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Lemp JM, Pengpid S, Buntup D, Sornpaisarn B, Peltzer K, Geldsetzer P, Probst C. Stakeholder-Informed Solutions To Address Barriers for Alcohol Screening and Brief Intervention in Thai Hypertension Care. J Prev (2022) 2024; 45:227-236. [PMID: 38148463 DOI: 10.1007/s10935-023-00763-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 12/28/2023]
Abstract
Premature deaths from NCDs disproportionately affect people in low- and middle-income countries. Since alcohol use is one of the most common causes of reversible hypertension, interventions targeting alcohol use may be a feasible and effective low-cost approach to synergistically reduce the prevalence of harmful drinking and high blood pressure. This study sought to identify key factors in successfully implementing alcohol use screening and brief intervention in hypertension care in Thailand. For this purpose, we surveyed participants (NRound 1 = 91, NRound 2 = 27) from three different groups of Thai stakeholders (policy- and decisionmakers, primary healthcare practitioners, and patients diagnosed with hypertension) in a two-round stakeholder elicitation. In round 1, we identified limited resources, lack of clear guidelines for lifestyle intervention, stigmatization, and inconsistent monitoring of patients' alcohol use as important barriers. In round 2, we sought to elicit solutions for the barriers identified in round 1. While stakeholders emphasized the need for adaptability to existing realities in Thai primary healthcare such as a high workload and limited digitization, they favorably evaluated a digital alcohol assessment tool with integrated, tailored advice for brief intervention as a potential scalable solution. Findings suggest that as one possible route to reduce the NCD burden caused by hypertension in Thailand, primary healthcare services may be enhanced by digital tools that support resource-effective, intuitive, and seamless delivery of alcohol screening and brief intervention.
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Affiliation(s)
- Julia M Lemp
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Supa Pengpid
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Doungjai Buntup
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, Thailand
| | - Bundit Sornpaisarn
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Faculty of Public Health, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - Karl Peltzer
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Chan Zuckerberg Biohub - San Francisco, San Francisco, CA, USA
| | - Charlotte Probst
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany.
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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2
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Parthasarathy S, Chi F, Metz V, Kline-Simon A, Asyyed A, Campbell C, Sterling S. Disparities in the Receipt of Alcohol Brief Intervention: The Intersectionality of Sex, Age and Race/ethnicity. Addiction 2023. [PMID: 36988614 DOI: 10.1111/add.16195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 02/27/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND AND AIMS The increasing trend in alcohol consumption among women, exacerbated by the COVID-19 pandemic, is of growing concern. Screening, Brief Intervention, and Referral to Treatment in primary care is an efficacious and cost-effective treatment approach for unhealthy alcohol use. However, disparities exist in delivery of brief interventions by sex, age and race/ethnicity. This study measures brief intervention rates among eligible patients by sex, age and race/ethnicity and their intersectionality, in the context of a program of systematic alcohol screening and brief intervention program in adult primary care in a large, integrated healthcare delivery system. DESIGN Population-based observational study. SETTING Primary care clinics in an integrated healthcare delivery system in Northern California, USA. PARTICIPANTS Adult (18+) patients (N=287,551) screening positive for unhealthy alcohol use between January 2014 and December 2017. MEASUREMENTS Receipt of brief intervention, patient and provider characteristics from electronic health records. FINDINGS Multilevel logistic regression showed that women had lower odds of receiving brief intervention than men, across all age, racial/ethnic groups and drinking levels. Sex differences were greater among those aged 35-49 (odds ratio [OR] [95% confidence interval [CI]] = 0.67 [0.64, 0.69]) and 50-65 years (OR [95% CI] = 0.69 [0.66, 0.72]) than among other age groups. Sex differences in odds of receiving brief intervention were greater for the Latino/Hispanic group for women vs. men (OR [95% CI] = 0.69 [0.66, 0.72]) and smaller for the Asian/Pacific Islander group (OR [95% CI] = 0.76 [0.72, 0.81]). CONCLUSION In the United States, compared with men, women appear to have lower odds of receiving brief intervention for unhealthy alcohol use across all age groups, particularly during middle age. Black women and Latina/Hispanic women appear to be less likely to receive brief intervention than women in other race/ethnicity groups. Receipt of brief intervention does not appear to differ by drinking levels between men and women.
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Affiliation(s)
- Sujaya Parthasarathy
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA, 94612-2403, USA
| | - Felicia Chi
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA, 94612-2403, USA
| | - Verena Metz
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA, 94612-2403, USA
| | - Andrea Kline-Simon
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA, 94612-2403, USA
| | - Asma Asyyed
- The Permanente Medical Group, 710 S Broadway, Walnut Creek, CA, 94596, USA
| | - Cynthia Campbell
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA, 94612-2403, USA
| | - Stacy Sterling
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA, 94612-2403, USA
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3
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Hammond CJ, Parhami I, Young AS, Matson PA, Alinsky RH, Adger H, Levy S, Horner M. Provider and Practice Characteristics and Perceived Barriers Associated With Different Levels of Adolescent SBIRT Implementation Among a National Sample of US Pediatricians. Clin Pediatr (Phila) 2021; 60:418-426. [PMID: 34342242 DOI: 10.1177/00099228211034334] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Pediatrician Screening, Brief Intervention, and Referral to Treatment (SBIRT) practices vary widely, though little is known about the correlates of SBIRT implementation. Using data from a national sample of US pediatricians who treat adolescents (n = 250), we characterized self-reported utilization rates of SBIRT among US pediatricians and identified provider- and practice-level characteristics and barriers associated with SBIRT utilization. All participants completed an electronic survey querying the demographics, practice patterns, and perceived barriers related to SBIRT practices. Our results showed that 88% of respondents reported screening for substance use annually, but only 26% used structured/validated screening instruments. Furthermore, 40% of respondents provided evidence-based brief interventions, and only 11% implemented all core SBIRT practices. Common barriers (eg, confidentiality and insufficient time) and unique provider- and setting-specific barriers to implementation were identified. These findings indicate that although most pediatricians deliver some SBIRT components in their practice, few implement the full SBIRT model, and barriers persist.
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Affiliation(s)
| | - Iman Parhami
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Andrea S Young
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Pamela A Matson
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Hoover Adger
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Michelle Horner
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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4
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Keen A, Thoele K, Oruche U, Newhouse R. Perceptions of the barriers, facilitators, outcomes, and helpfulness of strategies to implement screening, brief intervention, and referral to treatment in acute care. Implement Sci 2021; 16:44. [PMID: 33892758 PMCID: PMC8063328 DOI: 10.1186/s13012-021-01116-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 04/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a clinical intervention used to address alcohol and illicit drug use. SBIRT use has resulted in positive health and social outcomes; however, SBIRT implementation remains low. Research on implementing interventions, such as SBIRT, lacks information about challenges and successes related to implementation. The Expert Recommendations for Implementing Change (ERIC) provides a framework to guide comprehension, clarity, and relevance of strategies available for implementation research. This framework was applied to qualitative feedback gathered from site coordinators (SCs) leading SBIRT implementation. The purpose of this study was to describe the SCs’ experiences pertaining to SBIRT implementation across a health system. Methods Within the context of a larger parent study, a semi-structured interview guide was used to capture 14 SCs’ perceptions of the barriers, facilitators, and outcomes pertaining to SBIRT implementation. Qualitative data were analyzed using standard content analytic procedures. A follow-up survey was developed based on 14 strategies identified from qualitative data and was administered electronically to determine the SC’s perceptions of the most helpful implementation strategies on a scale of 1 (least helpful) to 5 (most helpful). Results All 14 invited SCs participated in the SBIRT implementation interview, and 11 of 14 (79%) responded to the follow-up survey. Within the categories of barriers, facilitators, and outcomes, 25 subthemes emerged. The most helpful implementation strategies were reexamining the implementation (M = 4.38; n = 8), providing ongoing consultation (M = 4.13; n = 8), auditing and providing feedback (M = 4.1; n = 10), developing education materials (M = 4.1; n = 10), identifying and preparing champions (M = 4; n = 7), and tailoring strategies (M = 4; n = 7). Conclusion SCs who led implementation efforts within a large healthcare system identified several barriers and facilitators to the implementation of SBIRT. Additionally, they identified clinician-related outcomes associated with SBIRT implementation into practice as well as strategies that were helpful in the implementation process. This information can inform the implementation of SBIRT and other interventions in acute care settings.
