentially increase the impact of public communication: survey experiments. Specifically, we analyze whether a public health campaign that pays for a survey experiment to pretest and choose between different messages for its public outreach has greater impact in expectation than an otherwise-identical campaign that does not. The main results of our analysis are 3-fold. First, we show that the benefit of such pretesting depends heavily on the values of several key parameters. Second, via simulations and an evidence review, we find that a campaign that allocates some of its budget to pretesting could plausibly increase its expected impact; that is, we estimate that pretesting is cost-effective. Third, we find pretesting has potentially powerful returns to scale; for well-resourced campaigns, we estimate pretesting is robustly cost-effective, a finding that emphasizes the benefit of public health campaigns sharing resources and findings. Our results suggest survey experiment pretesting could cost-effectively increase the impact of public health campaigns in a pandemic, have implications for practice, and establish a research agenda to advance knowledge in this space.

Reinforcement-Learning-Informed Queries Guide Behavioral Change

Algorithmically defined aspects of reinforcement learning correlate with psychopathology symptoms and change with symptom improvement following cognitive-behavioral therapy (CBT). Separate work in nonclinical samples has shown that varying the structure and statistics of task environments can change learning. Here, we combine these literatures, drawing on CBT-based guided restructuring of thought processes and computationally defined mechanistic targets identified by reinforcement-learning models in depression, to test whether and how verbal queries affect learning processes. Using a parallel-arm design, we tested 1,299 online participants completing a probabilistic reward-learning task while receiving repeated queries about the task environment (11 learning-query arms and one active control arm). Querying participants about reinforcement-learning-related task components altered computational-model-defined learning parameters in directions specific to the target of the query. These effects on learning parameters were consistent across depression-symptom severity, suggesting new learning-based strategies and therapeutic targets for evoking symptom change in mood psychopathology.

Development and Validation of the Perceived Interpersonal Relevancy Scales: A New Measure of Perceived Threat, Opportunity, and Invisibility Appraisals for Use Across the Adult Life Course

OBJECTIVES

Interpersonal relevancy appraisals are a dynamic and understudied aspect of human social cognition. Despite their importance, there are no existing measures. This study developed and validated a new measure of self-perceived interpersonal threat, opportunity, and invisibility appraisals among a life-course sample of adults. We also explored the relationships between relevance appraisals, social connectedness, loneliness, age, and sex assigned at birth.

METHODS

Items were developed based on a theoretical model of multidomain interpersonal relevance appraisals and refined following feedback from 5 experts in social psychology. Cross-sectional data were obtained online from a sample of 1,079 adults (age 18-90 years), recruited from the general population of Australia. Data were split into two pseudo-random samples used for (a) scale development and evaluation, and (b) assessment of internal consistency, construct validity, convergent validity with social connectedness and loneliness, and exploratory analysis with age and sex.

RESULTS

Results support the factor structure and internal consistency of 17- and 9-item versions of the Perceived Interpersonal Relevancy Scales (PIRS) and measurement invariance across younger and older age groups. Higher self-perceived threat and invisibility appraisals were associated with decreased social network size, increased loneliness, younger age, and male sex. Higher self-perceived opportunity appraisals were associated with increased social network size and decreased loneliness.

DISCUSSION

Results support this new measure of perceived interpersonal relevance appraisals, which shows relationships between the way we believe others perceive us, loneliness, and social isolation. The PIRS likely has wide utility for studies that seek to understand the intersections between human social cognition, well-being, and health across the lifespan.

Conceptualizing problematic use of medicinal Cannabis: Development and preliminary validation of a brief screening questionnaire

The use of Medicinal Cannabis (MC) for treating chronic pain is increasing, globally, yet the definition of problematic MC use remains unclear. Defining problematic use of cannabis in medical and non-medical contexts may be fundamentally different since individuals prescribed MC often experience physical dependence, which do not necessarily imply pathology. We aimed to conceptualize problematic use of MC and develop a brief questionnaire for identifying and quantifying problematic MC use. Content validation used a broad definition of problematic substance use, adapting and compiling an initial list of 36 items from various sources: (a) screening tools for assessing problematic prescription opioid medication use; (b) screening tools for problematic recreational cannabis use and (c) qualitative interviews with MC patients. 390 American self-identified chronic pain patients holding a MC card rated each item from the initial list on a 5-point frequency scale and filled out questionnaires assessing various clinical outcomes. Following initial item titration, a multi-group measurement invariance comparison strategy, using two external indicators: alcohol-related problems and depression, resulted a final eight-item list that met fit quality in a baseline model, presented excellent internal consistency reliability (α = 0.929), and significantly correlated with anxiety and low quality of life. Items in the final list related predominantly to negative consequences of MC use. Problematic use of MC is characterized by negative physiological, social, emotional and functional consequences. The final eight-item list was named the Medicinal Cannabis Negative Consequences Scale (MCNCS), emerging as a brief measure for problematic MC use and demonstrating preliminary reliability and validity, which could aid clinicians and researchers.

The causal effect of skin color bias in online dating

Despite the expansive literature on U.S. ethnoracial relations, issues such as reliance on observational data and inconsistent measures of skin color limit the research on skin color stratification and cross-ethnoracial relationships. These issues hinder researchers' capacity to disentangle the causal effect of colorism in perpetuating discrepancies within intergroup relationships, specifically within the context of online dating, a popular form of modern dating. In May-June 2021, I fielded a survey experiment that features online dating profiles of Black daters in which skin tone is the treatment. While the multivariate analyses show no statistically significant differences between light- and medium-toned daters, profiles featuring dark-skinned daters consistently receive a penalty in comparison to profiles of light- and medium-skinned people. The results suggest that colorism can have a direct impact on how dark-skinned Black people navigate their romantic lives, independent of other influential factors (e.g., socioeconomic status, social networks, etc.).

