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Florimbio AR, Coughlin LN, Bauermeister JA, Young SD, Zimmerman MA, Walton MA, Bonar EE. Risky Drinking in Adolescents and Emerging Adults: Differences between Individuals Using Alcohol Only versus Polysubstances. Subst Use Misuse 2022; 58:211-220. [PMID: 36537360 PMCID: PMC9877190 DOI: 10.1080/10826084.2022.2152192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Factors related to risky drinking (e.g., motives, protective behavioral strategies [PBS]) may vary between youth who engage in polysubstance use compared to those who consume alcohol only. We examined differences in factors among youth who consume alcohol only compared to alcohol with other substances (i.e., polysubstance use), and correlates associated with risky drinking between the groups. METHODS Participants (N = 955; ages 16-24; 54.5% female) who reported recent risky drinking completed measures of alcohol/substance use, alcohol-related consequences, drinking motives, alcohol PBS, mental health symptoms, and emotion dysregulation. Participants were in the polysubstance group if they reported using at least one other substance (e.g., cannabis, stimulants) in addition to alcohol in the past three months. Chi-square and t-tests examined differences between the two groups and multiple regression analyses examined correlates of risky drinking. RESULTS Most participants (70.4%, n = 672) reported polysubstance use; these individuals engaged in riskier patterns of drinking, experienced more alcohol-related consequences, used fewer PBS, had stronger drinking motives (enhancement, social, coping), endorsed more mental health symptoms, and reported more emotion dysregulation. Regression models showed that emotion dysregulation significantly associated with risky drinking in the alcohol-only group; conformity and coping motives, alcohol PBS, and anxiety symptoms significantly associated with risky drinking in the polysubstance group. CONCLUSIONS Among risky drinking youth, results indicated youth engaging in polysubstance use have greater comorbidities and individual-level factors associated with risky drinking than youth who consume alcohol only. These findings may inform the tailoring of interventions for individuals who engage in risky drinking and polysubstance use.
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Affiliation(s)
- Autumn Rae Florimbio
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
| | - Lara N. Coughlin
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
| | - José A. Bauermeister
- Department of Family and Community Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Sean D. Young
- Department of Emergency Medicine, University of California, Irvine, Irvine, CA, USA
- Department of Informatics, University of California, Irvine, Irvine, CA, USA
| | - Marc A. Zimmerman
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
| | - Maureen A. Walton
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
| | - Erin E. Bonar
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
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2
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Understanding factors associated with firearm possession: Examining differences between male and female adolescents and emerging adults seeking emergency department care. Prev Med 2022; 165:107286. [PMID: 36202257 PMCID: PMC10368177 DOI: 10.1016/j.ypmed.2022.107286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Abstract
Firearm possession increases the likelihood of hospital visits among adolescents and emerging adults for both males and females. To better inform prevention practices, we examine data among adolescents and emerging adults (A/EAs; ages 16 to 29) presenting to an urban emergency department for any reason to understand the differences in firearm possession between males and females (N = 1312; 29.6% male; 50.5% Black). Regression identified firearm possession correlates, such as male sex (AOR = 2.26), firearm attitudes (AOR = 1.23), peer firearm possession (AOR = 9.84), and community violence exposure (AOR = 1.02). When stratified by sex (e.g., male vs female), regression results yielded differences in correlates for firearm possession: in males, peer firearm possession (AOR = 8.96) were significant, and in females, firearm attitudes (AOR = 1.33) and peer firearm possession (AOR = 11.24) were significant. An interaction between sex and firearm attitudes demonstrated that firearm attitudes were differentially associated with firearm possession between female and male A/EAs (AOR = 1.28). Overall, we found that females are more likely to endorse retaliatory firearm attitudes, and both males and females are highly influenced by their perception of peer firearm possession. These results help inform prevention strategies across multiple settings, especially for hospital-based violence interventions, and suggest that tailored approaches addressing differences between male and female A/EAs are appropriate when addressing firearm violence and injury risk among A/EAs.
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Bonar EE, Bauermeister JA, Blow FC, Bohnert ASB, Bourque C, Coughlin LN, Davis AK, Florimbio AR, Goldstick JE, Wisnieski DM, Young SD, Walton MA. A randomized controlled trial of social media interventions for risky drinking among adolescents and emerging adults. Drug Alcohol Depend 2022; 237:109532. [PMID: 35759874 PMCID: PMC9745675 DOI: 10.1016/j.drugalcdep.2022.109532] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/02/2022] [Accepted: 06/03/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Alcohol use among adolescents and emerging adults is an important public health issue requiring prevention approaches. Herein, we describe outcomes from a randomized controlled trial testing the efficacy of group-based social media interventions targeting risky drinking among youth. PROCEDURES Using social media advertisements to screen potential participants, we recruited 955 youth (ages 16-24) reporting recent risky drinking. After completing a baseline assessment, participants were randomized to 8-week secret Facebook group conditions: Social Media Intervention + Incentives for engagement, Social Media Intervention only, and attention-placebo control. Electronic coaches trained in motivational interviewing facilitated interaction in intervention groups. Primary outcomes include past 3-month alcohol use and consequences over 3-, 6-, and 12-month follow-ups. Secondary outcomes include other drug use, consequences, and impaired driving. We also measured intervention engagement and acceptability. RESULTS The interventions were well-received, with significantly greater acceptability ratings and engagement in the SMI+I condition relative to other groups. In adjusted analyses, there were no significant differences between interventions and control on alcohol-related outcomes, with all groups showing reductions. Regarding secondary outcomes (70.4% used other drugs), compared to control, the incentivized group reduced other drug use, consequences, and cannabis-impaired driving; the non-incentivized group did not significantly differ from the control condition. CONCLUSIONS Among this predominantly poly-substance using sample, findings were mixed, with significant effects of the incentivized social media intervention on drug (but not alcohol) outcomes. Future studies are needed to further refine social media-delivered interventions to reduce alcohol and other drug use. TRIAL REGISTRATION ClinicalTrials.gov NCT02809586; University of Michigan HUM#00102242.
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Affiliation(s)
- Erin E. Bonar
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
| | - José A. Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104
| | - Frederic C. Blow
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Veterans Health Administration, Center for Clinical Management Research, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109, USA
| | - Amy S. B. Bohnert
- Veterans Health Administration, Center for Clinical Management Research, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109, USA,Department of Anesthesiology, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Carrie Bourque
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Lara N. Coughlin
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
| | - Alan K. Davis
- Center for Psychedelic Drug Research and Education, College of Social Work, The Ohio State University, 1947 College Rd, Columbus, OH 43210 USA,Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224 USA
| | - Autumn Rae Florimbio
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Jason E. Goldstick
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA,Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd Bldg 10-G080, Ann Arbor, MI 48109, USA,Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48105
| | - Diane M. Wisnieski
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Sean D. Young
- Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California Irvine, Irvine, CA 92697,Department of Emergency Medicine, University of California Irvine, Irvine, CA 92697
| | - Maureen A. Walton
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
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4
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Bonar EE, Souweidane MA, Blow FC, Bohnert ASB, Bauermeister JA, Young SD, Walton MA. High-intensity drinking among adolescent and emerging adult risky drinkers. Subst Abus 2022; 43:713-721. [PMID: 35100097 PMCID: PMC9720995 DOI: 10.1080/08897077.2021.2007513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: High-intensity drinking (HID; 8+ U.S. standard drinks for women, 10+ men) is initiated during adolescence/emerging adulthood, increasing risk for negative outcomes, including blackouts. We examined baseline data from a study of risky drinking youth to identify factors associated with HID. Methods: Risky drinkers (ages 16-24) were recruited online (positive 3-month AUDIT-C score) as part of a larger study to examine social media interventions for risky drinking. We used baseline survey data to examine HID in relation to demographics, substance use-related variables, and individual and social factors. Results: Among 931 risky drinkers, 29.8% reported past-month HID, and those with HID reported greater substance use and consequences. In multivariable analysis, HID was associated with male sex; greater social motives, impulsivity, and motivation; lower self-efficacy; and greater likelihood of not living with parents, drinking with important peers, and parental disapproval of posting drinking pictures. When examining age group interactions (16-20; 21-24), underage drinkers with high sensation-seeking scores and lower parental disapproval of posting drinking pictures on social media reported greater HID. Conclusions: Among risky drinking youth, male sex, social motives, impulsivity, higher motivation to and lower-self-efficacy to reduce drinking, living away from parents, more frequent drinking with important peers, and lower parental disapproval of posting drinking pictures on social media were positively associated with HID. Further, HID was associated with greater health consequences, underscoring the need for HID interventions. Such interventions may benefit from enhancing motivation and self-efficacy, particularly in social contexts, as well as increasing positive peer and leisure activities to reduce HID.
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Affiliation(s)
- Erin E. Bonar
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
| | - Mariam A. Souweidane
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Frederic C. Blow
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,VA Center for Clinical Management Research, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109-2800
| | - Amy S. B. Bohnert
- VA Center for Clinical Management Research, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109-2800,Department of Anesthesiology, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109-2800
| | - José A. Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104
| | - Sean D. Young
- Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California Irvine, Irvine, CA 92697,Department of Emergency Medicine, School of Medicine, University of California Irvine, Irvine, CA 92697
| | - Maureen A. Walton
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
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5
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Cochrane A, Booth A, Walker I, Morgan S, Mitchell A, Barlow-Pay M, Hewitt C, Taylor B, Chapman C, Raftery J, Fleming J, Torgerson D, Parkes J. Examining the effectiveness of Gateway-an out-of-court community-based intervention to reduce recidivism and improve the health and well-being of young adults committing low-level offences: study protocol for a randomised controlled trial. Trials 2021; 22:939. [PMID: 34923999 PMCID: PMC8684788 DOI: 10.1186/s13063-021-05905-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Young adult offenders represent a third of the UK prison population and are at risk of poor health outcomes including drug and alcohol misuse, self-harm and suicide. Court diversion interventions aim to reduce the negative consequences of formal criminal justice sanctions and focus resources on addressing the root causes of offending. Although diversions are widely used, evidence of their effectiveness has not yet been established. Hampshire Constabulary, working together with local charities, have developed the Gateway programme, an out-of-court intervention aimed at improving the life chances of young adults. Issued as a conditional caution, participants undertake a health and social care needs assessment, attend workshops encouraging analysis of own behaviour and its consequences and agree not to re-offend during the 16-week caution. METHODS This is a pragmatic, multi-site, parallel-group, superiority randomised controlled trial with a target sample size of 334. Participants are aged 18-24, reside in Hampshire and Isle of Wight and are being questioned for an eligible low-level offence. Police investigators offer potential participants a chance to receive the Gateway caution, and those interested are also invited to take part in the study. Police officers obtain Stage 1 consent and carry out an eligibility check, after which participants are randomised on a 1:1 basis either to receive Gateway or follow the usual process, such as court appearance or a different conditional caution. Researchers subsequently obtain Stage 2 consent and collect data at weeks 4 and 16, and 1 year post-randomisation. The primary outcome is the Warwick-Edinburgh Mental Well-being Scale (WEMWBS). Secondary outcomes include health status, alcohol and drug use, recidivism and resource use. The primary analysis will compare the WEMWBS score between the two groups at 12 months. DISCUSSION This pioneering trial aims to address the evidence gap surrounding diversion in 18-24-year-olds. The findings will inform law enforcement agencies, third sector organisations, policymakers and commissioners, as well as researchers working in related fields and with vulnerable target populations. TRIAL REGISTRATION International Standard Randomised Controlled Trial Register ( ISRCTN 11888938 ).
