Responsiveness to mHealth Intervention for Cannabis Use in Young Adults Predicts Improved Outcomes

Mobile health (mHealth) interventions have proliferated rapidly in part because of their advantages in reducing consumer and provider burden, but less attention has been paid to participant responsiveness to mHealth programs and how this may affect outcomes. This study adds to that literature by examining whether participant responsiveness to a text messaging-delivered intervention was predictive of treatment outcomes over baseline levels of the outcome. We analyzed data from a pilot-randomized controlled trial of a text messaging-intervention to treat young adults with cannabis use disorder (treatment arm, N = 47), examining three indicators of responsiveness (two behavioral: treatment completion and booster message participation; and one subjective: perceived helpfulness of treatment) on abstinence from cannabis use and use-related problems measured at 3-month follow-up. With the exception of completion, the indicators were positively correlated with each other. Each of the indicators was predictive of better treatment outcomes above and beyond baseline risk. Treatment completion and booster participation-measured via technical data captured during intervention administration-appeared to be stronger predictors of improved outcomes than self-reported perceived helpfulness. Results suggest that behavioral and subjective responsiveness measures appear to be valid indicators of treatment response to mHealth interventions for substance use. Responsiveness measured via technical data captured during intervention administration may be a stronger and more efficient strategy for monitoring continued engagement. We discuss implications of these findings for deploying mHealth interventions at scale and monitoring responsiveness.

Comparison of Conditional and Marginal Models in Assessing a Child Nutrition Intervention in Armenia

INTRODUCTION

Child malnutrition is a major issue in conflict zones. Evidence-based interventions and their thorough evaluation could help to eliminate malnutrition. We aimed to assess the causal effect of a community-based multidisciplinary nutrition program for children in a chronic conflict zone near the northeastern border of Armenia on two main outcomes: stunting and anemia. We further compared the interpretations and public health relevance of the obtained effect estimates.

METHODS

In 2016, the study measured hemoglobin and anthropometric measures and collected data from the children's caregivers. We used propensity score matching analyses, inverse probability weighting, and overlap weighting methods to examine the average treatment effects among treated population (ATT), and among population with overlapping weights (ATO).

RESULTS

The ATT for stunting among children who participated in the intervention program estimated by propensity score matching analyses (PSM-ATT) was (1.95; 95%CI 1.15-3.28). Nevertheless, children who took part in the program had a lower risk of anemia (0.28; 95%CI 0.19-0.42). The ATT, estimated by inverse probability weighting (IPTW-ATT), was slightly lower for stunting (1.82; 95%CI 1.16-2.86) while similar for anemia (0.33; 95%CI 0.23-0.46) compared to PSM-ATT. Compared to the IPTW-ATT and PSM-ATT the ATO was lower for stunting (1.75; 95%CI 1.14-2.68) and similar for anemia (0.31; 95%CI 0.22-0.43).

DISCUSSION

Marginal models could be used in similar quasi-experimental settings to identify the causal effect of interventions in specific populations of interest. Nonetheless, these methods do not eliminate threats to internal validity. Thorough study design and accurate data collection are necessary to improve the efficiency of marginal models.

Mechanisms Through Which a Family Caregiver Coaching Intervention Might Reduce Anxiety Among Children in Military Households

OBJECTIVES

Children of injured or disabled veterans and service members may be at risk for mental health and adjustment problems due to household stress. Yet, there are few widely available interventions to address the needs of this population. Reducing distress and improving coping skills of the parent who cares for the injured or disabled adult may improve child outcomes. This paper examines whether changes in caregiver psychosocial outcomes after a caregiver coaching intervention are associated with decreases in child anxiety.

METHODS

Using programmatic data collected between 2015 and 2019 from participants in a family caregiver coaching intervention (170 caregivers, 294 children), we apply linear mixed models to assess associations between changes in family caregiver well-being, including problem solving, depressive symptoms, burden, health complaints and quality of life, and changes in parent-reported child anxiety.

RESULTS

The baseline median Spence Children's Anxiety Scale-Parent score was 17; children aged 6-11 had slightly higher scores. Child anxiety scores decreased on average 2.8 points (SD 8.4) between baseline and follow-up. In adjusted models, decreases in caregiver depressive symptoms and health complaints were associated with decreases in child anxiety. Caregiver problem-solving skills, quality of life, and subjective burden were not associated with changes in child anxiety.

CONCLUSION

Family caregiver-focused interventions that decrease caregiver stress may positively affect children in the household. Few resources are directed at military children; therefore, practitioners should consider ways to leverage caregiver interventions to address child well-being, such as incorporating information on parenting strategies and addressing issues faced by military children.