Evaluating the Psychometric Properties of a Physical Activity and Sedentary Behavior Identity Scale: Survey Study With Two Independent Samples of Adults in the United States

BACKGROUND

Emerging evidence suggests a positive association between relevant aspects of one's psychological identity and physical activity engagement, but the current understanding of this relationship is primarily based on scales designed to assess identity as a person who exercises, leaving out essential aspects of physical activities (eg, incidental and occupational physical activity) and sedentary behavior.

OBJECTIVE

The goal of this study is to evaluate the validity of a new physical activity and sedentary behavior (PA/SB) identity scale using 2 independent samples of US adults.

METHODS

In study 1, participants answered 21 candidate items for the PA/SB identity scale and completed the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Study 2 participants completed the same PA/SB identity items twice over a 1-week interval and completed the IPAQ-SF at the end. We performed factor analyses to evaluate the structure of the PA/SB identity scale, evaluated convergent validity and test-retest reliability (in study 2) of the final scale scores, and examined their discriminant validity using tests for differences in dependent correlations.

RESULTS

The final PA/SB identity measure was comprised of 3 scales: physical activity role identity (F1), physical activity belief (F2), and sedentary behavior role identity (F3). The scales had high test-retest reliability (Pearson correlation coefficient: F1, r=0.87; F2, r=0.75; F3, r=0.84; intraclass correlation coefficient [ICC]: F1: ICC=0.85; F2: ICC=0.75; F3: ICC=0.84). F1 and F2 were positively correlated with each other (study 1, r=0.76; study 2, r=0.69), while both were negatively correlated with F3 (Pearson correlation coefficient between F1 and F3: r=-0.58 for study 1 and r=-0.73 for study 2; F2 and F3: r=-0.46 for studies 1 and 2). Data from both studies also demonstrated adequate discriminant validity of the scale developed. Significantly larger correlations with time in vigorous and moderate activities and time walking and sitting assessed by IPAQ-SF with F1, compared with F2, were observed. Significantly larger correlations with time in vigorous and moderate activities with F1, compared with F3, were also observed. Similarly, a larger correlation with time in vigorous activities and a smaller correlation with time walking were observed with F2, compared with F3.

CONCLUSIONS

This study provided initial empirical evidence from 2 independent studies on the reliability and validity of the PA/SB identity scales for adults.

Cognitive support for political partisans' understanding of policy data

Political partisanship might lead educated adults-even the highly numerate-to reason selectively about numbers that are relevant to and support their ideology ("motivated numeracy"). In this pre-registered study, we sought to examine the replicability of motivated numeracy, and investigate whether cognitive support (number lines) that improves the reasoning of children might also improve the reasoning of political partisans. To test this, we asked 1000 adults about their political ideology and asked them to interpret fictional data, in a table or number-line format, about ideology relevant (i.e., the effect of gun control on crime) or irrelevant (i.e., the effect of skin cream on rash) issues. We failed to replicate motivated numeracy when political identity was used but observed motivated numeracy when prior attitude was used. Moreover, data presented on number lines elicited 75 percent greater accuracy than data presented in tables, regardless of whether the information was ideology-relevant, or whether data supported, was neutral to, or contradicted participants' political outlooks. Findings imply that political partisans require cognitive support to be more objective about policy data.

Prevalence of Anxiety and Depression among Parents of Children with Cancer-A Preliminary Study

BACKGROUND

A child's cancer is a highly stressful experience for the entire family. Childhood cancer disrupts family functioning and is one of the most stressful and challenging events parents face, often beyond their control. Parents play a crucial role in providing emotional support to children throughout their illness, and their ability to cope can help reduce the child's negative emotions. The aim of this study was to assess the prevalence of anxiety and depression among parents of children with cancer.

METHODS

This cross-sectional study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines and included parents of children undergoing cancer treatment. Convenience sampling was used. The Beck Depression Inventory and the Hospital Anxiety and Depression Scale were utilized to assess the parents.

RESULTS

This study included 270 participants (73% women, 27% men) with children at an average age of 8.75 ± 4.82 years. Diagnoses included leukemia (53%), lymphoma (29%), and other cancers. On the Beck Depression Inventory, 33% of parents were mildly depressed, 12% moderately depressed, and 32% severely depressed, with an average score of 20.63 ± 12.39 points. The HADS-M scale indicated anxiety at 48.43 ± 20.78%, depression at 45.01 ± 22.8%, and aggression at 54.72 ± 28.71%.

CONCLUSIONS

Most parents of children with cancer have symptoms of depression and anxiety, which are influenced by the duration of the child's illness. A strong correlation was observed between the level of anxiety and the tendency for depression.

Social cure model: testing the link between identity centrality and body appreciation in diverse sexual orientation and gender identity groups

BACKGROUND

The level of experienced sociocultural pressure to have an idealized body can vary depending on a person's gender identity and sexual orientation. The current study explored whether differences in levels of body appreciation among people with different sexual orientations and gender identities vary because of differing levels of experienced pressure by in-group members and varying levels of experienced hostile behaviors because of their looks or body. Thereby, the study tests the social cure model, according to which high levels of identity centrality are associated with better mental health.

METHODS

An online cross-sectional questionnaire study was conducted with 1,587 people (51.3% cisgender women, 39.3% cisgender men, 9.5% non-binary; 52.9% identified as heterosexual, 27.7% identified as bisexual/pansexual, 11.2% identified as gay/lesbian, 8.2% identified as asexual/demi/queer; Mage = 32.9, SD = 12.6) from German-speaking countries. Variables were assessed with German-language versions of the Multidimensional and Multicomponent Measure of Social Identification, Body Appreciation Scale-2, the Perceived Stigmatization Questionnaire, and the Sociocultural Attitudes Towards Appearance Questionnaire-4, revised. A manifest-path model was calculated.