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Affiliation(s)
- A Cochrane
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - A Booth
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK.
| | - I Walker
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - S Morgan
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - A Mitchell
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - M Barlow-Pay
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - C Hewitt
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - B Taylor
- Hampshire Constabulary, Southampton Central Police Station, Southampton, SO15 1AN, UK
| | - C Chapman
- Hampshire Constabulary, Southampton Central Police Station, Southampton, SO15 1AN, UK
| | - J Raftery
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - J Fleming
- Department of Sociology, Social Policy and Criminology, University of Southampton, Southampton, SO17 1BJ, UK
| | - D Torgerson
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - J Parkes
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
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6
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Henderson JL, Wilkins LK, Hawke LD, Wang W, Sanches M, Brownlie EB, Beitchman JH. Longitudinal Emergence of Concurrent Mental Health and Substance Use Concerns in an Ontario School-Based Sample: The Research and Action for Teens Study. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2021; 30:249-263. [PMID: 34777508 PMCID: PMC8561851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/30/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES This study characterizes patterns of mental health, substance use and their co-occurrence, and identifies developmental trajectories associated with progression from single to concurrent mental health and substance use concerns in an Ontario school-based population. It is a longitudinal extension of the Ontario Student Drug Use and Mental Health Survey, as part of the RAFT collaborative project. METHODS In this study, an Ontario-wide survey was administered to students across three biennial waves starting in grades 7-8 (ages 12-14). We explored how developmental patterns of externalizing, internalizing and co-occurring symptoms were differentially associated with late-adolescent (ages 17-19) problematic substance use. RESULTS On average, students exhibited early (ages 12-14) moderate risk of an internalizing and/or externalizing disorder and approached the low threshold for a diagnostic concern for substance use disorder at age 17-19. The pattern confirmed a potential pathway from early mental health concerns to later adolescent problematic substance use, with rates of co-occurrence increasing with age. Youth with early moderate-to high externalizing and co-occurring internalizing and externalizing symptomology had the highest levels of problematic substance use, with scores indicating high likelihood of a substance use disorder diagnosis. CONCLUSIONS Given the overall pattern of progression, early identification and referral of at-risk youth, especially youth with co-occurring mental health concerns, is of critical importance. Findings support the importance of integrated and co-located mental health and substance use services for youth to more effectively serve a diverse population of youth with varying levels of need.
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Affiliation(s)
- Joanna L Henderson
- Centre for Addiction and Mental Health, Toronto, Ontario
- University of Toronto, Toronto, Ontario
| | | | - Lisa D Hawke
- Centre for Addiction and Mental Health, Toronto, Ontario
- University of Toronto, Toronto, Ontario
| | - Wei Wang
- Centre for Addiction and Mental Health, Toronto, Ontario
| | - Marcos Sanches
- Centre for Addiction and Mental Health, Toronto, Ontario
- University of Toronto, Toronto, Ontario
| | - E B Brownlie
- Centre for Addiction and Mental Health, Toronto, Ontario
| | - Joseph H Beitchman
- Centre for Addiction and Mental Health, Toronto, Ontario
- University of Toronto, Toronto, Ontario
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7
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Elkrief L, Spinney S, Vosberg DE, Banaschewski T, Bokde ALW, Quinlan EB, Desrivières S, Flor H, Garavan H, Gowland P, Heinz A, Brühl R, Martinot JL, Paillère Martinot ML, Nees F, Papadopoulos Orfanos D, Poustka L, Hohmann S, Millenet S, Fröhner JH, Smolka MN, Walter H, Whelan R, Schumann G, Pausova Z, Paus T, Huguet G, Conrod P. Endocannabinoid Gene × Gene Interaction Association to Alcohol Use Disorder in Two Adolescent Cohorts. Front Psychiatry 2021; 12:645746. [PMID: 33959052 PMCID: PMC8093566 DOI: 10.3389/fpsyt.2021.645746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/02/2021] [Indexed: 12/31/2022] Open
Abstract
Genetic markers of the endocannabinoid system have been linked to a variety of addiction-related behaviors that extend beyond cannabis use. In the current study we investigate the relationship between endocannabinoid (eCB) genetic markers and alcohol use disorder (AUD) in European adolescents (14-18 years old) followed in the IMAGEN study (n = 2,051) and explore replication in a cohort of North American adolescents from Canadian Saguenay Youth Study (SYS) (n = 772). Case-control status is represented by a score of more than 7 on the Alcohol Use Disorder Identification Test (AUDIT). First a set-based test method was used to examine if a relationship between the eCB system and AUDIT case/control status exists at the gene level. Using only SNPs that are both independent and significantly associated to case-control status, we perform Fisher's exact test to determine SNP level odds ratios in relation to case-control status and then perform logistic regressions as post-hoc analysis, while considering various covariates. Generalized multifactor dimensionality reduction (GMDR) was used to analyze the most robust SNP×SNP interaction of the five eCB genes with positive AUDIT screen. While no gene-sets were significantly associated to AUDIT scores after correction for multiple tests, in the case/control analysis, 7 SNPs were significantly associated with AUDIT scores of > 7 (p < 0.05; OR<1). Two SNPs remain significant after correction by false discovery rate (FDR): rs9343525 in CNR1 (pcorrected =0.042, OR = 0.73) and rs507961 in MGLL (pcorrected = 0.043, OR = 0.78). Logistic regression showed that both rs9353525 (CNR1) and rs507961 (MGLL) remained significantly associated with positive AUDIT screens (p < 0.01; OR < 1) after correction for multiple covariables and interaction of covariable × SNP. This result was not replicated in the SYS cohort. The GMDR model revealed a significant three-SNP interaction (p = 0.006) involving rs484061 (MGLL), rs4963307 (DAGLA), and rs7766029 (CNR1) predicted case-control status, after correcting for multiple covariables in the IMAGEN sample. A binomial logistic regression of the combination of these three SNPs by phenotype in the SYS cohort showed a result in the same direction as seen in the IMAGEN cohort (BETA = 0.501, p = 0.06). While preliminary, the present study suggests that the eCB system may play a role in the development of AUD in adolescents.
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Affiliation(s)
- Laurent Elkrief
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
- Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, QC, Canada
| | - Sean Spinney
- Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, QC, Canada
- Department of Pediatrics, Université de Montréal, Montreal, QC, Canada
| | - Daniel E. Vosberg
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Arun L. W. Bokde
- Discipline of Psychiatry, School of Medicine and Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Erin Burke Quinlan
- Centre for Population Neuroscience and Precision Medicine (PONS), SGDP Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Sylvane Desrivières
- Centre for Population Neuroscience and Precision Medicine (PONS), SGDP Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Herta Flor
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Hugh Garavan
- Departments of Psychiatry and Psychology, University of Vermont, Burlington, VT, United States
| | - Penny Gowland
- Sir Peter Mansfield Imaging Centre School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
| | - Andreas Heinz
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Campus Charité Mitte, Berlin, Germany
| | - Rüdiger Brühl
- Physikalisch-Technische Bundesanstalt, Berlin, Germany
| | - Jean-Luc Martinot
- Institut National de la Santé et de la Recherche Médicale, INSERM U1299 “Trajectoires développementales en psychiatrie,” Université Paris-Saclay, Ecole Normale supérieure Paris-Saclay, CNRS, Centre Borelli, Gif-sur-Yvette, France
| | - Marie-Laure Paillère Martinot
- Institut National de la Santé et de la Recherche Médicale, INSERM U A10 “Trajectoires développementales en psychiatrie,” Université Paris-Saclay, Ecole Normale supérieure Paris-Saclay, CNRS, Centre Borelli and AP-HP. Sorbonne Université, Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Paris, France
| | - Frauke Nees
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | | | - Luise Poustka
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Göttingen, Göttingen, Germany
| | - Sarah Hohmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Sabina Millenet
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Juliane H. Fröhner
- Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
| | - Michael N. Smolka
- Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
| | - Henrik Walter
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Campus Charité Mitte, Berlin, Germany
| | - Robert Whelan
- School of Psychology and Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Gunter Schumann
- Centre for Population Neuroscience and Precision Medicine (PONS), SGDP Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- PONS Research Group, Department of Psychiatry and Psychotherapy, Campus Charite Mitte, Humboldt University, Berlin, Germany
- Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Zdenka Pausova
- Departments of Physiology and Nutritional Science, Hospital for Sick Children, Toronto, ON, Canada
| | - Tomáš Paus
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Departments of Psychology and Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Guillaume Huguet
- Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, QC, Canada
- Department of Pediatrics, Université de Montréal, Montreal, QC, Canada
| | - Patricia Conrod
- Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, QC, Canada
- Department of Pediatrics, Université de Montréal, Montreal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
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8
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Goldstick JE, Roche JS, Carter PM, Arterberry BJ, Bonar EE, Walton MA, Zimmerman M, Cunningham RM. Sex Differences in the Association Between Gaming and Serious Violence Among Predominantly African American Youth. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP2410-NP2422. [PMID: 29580195 PMCID: PMC6119504 DOI: 10.1177/0886260518764104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Video gaming, a remarkably popular hobby in the United States, has been consistently identified as a correlate of aggressive behavior, and this association is not limited to violent video gaming. Prior studies of sex differences in the association between video gaming and aggression have not controlled for other well-known violence correlates (e.g., substance use, community violence exposure, violence attitudes) or focused primarily on high-risk youth. In this study, we used data from an emergency department in Flint, Michigan (N = 409, 59.9% female, 93.4% African American) to identify sex differences in the association between video gaming and serious peer violence. Youth aged 14 to 20 years were recruited from October 2011 to March 2015, and self-administered computerized surveys including measures of demographics, violence perpetration, gaming frequency, substance use, community violence exposure, and violence attitudes. The primary outcome was an indicator of any serious violence perpetration (e.g., choking, burning, weapon violence) in the past 2 months. Using logistic regression, we estimated the association between gaming and serious violence perpetration, and how it varied by sex, while controlling for demographics, substance use, community violence exposure, and violence attitudes. Approximately 36.6% of males and 27.3% of females reported past 2-month serious violence. On adjusted analysis, hours spent gaming was associated with violence among females (odds ratio [OR] = 1.40, 95% confidence interval [CI] = [1.16, 1.78]), but not males (OR = 1.03, 95% CI = [0.89, 1.19]); in the model including both males and females, the interaction between hours gaming and sex was significant (p < .01). Our findings suggest video gaming is a stronger marker of severe violence perpetration in females than males among at-risk youth. Violence interventions among females may be improved by including content related to video gaming and identifying other prosocial activities for youth as an alternative to video gaming. Additional research is required to clarify the causal process underlying the identified associations, and to determine what aspects of video gaming are risk-enhancing.