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Affiliation(s)
- Alyson Keen
- Indiana University School of Nursing, 600 Barnhill Dr., Indianapolis, IN, 46202, USA. .,Indiana University Health Adult Academic Health Center, 1701 N. Senate Ave, Indianapolis, IN, 46202, USA.
| | - Kelli Thoele
- Indiana University School of Nursing, 600 Barnhill Dr., Indianapolis, IN, 46202, USA
| | - Ukamaka Oruche
- Indiana University School of Nursing, 600 Barnhill Dr., Indianapolis, IN, 46202, USA
| | - Robin Newhouse
- Indiana University School of Nursing, 600 Barnhill Dr., Indianapolis, IN, 46202, USA
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5
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Kemp K, Webb M, Wolff J, Affleck K, Casamassima J, Weinstock L, Spirito A. Screening and Brief Intervention for Psychiatric and Suicide Risk in the Juvenile Justice System: Findings from an Open Trial. Evid Based Pract Child Adolesc Ment Health 2021; 6:410-419. [PMID: 34693005 PMCID: PMC8528172 DOI: 10.1080/23794925.2021.1908190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Court-involved non-incarcerated (CINI) youth endorse higher rates of lifetime suicide ideation (SI) and attempts than youth in the community. Brief intervention programs to address SI and related psychiatric symptoms upon entry into the juvenile justice system are rare. The current study reports the results of a pilot trial on a brief, coping intervention for CINI youth. Fifteen CINI youth (and caregivers) were eligible for participation based on youth report of SI or endorsing symptoms on a mental health screening tool. Youth completed a Coping Plan intervention with a master's-level counselor and received a 1-week follow-up call. Follow-up assessments were conducted at 1 and 3-months post-intervention. Participants were also interviewed about intervention acceptability. About half of the sample screened into the study based on SI and half screened in based on psychiatric symptoms on the Anxious/Depressed and Angry/Irritable subscales of the MAYSI-2. A reduction in SI and psychiatric symptoms was observed at 3-months post-intervention. Youth and caregivers reported the brief coping intervention was useful. This study highlights that intervening with youth with SI and psychiatric symptoms upon entry into the juvenile justice system can be successfully conducted with a population who historically has difficulty accessing mental health resources.
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Affiliation(s)
- Kathleen Kemp
- Rhode Island Hospital, 1 Hoppin St., Coro Building West, Suite 204, Providence, RI 02903
- Alpert Medical School of Brown University, 345 Blackstone Blvd., Duncan Building, Providence, RI 02906
| | - Margaret Webb
- Rhode Island Hospital, 1 Hoppin St., Coro Building West, Suite 204, Providence, RI 02903
- Alpert Medical School of Brown University, 345 Blackstone Blvd., Duncan Building, Providence, RI 02906
| | - Jennifer Wolff
- Emma Pendleton Bradley Hospital, 1011 Veterans Memorial Pkwy, Riverside, RI 02915
- Alpert Medical School of Brown University, 345 Blackstone Blvd., Duncan Building, Providence, RI 02906
| | - Katelyn Affleck
- Emma Pendleton Bradley Hospital, 1011 Veterans Memorial Pkwy, Riverside, RI 02915
- Alpert Medical School of Brown University, 345 Blackstone Blvd., Duncan Building, Providence, RI 02906
| | - Joseph Casamassima
- Alpert Medical School of Brown University, 345 Blackstone Blvd., Duncan Building, Providence, RI 02906
| | - Lauren Weinstock
- Alpert Medical School of Brown University, 345 Blackstone Blvd., Duncan Building, Providence, RI 02906
| | - Anthony Spirito
- Alpert Medical School of Brown University, 345 Blackstone Blvd., Duncan Building, Providence, RI 02906
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6
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Field CA, Von Sternberg K, Velasquez MM. Randomized Trial of Screening and Brief Intervention to Reduce Injury and Substance Abuse in an urban Level I Trauma Center. Drug Alcohol Depend 2020; 208:107792. [PMID: 32028253 DOI: 10.1016/j.drugalcdep.2019.107792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/26/2019] [Accepted: 11/30/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND The TIP (Traumatic Injury Prevention) Project evaluated the impact on post-injury drug use of two brief motivational interventions compared to brief advice (BA) among injured patients who use drugs. METHOD Three-group, single blind, randomized controlled trial in a Level 1Trauma Center enrolled 395 admitted patients with drug positive toxicology screen or verbal report of drug use in the previous 30 days. 34% were Hispanic, 45% non-Hispanic White, 16% non-Hispanic Black. 88% smoked marijuana, 28% used cocaine and 11% prescription opioids. Brief Advice (BA) provided advice to abstain from drugs, educational materials and referral to community resources. Brief Motivational Intervention (BMI) additionally included a 30-45 minute session, with assessment feedback, based on motivational interviewing. BMI + B included a telephone booster 4-weeks post-intervention. Drug use as measured by percent days abstinent and total abstinence, derived from the Timeline Follow back was the primary outcome. RESULTS A significant reduction from baseline was observed at 3, 6, and 12 months in the primary outcomes of any drug use (excluding alcohol); cannabis and cocaine, the most frequently used drugs, were analyzed individually. There were no between group differences or group X time interactions. Similarly, there were no between groups differences on secondary outcomes including perceived health status, re-injury, arrest, incarceration, alcohol and drug treatment, employment, AA attendance, homelessness, physical abuse, and problems associated with alcohol and drug use. CONCLUSIONS The study does not support use of these enhanced motivational interventions over brief advice for trauma patients with a positive screen for drug use.
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7
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Young CM, Neighbors C. Incorporating Writing into a Personalized Normative Feedback Intervention to Reduce Problem Drinking Among College Students. Alcohol Clin Exp Res 2019; 43:916-926. [PMID: 30817010 DOI: 10.1111/acer.13995] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 02/18/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Personalized normative feedback (PNF) interventions have repeatedly been found to reduce drinking among undergraduates. However, effects tend to be small, potentially due to inattention to and inadequate processing of the information. Adding a writing component to PNF interventions may allow for greater cognitive processing of the feedback, thereby boosting intervention efficacy. Additionally, expressive writing (EW) has been shown to reduce drinking intentions; however, studies have not examined whether it can reduce drinking behavior. The present experiment evaluated whether including a writing task would improve the efficacy of PNF and whether EW alone can be used to reduce drinking and alcohol-related problems. METHODS Heavy drinking undergraduates (N = 250) were randomized to receive either: (i) PNF about their alcohol use; (ii) EW about a negative, heavy drinking occasion; (iii) PNFplus writing about the norms feedback; or (iv) attention control feedback about their technology use in an online brief intervention. Participants (N = 169) then completed a 1-month follow-up survey about their past month alcohol use and alcohol-related problems online. RESULTS PNFplus writing reduced alcohol-related problems compared to all other conditions. No significant reductions were found for EW. Both PNF and PNFplus writing reduced perceived norms and perceived norms mediated intervention effects for both feedback conditions. CONCLUSIONS The current findings suggest that adding a writing component to traditional norms-based feedback approaches might be an efficacious strategy, particularly for reducing alcohol-related consequences.