RESULTS

Non-binary persons reported lower levels of body appreciation than did cisgender men and sexual minority persons reported lower levels of body appreciation than did heterosexual persons. Furthermore, sexual minority persons experienced more hostile behaviors directed towards them because of their looks or body than did heterosexual persons. Similarly, non-binary persons experienced more hostile behaviors than did men. Non-binary persons were subjected to lower levels of in-group pressure than were men. Gay/lesbian persons and asexual persons were subjected to lower levels of in-group pressure than were heterosexual persons. More hostile behaviors and stronger in-group pressure were related to lower body appreciation. In cisgender women and men indirect links revealed associations between strong identity centrality and low levels of body appreciation through the mediator of high in-group pressure.

CONCLUSIONS

Data in sexual minority individuals or non-binary persons supported the social cure model, according to which persons can find support and validation for their looks and body from in-group members. In cisgender women and men, strong identification as a woman or man can be related to stronger in-group pressure and in turn to lower body appreciation.

Large-scale evidence for the validity of remote MoCA administration among people with cerebellar ataxia

Objective: For over half a century, studies of rare diseases using in-person cognitive tools have faced challenges, such as long study periods and small sample sizes (e.g. n = 10). The Montreal Cognitive Assessment (MoCA) was widely employed to assess mild cognitive impairment (MCI). We aimed to validate a modified online version of the MoCA in a large sample of a rare disease (population prevalence < .01%). Method: First, we analyzed 20 previous findings (n = 1,377), comparing the MoCA scores between large groups of neurotypically healthy (NH; n = 837) and cerebellar ataxia (CA; n = 540), where studies were conducted in-person. Second, we administered the MoCA in-person to a group of NH (n = 41) and a large group of CA (n = 103). Third, we administered a video conferencing version of the MoCA to NH (n = 38) and a large group of CA (n = 83). Results: We observed no performance differences between online and in-person MoCA administration in the NH and CA groups (p > .05, η2 = 0.001), supporting reliability. Additionally, our online CA group had lower MoCA scores than the NH group (p < .001, Hedges' g = 0.68). This result is consistent with previous studies, as demonstrated by our forest plot across 20 previous in-person findings, supporting construct validity. Conclusion: The results indicate that an online screening tool is valid in a large sample of individuals with CA. Online testing is not only time and cost-effective, but facilitates disease management and monitoring, ultimately enabling early detection of MCI.

Weight stigma and binge eating related to poorer perceptions of healthcare provider interaction quality in a community-based sample

BACKGROUND

Weight stigma refers to the social rejection, discrimination, and ideological devaluation of individuals because of body size and is a direct result of weight bias and anti-fat attitudes. Individuals with higher weight may be less likely to seek healthcare due to weight stigma, and if or when they do present for care, medical providers with weight bias may fail to provide high quality care. Little, however, is known about the intersectionality of weight stigma and perceptions of healthcare interactions as experienced by individuals who also binge eat.

METHODS

Community-based adults completed online self-report questionnaires regarding generalized weight stigma (Attitudes Towards Obese Persons1), healthcare interaction quality (Patient Perceptions of Healthcare Provider Interaction Quality; PPH), and disordered eating (Eating Disorder Examination-Questionnaire) via Amazon's Mechanical Turk platform. For this cross-sectional study, participants were categorized by the presence and absence of regular binge episodes. Pearson's correlations, T-tests, ANOVA/ANCOVA, and a multivariate regression were used to examine relationships among demographic variables, weight stigma, disordered eating, and the PPH.

RESULTS

Participants (N = 648) primarily identified as female (65.4%) and White, non-Hispanic (72.7%). Participants' average age and body mass index (BMI) were 37.5 (SD = 12.3) years old and 27.3 (SD = 6.9) kg/m2, respectively. Higher healthcare provider interaction quality ratings (PPH) were significantly related to lower BMI (r(648)=-0.098,p = 0.012), less weight stigma (r(648) = 0.149,p < 0.001), and identifying as a woman (t(514) = 2.09, p = 0.037, Cohen's d = 0.165) or White, non-Hispanic (t(646)=-2.73, p = 0.007, Cohen's d=-0.240). Participants reporting regular binge eating endorsed significantly worse perceptions of healthcare provider quality than those who did not, even after accounting for BMI, F(1, 645) = 8.42, p = 0.004, η2 = 0.013. A multivariate linear regression examining the PPH as dependent, and weight stigma and binge eating as independent, variable/s, was significant even after accounting for covariates (sex, race, BMI), F(95, 640) = 7.13,p < 0.001, R2 = 0.053 (small effect).

CONCLUSIONS

More negative experiences with healthcare providers was associated with worse weight stigma, higher BMI, regular binge eating and overall disordered eating, and for participants identifying as male or a Person of Color. These data have implications for non-clinical community populations and are particularly important as experiencing poorer quality of interactions with healthcare providers may decrease individuals' likelihood of seeking needed care for both disordered eating and health-related concerns.

TRIAL REGISTRATION

N/A.

Examining worry and secondary stressors on grief severity using machine learning

BACKGROUND & OBJECTIVES

Worry and loss-related secondary stressors appear to be important correlates of problematic grief responses. However, the relative importance of these variables in the context of established correlates of grief responding, ranging from indicators of identity disruption and demographic characteristics of the bereaved to characteristics of the loss of quality of the relationship with the deceased, is unknown. Modeling the relative associations of these factors can be problematic, given the high degree of collinearity between these variables. This study used a machine learning approach to provide accurate estimations of the relative importance of these correlates for post-loss symptom severity.