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Affiliation(s)
- Jason E. Goldstick
- Department of Emergency Medicine, University of Michigan, E Medical Center Dr, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
| | - Jessica S. Roche
- Department of Emergency Medicine, University of Michigan, E Medical Center Dr, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Youth Violence Prevention Center, Ann Arbor, MI, USA
| | - Patrick M. Carter
- Department of Emergency Medicine, University of Michigan, E Medical Center Dr, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Youth Violence Prevention Center, Ann Arbor, MI, USA
| | - Brooke J. Arterberry
- University of Michigan Addiction Center and Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Erin E. Bonar
- University of Michigan Addiction Center and Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Maureen A. Walton
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Addiction Center and Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Marc Zimmerman
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Youth Violence Prevention Center, Ann Arbor, MI, USA
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Rebecca M. Cunningham
- Department of Emergency Medicine, University of Michigan, E Medical Center Dr, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Youth Violence Prevention Center, Ann Arbor, MI, USA
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Department of Emergency Medicine, Hurley Medical Center, MI, USA
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9
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Reichenheim ME, Interlenghi GS, Ferreira MF, de Moraes CL. The Alcohol Use Disorders Identification Test (AUDIT) in Adolescents: Using a Model-Based Approach to Identify Patterns of Alcohol Misuse. Subst Use Misuse 2021; 56:1915-1922. [PMID: 34396898 DOI: 10.1080/10826084.2021.1958859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To explore the latent structure of the Alcohol Use Disorders Identification Test (AUDIT) among adolescents of different school grades (age strata). Methods: Data derived from two simultaneous run cohort studies from the "Adolescent Nutritional Assessment Longitudinal Study-ELANA" conducted in private and public schools of Rio de Janeiro/Brazil. Participants comprised 564 seventh-graders and 419 ninth-graders, respectively sampled in 2011 and 2013 from cohort 1, and 730 eleventh-graders sampled in 2011 from cohort 2. Latent class factor analytical (LCFA) models were applied to the AUDIT items to identify internally homogeneous latent groups of individuals representing distinct patterns of alcohol use, and optimal group-separating cutoffs. The classification agreement was also evaluated. Results: Three and two groups (classes) were found for the eleventh and the earlier grades, respectively. These best-fitting models held a very high degree of class separation (entropy >0.9). By contrasting the AUDIT's raw scores (0-10) with the model-based latent classes, the cutoff separating the base (milder) category was found between scores 0 and 1 in all grades. The eleventh-graders differed from the others by showing a third and more intense category of alcohol use (cutoff between 4 and 5). The classification agreement was almost perfect in eleventh-graders (98.6%) and perfect in the earlier grades (100%). Conclusions: Findings show that the AUDIT may be adequately used in adolescents of different ages and school grades, although the number of homogeneous categories may differ accordingly. Besides, raw scores may be pragmatically used to identify groups with confidence by applying specific optimal cutoffs.
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Affiliation(s)
- Michael E Reichenheim
- Department of Epidemiology, Institute of Social Medicine, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Gabriela S Interlenghi
- Department of Epidemiology, Institute of Social Medicine, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Marcela F Ferreira
- Department of Epidemiology, Institute of Social Medicine, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Claudia L de Moraes
- Department of Epidemiology, Institute of Social Medicine, Rio de Janeiro State University, Rio de Janeiro, Brazil.,Family Health Postgraduation Program and School of Medicine, Estácio de Sá University, Rio de Janeiro, Brazil
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10
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Kaye S, Lewandowski A, Bowman J, Doyle MF. Crystal methamphetamine use among young people entering custody: Prevalence, correlates and comorbidity. Drug Alcohol Rev 2020; 40:1266-1274. [PMID: 33155354 DOI: 10.1111/dar.13210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 09/28/2020] [Accepted: 10/07/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION AND AIMS Crystal methamphetamine (CM) is associated with a range of physical and mental health harms and may be of particular concern among young people at risk of early, problematic substance use, such as those in contact with the criminal justice system. This study aimed to investigate the prevalence and correlates of regular (i.e. at least weekly) CM use among young people preceding entry into custody. DESIGN AND METHODS Data were collected from 207 participants aged 14-18 years as part of the 2015 Young People in Custody Health Survey, a cross-sectional survey of youth in custody in New South Wales, Australia. Participants were administered face-to-face structured interviews assessing sociodemographic, childhood and family characteristics, offending history, substance use and psychopathology. Multivariable logistic regression analyses were conducted to identify factors independently associated with regular CM use. RESULTS Regular CM use was reported by 31% of participants and was independently associated with higher levels of antisocial traits/behaviour [adjusted odds ratio (AOR) 1.13, 95% confidence interval (CI) 1.02, 1.25], increased polydrug use (AOR 1.34, 95% CI 1.14, 1.58), injecting drug use (AOR 4.06, 95% CI 1.02, 16.16) and meeting symptom thresholds for two or more current psychological disorders (AOR 3.20, 95% CI 1.15, 8.94). DISCUSSION AND CONCLUSIONS Regular CM users present with more complex comorbidity than other young people in custody, increasing the health-care burden in custodial and community settings. Early identification and appropriate treatment of this comorbidity is crucial to improving the health, psychosocial and behavioural outcomes of this vulnerable group.
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Affiliation(s)
- Sharlene Kaye
- Research Unit, Justice Health and Forensic Mental Health Network, Sydney, Australia.,National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Amy Lewandowski
- Research Unit, Justice Health and Forensic Mental Health Network, Sydney, Australia
| | - Julia Bowman
- Research Unit, Justice Health and Forensic Mental Health Network, Sydney, Australia.,Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Michael F Doyle
- Centre of Research Excellence Indigenous Health and Alcohol, Sydney Medical School, University of Sydney, Sydney, Australia
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11
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Bonar EE, Schneeberger DM, Bourque C, Bauermeister JA, Young SD, Blow FC, Cunningham RM, Bohnert AS, Zimmerman MA, Walton MA. Social Media Interventions for Risky Drinking Among Adolescents and Emerging Adults: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e16688. [PMID: 32401225 PMCID: PMC7254293 DOI: 10.2196/16688] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/30/2020] [Accepted: 02/16/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Despite intervention efforts to date, the prevalence of risky drinking among adolescents and emerging adults remains high, increasing the risk for health consequences and the development of alcohol use disorders. Peer influences are particularly salient among this age group, including via social media. Thus, the development of efficacious early interventions for youth, delivered with a broad reach via trained peers on social media, could have an important role in addressing risky drinking and concomitant drug use. OBJECTIVE This paper describes the protocol of a randomized controlled trial (RCT) testing the efficacy of a social media intervention among adolescents and emerging adults who meet the criteria for risky drinking (using the Alcohol Use Disorders Identification Test-Consumption [AUDIT-C]), delivered with and without financial incentives for participation, compared with an attention placebo control condition (ie, entertaining social media content), on alcohol consumption and consequences. METHODS This RCT involved recruiting 955 youths (aged 16-24 years) via advertisements on Facebook and Instagram to self-administer a brief web-based screening survey. Those screening positive for past 3-month risky drinking (AUDIT-C positive: ages 16-17 years: ≥3 females and ≥4 males; and ages 18-24 years: ≥4 females and ≥5 males) were eligible for the RCT. After providing consent (a waiver of parental consent was obtained for minors), participants completed a web-based baseline survey and several verification procedures, including a selfie photo matched to Facebook profile photos. Participants were then randomized to join invitation-only secret Facebook groups, which were not searchable or viewable by parents, friends, or anyone not recruited by the study. The 3 conditions were social media intervention with incentives, social media intervention without incentives (SMI), and attention placebo control. Each condition lasted 8 weeks and consisted of bachelor's-level and master's-level therapist electronic coaches posting relevant content and responding to participants' posts in a manner consistent with Motivational Interviewing. Participants in the control condition and SMI condition did not receive payments but were blind to condition assignment between these 2 conditions. Follow-ups are ongoing and occur at 3, 6, and 12 months poststart of the groups. RESULTS We enrolled 955 participants over 10 waves of recruitment who screened positive for risky drinking into the RCT. CONCLUSIONS The findings of this study will provide the critical next step in delivering early alcohol interventions to the youth, capitalizing on social media platforms, which could have significant public health impact by altering alcohol use trajectories of adolescents and emerging adults engaged in risky drinking. TRIAL REGISTRATION ClinicalTrials.gov NCT02809586; https://clinicaltrials.gov/ct2/show/NCT02809586. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/16688.
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Affiliation(s)
- Erin E Bonar
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Addiction Center, University of Michigan, Ann Arbor, MI, United States
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
| | - Diane M Schneeberger
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Addiction Center, University of Michigan, Ann Arbor, MI, United States
| | - Carrie Bourque
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Addiction Center, University of Michigan, Ann Arbor, MI, United States
| | - Jose A Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Sean D Young
- Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California Irvine, Irvine, CA, United States
- Department of Emergency Medicine, University of California Irvine, Irvine, CA, United States
| | - Frederic C Blow
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Addiction Center, University of Michigan, Ann Arbor, MI, United States
- Center for Clinical Management Research, Veterans Health Administration, Ann Arbor, MI, United States
| | - Rebecca M Cunningham
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States
- Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Amy Sb Bohnert
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
- Center for Clinical Management Research, Veterans Health Administration, Ann Arbor, MI, United States
| | - Marc A Zimmerman
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
- Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Maureen A Walton
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Addiction Center, University of Michigan, Ann Arbor, MI, United States
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
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12
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Carter PM, Cranford JA, Buu A, Walton MA, Zimmerman MA, Goldstick J, Ngo Q, Cunningham RM. Daily patterns of substance use and violence among a high-risk urban emerging adult sample: Results from the Flint Youth Injury Study. Addict Behav 2020; 101:106127. [PMID: 31645000 PMCID: PMC6999833 DOI: 10.1016/j.addbeh.2019.106127] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/04/2019] [Accepted: 09/09/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Interpersonal violence is a significant public health problem, with substance use a key risk factor. Intensive longitudinal methods (ILMs) provide data on daily patterns/relationships between substance use and violence, informing prevention. Prior daily research has not focused on these relationships among urban minority samples. METHODS Within an RCT comparing ILM assessment/schedule methods, 162-participants completed daily IVR (n = 81) or SMS (n = 81) assessments measuring 19 substance use and violence (partner/non-partner) behaviors daily for 90-days. GLMMs characterized between- and within-person predictors of daily violence. RESULTS Participants [48.7%-female; age = 24.4; 62.3%-African-American; 66.7%-public assistance] completed an average of 46.5 daily reports [SD = 26.7]. Across 90-days, alcohol was characterized by episodic weekend use (average = 10 days-of-use, 34.4% drinking-days involved binge-drinking), while marijuana use was continuous (average = 27 days-of-use; 1.7 times/day), with no weekend differences. Among 118-violent conflicts, 52.5% occurred on weekends; 57.6% were with non-partners/peers; 61.0% involved perpetration/57.6% victimization; and 52.5% involved severe violence. For violence conflicts, 27.1% were preceded by alcohol/22.9% preceded by drug use. Between-person predictors of daily violence included retaliatory attitudes (AOR = 3.2) and anxiety (AOR = 1.1). Within-person predictors included weekends (AOR = 1.6), binge drinking (AOR = 1.9), non-medical prescription opioid use (AOR = 3.5) and illicit drug use (AOR = 8.1). CONCLUSION Among a high-risk urban minority sample, we found that higher baseline retaliatory attitudes and anxiety, as well as same-day binge drinking, non-medical prescription opioid use, and illicit drug use were associated with daily violence, likely reflecting both pharmacological and socio-contextual factors. Addressing substance use and retaliatory violence with tailored prevention efforts may aid in decreasing negative interpersonal violence outcomes.