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Affiliation(s)
- Chelsie M Young
- Department of Psychology, Rowan University, Glassboro, New Jersey
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8
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Grodin EN, Ray LA, MacKillop J, Lim AC, Karno MP. Elucidating the Effect of a Brief Drinking Intervention Using Neuroimaging: A Preliminary Study. Alcohol Clin Exp Res 2019; 43:367-377. [PMID: 30556913 DOI: 10.1111/acer.13941] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/09/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Brief interventions have empirical support for acutely reducing alcohol use among non-treatment-seeking heavy drinkers. Neuroimaging techniques allow for the examination of the neurobiological effect of behavioral interventions, probing brain systems putatively involved in clinical response to treatment. Few studies have prospectively evaluated whether psychosocial interventions attenuate neural cue reactivity that in turn reduces drinking in the same population. This study aimed to examine the effect of a brief intervention on drinking outcomes, neural alcohol cue reactivity, and the ability of neural alcohol cue reactivity to prospectively predict drinking outcomes. METHODS Non-treatment-seeking heavy drinking participants were randomized to receive a brief interview intervention (n = 22) or an attention-matched control (n = 24). Immediately following the intervention or control, participants underwent a functional magnetic resonance imaging scan comprised of the alcohol taste cues paradigm. Four weeks after the intervention (or control), participants completed a follow-up visit to report on their past-month drinking. Baseline and follow-up percent heavy drinking days (PHDD) were calculated for each participant. RESULTS There was no significant effect of the brief intervention on PHDD at follow-up or on modulating neural activation to alcohol relative to water taste cues. There was a significant association between neural response to alcohol taste cues and PHDD across groups (Z > 2.3, p < 0.05), such that individuals who had greater neural reactivity to alcohol taste cues in the precuneus and prefrontal cortex (PFC) had fewer PHDD at follow-up. CONCLUSIONS This study did not find an effect of the brief intervention on alcohol use in this sample, and the intervention was not associated with differential neural alcohol cue reactivity. Nevertheless, greater activation of the precuneus and PFC during alcohol cue exposure predicted less alcohol use prospectively suggesting that these neural substrates subserve the effects of alcohol cues on drinking behavior.
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Affiliation(s)
- Erica N Grodin
- Department of Psychology, University of California, Los Angeles, Los Angeles, California.,Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, California.,Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - James MacKillop
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Aaron C Lim
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Mitchell P Karno
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, University of California, Los Angeles, Los Angeles, California
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9
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Moxley-Kelly N, Ouimet MC, Dongier M, Chanut F, Tremblay J, Marcantoni W, Brown TG. The Role of Behavioral Phenotypes on Impaired Driving Recidivism Risk and Treatment Response to Brief Intervention: A Preliminary Study. Alcohol Clin Exp Res 2018; 43:324-333. [PMID: 30536575 DOI: 10.1111/acer.13935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 11/24/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Heterogeneity in the driving while impaired (DWI) offender population and modest outcomes from remedial programs are fueling interest in clarifying clinically significant DWI subtypes to better assess recidivism risk and target interventions. Our previous research identified 2 putative behavior phenotypes of DWI offenders with distinct behavioral, personality, cognitive, and neurobiological profiles: (i) offenders primarily engaging in DWI (pDWI); and (ii) offenders engaging in DWI and other traffic violations (MIXED). Here, we evaluate these phenotypes' clinical significance for prediction of recidivism and intervention targeting. METHODS DWI recidivists participating in a previous randomized controlled trial (N = 184 comparing brief motivational interviewing (BMI) and an information and advice control condition (IA) were retrospectively classified as either pDWI (n = 97) or MIXED (n = 87). Secondary analyses then evaluated the effect of this phenotypic classification on self-reported 6- and 12-month alcohol misuse outcomes and documented 5-year DWI recidivism violations, and in response to either BMI or IA (i.e., pDWI-BMI, n = 46; MIXED-BMI, n = 45; pDWI-IA, n = 51; MIXED-IA, n = 42). Two hypotheses were tested: (i) MIXED classification is associated with poorer alcohol misuse outcomes and recidivism outcomes than pDWI classification; and (ii) pDWI paired with BMI is associated with better outcomes compared to MIXED paired with BMI. RESULTS MIXED classification was associated with significantly greater risk of recidivism over the 5-year follow-up compared to pDWI classification. Moreover, the pDWI-BMI pairing was associated with significantly decreased recidivism risk compared to the MIXED-BMI pairing. Analyses of 6- and 12-month alcohol use outcomes produced null findings. CONCLUSIONS The clinical significance of phenotypic classification for risk assessment and targeting intervention was partially supported with respect to recidivism risk. Prospective investigation of this and other behavioral phenotypes is indicated.
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Affiliation(s)
- Nathaniel Moxley-Kelly
- Douglas Hospital Research Center, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Marie Claude Ouimet
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Quebec, Canada
| | - Maurice Dongier
- Douglas Hospital Research Center, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Florence Chanut
- Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada
| | - Jacques Tremblay
- Douglas Hospital Research Center, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Walter Marcantoni
- Department of Psychology, Concordia University, Montreal, Quebec, Canada
| | - Thomas G Brown
- Douglas Hospital Research Center, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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10
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Braciszewski JM, Tzilos Wernette GK, Moore RS, Bock BC, Stout RL, Chamberlain P. A Pilot Randomized Controlled Trial of a Technology-Based Substance Use Intervention for Youth Exiting Foster Care. Child Youth Serv Rev 2018; 94:466-476. [PMID: 31435121 PMCID: PMC6703817 DOI: 10.1016/j.childyouth.2018.08.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Youth exiting foster care represent a unique, at-risk population in that they receive supportive health services while under the umbrella of the foster care system, but access to care can drop precipitously upon release from foster custody. Traditional means of substance use treatment may not meet the needs of this vulnerable population. Mobile interventions, however, have demonstrated high acceptability and efficacy across a range of mental and physical health issues. The specific advantages to mobile interventions dovetail well with the barriers faced by youth exiting foster care. This study describes the feasibility, acceptability, and initial efficacy of iHeLP, a computer- and mobile phone-based intervention based in Motivational Interviewing for reducing substance use among youth exiting foster care (n = 33). Participants were randomly assigned to either iHeLP or a contact control, each of which lasted six months. Feasibility was evaluated through eligibility and enrollment rates at baseline, and retention and intervention reach rates 3, 6, 9, and 12 months later. Acceptability was measured through a 5-item satisfaction measure and exit interviews. The two groups were then compared on a monthly measure of substance use. Study enrollment, retention, response rate, engagement, and satisfaction were all very good. Participants receiving iHeLP reported higher percent days abstinent than the control group, with effect sizes ranging from 0.32 to 0.62. Technology-based interventions such as iHeLP may be attractive to this population and support efforts towards reductions in substance use.