METHODS AND RESULTS

A convenience sample of 428 bereaved people who had lost a parent, spouse, or child in the last 30 to 365 days completed an online survey. Random forest regression modeling examined the effects of worry and secondary stressors on symptom severity in the context of established correlates. Results indicated worry and the number of secondary stressors experienced were among the factors most strongly associated with severity of grief, depression, posttraumatic stress and problems functioning.

CONCLUSIONS

These results also provide insight into the relative importance of worry and secondary stressors affecting grief severity to guide future research.

Vulnerability in research ethics: A call for assessing vulnerability and implementing protections

Ethics standards reference the need for special consideration of vulnerable populations, such as pregnant women, incarcerated individuals, and minors. The concept of vulnerability is poorly conceptualized in the medical sciences where it originated, and its application to the social sciences is even more challenging. Social science researchers may unwittingly fail to appreciate preexisting vulnerabilities and indeed may be responsible for inducing new research-related vulnerability. In this paper, we present the first comprehensive coding of country-level vulnerability designations. Specifically, we coded all 355 official documents governing social/behavioral human subjects research for the 107 countries with such regulations and identified 68 distinct vulnerability categories. The data reveal substantial regional variation, overemphasis of categories derived from medical sciences, neglect of critical categories such as displacement, and likely heterogeneity within and across groups. The article provides a conceptual framework that shifts the problem away from static, enumerated categories toward emphasis on research-induced vulnerability. Based on our conceptualization and coding, we present a framework for assessing vulnerability and implementing appropriate protections.

Valiquette C, Somogyi R. Understanding the Appropriate and Beneficial Use of Before and After Photos in Breast Surgery: A North American Survey

Introduction: Before and after photographs (BAPs) in breast surgery have been identified as important components of the informed consent process. Currently, there is limited consensus on the contents and presentation of BAPs. This study collected the opinions of prior and prospective patients on this topic. Methods: A survey, based on criteria identified by our previous nominal group technique (NGT) study, was designed to obtain patient perspectives on BAPs in breast surgery. Amazon Mechanical Turk, a validated crowd-sourcing tool, was used to identify and survey a group of 72 participants who indicated that they had undergone or were planning to undergo breast surgery. Likert items were analyzed using either chi-squared or Fisher's exact test. Results: Most respondents were cis-gendered-women (89%), Caucasian (83%), and between 31 and 41 years old (38%). Respondents agreed that BAPs are important to the consent process, for enabling patient-centered care, and should be presented in standardized sets. BAPs should be more accessible through different platforms, display multiple time points to show the healing process, and have multiple views including close-ups of scars. Photos should be unaltered except for de-identification, and have more diversity with regard to patient gender, age, skin color, and body mass index. These results align with results from our NGT study. Conclusion: Through this study we have identified many criteria that BAPs should meet according to prior and prospective breast surgery patients. Surgeons should think critically about how they present BAPs during the consent process to ensure effective patient-centered care.

"Say Her Name": Symbolic Racism and Officer Valuing Predict White Americans' Reactions to the Fatal Police Shooting of a Black Woman

A report entitled Say Her Name: Resisting Police Brutality against Black Women underscores the paucity of research examining police violence toward Black women. This study focused on how valuing a White police officer and symbolic racism moderate reactions when the officer fatally shoots a Black or White woman during a traffic stop. At high levels of officer valuing, symbolic racism was positively associated with perceptions the victim presented a threat to the officer, but negatively associated with support for punishing the officer and perceived victim compliance; these associations were stronger when the victim was Black relative to White. At low officer valuing levels, there was no variability in the link between symbolic racism and the outcome variables as a function of victim race. Implications for bias in judicial outcomes for the victim and officer are discussed.

The WOUND-Q Function and Symptoms Scales for Chronic Lower Extremity Wounds: A Validation Study

Objective: Determine the validity and reliability of the LIMB-Q scales, Function, and Symptoms in patients with chronic lower extremity wounds. Approach: Cognitive debriefing interviews with people with current or previous wounds were conducted to examine content validity. Scales were field-tested in an international sample of people with chronic lower extremity wounds sourced from an online platform (i.e., Prolific). Psychometric properties were examined using the Rasch Measurement Theory analysis. A test-retest reproducibility study was performed, and construct validity was examined. Results: Content validity was established after 10 cognitive interviews. A total of 233 people with lower extremity wounds (age 19-80 years, mean 39.3) participated in the field test. All 25 items tested demonstrated good fit to the Rasch model with ordered thresholds. One item had a fit residual outside ±2.5, but no items had significant χ2 values after Bonferroni adjustment. Reliability was high with the person separation index, Cronbach alpha, and intraclass correlation coefficient values >0.8. Strong correlations were found between the Function and Symptoms scales and EQ-5D dimensions measuring similar constructs as well as the EQ-5D global score. All hypotheses for construct validity were confirmed. Innovation: Patient-reported outcome measures are an important component of patient-centered care, as they capture the patient's perspective in a rigorous and reproducible way. Adding these two scales to the WOUND-Q provides a means to measure function and symptoms associated with lower extremity wounds. Conclusion: These new WOUND-Q scales can be used to measure outcomes important to patients with lower extremity wounds in clinical settings and research studies.