Data and supplemental material of the paper "Effectiveness of digital-based interventions for children with mathematical learning difficulties: A meta-analysis"

Data and supplement material of the article "Effectiveness of digital-based interventions for children with mathematical learning difficulties: A meta-analysis" (Benavides-Varela et al.) [1] are presented. Data were collected from studies included in the meta-analysis to evaluate the effects of digital-based interventions for children with mathematical learning difficulties compared to control conditions in group-designed randomized controlled trials. Literature search, inclusion criteria and coding procedure are described. PRISMA flow-chart is reported to summarize the literature search and coding of all the relevant characteristics of the primary studies is made available. This allows other researchers to easily access to the information needed to evaluate the studies and to use these data in future meta-analyses. However, researchers are highly recommended to refer to the original papers in order to check studies suitability to their own criteria. Moreover, in the supplemental material all the information needed to reproduce the meta-analysis results is reported together with the R code syntax. Data and supplemental material are available online (https://osf.io/ajdnv/).

Alterations of mental defeat and cognitive flexibility during cognitive behavioral therapy in patients with major depressive disorder: a single-arm pilot study

Objective

Mental defeat affects the occurrence and chronicity of depression and cognitive flexibility. This study aimed to examine changes in mental defeat and cognitive flexibility scores after cognitive behavioral therapy including IR. In the intervention group, patients with depression (n = 18, mean age = 37.89 years) received 15 cognitive behavioral therapy sessions. Patients completed the Beck Depression Inventory-II; Mental Defeat Scale; Cognitive Flexibility Scale; EuroQol five dimensions questionnaire; Patient Health Questionnaire-9 and seven-item Generalized Anxiety Disorder Scale before the intervention, after six sessions, and post-intervention. The healthy control group (n = 33, mean age = 37.91) completed all scales once and did not receive treatment.

Results

Post-cognitive behavioral therapy, a significant decrease was observed in Beck Depression Inventory-II, Mental Defeat Scale, Cognitive Flexibility Scale, and Patient Health Questionnaire-9 scores. Although mental defeat and cognitive flexibility did not reach the level of the healthy control group, they demonstrated improvement. Therefore, when treating depression, mental defeat and cognitive flexibility should be measured in addition to depressive symptoms.

Trial registration This study was registered retrospectively in the national UMIN Clinical Trials Registry on July 25, 2016 (registration ID: UMIN000023320)

Changing Friend Selection in Middle School: A Social Network Analysis of a Randomized Intervention Study Designed to Prevent Adolescent Problem Behavior

Adolescent friendships that promote problem behavior are often chosen in middle school. The current study examines the unintended impact of a randomized school-based intervention on the selection of friends in middle school, as well as on observations of deviant talk with friends 5 years later. Participants included 998 middle school students (526 boys and 472 girls) recruited at the onset of middle school (age 11-12 years) from three public middle schools participating in the Family Check-up model intervention. The current study focuses only on the effects of the SHAPe curriculum-one level of the Family Check-up model-on friendship choices. Participants nominated friends and completed measures of deviant peer affiliation. Approximately half of the sample (n = 500) was randomly assigned to the intervention, and the other half (n = 498) comprised the control group within each school. The results indicate that the SHAPe curriculum affected friend selection within school 1 but not within schools 2 or 3. The effects of friend selection in school 1 translated into reductions in observed deviancy training 5 years later (age 16-17 years). By coupling longitudinal social network analysis with a randomized intervention study, the current findings provide initial evidence that a randomized public middle school intervention can disrupt the formation of deviant peer groups and diminish levels of adolescent deviance 5 years later.

Diffusion of Intervention Effects: The Impact of a Family-Based Substance Use Prevention Program on Friends of Participants

PURPOSE

We tested whether effects of the Strengthening Families Program for Youth 10-14 (SFP10-14) diffused from intervention participants to their friends. We also tested which program effects on participants accounted for diffusion.

METHODS

Data are from 5,449 students (51% female; mean initial age = 12.3 years) in the PROmoting School-community-university Partnerships to Enhance Resilience community intervention trial (2001-2006) who did not participate in SFP10-14 (i.e., nonparticipants). At each of five waves, students identified up to seven friends and self-reported past month drunkenness and cigarette use, substance use attitudes, parenting practices, and unsupervised time spent with friends. We computed two measures of indirect exposure to SFP10-14: total number of SFP-attending friends at each wave and cumulative proportion of SFP-attending friends averaged across the current and all previous post-intervention waves.

RESULTS

Three years post-intervention, the odds of getting drunk (odds ratio = 1.4) and using cigarettes (odds ratio = 2.7) were higher among nonparticipants with zero SFP-attending friends compared with nonparticipants with three or more SFP-attending friends. Multilevel analyses also provided evidence of diffusion: nonparticipants with a higher cumulative proportion of SFP-attending friends at a given wave were less likely than their peers to use drugs at that wave. Effects from SFP10-14 primarily diffused through friendship networks by reducing the amount of unstructured socializing (unsupervised time that nonparticipants spent with friends), changing friends' substance use attitudes, and then changing nonparticipants' own substance use attitudes.

CONCLUSIONS

Program developers should consider and test how interventions may facilitate diffusion to extend program reach and promote program sustainability.