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Affiliation(s)
- Jordan M Braciszewski
- Center for Health Policy and Health Services Research, Henry Ford Health System, 1 Ford Place, Suite 3A, Detroit, MI, USA 48202,
| | - Golfo K Tzilos Wernette
- Department of Family Medicine, University of Michigan Medical School, 1018 Fuller St., Ann Arbor, MI, USA 48104,
| | - Roland S Moore
- Prevention Research Center, Pacific Institute for Research and Evaluation, 180 Grand Avenue Suite 1200, Oakland, CA 94612,
| | - Beth C Bock
- The Miriam Hospital, 167 Point St., Suite 1B, Providence, RI 02903,
| | - Robert L Stout
- Decision Sciences Institute, Pacific Institute for Research and Evaluation, 1005 Main St., Suite 8210, Pawtucket, RI 02860,
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11
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Miller MB, DiBello AM, Carey KB, Pedersen ER. Blackouts as a Moderator of Young Adult Veteran Response to Personalized Normative Feedback for Heavy Drinking. Alcohol Clin Exp Res 2018; 42:1145-1153. [PMID: 29602274 DOI: 10.1111/acer.13637] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/22/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Blackouts-or periods of alcohol-induced amnesia for all or part of a drinking event-have been identified as independent predictors of alcohol-related harm that may be used to identify individuals who would benefit from intervention. However, little is known about the prevalence and impact of blackouts among Veterans. This study examined blackouts as a moderator of young adult veteran response to a brief, online personalized normative feedback (PNF) intervention for heavy drinking. METHODS Veterans scoring ≥3/4 (women/men) on the Alcohol Use Disorders Identification Test completed a baseline and 1-month assessment as part of a larger intervention trial (N = 571; 83% male; age M = 28.9, SD = 3.3). Participants were randomized to alcohol PNF (n = 285) or a video game attention control (n = 286). Hierarchical regression was used to examine the interaction between intervention condition and blackouts on alcohol-related outcomes at 1-month follow-up. RESULTS At baseline, 26% of participants reported loss of memory for drinking events in the past 30 days. The interaction between condition and blackouts was significant, such that PNF participants who had experienced blackouts at baseline reported greater decreases in drinking quantity at 1 month than those who had not, and only PNF participants who had experienced baseline blackouts reported a decrease in alcohol problems at follow-up. CONCLUSIONS PNF appears to be particularly effective for individuals who have experienced alcohol-induced blackout, perhaps because blackouts prime them for feedback on their alcohol use. While other negative consequences may also prime individuals for behavior change, blackouts are posited as a particularly useful screening tool because they are prevalent among young adults, have a strong association with alcohol-related harm, and are assessed in widely used clinical measures.
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Affiliation(s)
- Mary Beth Miller
- Department of Psychiatry, University of Missouri School of Medicine, Columbia, Missouri.,Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island
| | - Angelo M DiBello
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island
| | - Kate B Carey
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island
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12
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Mastroleo NR, Celio MA, Barnett NP, Colby SM, Kahler CW, Operario D, Suffoletto BP, Monti PM. Feasibility and Acceptability of a Motivational Intervention Combined with Text Messaging for Alcohol and Sex Risk Reduction with Emergency Department Patients: A Pilot Trial. Addict Res Theory 2018; 27:85-94. [PMID: 31073283 PMCID: PMC6502468 DOI: 10.1080/16066359.2018.1444159] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 02/16/2018] [Accepted: 02/19/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Interventions aimed at reducing co-occurring heavy drinking and risky sexual behavior among Emergency Department (ED) patients require feasibility and acceptability to optimally engage individuals. OBJECTIVES This pilot study explored the feasibility and acceptability of an interactive text-messaging (TM) supplement to a brief in-person intervention previously found successful in reducing alcohol use and condomless sex. METHODS Using a mixed-method design, ED patients with past hazardous alcohol use and condomless sex (N= 20) were randomly assigned to receive either a Motivational Intervention + TM or Brief Advice + TM. All participants completed exit interviews at four weeks follow-up, and transcripts were transcribed and coded to identify themes. We evaluated feasibility through quantitative assessment of TM response rates and latency to response, while acceptability was evaluated through thematic analysis of exit interviews. RESULTS Findings provide support for the delivery of an integrated and personalized MI and TM. Participants engaged positively with the TM intervention and qualitative interviews offered strong support for the acceptability while offering information necessary to enhance the TM component. CONCLUSIONS Integrating MI with TM is feasible and acceptable to at-risk ED patients and could facilitate behavior changes beyond MI alone.
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Affiliation(s)
- Nadine R. Mastroleo
- College of Community and Public Affairs, Binghamton University, PO Box 6000, Binghamton, NY 13902
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI 02912
| | - Mark A. Celio
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI 02912
| | - Nancy P. Barnett
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI 02912
| | - Suzanne M. Colby
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI 02912
| | - Christopher W. Kahler
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI 02912
| | - Don Operario
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI 02912
| | - Brian P. Suffoletto
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA 15261
| | - Peter M. Monti
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI 02912
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13
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Montag AC, Dusek ML, Ortega ML, Camp-Mazzetti A, Calac DJ, Chambers CD. Tailoring an Alcohol Intervention for American Indian Alaska Native Women of Childbearing Age: Listening to the Community. Alcohol Clin Exp Res 2017; 41:1938-1945. [PMID: 28833270 DOI: 10.1111/acer.13485] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 08/17/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Reduction of risky drinking in women of childbearing age is 1 strategy that may be employed to prevent fetal alcohol spectrum disorder, a sequela of prenatal alcohol exposure. Communities differ in risk and protective factors, necessitating culturally informed interventions for maximal efficacy. This article describes the modification of an existing web-based screening, brief intervention, and referral to treatment intervention to reduce risky drinking among American Indian Alaska Native (AIAN) women of childbearing age in Southern California into a peer-to-peer-based intervention using motivational interviewing (MI). METHODS The modification process was iterative and included various community focus groups, interviews, and a final review. RESULTS Intervention modification was required for cultural congruence. Components of the peer-to-peer intervention designed by this project included a flip chart used to guide the motivational interviewing, charts of the financial and physical costs of alcohol consumption, revised baseline and follow-up questionnaires, and guidance regarding the application of MI techniques. CONCLUSIONS This study may inform the modification of future interventions among AIAN communities.