Awareness of the potential consequences of alcohol consumption in the context of chronic pain and prescription opioid use

Background: Alcohol and prescription opioid use are highly prevalent among chronic pain populations. One-fifth of individuals prescribed opioids report same-day use of alcohol and opioids. Alcohol use and alcohol/opioid co-use can have deleterious pain management and health outcomes. The extent to which individuals with chronic pain are aware of these deleterious outcomes is considerably understudied.Objectives: To explore individuals' understanding of seven health- and pain-related risks of alcohol/alcohol-opioid use. An exploratory aim was to examine whether greater risk awareness was associated with alcohol/opioid use patterns.Methods: Participants included 261 adults age ≥21(36.4% women) endorsing current alcohol use, chronic musculoskeletal pain, and opioid prescription who completed an online survey via Amazon Mechanical Turk.Results: Distribution of the total number of items for which a participant endorsed awareness was as follows: zero (10.7%), one (5.0%), two (13.0%), three (13.8%), four (13.8%), five (11.5%), six (10.0%), and seven items (22.2%). Awareness of the health consequences of alcohol/alcohol-opioid use was positively associated with opioid misuse behaviors (β = .525, ΔR2 = .251, p < .001), and higher-risk alcohol consumption (β = .152, ΔR2 = .021, p = .011).Conclusion: Many adults with chronic pain are unaware of the health consequences of alcohol/alcohol-opioid use. Findings of positive covariation between risk awareness and higher-risk alcohol/opioid use suggest that future interventions among this population should go beyond simple risk education and utilize motivational enhancement to help change decisional balance.

Does parental use of harsh discipline and punishment in response to ambiguous child situations vary by child physical abuse risk?

BACKGROUND/OBJECTIVES

The present study investigated the extent to which fathers and mothers at high-risk and low-risk for child physical abuse (CPA) differed in their use of harsh discipline and punishment when presented ambiguous child situations (situations where differences in positive and negative valences are close to zero).

PARTICIPANTS/METHODS

High-risk for CPA parents (N = 74: fathers, n = 41; mothers, n = 33) and low-risk parents (N = 178: fathers, n = 91; mothers, n = 87) were asked to indicate their likelihood of using harsh verbal discipline (HVD), harsh physical discipline (HPD), and punishment (i.e., retributive harm separate from HVD and HPD) after viewing each of eighteen ambiguous child situations.

RESULTS

As expected, high-risk, compared to low-risk, for CPA parents were significantly (ps < 0.001) more likely to use HVD (d = 0.546), HPD (d = 0.595), and punishment (d = 0.564). Overall, fathers, relative to mothers, were significantly more likely to use HVD (d = 0.261) and HPD (d = 0.238). For punishment, however, there was no significant parental role (father, mother) difference (d = 0.136).

CONCLUSIONS

Since in everyday living situations many child behaviors are ambiguous, the findings that parents, especially high-risk for CPA parents, use harsh discipline and punishment when encountering ambiguous child situations suggest that non-contingent harsh child-related parental behaviors may be frequent in the lives of some children. The findings that parents may use non-contingent discipline and punishment suggest the need to explore whether, when these parenting behaviors occur, they increase the likelihood of negative child outcomes.

Rationale and Study Checklist for Ethical Rejection of Participants on Crowdsourcing Research Platforms

Online participant recruitment ("crowdsourcing") platforms are increasingly being used for research studies. While such platforms can rapidly provide access to large samples, there are concomitant concerns around data quality. Researchers have studied and demonstrated means to reduce the prevalence of low-quality data from crowdsourcing platforms, but approaches to doing so often involve rejecting work and/or denying payment to participants, which can pose ethical dilemmas. We write this essay as an associate professor and two institutional review board (IRB) directors to provide a perspective on the competing interests of participants/workers and researchers and to propose a checklist of steps that we believe may support workers' agency on the platform and lessen instances of unfair consequences to them while enabling researchers to definitively reject lower-quality work that might otherwise reduce the likelihood of their studies producing true results. We encourage further, explicit discussion of these issues among academics and among IRBs.

Randomised experiment for the effect of 'Tobacco-Free Nicotine' messaging on current e-cigarette users' perceptions, preferences and intentions

BACKGROUND

It is unclear whether emerging synthetic tobacco-free nicotine superiority messages such as 'better flavor and better experience' and 'no residual impurities of tobacco-derived nicotine' may impact consumer perception and product choice between synthetic and tobacco-derived nicotine vaping products.

METHODS

Through a 2022 online survey of current e-cigarette users, we identified synthetic nicotine never users for randomisation into an embedded between-subjects experiment. The test group (n=186) viewed a tobacco-free nicotine message versus no message control (n=168). Multivariable regressions assessed messaging effects on three comparative measures between tobacco-free and tobacco-derived nicotine: harm perception, purchase intention and willingness to pay.

RESULTS

Participants (n=354; age, mean (SD)=34.6 (11.1) years old) were recruited from geographically diverse regions with 27.7% rural residents. The overall sample comprised 44.1% females, 73.5% non-Hispanic white and 71.8% daily e-cigarette users. Sociodemographics and tobacco use status were not significantly different between two randomised groups. The test group (vs control) reported a higher intention to use tobacco-free than tobacco-derived nicotine vaping products (adjusted OR (AOR)=2.4, 95% CI 1.3 to 4.4, p=0.006) and willingness to pay more for tobacco-free nicotine vaping products (AOR=2.6, 95% CI 1.2 to 5.8, p=0.02). Urban (vs rural) synthetic-naïve vapers had lower harm perception (AOR=2.0, 95% CI 1.1 to 3.6, p=0.02) and higher intention to use tobacco-free than tobacco-derived nicotine vaping products (AOR=2.2, 95% CI 1.1 to 4.5, p=0.04); infrequent vapers were more willing to pay more for tobacco-free nicotine vaping products (AOR=1.1, 95% CI 1.03 to 1.17, p=0.002).

CONCLUSION

Tobacco-free nicotine marketing message may prompt the transition to and promote a price premium for such products. With the proliferation of products in the market, comprehensive regulation of emerging synthetic vaping products is needed.