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Affiliation(s)
- Patrick M. Carter
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America,Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States of America,Corresponding author at: Department of Emergency Medicine, University of Michigan, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan 48109, United States of America. (P.M. Carter)
| | - James A. Cranford
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America,University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Rd., Ann Arbor, MI 48109, United States of America,Hurley Medical Center, Department of Emergency Medicine, 1 Hurley Plaza, Flint, MI 48503, United States of America
| | - Anne Buu
- Department of Health Behavior & Biological Sciences, University of Michigan, 400 North Ingalls Building, Ann Arbor, MI 48109-5482, United States of America
| | - Maureen A. Walton
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America,University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Rd., Ann Arbor, MI 48109, United States of America
| | - Marc A. Zimmerman
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America,Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States of America,Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, MI 48109, United States of America
| | - Jason Goldstick
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America
| | - Quyen Ngo
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America
| | - Rebecca M. Cunningham
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America,Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States of America,Hurley Medical Center, Department of Emergency Medicine, 1 Hurley Plaza, Flint, MI 48503, United States of America
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13
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Bonar EE, Goldstick JE, Cunningham RM, Fernandez AC, Davis AK, Ilgen MA, Walton MA. Individual and Social Factors Related to Trajectories of Blackouts among Underage Drinkers in the Emergency Department. Alcohol Alcohol 2020; 54:370-377. [PMID: 30608570 DOI: 10.1093/alcalc/agy087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 11/19/2018] [Accepted: 11/23/2018] [Indexed: 12/19/2022] Open
Abstract
AIMS Alcohol-related blackouts can result in acute injuries and other negative outcomes. Among underage risky drinkers, we examined longitudinal trajectories of blackout frequency following an emergency department (ED) visit, and identified baseline characteristics associated with blackout trajectory membership. METHODS Participants (ages 14-20; N = 836) attending an ED who screened positive for risky drinking and enrolled in a randomized-controlled trial of brief alcohol interventions were assessed at baseline, 3-, 6-, and 12-months. We used group-based trajectory modeling to determine characteristic trajectories of blackout frequency over 12-months in relation to baseline characteristics: demographics, substance use, delinquency, depression/anxiety symptoms, sexual assault, dating violence, and peer and sibling influences. RESULTS We identified four groups: No/Low blackouts (n = 248; 29.7%), Declining blackouts (n = 92; 11.0%), Moderate blackouts (n = 337; 40.3%) and High blackouts (n = 159; 19.0%); group membership did not differ based on intervention receipt. In adjusted analyses, compared to the No/Low group all other groups had higher odds of having an alcohol-related baseline ED visit. Female sex, alcohol consumption, prescription drug misuse, sexual assault while incapacitated due to substances, and negative peer influences were positively associated with membership in the High group; College/Greek life involvement was also highest. Negative peer influences and being in high school (vs. College/Greek life) also distinguished the Moderate group. CONCLUSION Blackout frequency was largely stable over time and riskier trajectories were marked by risk factors such as negative peer influences and college/Greek life involvement. Findings may inform targeted interventions, particularly for women who were in higher risk trajectories.
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Affiliation(s)
- Erin E Bonar
- Addiction Center, University of Michigan Department of Psychiatry, Ann Arbor, MI.,Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
| | - Jason E Goldstick
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA.,Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Rebecca M Cunningham
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA.,Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Health Behavior and Health Education, University of Michigan, School of Public Health, Ann Arbor, MI, USA
| | - Anne C Fernandez
- Addiction Center, University of Michigan Department of Psychiatry, Ann Arbor, MI
| | - Alan K Davis
- Addiction Center, University of Michigan Department of Psychiatry, Ann Arbor, MI.,Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Mark A Ilgen
- Addiction Center, University of Michigan Department of Psychiatry, Ann Arbor, MI.,Center for Clinical Management Research, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI, USA
| | - Maureen A Walton
- Addiction Center, University of Michigan Department of Psychiatry, Ann Arbor, MI.,Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
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14
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Carter PM, Mouch CA, Goldstick JE, Walton MA, Zimmerman MA, Resnicow K, Cunningham RM. Rates and correlates of risky firearm behaviors among adolescents and young adults treated in an urban emergency department. Prev Med 2020; 130:105891. [PMID: 31726077 PMCID: PMC7182087 DOI: 10.1016/j.ypmed.2019.105891] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/12/2019] [Accepted: 11/08/2019] [Indexed: 12/14/2022]
Abstract
Firearm violence is a leading cause of death for urban adolescents and young adults (A/YAs). Little is known about patterns of risky firearm behaviors (RFBs) that may increase firearm-related fatality and non-fatal injury risk. To inform prevention efforts, we examined the rates and correlates of RFBs, including firearm carriage in risky situations (e.g., while drunk/high), discharge in risky situations (e.g., fleeing police), and firearm aggression (e.g., firearm threats/use against a partner/non-partner), among a sample of A/YAs (age-16-29) seeking medical or injury related care (7/2017-6/2018) at a Level-1 urban Emergency Department (ED). In total, 1312 A/YAs completed the survey (mean-age 23.2; 29.6%-male; 50.5%-Black; 56.3%-public assistance), with 102 (7.8%) engaging in RFBs. Among those engaging in RFBs, 42% reported firearm ownership, 68.6% firearm carriage in high-risk situations, 39.2% firearm discharge in risky situations, and 41.2% reported partner/non-partner firearm aggression. Regression identified RFBs correlates, including older age (AOR = 1.09), male sex (AOR = 1.63), Black race/ethnicity (AOR = 2.01), substance misuse (AOR = 2.75), attitudes favoring firearm use/retaliation (AOR = 1.38), peer firearm ownership/carriage (AOR = 3.26), higher levels of community violence exposure (AOR = 1.05), and active parole/probation (AOR 2.38). Higher coping skills were protective for RFBs (AOR = 0.83). Overall, we found that A/YAs seeking urban ED treatment reported elevated RFB rates, emphasizing the need for novel prevention initiatives, especially those incorporating tailored content addressing substance use, retaliatory violence, and peer delinquency/norms, while enhancing self-efficacy for avoiding RFBs and providing access to external resources within a resiliency-based framework. Such prevention approaches may be a critical step towards addressing the public health problem of firearm violence. Primary Funding Sources: NIH/NIDA K23DA039341; NIH/NCATS UL1TR000433.
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Affiliation(s)
- Patrick M Carter
- Univ. of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Youth Violence Prevention Center, University of Michigan, School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States of America.
| | - Charles A Mouch
- Univ. of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Department of Surgery, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America.
| | - Jason E Goldstick
- Univ. of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America.
| | - Maureen A Walton
- Univ. of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; University of Michigan, Addiction Center, Department of Psychiatry, School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, United States of America.
| | - Marc A Zimmerman
- Univ. of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Youth Violence Prevention Center, University of Michigan, School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States of America; University of Michigan, Addiction Center, Department of Psychiatry, School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, United States of America.
| | - Ken Resnicow
- Department of Health Behavior & Health, Education, University of Michigan, School of Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, MI 48109, United States of America.
| | - Rebecca M Cunningham
- Univ. of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Youth Violence Prevention Center, University of Michigan, School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States of America; Department of Health Behavior & Health, Education, University of Michigan, School of Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, MI 48109, United States of America; Hurley Medical Center, Department of Emergency Medicine, 1 Hurley Plaza, Flint, MI 48503, United States of America.
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15
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Deluca P, Coulton S, Alam MF, Boniface S, Donoghue K, Gilvarry E, Kaner E, Lynch E, Maconochie I, McArdle P, McGovern R, Newbury-Birch D, Patton R, Pellatt-Higgins T, Phillips C, Phillips T, Pockett R, Russell IT, Strang J, Drummond C. Screening and brief interventions for adolescent alcohol use disorders presenting through emergency departments: a research programme including two RCTs. PROGRAMME GRANTS FOR APPLIED RESEARCH 2020. [DOI: 10.3310/pgfar08020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Alcohol consumption and related harm increase steeply from the ages of 12–20 years. Adolescents in the UK are among the heaviest drinkers in Europe. Excessive drinking in adolescents is associated with increased risk of accidents, injuries, self-harm, unprotected or regretted sex, violence and disorder, poisoning and accidental death. However, there is lack of clear evidence for the most clinically effective and cost-effective screening and brief interventions for reducing or preventing alcohol consumption in adolescents attending emergency departments (EDs).
Objectives
To estimate the distribution of alcohol consumption, alcohol-related problems and alcohol use disorders in adolescents attending EDs; to develop age-appropriate alcohol screening and brief intervention tools; and to evaluate the clinical effectiveness and cost-effectiveness of these interventions.
Design
The research has been conducted in three linked stages: (1) a prevalence study, (2) intervention development and (3) two linked randomised controlled trials (RCTs).
Setting
Twelve EDs in England (London, North East, and Yorkshire and The Humber).
Participants
A total of 5376 participants in the prevalence study [mean age 13.0 years, standard deviation (SD) 2.0 years; 46.2% female] and 1640 participants in the two linked RCTs (mean age 15.6 years, SD 1.0 years; 50.7% female).
Interventions
Personalised feedback and brief advice (PFBA) and personalised feedback plus electronic brief intervention (eBI), compared with alcohol screening alone. These age-appropriate alcohol interventions were developed in collaboration with the target audience through a series of focus groups and evaluations during stage 2 of the research programme and following two literature reviews.