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Affiliation(s)
- Annika C Montag
- Department of Pediatrics , University of California San Diego, San Diego, California
| | - Marlené L Dusek
- Southern California Tribal Health Clinic , San Diego, California
| | - Marina L Ortega
- Southern California Tribal Health Clinic , San Diego, California
| | | | - Dan J Calac
- Southern California Tribal Health Clinic , San Diego, California
| | - Christina D Chambers
- Department of Pediatrics , University of California San Diego, San Diego, California
- Department Family Medicine and Public Health , University of California San Diego, San Diego, California
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14
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Widmann M, Apondi B, Musau A, Warsame AH, Isse M, Mutiso V, Veltrup C, Ndetei D, Odenwald M. Comorbid psychopathology and everyday functioning in a brief intervention study to reduce khat use among Somalis living in Kenya: description of baseline multimorbidity, its effects of intervention and its moderation effects on substance use. Soc Psychiatry Psychiatr Epidemiol 2017; 52:1425-1434. [PMID: 28321455 DOI: 10.1007/s00127-017-1368-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/22/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS Migration and khat use were found to correlate with high rates of psychopathology. In this paper we aimed for assessing baseline multimorbidity and its interactions with a Brief Intervention. METHODS In the RCT, 330 male Somali khat users were assigned to treatment conditions (khat use is a predominantly male habit). The ASSIST-linked BI for khat users was administered. Using the TLFB Calendar, the PHQ-9, a Somali short version of the PDS and parts from the CIDI, khat use and comorbidity was assessed. With a regression analysis we tested for the influence of comorbidity and with mixed effect models group differences over time in sleep duration, khat use-time and everyday functioning. RESULTS We found high rates of baseline multimorbidity: 51% (N = 168) for depression, 22% (N = 74) for PTSD and 23% (N = 73) for khat-psychotic symptoms. Depression and khat-psychotic symptoms, but not PTSD symptoms decreased without group differences. Khat use-time decreased and functional time increased with significant time × group interactions (p ≤ 0.046). Depression and PTSD did not influence therapy success but in participants without comorbid psychopathology, more khat use reduction after the intervention was found (p = 0.024). CONCLUSION Somali khat users in Kenya are highly burdened by multimorbidity of depression, PTSD and khat-psychotic symptoms. The main effects for time and differences in healthy vs. mentally ill khat users indicate potential of unspecific support and the specific need for mental health care in combination with substance abuse treatment. The increase of everyday functioning promises more options for alternative activities, preventing excessive use and addiction.
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Affiliation(s)
- Marina Widmann
- University of Konstanz, Box 23, 78457, Konstanz, Germany.,vivo international e.V., PO Box 5108, 78430, Konstanz, Germany
| | - Bernice Apondi
- Africa Mental Health Foundation, Mawensi Gardens, Upperhill Nairobi, Kenya
| | - Abednego Musau
- Africa Mental Health Foundation, Mawensi Gardens, Upperhill Nairobi, Kenya
| | | | - Maimuna Isse
- Tawakal Medical Clinic, 5th street, Eastleigh, Nairobi, Kenya
| | - Victoria Mutiso
- Africa Mental Health Foundation, Mawensi Gardens, Upperhill Nairobi, Kenya
| | - Clemens Veltrup
- Fachklinik Freudenholm-Ruhleben, Postfach 5, 24301, Plön, Germany
| | - David Ndetei
- Africa Mental Health Foundation, Mawensi Gardens, Upperhill Nairobi, Kenya.,University of Nairobi, Nairobi, Kenya
| | - Michael Odenwald
- University of Konstanz, Box 23, 78457, Konstanz, Germany. .,vivo international e.V., PO Box 5108, 78430, Konstanz, Germany.
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15
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Walsh K, Gilmore AK, Frazier P, Ledray L, Acierno R, Ruggiero KJ, Kilpatrick DG, Resnick HS. A Randomized Clinical Trial Examining the Effect of Video-Based Prevention of Alcohol and Marijuana Use Among Recent Sexual Assault Victims. Alcohol Clin Exp Res 2017; 41:2163-2172. [PMID: 28940320 DOI: 10.1111/acer.13505] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 09/12/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND This study examined whether a brief video intervention (Prevention of Post-Rape Stress [PPRS]) delivered in the emergency department to recent sexual assault (SA) victims reduced alcohol and marijuana use at 3 points over the course of a 6-month follow-up compared to treatment as usual (TAU) and an active control condition (Pleasant Imagery and Relaxation Instruction [PIRI]). Prior assault history, minority status, and pre-SA substance use also were examined as moderators of intervention efficacy. METHODS Women aged 15 and older (N = 154) who participated in a post-SA medical forensic examination were randomly assigned to watch the PPRS video (n = 54) or the PIRI video (n = 48) or receive TAU (n = 52) and completed at least 1 follow-up assessment targeted at 1.5 (T1), 3 (T2), or 6 (T3) months following the examination. RESULTS Regression analyses revealed that, relative to TAU, PPRS was associated with less frequent alcohol use at 6 months post-SA among women reporting pre-SA binge drinking and minority women. Relative to TAU, PPRS also was associated with fewer days of marijuana use at T1 among those who did not report pre-SA marijuana use and prior SA. Findings for pre-SA marijuana use were maintained at T3; however, findings for prior SA shifted such that PPRS was associated with fewer days of marijuana use at T3 for women with a prior SA. CONCLUSIONS PPRS may be effective at reducing substance use for some recent SA victims, including those with a prior SA history, a prior substance use history, and minority women.
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Affiliation(s)
- Kate Walsh
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
| | - Amanda K Gilmore
- Department of Psychiatry and Behavioral Sciences, National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, South Carolina
| | - Patricia Frazier
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota
| | - Linda Ledray
- Sane Sart Resource Service, Minneapolis, Minnesota
| | - Ron Acierno
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Kenneth J Ruggiero
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Dean G Kilpatrick
- Department of Psychiatry and Behavioral Sciences, National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, South Carolina
| | - Heidi S Resnick
- Department of Psychiatry and Behavioral Sciences, National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, South Carolina
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16
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Doumas DM, Esp S, Miller R. Impact of Brief Intervention Workshops on Addiction Provider Knowledge, Skills, Negative Attitudes, and Interest in Implementing Evidence-Based Practices. J Drug Educ 2017; 47:121-137. [PMID: 30253656 DOI: 10.1177/0047237918800985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study evaluated the impact of Motivational Interviewing (MI) and Screening, Brief Intervention, and Referral to Treatment (SBIRT) workshops on posttraining knowledge, skills, negative attitudes, and interest in implementing evidence-based practices (EBPs). Participants ( N = 70) were primarily mental health counselor (41.4%), social workers (20.0%), substance abuse counselors (15.7%), school counselors (5.7%), and nursing professionals (4.3%) who selected the 1- or 2-day workshop for continuing education credit. Participants attended either a Basic MI training workshop (1 day) or a Basic MI training plus an advanced MI/SBIRT training workshop (2 days) to assess if exposure to two EBPs would improve training outcomes. Participants in both the 1-day and 2-day workshops reported posttraining increased perceived knowledge and skills, decreased negative attitudes toward EBPs, and increased interest in implementing EBPs from pretraining to posttraining. There were no differences between participants in the Basic MI or MI plus advanced MI/SBIRT training conditions. Implications for reducing the research-practice gap in EBPs are discussed.