Self-certification: A novel method for increasing sharing discernment on social media

The proliferation of misinformation on social media platforms has given rise to growing demands for effective intervention strategies that increase sharing discernment (i.e. increase the difference in the probability of sharing true posts relative to the probability of sharing false posts). One suggested method is to encourage users to deliberate on the veracity of the information prior to sharing. However, this strategy is undermined by individuals' propensity to share posts they acknowledge as false. In our study, across three experiments, in a simulated social media environment, participants were shown social media posts and asked whether they wished to share them and, sometimes, whether they believed the posts to be truthful. We observe that requiring users to verify their belief in a news post's truthfulness before sharing it markedly curtails the dissemination of false information. Thus, requiring self-certification increased sharing discernment. Importantly, requiring self-certification didn't hinder users from sharing content they genuinely believed to be true because participants were allowed to share any posts that they indicated were true. We propose self-certification as a method that substantially curbs the spread of misleading content on social media without infringing upon the principle of free speech.

Does mental contamination mediate the association between childhood trauma and obsessive-compulsive symptoms in adults?

BACKGROUND

Previous research has shown that individuals with obsessive-compulsive disorder (OCD) and OCD symptoms have higher rates of childhood trauma. Although it has been suggested that this relationship is due to mental contamination that developed in response to trauma, no studies have investigated the associations between childhood trauma, mental contamination, and OCD, and none have examined whether the relationship between childhood trauma and OCD is mediated by mental contamination.

OBJECTIVE

We hypothesized that OCD, childhood trauma, and mental contamination are positively correlated, and that mental contamination would mediate the association between childhood trauma and OCD symptoms PARTICIPANTS AND SETTING: We tested these hypotheses in a sample of 245 individuals, which comprised 158 MTurk workers recruited via CloudResearch.com and 87 individuals recruited through social media with OCD diagnoses or OCD symptoms above the clinical cutoff on the Obsessive-Compulsive Inventory-Revised.

METHODS

Participants completed online self-report questionnaires on childhood trauma, mental contamination, and OCD symptoms.

RESULTS

The results revealed statistically significant positive correlations between childhood trauma, mental contamination, and OCD, and statistically significant total and indirect effects for the simple mediational model. Exploratory re-analyses with participants who had high OCD symptoms (n = 87) showed similar results.

CONCLUSIONS

Our research shows that the association between childhood trauma and OCD may be explained by mental contamination. We recommend that mental contamination should be assessed and addressed in OCD patients with a history of childhood trauma.

Bullying Victimization and Adverse Childhood Experiences: Retrospective Reports of Relative Impact on Emotional Distress

The literature suggests that there is a significant overlap in definition, measurement, and outcomes between trauma and bullying victimization, but the relative impact on current emotional distress of these events has not been explored. The goal of the current study was to explore whether traditional and cyber bullying victimization has a similar negative impact on current emotional disrtresss as other adverse childhood experiences which may also lead to a traumatic response. In addition, this study examined whether the association between bullying victimization and emotional distress is exacerbated when individuals also experience additional ACEs. Retrospective reports from a diverse sample of 576 adults were collected via an online survey. When ranked against other ACEs such as viewing family mental health problems or substance abuse, or verbal, physical, emotional, and sexual victimization not from peers, nearly 30% of participants ranked bullying victimization as having the most negative impact on their levels of emotional distress. Multi-group path analyses indicated that experiencing additional ACEs seems to exacerbate distress caused by bullying and cyber bullying victimization. The current study suggests that bullying victimization may be just as detrimental as other types of ACEs that occur in childhood.

Diversity in the study of aging and lifespan development

In psychology, authors have shined a light on a lack of ethnic/racial and cultural diversity in sampling and scholarship. These issues pertain also to the study of aging and lifespan development. This article presents examples of how diverse sampling, across ethnic/racial groups and cultures, enriches theories of aging and adult development. There remain, however, numerous theoretical insights that are yet to be uncovered by future research that seeks to further diversify this sub-discipline. Good practices and avenues to diversification are considered, including targeted sampling of minority groups in the community, online sampling with use of data screening tools, lifespan-orientated surveys initiated in non-Western countries, and a redress of the balance in the perceived value of research from different regions of the world.

Using a standardized sound set to help characterize misophonia: The International Affective Digitized Sounds

Misophonia is a condition characterized by negative affect, intolerance, and functional impairment in response to particular repetitive sounds usually made by others (e.g., chewing, sniffing, pen tapping) and associated stimuli. To date, researchers have largely studied misophonia using self-report measures. As the field is quickly expanding, assessment approaches need to advance to include more objective measures capable of differentiating those with and without misophonia. Although several studies have used sounds as experimental stimuli, few have used standardized stimuli sets with demonstrated reliability or validity. To conduct rigorous research in an effort to better understand misophonia, it is important to have an easily accessible, standardized set of acoustic stimuli for use across studies. Accordingly, in the present study, the International Affective Digitized Sounds (IADS-2), developed by Bradley and Lang (Bradley MM et al., 2007), were used to determine whether participants with misophonia responded to certain standardized sounds differently than a control group. Participants were 377 adults (132 participants with misophonia and 245 controls) recruited from an online platform to complete several questionnaires and respond to four probes (arousal, valence, similarity to personally-relevant aversive sounds, and sound avoidance) in response to normed pleasant, unpleasant, and neutral IADS-2 sounds. Findings indicated that compared to controls, participants with high misophonia symptoms rated pleasant and neutral sounds as significantly more (a) arousing and similar to trigger sounds in their everyday life, (b) unpleasant and (c) likely to be avoided in everyday life. For future scientific and clinical innovation, we include a ranked list of IADS-2 stimuli differentiating responses in those with and without misophonia, which we call the IADS-M.