Main outcome measures
Total alcohol consumed in standard UK units (1 unit = 8 g of ethanol) over the previous 3 months at 12-month follow-up, assessed using the Alcohol Use Disorders Identification Test, Consumption (3 items) (AUDIT-C).
Results
In the prevalence study, 2112 participants (39.5%) reported having had a drink of alcohol that was more than a sip in their lifetime, with prevalence increasing steadily with age and reaching 89.5% at the age of 17 years. The prevalence of at-risk alcohol consumption was 15% [95% confidence interval (CI) 14% to 16%] and the optimum cut-off point of the AUDIT-C in identifying at-risk drinking was ≥ 3. Associations of alcohol consumption and early onset of drinking with poorer health and social functioning were also found. In the RCT, the analysis of the primary outcome (average weekly alcohol consumption at month 12) identified no significant differences in effect between the three groups in both trials. In the high-risk drinking trial, the mean difference compared with control was 0.57 (95% CI –0.36 to 1.70) for PFBA and 0.19 (95% CI –0.71 to 1.30) for eBI. In the low-risk drinking trial, the mean difference compared with control was 0.03 (95% CI –0.07 to 0.13) for PFBA and 0.01 (95% CI –0.10 to 0.11) for eBI. The health economic analysis showed that eBI and PFBA were not more cost-effective than screening alone.
Conclusions
The ED can offer an opportunity for the identification of at-risk alcohol use in adolescents. A simple, short, self-completed screening instrument, the AUDIT-C, is an effective tool for identifying adolescents who are at risk of alcohol-related problems. Associations of alcohol consumption and earlier onset of drinking with poorer health and social functioning were observed in the prevalence study. The trials were feasible to implement and exceeded the recruitment target and minimum follow-up rates. However, PFBA and eBI were not found to be more effective than screening alone in reducing or preventing alcohol consumption in 14- to 17-year-olds attending EDs.
Limitations and future work
Only one-third of participants engaged with the application program; this is likely to have limited the effect of the intervention. We recommend that future research should focus on methods to maximise engagement with digital interventions and evaluate the effect of such engagement on clinical outcomes.
Trial registration
Current Controlled Trials ISRCTN45300218.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 8, No. 2. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Paolo Deluca
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Simon Coulton
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | | | - Sadie Boniface
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Kim Donoghue
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Eilish Gilvarry
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Ellen Lynch
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Ian Maconochie
- Paediatric Emergency Medicine, Imperial College London, London, UK
| | - Paul McArdle
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ruth McGovern
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Robert Patton
- School of Psychology, University of Surrey, Guildford, UK
| | | | - Ceri Phillips
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Thomas Phillips
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Institute for Clinical and Applied Health Research, University of Hull, Hull, UK
| | - Rhys Pockett
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | | | - John Strang
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Colin Drummond
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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16
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Abstract
OBJECTIVE The aim of this study was to determine the psychometric properties of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) 2-question alcohol screen within 16 Pediatric Emergency Care Applied Research Network pediatric emergency departments. This article describes the study methodology, sample characteristics, and baseline outcomes of the NIAAA 2-question screen. METHODS Participants included 12- to 17-year-olds treated in one of the participating pediatric emergency departments across the United States. After enrollment, a criterion assessment battery including the NIAAA 2-question screen and other measures of alcohol, drug use, and risk behavior was self-administered by participants on a tablet computer. Two subsamples were derived from the sample. The first subsample was readministered the NIAAA 2-question screen 1 week after their initial visit to assess test-retest reliability. The second subsample is being reassessed at 12 and 24 months to examine predictive validity of the NIAAA 2-question screen. RESULTS There were 4834 participants enrolled into the study who completed baseline assessments. Participants were equally distributed across sex and age. Forty-six percent of the participants identified as white, and 26% identified as black. Approximately one quarter identified as Hispanic. Using the NIAAA 2-question screen algorithm, approximately 8% were classified as low risk, 12% were classified as moderate risk, and 4% were classified as highest risk. Alcohol use was less likely to be reported by black participants, non-Hispanic participants, and those younger than 16 years. DISCUSSION This study successfully recruited a large, demographically diverse sample to establish rates of the NIAAA screen risk categories across age, sex, ethnicity, and race within pediatric emergency departments.
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17
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Abstract
OBJECTIVE There is a lack of accurate alcohol-use biomarkers in children/adolescents due to a short drinking duration/rapid normalization of elevated markers. We checked if lysosomal exoglycosidases, elevated earlier in binge-drinking young adults, can be applicable in children/adolescents as markers of harmful alcohol use. METHODS The serum activities (pKat/mL) of α-fucosidase (FUC), β-galactosidase (GAL), β-glucuronidase (GLU), β-hexosaminidase (HEX; its HEX A and HEX B isoenzymes), and α-mannosidase (MAN) were determined in 20 healthy controls (C) and 25 children/adolescents with harmful alcohol use (intoxicated by alcohol at hospital admission -AI1 and on the next day -AI2). RESULTS The serum HEX A and alanine aminotransferase (ALT) activity was significantly higher in the AI1 group than in the control. The activities of FUC, GAL, GLU, HEX B, and MAN were lower in the AI group. We found fair and poor accuracy, respectively, for increased enzymes HEX A and ALT. We found fair accuracy for decreased HEX B (AI1) and MAN (AI1), good accuracy for GLU (AI2), FUC (AI2), GAL (AI1, AI2), MAN (AI2), and excellent for FUC (AI1). Correlations were found: ALT with C-reactive protein (CRP), HEX A with white blood cell (WBC) count, blood alcohol concentration with FUC, MAN and HEX B, and WBC with FUC. CONCLUSIONS Decreased FUC, GLU, GAL, MAN values, and especially FUC (AI1) have the potential to be markers of harmful alcohol use in children/adolescents. The raised activity of HEX A and ALT points to the need for further research to check another inflammatory agent as potential alcohol marker in children and adolescents. Samples need to be collected before intravenous fluid therapy.
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18
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Dora-Laskey AD, Goldstick JE, Buckley L, Bonar EE, Zimmerman MA, Walton MA, Cunningham RM, Carter PM. Trajectories of Driving after Drinking among Marijuana-Using Youth in the Emergency Department: Substance Use, Mental Health, and Peer and Parental Influences. Subst Use Misuse 2019; 55:175-187. [PMID: 31502499 PMCID: PMC6980673 DOI: 10.1080/10826084.2019.1660675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: The psychosocial correlates and longitudinal trajectories of driving after drinking (DAD) among youth remain understudied in at-risk populations. Objectives: We investigated the relationships of DAD trajectories and negative peer and parental influences, substance use, and mental health among predominantly marijuana-using youth seeking emergency department (ED) treatment. Methods: Data were from a 2-year prospective cohort study of drug-using patients (97.4% used marijuana) ages 14-24 seeking ED care for assault injury, or as part of a non-assaulted comparison group. Validated surveys measured DAD behaviors and correlates at baseline, 6, 12, 18, and 24 months. Latent class growth analysis identified characteristic DAD trajectory groups; baseline predictors were analyzed descriptively and using multinomial logistic regression. Results: Three DAD trajectory groups were identified among driving-age youth (n = 580): no DAD (NDAD; 55.2%), low-steady (LDAD; 29.0%), and high-declining (HDAD; 15.9%). In unadjusted analyses, HDAD youth were older, but otherwise similar to other groups demographically. Compared to NDAD, LDAD and HDAD group members had higher rates of drug and alcohol use disorders (p < .001). Further, HDAD group members had higher rates of anxiety symptoms and were more likely to be diagnosed with PTSD or depression than NDAD or LDAD youth (p < .05). Negative peer and parent influences were significantly higher in progressively more severe trajectory groups (p < .01). Adjusted effects from the multinomial model were analogous for peer and parental influences and substance use disorders, but not mental health. Conclusion: DAD is strongly associated with negative social influences and substance use disorders among marijuana-using youth, reinforcing their importance when developing interventions.
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Affiliation(s)
- Aaron D Dora-Laskey
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
- University of Michigan Addiction Center, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
- Hurley Medical Center, Flint, Michigan, USA
| | - Jason E Goldstick
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
| | - Lisa Buckley
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
- The University of Queensland, St. Lucia, Queensland, Australia
| | - Erin E Bonar
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
- University of Michigan Addiction Center, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Marc A Zimmerman
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
- University of Michigan Youth Violence Prevention Center, Ann Arbor, Michigan, USA
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan, USA
| | - Maureen A Walton
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
- University of Michigan Addiction Center, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Rebecca M Cunningham
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
- Hurley Medical Center, Flint, Michigan, USA
- University of Michigan Youth Violence Prevention Center, Ann Arbor, Michigan, USA
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan, USA
| | - Patrick M Carter
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
- University of Michigan Youth Violence Prevention Center, Ann Arbor, Michigan, USA
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19
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Alcohol screening and assessment measures for young people: A systematic review and meta-analysis of validation studies. Drug Alcohol Depend 2019; 202:39-49. [PMID: 31299552 DOI: 10.1016/j.drugalcdep.2019.01.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND There is a strong rationale for clinicians to identify risky drinking among young people given the harms caused by alcohol. This systematic review evaluates the quality of evidence in the validation literature on alcohol screening and assessment measures for young people under 25. METHODS Six electronic databases (MEDLINE; EMBASE; PsycINFO; SSCI; HMIC; ADAI) were searched in May 2016 for published and grey literature. Full-text reports published in English since 1980 were included if they aimed to validate an alcohol screening or assessment measure in comparison with a previously validated alcohol measure. Risk of bias was assessed in studies surpassing a priori quality thresholds for predictive validity, internal and test-retest reliability using COSMIN and QUADAS-2. RESULTS Thirty nine reports comprising 135 discrete validation studies were included. Summary estimates indicated that the screening instruments performed well - AUC 0.91 (95% CI: 0.88 to 0.93); sensitivity 0.98 (0.95 to 0.99); specificity 0.78 (0.74 to 0.82). Noting a paucity of validation evidence for existing assessment instruments, aggregated reliability estimates suggest a reliability of 0.81 (0.78 to 0.83) adjusted for 10 items. Risk of bias was high for both types of studies. CONCLUSIONS The volume and quality of available evidence are superior for screening measures. It is recommended that clinicians use alcohol frequency or quantity items if asking a single question. If there is an opportunity to ask more questions either the 3-item AUDIT-C or the 10-item AUDIT are recommended. There is a need to develop new instruments to assess young people's alcohol-related problems.