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Affiliation(s)
- Diana M Doumas
- 1 Department of Counselor Education, Institute for the Study of Behavioral Health and Addiction, Boise State University, ID, USA
| | - Susan Esp
- 1 Department of Counselor Education, Institute for the Study of Behavioral Health and Addiction, Boise State University, ID, USA
| | - Raissa Miller
- 1 Department of Counselor Education, Institute for the Study of Behavioral Health and Addiction, Boise State University, ID, USA
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17
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Giles EL, Coulton S, Deluca P, Drummond C, Howel D, Kaner E, McColl E, McGovern R, Scott S, Stamp E, Sumnall H, Tate L, Todd L, Vale L, Albani V, Boniface S, Ferguson J, Frankham J, Gilvarry E, Hendrie N, Howe N, McGeechan GJ, Stanley G, Newbury-Birch D. Multicentre individual randomised controlled trial of screening and brief alcohol intervention to prevent risky drinking in young people aged 14-15 in a high school setting (SIPS JR-HIGH): study protocol. BMJ Open 2016; 6:e012474. [PMID: 28011807 PMCID: PMC5223663 DOI: 10.1136/bmjopen-2016-012474] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/23/2016] [Accepted: 10/12/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Drinking has adverse impacts on health, well-being, education and social outcomes for adolescents. Adolescents in England are among the heaviest drinkers in Europe. Recently, the proportion of adolescents who drink alcohol has fallen, although consumption among those who do drink has actually increased. This trial seeks to investigate how effective and efficient an alcohol brief intervention is with 11-15 years olds to encourage lower alcohol consumption. METHODS AND ANALYSIS This is an individually randomised two-armed trial incorporating a control arm of usual school-based practice and a leaflet on a healthy lifestyle (excl. alcohol), and an intervention arm that combines usual practice with a 30 min brief intervention delivered by school learning mentors and a leaflet on alcohol. At least 30 schools will be recruited from four regions in England (North East, North West, London, Kent and Medway) to follow-up 235 per arm. The primary outcome is total alcohol consumed in the last 28 days, using the 28 day Timeline Follow Back questionnaire measured at the 12-month follow-up. The analysis of the intervention will consider effectiveness and cost-effectiveness. A qualitative study will explore, via 1:1 in-depth interviews with (n=80) parents, young people and school staff, intervention experience, intervention fidelity and acceptability issues, using thematic narrative synthesis to report qualitative data. ETHICS AND DISSEMINATION Ethical approval was granted by Teesside University. Dissemination plans include academic publications, conference presentations, disseminating to local and national education departments and the wider public health community, including via Fuse, and engaging with school staff and young people to comment on whether and how the project can be improved. TRIAL REGISTRATION TRIAL ISRCTN45691494; Pre-results.
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Affiliation(s)
- Emma L Giles
- Health and Social Care Institute, Alcohol and Public Health Team, Teesside University, Middlesbrough, UK
| | - Simon Coulton
- Centre for Health Services Research, George Allen Wing, University of Kent, Canterbury, UK
| | - Paolo Deluca
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Colin Drummond
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Denise Howel
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Elaine McColl
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Ruth McGovern
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Stephanie Scott
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Elaine Stamp
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Harry Sumnall
- Centre for Public Health, Liverpool John Moores University, Liverpool, UK
| | - Les Tate
- Young People's Drug and Alcohol Department, North Tyneside Council, Tyne and Wear, UK
| | - Liz Todd
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Viviana Albani
- Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Sadie Boniface
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jennifer Ferguson
- Health and Social Care Institute, Alcohol and Public Health Team, Teesside University, Middlesbrough, UK
| | - Jo Frankham
- Faculty of Education, Health and Community, Liverpool John Moores University, Liverpool, UK
| | - Eilish Gilvarry
- Northumberland, Tyne and Wear NHS Foundation Trust, St. Nicholas Hospital, Newcastle upon Tyne, UK
| | - Nadine Hendrie
- Centre for Health Services Research, George Allen Wing, University of Kent, Canterbury, UK
| | - Nicola Howe
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Grant J McGeechan
- Health and Social Care Institute, Alcohol and Public Health Team, Teesside University, Middlesbrough, UK
| | - Grant Stanley
- Faculty of Education, Health and Community, Liverpool John Moores University, Liverpool, UK
| | - Dorothy Newbury-Birch
- Health and Social Care Institute, Alcohol and Public Health Team, Teesside University, Middlesbrough, UK
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18
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Cuevas J, Chi DL. SBIRT-Based Interventions to Improve Pediatric Oral Health Behaviors and Outcomes: Considerations for Future Behavioral SBIRT Interventions in Dentistry. Curr Oral Health Rep 2016; 3:187-192. [PMID: 27857880 PMCID: PMC5108451 DOI: 10.1007/s40496-016-0106-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Dental caries is the most common chronic disease in children and is caused by poor oral health behaviors. These behaviors include high-sugar diet, inadequate exposure to topical fluorides, and irregular use of professional dental care services. A number of behavioral intervention approaches have been used to modify health behaviors. One example is the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model, which has been widely used to reduce substance abuse in both adults and children. SBIRT is a promising behavior change approach that could similarly be used to address problematic oral health behaviors. In this paper, we will review oral health studies that have adopted SBIRT components, assess if these interventions improved oral health behaviors and outcomes, and outline considerations for researchers interested in developing and testing future oral health-related SBIRT interventions in dentistry.
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Affiliation(s)
- Josué Cuevas
- Undergraduate Research Assistant, University of Washington, School of Public Health, Cell: 509-366-2996
| | - Donald L. Chi
- Associate Professor, Department of Oral Health Sciences, University of Washington, School of Dentistry, Box 357475, B509f Health Sciences Building, Seattle, WA 98195-7475, Office: 206-616-4332, Cell: 206-650-7652, Fax: 206-685-4258
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19
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Havard A, Shakeshaft AP, Conigrave KM. Randomized Controlled Trial of Mailed Personalized Feedback for Risky Drinkers in the Emergency Department: The Impact on Alcohol Consumption, Alcohol-Related Injuries, and Repeat Emergency Department Presentations. Alcohol Clin Exp Res 2015; 39:1260-6. [PMID: 26031313 DOI: 10.1111/acer.12760] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 04/22/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Due to the difficulty encountered in disseminating resource-intensive emergency department (ED)-based brief alcohol interventions into real-world settings, this study evaluated the effect of a mailed personalized feedback intervention for problem drinking ED patients. At 6-week follow-up, this intervention was associated with a statistically significant reduction in alcohol consumption among patients with alcohol-involved ED presentations. This study aimed to evaluate the effects of this intervention over time. METHODS A randomized controlled trial was conducted among problem drinking ED patients, defined as those scoring 8 or more on the Alcohol Use Disorders Identification Test. Participants in the intervention group received mailed personalized feedback regarding their alcohol consumption. The control group received no feedback. Follow-up interviews were conducted over the phone, postal survey, or email survey 6 weeks and 6 months after baseline screening, and repeat ED presentations over 12-month follow-up were ascertained via linked ED records. RESULTS Six-month follow-up interviews were completed with 210 participants (69%), and linked ED records were obtained for 286 participants (94%). The intervention had no effect on alcohol consumption, while findings regarding alcohol-related injuries and repeat ED presentations remain inconclusive. CONCLUSIONS Further research in which the receipt of feedback is improved and a booster intervention is provided is recommended.
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Affiliation(s)
- Alys Havard
- Centre for Big Data Research in Health, UNSW Australia, Sydney, New South Wales, Australia.,Centre for Health Research, University of Western Sydney, Sydney, New South Wales, Australia.,National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia
| | - Anthony P Shakeshaft
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia
| | - Katherine M Conigrave
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia.,Drug Health Service, Royal Prince Alfred Hospital and Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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20
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Ondersma SJ, Beatty JR, Svikis DS, Strickler RC, Tzilos GK, Chang G, Divine GW, Taylor AR, Sokol RJ. Computer-Delivered Screening and Brief Intervention for Alcohol Use in Pregnancy: A Pilot Randomized Trial. Alcohol Clin Exp Res 2015; 39:1219-26. [PMID: 26010235 DOI: 10.1111/acer.12747] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 04/02/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although screening and brief intervention (SBI) for unhealthy alcohol use has demonstrated efficacy in some trials, its implementation has been limited. Technology-delivered approaches are a promising alternative, particularly during pregnancy when the importance of alcohol use is amplified. The present trial evaluated the feasibility and acceptability of an interactive, empathic, video-enhanced, and computer-delivered SBI (e-SBI) plus 3 tailored mailings, and estimated intervention effects. METHODS We recruited 48 pregnant women who screened positive for alcohol risk at an urban prenatal care clinic. Participants were randomly assigned to the e-SBI plus mailings or to a control session on infant nutrition, and were re-evaluated during their postpartum hospitalization. The primary outcome was 90-day period prevalence abstinence as measured by timeline follow-back interview. RESULTS Participants rated the intervention as easy to use and helpful (4.7 to 5.0 on a 5-point scale). Blinded follow-up evaluation at childbirth revealed medium-size intervention effects on 90-day period prevalence abstinence (OR = 3.4); similarly, intervention effects on a combined healthy pregnancy outcome variable (live birth, normal birthweight, and no neonatal intensive care unit stay) were also of moderate magnitude in favor of e-SBI participants (OR = 3.3). As expected in this intentionally underpowered pilot trial, these effects were nonsignificant (p = 0.19 and 0.09, respectively). CONCLUSIONS This pilot trial demonstrated the acceptability and preliminary efficacy of e-SBI plus tailored mailings for alcohol use in pregnancy. These findings mirror the promising results of other trials using a similar approach and should be confirmed in a fully powered trial.