The associations between repetitive negative thinking, insomnia symptoms, and sleep quality in adults with a history of trauma

BACKGROUND

Posttraumatic stress disorder (PTSD) and sleep disturbance are highly comorbid and repetitive negative thinking (RNT) is associated with both sleep disturbance and PTSD. However, few studies have examined the association between RNT and sleep disturbance in individuals exposed to trauma, with and without PTSD.

METHOD

Associations between trait-level and trauma-related RNT, insomnia, and sleep quality were investigated in a trauma-exposed MTurk (N = 342) sample. Additionally, PTSD symptom severity was tested as a moderator of the associations between RNT and insomnia and sleep quality.

RESULTS

Trait-level RNT predicted poorer sleep quality and greater insomnia, regardless of PTSD severity. Trauma-related RNT was also associated with greater insomnia, though the effect was moderated by PTSD severity such that it was significant for participants with low and moderate, but not severe, PTSD. Both trait- and trauma-related RNT were associated with several specific aspects of sleep quality, including: sleep disturbances, daytime dysfunction, use of sleep medications, sleep onset latency, and subjective sleep quality.

CONCLUSIONS

This study demonstrates significant associations linking RNT with insomnia and sleep disturbance in trauma-exposed individuals. Clinically, results suggest that it may be helpful to target both general and trauma-related RNT in sleep interventions for trauma-exposed individuals with insomnia.

Influence of Betrayal Trauma on Schizotypal Personality Pathology

Schizotypal personality pathology (SZP) is a persistent and debilitating problem for a substantial number of people. Research on SZP has typically emphasized its biological and more specifically genetic origins. However, recent research has highlighted the potential influence of trauma on SZP. This research is promising, although it has thus far focused primarily on type of trauma (e.g., different types of abuse vs. neglect in childhood) rather than who perpetrated the trauma. Previous studies on both personality pathology in general and psychotic-spectrum experiences characteristic of SZP in particular have highlighted the influence of trauma perpetrated by someone with whom the trauma survivor was close (i.e., betrayal trauma), although this has not yet been examined with respect to SZP specifically. In this study we examined this, evaluating the influence of trauma with varying degrees of betrayal on SZP in a sample of adults (N = 364) using structural equation modeling. Results suggest that interpersonal trauma in general was associated with higher levels of SZP. Findings further indicate that for women but not men, trauma with a high degree of betrayal was uniquely associated with SZP. These results underscore the potential role of trauma in SZP and have implications for future research on and intervention with people with high levels of SZP.

On the Selection of Item Scores or Composite Scores for Clinical Prediction

Recent shifts to prioritize prediction, rather than explanation, in psychological science have increased applications of predictive modeling methods. However, composite predictors, such as sum scores, are still commonly used in practice. The motivations behind composite test scores are largely intertwined with reducing the influence of measurement error in answering explanatory questions. But this may be detrimental for predictive aims. The present paper examines the impact of utilizing composite or item-level predictors in linear regression. A mathematical examination of the bias-variance decomposition of prediction error in the presence of measurement error is provided. It is shown that prediction bias, which may be exacerbated by composite scoring, drives prediction error for linear regression. This may be particularly salient when composite scores are comprised of heterogeneous items such as in clinical scales where items correspond to symptoms. With sufficiently large training samples, the increased prediction variance associated with item scores becomes negligible even when composite scores are sufficient. Practical implications of predictor scoring are examined in an empirical example predicting suicidal ideation from various depression scales. Results show that item scores can markedly improve prediction particularly for symptom-based scales. Cross-validation methods can be used to empirically justify predictor scoring decisions.

Better social reversal learning is associated with a more social approach across time

Flexibly updating behaviors towards others is crucial for adaptive social functioning. Previous studies have found that difficulties in flexibly updating behaviors are associated with social anxiety (SA). However, it is unclear whether such difficulties relate to actual social behaviors. The current study investigated the relationships between negative-to-positive social reversal learning, social approach behavior, and SA across time. Participants (MTurk, Time 1 = 275, Time 2 = 126, 16 weeks later) completed a performance-based social reversal-learning task. In the initial phase, participants learned that interactions with certain individuals are associated with negative outcomes, whereas interactions with other individuals are associated with positive outcomes. In the reversal phase, these associations were reversed, requiring participants to update their behaviors. The relationships between the performance in the task, SA severity, and social approach behavior reported by participants were assessed cross-sectionally and longitudinally. We found that negative-to-positive updating was negatively associated with SA severity. Furthermore, negative-to-positive updating was positively correlated with social approach behavior, both cross-sectionally and prospectively. Hence, individuals with better negative-to-positive updating at Time 1 reported significantly more social approach behaviors across time. The results support the role of negative-to-positive updating as a mechanism associated with SA and social approach, advancing and refining interpersonal and cognitive theories of SA.

Online cognitive testing in Parkinson's disease: advantages and challenges

Parkinson's disease (PD) is primarily characterized by motor symptoms. Yet, many people with PD experience cognitive decline, which is often unnoticed by clinicians, although it may have a significant impact on quality of life. For over half a century, traditional in-person PD cognitive assessment lacked accessibility, scalability, and specificity due to its inherent limitations. In this review, we propose that novel methods of online cognitive assessment could potentially address these limitations. We first outline the challenges of traditional in-person cognitive testing in PD. We then summarize the existing literature on online cognitive testing in PD. Finally, we explore the advantages, but also the limitations, of three major processes involved in online PD cognitive testing: recruitment and sampling methods, measurement and participation, and disease monitoring and management. Taking the limitations into account, we aim to highlight the potential of online cognitive testing as a more accessible and efficient approach to cognitive testing in PD.