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20
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Shenoi RP, Linakis JG, Bromberg JR, Casper TC, Richards R, Mello MJ, Chun TH, Spirito A. Predictive Validity of the CRAFFT for Substance Use Disorder. Pediatrics 2019; 144:e20183415. [PMID: 31341007 PMCID: PMC6855834 DOI: 10.1542/peds.2018-3415] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The utility of CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) in identifying current and future problematic substance use and substance use disorders (SUDs) in pediatric emergency department (PED) patients is unknown. We conducted a secondary analysis of a study in 16 PEDs to determine the concurrent and predictive validity of CRAFFT with respect to SUD. METHODS At baseline, 4753 participants aged 12 to 17 years completed an assessment battery (CRAFFT and other measures of alcohol, drug use, and risk behaviors). A subsample was readministered the battery at 1-, 2-, and 3-year follow-up to investigate future SUDs. RESULTS Of 2175 participants assigned to follow-up, 1493 (68.6%) completed 1-year, 1451 (66.7%) completed 2-year, and 1265 (58.1%) completed the 3-year follow-up. A baseline CRAFFT value of ≥2 was significantly associated with problematic substance use or mild or moderate to severe SUD diagnosis on the Diagnostic Interview Schedule for Children at baseline (P < .001). The results persisted after 1, 2, and 3 years (P < .001). The best combined sensitivity and specificity was achieved with a baseline CRAFFT value of ≥1 as a cutoff for predicting problematic substance use and a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnosis of mild SUD at 1, 2, and 3 years. The baseline CRAFFT score that best predicted a moderate to severe SUD at 1 year was ≥2; but at 2 and 3 years, the cutoff score was ≥1. CONCLUSIONS CRAFFT has good concurrent validity for problematic substance use and SUD in PED patients and is useful in predicting SUDs at up to 3 years follow-up but with limited sensitivity.
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Affiliation(s)
- Rohit P Shenoi
- Department of Pediatrics, Baylor College of Medicine and Department of Emergency Medicine, Texas Children's Hospital, Houston, Texas;
| | - James G Linakis
- Emergency Medicine and
- Pediatrics, The Warren Alpert Medical School, Brown University, Providence, Rhode Island; Departments of
- Emergency Medicine and
| | | | | | | | | | - Thomas H Chun
- Emergency Medicine and
- Pediatrics, The Warren Alpert Medical School, Brown University, Providence, Rhode Island; Departments of
- Pediatric Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island; and
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21
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D’Amico EJ, Parast L, Osilla KC, Seelam R, Meredith LS, Shadel WG, Stein BD. Understanding Which Teenagers Benefit Most From a Brief Primary Care Substance Use Intervention. Pediatrics 2019; 144:peds.2018-3014. [PMID: 31296568 PMCID: PMC6746575 DOI: 10.1542/peds.2018-3014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The primary care (PC) setting provides an opportunity to address adolescent alcohol and marijuana use. We examined moderators of effectiveness for a PC brief motivational intervention on adolescents' alcohol and marijuana use and consequences 1 year later. METHODS We conducted a randomized controlled trial in 4 PC clinics from April 2013 to November 2015 and followed adolescents using Web-based surveys. We examined whether demographic factors and severity of use moderated 12-month outcomes. Adolescents aged 12 through 18 were screened by using the National Institute on Alcohol Abuse and Alcoholism Screening Guide. Those identified as at risk were randomly assigned to the intervention (CHAT) or to usual care (UC). RESULTS The sample (n = 294) was 58% female, 66% Hispanic, 17% African American, 12% white, and 5% multiethnic or of other race with an average age of 16 years. After controlling for baseline values of outcomes, teens in CHAT who reported more negative consequences from drinking or had an alcohol use disorder at baseline reported less alcohol use, heavy drinking, and consequences 1 year later compared with teens in UC. Similarly, teens in CHAT with more negative consequences from marijuana use at baseline reported less marijuana use 1 year later compared with teens in UC; however, teens in CHAT who reported fewer marijuana consequences at baseline reported greater marijuana use 1 year later compared with teens in UC. CONCLUSIONS A brief intervention can be efficacious over the long-term for adolescents who report problems from alcohol and marijuana use. Findings emphasize the importance of both screening and intervention in at-risk adolescents in PC.
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22
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Linakis JG, Bromberg JR, Casper TC, Chun T, Mello MJ, Ingebretsen H, Spirito A. Reliability and Validity of the Newton Screen for Alcohol and Cannabis Misuse in a Pediatric Emergency Department Sample. J Pediatr 2019; 210:154-160.e1. [PMID: 30967250 PMCID: PMC6592736 DOI: 10.1016/j.jpeds.2019.02.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/15/2019] [Accepted: 02/26/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To determine the test-retest reliability, concurrent, convergent, and discriminant validity of a recently devised screen (the Newton screen) for alcohol and cannabis use/misuse, and its predictive validity at follow-up. STUDY DESIGN Adolescents, 12-17 years old (n = 4898), treated in 1 of 16 participating pediatric emergency departments across the US were enrolled in a study as part of a larger study within the Pediatric Emergency Care Applied Research Network. Concurrent and predictive validity (at 1, 2, and 3 years of follow-up) were assessed in a random subsample with a structured Diagnostic and Statistical Manual of Mental Disorders-based interview. Convergent validity was assessed with the Alcohol Use Disorders Identification, a widely used alcohol screening measure. RESULTS The sensitivity of the Newton screen for alcohol use disorder at baseline was 78.3% with a specificity of 93.0%. The cannabis use question had a baseline sensitivity of 93.1% and specificity of 93.5% for cannabis use disorder. Predictive validity analyses at 1, 2, and 3 years revealed high specificity but low sensitivity for alcohol and high specificity and moderate sensitivity for cannabis. CONCLUSIONS The Newton screening instrument may be an appropriate brief screening tool for use in the busy clinical environment. Specificity was high for both alcohol and cannabis, but sensitivity was higher for cannabis than alcohol. Like other brief screens, more detailed follow-up questions may be necessary to definitively assess substance misuse risk and the need for referral to treatment.
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Affiliation(s)
- James G. Linakis
- The Warren Alpert Medical School of Brown University, Providence, RI,Rhode Island Hospital, Providence, RI
| | - Julie R. Bromberg
- The Warren Alpert Medical School of Brown University, Providence, RI,Rhode Island Hospital, Providence, RI
| | | | - Thomas Chun
- The Warren Alpert Medical School of Brown University, Providence, RI,Rhode Island Hospital, Providence, RI
| | - Michael J. Mello
- The Warren Alpert Medical School of Brown University, Providence, RI,Rhode Island Hospital, Providence, RI
| | | | - Anthony Spirito
- The Warren Alpert Medical School of Brown University, Providence, RI
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23
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Identifying Problematic Substance Use in a National Sample of Adolescents Using Frequency Questions. J Am Board Fam Med 2019; 32:550-558. [PMID: 31300575 PMCID: PMC7043279 DOI: 10.3122/jabfm.2019.04.180284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 03/08/2019] [Accepted: 03/10/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Brief substance use screening questions for tobacco, alcohol, cannabis, and other drugs need further validation in adolescents. In particular, optimal age-specific screening cut-points are not known, and no study has been large enough to evaluate screening questions for noncannabis illicit drug use. METHODS Adolescent respondents to an annual national household survey were included (2008 to 2014; n = 169,986). Days of tobacco use in the past month, and days of alcohol, cannabis, other illicit drug use in the past year, were assessed as brief screens for tobacco dependence and DSM-IV alcohol (AUD), cannabis (CUD), and other illicit drug use disorders (DUD). Areas under receiver operating characteristics curves (AUCs), sensitivity and specificity were estimated separately by age group (12-15-, 16-17-, and 18-20-year-olds) and cut-points that maximized combined values of sensitivity and specificity were considered optimal. RESULTS The prevalence of tobacco dependence, AUD, CUD, and DUD was 5.8%, 7.1%, 4.5%, and 2.0%, respectively. AUCs ranged 0.84 to 0.99. The optimal cut-points for screening for tobacco dependence and DUDs was the same for all age groups: ≥1 day. The optimal cut-points for alcohol and cannabis varied by age: ≥3 days for 12-15-year-olds and ≥12 days for older adolescents. CONCLUSIONS Brief measures of past-year use, or past-month use for tobacco, accurately identified adolescents with problematic substance use. However, health systems should use age-specific screening cut-points for alcohol and cannabis to optimize screening performance.
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24
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McCarty CA, Gersh E, Katzman K, Lee CM, Sucato GS, Richardson LP. Screening and brief intervention with adolescents with risky alcohol use in school-based health centers: A randomized clinical trial of the Check Yourself tool. Subst Abus 2019; 40:510-518. [PMID: 30883284 DOI: 10.1080/08897077.2019.1576090] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: This study aimed to compare care delivery and alcohol and marijuana use for adolescents with risky alcohol use who received a school-based health center (SBHC) visit with and without the Check Yourself tool, an electronic tool that gives motivational feedback on substance use and summarizes results for providers. Methods: We conducted a randomized controlled trial with 148 adolescents aged 13-18 who met criteria for moderate- to high- risk alcohol use, recruited from urban SBHCs. Participants were randomized to receive their SBHC visit with (n = 73) or without (n = 75) the Check Yourself screening and feedback tool. All SBHC providers received a brief training on motivational interviewing. Results: Adolescents who received the Check Yourself tool + SBHC visit reported higher levels of alcohol (67%) and marijuana (73%) counseling from the provider during their visit, compared with those who received a SBHC visit without the tool (40% and 45%, respectively, Ps < .005), and had higher motivation to decrease marijuana use relative to those who did not (P = .02). Relative to baseline, adolescents in both groups reduced their typical number of drinks of alcohol, maximum number of drinks of alcohol, and hours high on marijuana over time (Ps < .02) at 2-month follow-up. Conclusion: When adolescent patients are given an electronic screening and feedback tool, it can prompt providers to increase counseling of adolescents with substance use risk. Overall, participants who had a visit with a trained provider reported high satisfaction with care and decreased the amount of alcohol use over 2 months, suggesting that SBHCs are an excellent venue for delivery of brief substance use interventions.