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Affiliation(s)
- Steven J Ondersma
- Department of Psychiatry & Behavioral Neurosciences and Merrill-Palmer Skillman Institute, Wayne State University, Detroit, Michigan
| | - Jessica R Beatty
- Department of Psychiatry & Behavioral Neurosciences and Merrill-Palmer Skillman Institute, Wayne State University, Detroit, Michigan
| | - Dace S Svikis
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia.,Department of Psychiatry and Obstetrics/Gynecology, Virginia Commonwealth University, Richmond, Virginia
| | | | - Golfo K Tzilos
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
| | - Grace Chang
- VA Boston Healthcare System and Harvard Medical School, Boston, Massachusetts
| | | | | | - Robert J Sokol
- Department of Obstetrics & Gynecology, Wayne State University, Detroit, Michigan
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21
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Dembo R, Briones-Robinson R, Wareham J, Schmeidler J, Winters KC, Barrett K, Ungaro R, Karas LM, Belenko S. Impact of Brief Intervention Services on Drug Using Truant Youth Arrest Charges over Time. J Child Adolesc Subst Abuse 2014; 23:375-388. [PMID: 25382960 DOI: 10.1080/1067828x.2012.741560] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
School truancy is a serious concern in the U.S., with far-reaching negative consequences. Truancy has been positively associated with substance use and delinquent behavior; however, research is limited. Consequently, the Truancy Brief Intervention Project was established to treat and prevent substance use and other risky behaviors among truants. This article examines whether the Brief Intervention program is more effective in preventing future delinquency over a 12-month follow-up period, than the standard truancy program. Results indicate the Brief Intervention was marginally significant in effecting future delinquency among truants, compared to the standard truancy program. Future implications of this study are discussed.
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Affiliation(s)
- Richard Dembo
- Criminology Department University of South Florida 4202 E. Fowler Avenue Tampa, FL 33620
| | | | - Jennifer Wareham
- Department of Criminal Justice Wayne State University 3278 Faculty/Administration Building Detroit, MI 48202
| | - James Schmeidler
- Department of Psychiatry Mt. Sinai Medical School One Gustove Levy Place New York, NY 10029
| | - Ken C Winters
- Department of Psychiatry University of Minnesota F282/2A 2450 Riverside Avenue Minneapolis, MN 55454 (Also affiliated with Treatment Research Institute, Philadelphia, PA)
| | - Kimberly Barrett
- Criminology Department University of South Florida 4202 E. Fowler Avenue Tampa, FL 33620
| | - Rocio Ungaro
- Criminology Department University of South Florida 4202 E. Fowler Avenue Tampa, FL 33620
| | - Lora M Karas
- Mediation Program 13 Judicial Circuit 800 E. Twiggs St Tampa, FL 33602
| | - Steven Belenko
- Department of Criminal Justice Temple University 558-9 Gladfelter Hall 1115 West Berks Street Philadelphia, PA 19122 (Also affiliated with Treatment Research Institute, Philadelphia, PA)
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22
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Dembo R, Briones-Robinson R, Wareham J, Winters KC, Ungaro R, Schmeidler J. Brief Intervention Impact on Truant Youth Attitudes to School and School Behavior Problems: A Longitudinal Study. J Educ Develop Psychol 2014; 4:163-193. [PMID: 25247027 PMCID: PMC4167876 DOI: 10.5539/jedp.v4n1p163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Truancy continues to be a major problem, affecting most school districts in the U.S. Truancy is related to school dropout, with associated adverse consequences, including unemployment and delinquency. It is important to obtain a more complete picture of truants' educational experience. First, the present study sought to examine the longitudinal growth (increasing/decreasing trend) in truant youths' attitudes toward school and misbehavior in school (disobedience, inappropriate behavior, skipping school). Second, this study focused on examining the impact of a Brief Intervention (BI) targeting the youths' substance use, as well as socio-demographic and background covariates, on their attitudes toward school and school behavior problems over time. A linear growth model was found to fit the attitudes toward school longitudinal data, suggesting the youths' attitudes toward school are related across time. An auto-regressive lag model was estimated for each of the school misbehaviors, indicating that, once initiated, youth continued to engage in them. Several socio-demographic covariates effects were found on the youths' attitudes towards school and school misbehaviors over time. However, no significant, overall BI effects were uncovered. Some statistically significant intervention effects were found at specific follow-up points for some school misbehaviors, but none were significant when applying the Holm procedure taking account of the number of follow-ups. The implications of these findings are discussed.
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Affiliation(s)
- Richard Dembo
- Department of Criminology, University of South Florida, Tampa, FL
| | | | - Jennifer Wareham
- Department of Criminal Justice, Wayne State University, Detroit, MI
| | - Ken C Winters
- Department of Psychiatry, University of Minnesota, Minneapolis, MN
| | - Rocío Ungaro
- Department of Criminology, University of South Florida, Tampa, FL
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Sommers MS, Lyons MS, Fargo JD, Sommers BD, McDonald CC, Shope JT, Fleming MF. Emergency department-based brief intervention to reduce risky driving and hazardous/harmful drinking in young adults: a randomized controlled trial. Alcohol Clin Exp Res 2013; 37:1753-62. [PMID: 23802878 DOI: 10.1111/acer.12142] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 02/18/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Risky driving and hazardous drinking are associated with significant human and economic costs. Brief interventions for more than one risky behavior have the potential to reduce health-compromising behaviors in populations with multiple risk-taking behaviors such as young adults. Emergency department (ED) visits provide a window of opportunity for interventions meant to reduce both risky driving and hazardous drinking. METHODS We determined the efficacy of a Screening, Brief Intervention, and Referral to Treatment (SBIRT) protocol addressing risky driving and hazardous drinking. We used a randomized controlled trial design with follow-ups through 12 months. ED patients aged 18 to 44 who screened positive for both behaviors (n = 476) were randomized to brief intervention (BIG), contact control (CCG), or no-contact control (NCG) groups. The BIG (n = 150) received a 20-minute assessment and two 20-minute interventions. The CCG (n = 162) received a 20-minute assessment at baseline and no intervention. The NCG (n = 164) were asked for contact information at baseline and had no assessment or intervention. Outcomes at 3, 6, 9, and 12 months were self-reported driving behaviors and alcohol consumption. RESULTS Outcomes were significantly lower in BIG compared with CCG through 6 or 9 months, but not at 12 months: Safety belt use at 3 months (adjusted odds ratio [AOR], 0.22; 95% confidence interval [CI], 0.08 to 0.65); 6 months (AOR, 0.13; 95% CI, 0.04 to 0.42); and 9 months (AOR, 0.18; 95% CI, 0.06 to 0.56); binge drinking at 3 months (adjusted rate ratio [ARR] 0.84; 95% CI, 0.74 to 0.97) and 6 months (ARR, 0.81; 95% CI, 0.67 to 0.97); and ≥5 standard drinks/d at 3 months (AOR, 0.43; 95% CI, 0.20 to 0.91) and 6 months (AOR, 0.41; 95% CI, 0.17 to 0.98). No substantial differences were observed between BIG and NCG at 12 months. CONCLUSIONS Our findings indicate that SBIRT reduced risky driving and hazardous drinking in young adults, but its effects did not persist after 9 months. Future research should explore methods for extending the intervention effect.