Enhancing Psychotherapy Outcomes by Encouraging Patients to Regularly Self-Monitor, Reflect on, and Share Their Affective Responses Toward Their Therapist: Protocol for a Randomized Controlled Trial

BACKGROUND

The quality of the therapeutic relationship is pivotal in determining psychotherapy outcomes. However, facilitating patients' self-awareness, reflection on, and sharing of their affective responses toward their therapist remains underexplored as a potential tool for enhancing this relationship and subsequent treatment outcomes.

OBJECTIVE

The primary objective of this study is to examine whether and how the patients' regular self-monitoring and self-reflection (fostered by the systematic compilation of a brief postsession battery) on their affective reactions toward the psychotherapist impact the quality of the therapeutic relationship and treatment outcomes in individual psychotherapy. Secondary objectives are to (1) explore whether and how the characteristics of the patient, the therapist, and the process moderate the effect of regular self-monitoring on the therapeutic relationship and outcomes; (2) examine the relationships between the affective response of the patient, the alliance, and the result of the therapy session outcome; and (3) explore how the affective responses of the patient unfold or change throughout the course of the therapy.

METHODS

We conducted a 1:1 randomized controlled trial of adults in individual psychotherapy versus individual psychotherapy plus self-monitoring. Participants will be enrolled through the web-based recruitment platforms "ResearchMatch" and "Research for Me," and data will be collected through web-based surveys. Participants in the control group will receive only their regular individual psychotherapy (treatment as usual) and will not complete postsession questionnaires. Participants in the intervention group will continue their regular individual psychotherapy sessions and complete the "in-Session Patient Affective Reactions Questionnaire" and the "Rift In-Session Questionnaire" following each therapy session in the 10 weeks of the trial. Additionally, after completion of the postsession battery, they will receive general written feedback encouraging them to discuss their feelings and reflections with their therapist. Participants in both groups will complete a comprehensive psychological assessment at baseline, midtrial (week 5), and end-of-trial (week 10). The primary outcome measure of the trial is the "Clinical Outcomes in Routine Evaluation-Outcome Measure," while the secondary outcomes are the "Real Relationship Inventory-Client-Short Form," the "Working Alliance Inventory-Short Revised," and the number of scheduled therapy sessions that the patient has missed or canceled.

RESULTS

The trial was approved by the institutional review board of the University of North Carolina at Chapel Hill. Recruitment started in September 2023. A total of 475 individuals completed the baseline assessment. Data collection was completed in February 2024. The results are expected to be published in the autumn of 2024.

CONCLUSIONS

This study could reveal key information on how regular self-monitoring and introspection can influence both the therapeutic relationship and treatment outcomes. Findings have the potential to shape interventions, enhance the efficacy of psychotherapeutic sessions, and possibly offer a cost-effective strategy for improving patients' well-being.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06038747; https://classic.clinicaltrials.gov/ct2/show/NCT06038747.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/55369.

Methodological considerations for behavioral studies relying on response time outcomes through online crowdsourcing platforms

This perspective paper explores challenges associated with online crowdsourced data collection, particularly focusing on longitudinal tasks with time-sensitive outcomes like response latencies. Based on our research, we identify two significant sources of bias: technical shortcomings such as low, variable frame rates, and human factors, contributing to high attrition rates. We explored potential solutions to these problems, such as enforcing hardware acceleration and defining study-specific frame rate thresholds, as well as pre-screening participants and monitoring hardware performance and task engagement over each experimental session. With this discussion, we intend to provide recommendations on how to improve the quality and reliability of data collected via online crowdsourced platforms and emphasize the need for researchers to be cognizant of potential pitfalls in online research.

Temporal self-appraisals associated with suicide-related thoughts and behaviors

BACKGROUND

Temporal self-appraisal (TSA) is the trajectory of self-appraisal over time, including how a person views their past and future selves in relation to their present self. In this study, we examined the TSA of individuals with and without a history of suicide-related thoughts and behaviors (STBs).

METHODS

Using Amazon Mechanical Turk for recruitment, we studied 397 participants on validated measures of TSA, STBs, and mood.

RESULTS

The non-STB group (n = 291) had a TSA trajectory similar to that previously found for nonclinical populations, with perceived self-improvement over time. In contrast, the TSA of the STB group (n = 106) had two distinct qualities: their TSA profiles were more negative at all time points (past, present, and future) than the non-STB group, and they displayed similar anticipated present-to-future growth as the non-STB group but perceived minimal past-to-present change. These differences persisted when controlling for depression, anxiety, and stress, suggesting a distinct STB-related TSA profile independent of comorbid affective states.

LIMITATIONS

This study is limited by the use of self-report measures and cross-sectional design.

CONCLUSIONS

By investigating TSA, this study provides insights into the unique aspects of self-appraisal associated with having a history of STBs and emphasizes the need for therapeutic interventions that foster self-continuity and positive self-appraisal across time. Future research should focus on clarifying the mechanisms underlying this distinct self-appraisal pattern in the STB group and the effects of interventions that enhance temporal self-appraisal.

Concerns, Worries, and Fears During Pregnancy in Active-Duty United States Air Force Families

There are no published studies on pregnancy-related concerns, worries, and fears (CWFs) in primiparous and multiparous women and men in U.S. Air Force (USAF) families. Reflecting a biopsychosocial model of behavioral health, women's and men's pregnancy-related CWF Questionnaires were developed. Usable data were obtained from 260 women and 243 men in USAF families. Similarities and differences in pregnancy-related CWFs were found when USAF and general population data were compared. The present findings can inform not only the general provision of pregnancy health-related services but also USAF secondary prevention pregnancy-related programs (e.g., USAF nurse home visiting programs for first-time parents). If CWF Questionnaires are individually administered, the information can be used to tailor services to individual client needs.