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Affiliation(s)
- Carolyn A McCarty
- Department of Pediatrics, University of Washington, Seattle, Washington, USA.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Elon Gersh
- Orygen, the National Centre of Excellence in Youth Mental Health, Department of Research and Translation, Melbourne, Australia.,University of Melbourne, Centre for Youth Mental Health, Melbourne, Australia
| | - Katherine Katzman
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Christine M Lee
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Gina S Sucato
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Laura P Richardson
- Department of Pediatrics, University of Washington, Seattle, Washington, USA.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
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25
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Linakis JG, Bromberg JR, Casper TC, Chun TH, Mello MJ, Richards R, Mull CC, Shenoi RP, Vance C, Ahmad F, Bajaj L, Brown KM, Chernick LS, Cohen DM, Fein J, Horeczko T, Levas MN, McAninch B, Monuteaux MC, Grupp-Phelan J, Powell EC, Rogers A, Suffoletto B, Dean JM, Spirito A. Predictive Validity of a 2-Question Alcohol Screen at 1-, 2-, and 3-Year Follow-up. Pediatrics 2019; 143:e20182001. [PMID: 30783022 PMCID: PMC6398369 DOI: 10.1542/peds.2018-2001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The National Institute on Alcohol Abuse and Alcoholism (NIAAA) 2-question screen is a valid adolescent alcohol screening tool. No studies have examined if this tool predicts future alcohol problems. We conducted a study at 16 pediatric emergency departments to determine the tool's predictive validity for alcohol misuse and alcohol use disorders (AUDs). METHODS Participants (N = 4834) completed a baseline assessment battery. A subsample of participants completed the battery at 1, 2, and 3 years follow up. RESULTS Of the 2209 participants assigned to follow-up, 1611 (73%) completed a 1-year follow-up, 1591 (72%) completed a 2-year follow-up, and 1377 (62%) completed a 3-year follow-up. The differences in AUDs between baseline NIAAA screen nondrinkers and lower-risk drinkers were statistically significant at 1 year (P = .0002), 2 years (P <.0001), and 3 years (P = .0005), as were the differences between moderate- and highest-risk drinkers at 1 and 2 years (P < .0001 and P = .0088, respectively) but not at 3 years (P = .0758). The best combined score for sensitivity (86.2% at 1 year, 75.6% at 2 years, and 60.0% at 3 years) and specificity (78.1% at 1 year, 79.2% at 2 years, and 80.0% at 3 years) was achieved by using "lower risk" and higher as a cutoff for the prediction of a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnosis. CONCLUSIONS The NIAAA 2-question screen can accurately characterize adolescent risk for future AUDs. Future studies are needed to determine optimaluse of the screen.
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Affiliation(s)
- James G. Linakis
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island
- Rhode Island Hospital, Providence, Rhode Island
| | - Julie R. Bromberg
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island
- Rhode Island Hospital, Providence, Rhode Island
| | | | - Thomas H. Chun
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island
- Rhode Island Hospital, Providence, Rhode Island
| | - Michael J. Mello
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island
- Rhode Island Hospital, Providence, Rhode Island
| | | | - Colette C. Mull
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Rohit P. Shenoi
- Texas Children’s Hospital and College of Medicine, Baylor University, Houston, Texas
| | - Cheryl Vance
- University of California, Davis, Davis, California
| | - Fahd Ahmad
- St Louis Children’s Hospital and School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Lalit Bajaj
- Children’s Hospital Colorado, Aurora, Colorado
| | - Kathleen M. Brown
- Children’s National Medical Center, Washington, District of Columbia
| | | | | | - Joel Fein
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Brett McAninch
- University of Pittsburg Medical Center Children’s Hospital of Pittsburgh and School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Elizabeth C. Powell
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; and
| | | | - Brian Suffoletto
- University of Pittsburg Medical Center Children’s Hospital of Pittsburgh and School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Anthony Spirito
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - for the Pediatric Emergency Care Applied Research Network
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island
- Rhode Island Hospital, Providence, Rhode Island
- University of Utah, Salt Lake City, Utah
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
- Texas Children’s Hospital and College of Medicine, Baylor University, Houston, Texas
- University of California, Davis, Davis, California
- St Louis Children’s Hospital and School of Medicine, Washington University in St Louis, St Louis, Missouri
- Children’s Hospital Colorado, Aurora, Colorado
- Children’s National Medical Center, Washington, District of Columbia
- Columbia University Irving Medical Center, New York City, New York
- Nationwide Children’s Hospital, Columbus, Ohio
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Los Angeles Biomedical Research Institute, Torrance, California
- Medical College of Wisconsin, Milwaukee, Wisconsin
- University of Pittsburg Medical Center Children’s Hospital of Pittsburgh and School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Boston Children’s Hospital, Boston, Massachusetts
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; and
- University of Michigan, Ann Arbor, Michigan
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Coulton S, Alam MF, Boniface S, Deluca P, Donoghue K, Gilvarry E, Kaner E, Lynch E, Maconochie I, McArdle P, McGovern R, Newbury-Birch D, Patton R, Phillips CJ, Phillips T, Rose H, Russell I, Strang J, Drummond C. Opportunistic screening for alcohol use problems in adolescents attending emergency departments: an evaluation of screening tools. J Public Health (Oxf) 2019; 41:e53-e60. [PMID: 29590416 PMCID: PMC6459356 DOI: 10.1093/pubmed/fdy049] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 12/19/2017] [Accepted: 02/28/2018] [Indexed: 12/20/2022] Open
Abstract
Objective To estimate and compare the optimal cut-off score of Alcohol Use Disorders Identification Test (AUDIT) and AUDIT-C in identifying at-risk alcohol consumption, heavy episodic alcohol use, ICD-10 alcohol abuse and alcohol dependence in adolescents attending ED in England. Design Opportunistic cross-sectional survey. Setting 10 emergency departments across England. Participants Adolescents (n = 5377) aged between their 10th and 18th birthday who attended emergency departments between December 2012 and May 2013. Measures Scores on the AUDIT and AUDIT-C. At-risk alcohol consumption and monthly episodic alcohol consumption in the past 3 months were derived using the time-line follow back method. Alcohol abuse and alcohol dependence was assessed in accordance with ICD-10 criteria using the MINI-KID. Findings AUDIT-C with a score of 3 was more effective for at-risk alcohol use (AUC 0.81; sensitivity 87%, specificity 97%), heavy episodic use (0.84; 76%, 98%) and alcohol abuse (0.98; 91%, 90%). AUDIT with a score of 7 was more effective in identifying alcohol dependence (0.92; 96%, 94%). Conclusions The 3-item AUDIT-C is more effective than AUDIT in screening adolescents for at-risk alcohol use, heavy episodic alcohol use and alcohol abuse. AUDIT is more effective than AUDIT-C for the identification of alcohol dependence.
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Affiliation(s)
- Simon Coulton
- Centre for Health Services Studies, School of Social Science and Social Policy Research, George Allen Wing, University of Kent, Canterbury, Kent, UK
| | - M Fasihul Alam
- College of Health Sciences, Qatar University, Doha, Qatar
| | - Sadie Boniface
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paolo Deluca
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kim Donoghue
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eilish Gilvarry
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Ellen Lynch
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Ian Maconochie
- Paediatric Emergency Medicine, Imperial College London, London, UK
| | - Paul McArdle
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - Ruth McGovern
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | | | - Robert Patton
- School of Psychology, University of Surrey, Guildford, UK
| | - Ceri J Phillips
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Thomas Phillips
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,University of Hull, Hull, UK
| | - Hannah Rose
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ian Russell
- Swansea University Medical School, Swansea, UK
| | - John Strang
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Colin Drummond
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Chhoa KH, Zakaria H, Abd Rahman FN. Problematic alcohol use and depression in secondary school students in Miri, Malaysia. Pediatr Int 2019; 61:284-292. [PMID: 30636372 DOI: 10.1111/ped.13789] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 09/12/2018] [Accepted: 10/30/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Alcohol consumption in the under-aged is one of the main concerns regarding Malaysian adolescents. There is no previous study on problematic alcohol use (PAU) in adolescents in Sarawak. The aim of this study was to determine the prevalence of PAU, its associated variables and its relationship with depression. METHODS This was a cross-sectional study. A total of 327 secondary school students completed the Alcohol Use Disorder Identification Test and Children's Depression Inventory, and a sociodemographic questionnaire. Binary and multivariable logistic regression were used to examine the relationship between the different variables. RESULTS A total of 42.2% of adolescents had PAU. Urban adolescents had a higher prevalence compared with rural adolescents (OR, 1.612; 95% CI: 1.036-2.508 P = 0.034). Female adolescents (56.8%) and Bumiputera Sarawak adolescents (76.8%) comprised a large proportion of the respondents with PAU. Cultural norm (78.3%) and curiosity (68.1%) were the two main reasons for PAU. Only family history of alcohol use (OR, 2.273; 95% CI: 1.013-5.107; P = 0.047), ever consumed alcohol (OR, 57.585; 95% CI: 21.885-151.525; P < 0.001) and ever consumed beer (OR, 2.564; 95% CI: 1.032-6.372; P = 0.043) were significantly associated with PAU. The prevalence of depression was 21.4%. A significant relationship between PAU and depression was seen (OR, 2.557; 95% CI: 1.479-4.420; P = 0.001). CONCLUSION There is a high prevalence of PAU in adolescents in Miri, Malaysia. More effort is needed to implement policies for this vulnerable group, with collaboration between agencies to ensure their mental and physical wellbeing and prevent a negative impact later. Clinicians should be more vigilant in detecting depression in adolescents with PAU to enable early intervention.
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Affiliation(s)
- Keng Hong Chhoa
- Psychiatry and Mental Health Department, Limbang Hospital, Limbang, Sarawak, Malaysia
| | - Hazli Zakaria
- Psychiatry Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Fairuz Nazri Abd Rahman
- Psychiatry Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Davis AK, Arterberry BJ, Schneeberger D, Bonar EE, Bauermeister JA, Young SD, Cunningham RM, Walton MA. Evaluation of the Dualistic Model of Passion for Alcohol Consumption among Emerging Adults Engaged in Risky Drinking. ADDICTION RESEARCH & THEORY 2019; 28:21-28. [PMID: 33041737 PMCID: PMC7539847 DOI: 10.1080/16066359.2019.1571192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 01/02/2019] [Accepted: 01/03/2019] [Indexed: 06/11/2023]
Abstract
Understanding factors influencing risky drinking among emerging adults could enhance interventions to reduce adverse outcomes. As a motivational construct, the dualistic model of passion (i.e., obsessive passion: drinking is compelling and conflicts with other life activities/values; harmonious passion: drinking is an important, but not overwhelming, part of life) offers a novel explanation for persistent alcohol use. Yet, the dualistic model of passion has not yet been evaluated in this at-risk population. Therefore, we examined whether the variables proposed by the dualistic model of passion were associated with sex, binge-drinking, and alcohol-related consequences among young risky drinkers. We analyzed cross-sectional baseline data collected as part of an ongoing randomized controlled trial of emerging adults (n=327; M age=22.6, SD=1.1, range 21-24; 61% female; 76% White non-Hispanic) engaged in risky drinking (AUDIT-C score ≥ 4 females, ≥ 5 males) recruited nationally via social media advertisements. A path analysis revealed significant positive direct effects between obsessive passion and binge drinking and alcohol-related consequences, and significant negative direct effects between male sex and harmonious passion and binge drinking. There was also a positive direct effect between binge drinking and alcohol-related consequences. Male sex and obsessive passion were both indirectly related to alcohol-related consequences via binge drinking. Type of passion and male sex differentiates risky drinkers who binge drink and who experienced alcohol-related consequences. Future research should examine whether targeting obsessive passion reduces binge drinking and negative outcomes.