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Affiliation(s)
- Marilyn S Sommers
- School of Nursing , University of Pennsylvania, Philadelphia, Pennsylvania
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Abstract
Patients' insight has a critical role in the recovery from problematic behavior. The aim of this study was to evaluate the effects of a brief intervention to promote insight among alcohol-dependent patients. A total of 41 alcohol-dependent patients (30 males, 11 females) in an insight-deficient state who had been admitted to a community-based alcohol treatment center, were randomized into two groups based on their admission order: an intervention group (IG) (n = 20) and a control group (CG) (n = 21). Patients in both the IG and CG participated in an identical treatment program with one exception: patients in the IG were required to undergo five sessions of brief individual intervention focusing on insight enhancement. Changes in insight state were assessed after the intervention. The IG exhibited significant (P < 0.05) changes in the distribution of insight level, while the CG did not exhibit any significant changes in the distribution of insight level. The insight score after intervention was significantly (P < 0.05) greater for the IG than the CG with adjustment for the baseline characteristics. The results suggest that a brief individual intervention focused on insight enhancement may be an effective tool to improve insight among alcohol-dependent patients.
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Affiliation(s)
- Jin-Gyu Jung
- Department of Family Medicine, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jong-Sung Kim
- Department of Family Medicine, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, Korea
| | - Gap-Jung Kim
- Department of Psychiatry, Hanmaum Alcohol Treatment Center, Daejeon, Korea
| | - Mi-Kyeong Oh
- Department of Family Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Sung-Soo Kim
- Department of Family Medicine, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, Korea
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Kelley-Baker T, Johnson MB, Romano E, Mumford EA, Miller BA. Preventing victimization among young women: The SafeNights intervention. Am J Health Stud 2011; 26:185-195. [PMID: 24634576 PMCID: PMC3953031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE We examined the effect of a brief intervention, titled SafeNights, to reduce victimization among young college-aged females. PARTICIPANTS A total of 1,048 women participated; 496 participants in the control and 552 in the experimental condition. METHOD Young Americans crossing the U.S. border to patronize Tijuana bars were randomly assigned to an intervention as they traveled into Tijuana. Upon returning to the United States, participants provided a breath sample and were interviewed. RESULTS SafeNights was significantly associated with reductions in reported victimization independent of alcohol consumption. CONCLUSIONS The intervention will be refined for a broader spectrum of collegiate settings at high risk for heavy drinking and potential victimization.
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Affiliation(s)
| | - Mark B. Johnson
- Pacific Institute for Research and Evaluation, Calverton, MD
| | - Eduardo Romano
- Pacific Institute for Research and Evaluation, Calverton, MD
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Barnett NP, Apodaca TR, Magill M, Colby SM, Gwaltney C, Rohsenow DJ, Monti PM. Moderators and mediators of two brief interventions for alcohol in the emergency department. Addiction 2010. [PMID: 20402989 DOI: 10.1038/nature09421.oxidative] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate moderators and mediators of brief alcohol interventions conducted in the emergency department. METHODS Patients (18-24 years; n = 172) in an emergency department received a motivational interview with personalized feedback (MI) or feedback only (FO), with 1- and 3-month booster sessions and 6- and 12-month follow-ups. Gender, alcohol status/severity group [ALC+ only, Alcohol Use Disorders Identification Test (AUDIT+) only, ALC+/AUDIT+], attribution of alcohol in the medical event, aversiveness of the event, perceived seriousness of the event and baseline readiness to change alcohol use were evaluated as moderators of intervention efficacy. Readiness to change also was evaluated as a mediator of intervention efficacy, as were perceived risks/benefits of alcohol use, self-efficacy and alcohol treatment seeking. RESULTS Alcohol status, attribution and readiness moderated intervention effects such that patients who had not been drinking prior to their medical event, those who had low or medium attribution for alcohol in the event and those who had low or medium readiness to change showed lower alcohol use 12 months after receiving MI compared to FO. In the AUDIT+ only group those who received MI showed lower rates of alcohol-related injury at follow-up than those who received FO. Patients who had been drinking prior to their precipitating event did not show different outcomes in the two interventions, regardless of AUDIT status. Gender did not moderate intervention efficacy and no significant mediation was found. CONCLUSIONS Findings may help practitioners target patients for whom brief interventions will be most effective. More research is needed to understand how brief interventions transmit their effects.
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Affiliation(s)
- Nancy P Barnett
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
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27
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Abstract
OBJECTIVE To evaluate moderators and mediators of brief alcohol interventions conducted in the emergency department. METHODS Patients (18-24 years; n = 172) in an emergency department received a motivational interview with personalized feedback (MI) or feedback only (FO), with 1- and 3-month booster sessions and 6- and 12-month follow-ups. Gender, alcohol status/severity group [ALC+ only, Alcohol Use Disorders Identification Test (AUDIT+) only, ALC+/AUDIT+], attribution of alcohol in the medical event, aversiveness of the event, perceived seriousness of the event and baseline readiness to change alcohol use were evaluated as moderators of intervention efficacy. Readiness to change also was evaluated as a mediator of intervention efficacy, as were perceived risks/benefits of alcohol use, self-efficacy and alcohol treatment seeking. RESULTS Alcohol status, attribution and readiness moderated intervention effects such that patients who had not been drinking prior to their medical event, those who had low or medium attribution for alcohol in the event and those who had low or medium readiness to change showed lower alcohol use 12 months after receiving MI compared to FO. In the AUDIT+ only group those who received MI showed lower rates of alcohol-related injury at follow-up than those who received FO. Patients who had been drinking prior to their precipitating event did not show different outcomes in the two interventions, regardless of AUDIT status. Gender did not moderate intervention efficacy and no significant mediation was found. CONCLUSIONS Findings may help practitioners target patients for whom brief interventions will be most effective. More research is needed to understand how brief interventions transmit their effects.
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Affiliation(s)
| | - Timothy R. Apodaca
- Brown University Center for Alcohol and Addiction Studies
- Children’s Mercy Hospital, University of Missouri-Kansas City School of Medicine
| | - Molly Magill
- Brown University Center for Alcohol and Addiction Studies
| | | | - Chad Gwaltney
- Brown University Center for Alcohol and Addiction Studies
| | - Damaris J. Rohsenow
- Brown University Center for Alcohol and Addiction Studies
- Providence VA Medical Center
| | - Peter M. Monti
- Brown University Center for Alcohol and Addiction Studies
- Providence VA Medical Center
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