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Affiliation(s)
- Alan K Davis
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD
- Department of Psychology, University of Iowa, 901 Stange Road, Ames, IA
| | | | - Diane Schneeberger
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI
| | - Erin E Bonar
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI
| | - José A Bauermeister
- University of Pennsylvania, Department of Family and Community Health, School of Nursing, 418 Curie Blvd., Philadelphia, PA
| | - Sean D Young
- University of California Institute for Prediction Technology, Department of Family Medicine, School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90024
| | - Rebecca M Cunningham
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI
| | - Maureen A Walton
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI
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29
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Riva K, Allen-Taylor L, Schupmann WD, Mphele S, Moshashane N, Lowenthal ED. Prevalence and predictors of alcohol and drug use among secondary school students in Botswana: a cross-sectional study. BMC Public Health 2018; 18:1396. [PMID: 30572874 PMCID: PMC6302490 DOI: 10.1186/s12889-018-6263-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 11/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Alcohol and illicit drug use has been recognized as a growing problem among adolescents in Botswana. Little is known about factors affecting alcohol and drug use among Botswana's secondary school students. To aid the design and implementation of effective public health interventions, we sought to determine the prevalence of alcohol and drug use in secondary school students in urban and peri-urban areas of Botswana, and to evaluate risk and protective factors for substance use. METHODS We performed a 72-item cross-sectional survey of students in 17 public secondary schools in Gaborone, Lobatse, Molepolole and Mochudi, Botswana. The World Health Organization's (WHO) Alcohol Use Disorder Identification Test (AUDIT) was used to define hazardous drinking behavior. Using Jessor's Problem Behavior Theory (PBT) as our conceptual framework, we culturally-adapted items from previously validated tools to measure risk and protective factors for alcohol and drug use. Between-group differences of risk and protective factors were compared using univariate binomial and multinomial-ordinal logit analysis. Relative risks of alcohol and drug use by demographic, high risks and low protections were calculated. Multivariate ordinal-multinomial cumulative logit analysis, multivariate nominal-multinomial logit analysis, and binominal logit analysis were used to build models illustrating the relationship between risk and protective factors and student alcohol and illicit drug use. Clustered data was adjusted for in all analyses using Generalized Estimating Equations (GEE) methods. RESULTS Of the 1936 students surveyed, 816 (42.1%) reported alcohol use, and 434 (22.4%) met criteria for hazardous alcohol use. Illicit drug use was reported by 324 students (16.7%), with motokwane (marijuana) being the most commonly used drug. Risk factors more strongly associated with alcohol and drug use were reported alcohol availability, individual and social vulnerability factors, and poor peer modeling. Individual and social controls protections appear to mitigate risk of student alcohol and drug use. CONCLUSIONS Alcohol and illicit drug use is prevalent among secondary school students in Botswana. Our data suggest that interventions that reduce the availability of alcohol and drugs and that build greater support networks for adolescents may be most helpful in decreasing alcohol and drug use among secondary school students in Botswana.
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Affiliation(s)
- Katherine Riva
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Second Floor, Philadelphia, PA, 19104, USA.
| | - Lynne Allen-Taylor
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, 516B Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA
| | - Will D Schupmann
- University of Pennsylvania Perelman School of Medicine, 2716 South St, Room 11242, Philadelphia, PA, 19146, USA
| | - Seipone Mphele
- Department of Psychology, University of Botswana, Private Bag UB 0022, Gaborone, Botswana
| | - Neo Moshashane
- Department of Psychology, University of Botswana, Private Bag UB 0022, Gaborone, Botswana
| | - Elizabeth D Lowenthal
- Pediatrics and Epidemiology, University of Pennsylvania Perelman School of Medicine, 2716 South St, Room 11242, Philadelphia, PA, 19146, USA
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30
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Carter PM, Dora-Laskey AD, Goldstick JE, Heinze JE, Walton MA, Zimmerman MA, Roche JS, Cunningham RM. Arrests Among High-Risk Youth Following Emergency Department Treatment for an Assault Injury. Am J Prev Med 2018; 55:812-821. [PMID: 30344036 PMCID: PMC6246796 DOI: 10.1016/j.amepre.2018.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/20/2018] [Accepted: 07/03/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Violence is a leading cause of morbidity and mortality for youth, with more than 600,000 emergency department visits annually for assault-related injuries. Risk for criminal justice involvement among this population is poorly understood. The objective of this study was to characterize arrests among high-risk, assault-injured, drug-using youth following emergency department treatment. METHODS Youth (aged 18-24 years) with past 6-month drug use who were seeking emergency department treatment for either an assault or for non-violence reasons were enrolled (December 2009-September 2011) in a 2-year longitudinal study. Arrests in the 24 months following the emergency department visit were analyzed in 2016-2017 using survival analysis of objective Law Enforcement Information Network data. Hazard ratios quantifying the association between risk factors for arrest were estimated using Cox regression. RESULTS In the longitudinal cohort, 511 youth seeking emergency department care (assault injury group n=299, comparison group n=212) were aged ≥18 years and were included for analysis. Youth in the assault injury group cohort had a 47% higher risk of arrest than the comparison group (38.1% vs 25.9%, RR=1.47, p<0.05). In unadjusted analyses, male sex, assault injury, binge drinking, drug use disorder, and community violence exposure were all associated with increased risk of arrest during the follow-up period. Cox regression identified that male sex (hazard ratio=2.57), drug use disorder diagnosis (hazard ratio=1.42), assault injury at baseline (hazard ratio=1.63), and community violence exposure (hazard ratio=1.35) increased risk for arrest. CONCLUSIONS Drug-using assault-injured youth have high rates of arrest. Emergency department and community interventions addressing substance use and violence involvement may aid in decreasing negative violence and criminal justice outcomes among high-risk youth. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT01152970.
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Affiliation(s)
- Patrick M Carter
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan.
| | - Aaron D Dora-Laskey
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Hurley Medical Center, Department of Emergency Medicine, Flint, Michigan
| | - Jason E Goldstick
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Justin E Heinze
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan; Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Maureen A Walton
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan; University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Marc A Zimmerman
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan; Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Jessica S Roche
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Rebecca M Cunningham
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan; Hurley Medical Center, Department of Emergency Medicine, Flint, Michigan; Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
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31
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Zhornitsky S, Ide JS, Wang W, Chao HH, Zhang S, Hu S, Krystal JH, Li CSR. Problem Drinking, Alcohol Expectancy, and Thalamic Resting-State Functional Connectivity in Nondependent Adult Drinkers. Brain Connect 2018; 8:487-502. [PMID: 30198312 PMCID: PMC6207153 DOI: 10.1089/brain.2018.0633] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Alcohol misuse is associated with thalamic dysfunction. The thalamus comprises subnuclei that relay and integrate information between cortical and subcortical structures. However, it is unclear how the subnuclei contribute to thalamic dysfunctions in problem drinking. We investigated resting-state functional connectivity (rsFC) of thalamic subregions in 107 nondependent drinkers (57 women), using masks delineated by white matter tractography. Thalamus was parceled into motor, somatosensory, visual, premotor, frontal association, parietal association, and temporal association subregions. Whole-brain linear regression, each against Alcohol Use Disorders Identification Test (AUDIT) and positive alcohol expectancy (AE) score with age as a covariate, was performed for each seed, for men and women combined, and separately. Overall, problem drinking was associated with increased thalamic connectivities, whereas AE was associated with a mixed pattern of increased and decreased connectivities. Motor, premotor, somatosensory, and frontal association thalamic connectivity with bilateral caudate head was positively correlated with AUDIT score in men and women combined. Connectivity of the right caudate head with frontal association and premotor thalamus was also positively correlated with AE score in men and women combined. In contrast, motor and premotor thalamic connectivity with a number of cortical and subcortical structures showed sex differences in the correlation each with AUDIT and AE score. In mediation analyses, AE score completely mediated the correlation between thalamic caudate connectivity and AUDIT score, whereas the model where AE contributed to problem drinking and, in turn, altered thalamic caudate connectivity was not supported. To conclude, thalamic subregional rsFCs showed both shared and distinct changes and sex differences in association with problem drinking and AE. Increased thalamic caudate connectivity may contribute to problem drinking via enhanced AE. The findings suggest the importance of examining thalamic subdivisions and sex in investigating the functional roles of thalamus in problem drinking.
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Affiliation(s)
- Simon Zhornitsky
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Jaime S. Ide
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Wuyi Wang
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Herta H. Chao
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Sheng Zhang
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Sien Hu
- Department of Psychology, State University of New York, Oswego, New York
| | - John H. Krystal
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Department of Neuroscience, Yale University School of Medicine, New Haven, Connecticut
- Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, Connecticut
| | - Chiang-shan R. Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Department of Neuroscience, Yale University School of Medicine, New Haven, Connecticut
- Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, Connecticut
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32
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Lam T, Ogeil RP, Allsop S, Chikritzhs T, Fischer J, Midford R, Gilmore W, Lenton S, Liang W, Lloyd B, Aiken A, Mattick R, Burns L, Lubman DI. Insomnia and Regulation of Sleep-Wake Cycle With Drugs Among Adolescent Risky Drinkers. J Clin Sleep Med 2018; 14:1529-1537. [PMID: 30176972 DOI: 10.5664/jcsm.7330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 05/22/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES We aimed to explore symptoms of insomnia in a group of youths characterized as engaging in risky drinking, their use of drugs as sleep/ wake aids, and the relationships between alcohol and other drug use and insomnia. METHODS Face-to-face interviews were conducted with 596 Australian 14 to 19-year-olds identified as engaging in regular risky drinking. They completed the Insomnia Severity Index and were assessed for recent alcohol and other drug use, including drugs used specifically as sleep aids or to stay awake. Alcohol-related problems, emotional distress, self-control, and working outside of traditional hours were also assessed using validated scales. RESULTS More than one-third of the study participants (36%) reported moderate to very severe sleep-onset insomnia, and 39% screened positive for clinical insomnia using adolescent criteria. Three-fourths used drugs in the past 2 weeks to regulate their sleep cycle (65% used stimulants to stay awake, mainly caffeine, and 32% used a depressant to get to sleep, mainly cannabis). Regression analyses showed that after controlling for variables such as sex, emotional distress, self-control, alcohol use problems, and past 6-month illicit or non-prescribed drug use, those who used drugs specifically to get to sleep or to stay awake were 2.0 (P < .001) and 1.7 (P = .02) times more likely to report clinical insomnia, respectively. CONCLUSIONS Insomnia was commonly reported in this community sample of adolescents characterized as engaging in risky drinking. Those with symptoms of insomnia appeared to be managing their sleep-related symptoms through alcohol and other drug use, which may have further exacerbated their sleep issues.
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Affiliation(s)
- Tina Lam
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Rowan P Ogeil
- Turning Point and Monash University, Melbourne, Australia
| | - Steve Allsop
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Tanya Chikritzhs
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Jane Fischer
- National Centre for Education and Training on Addiction, Flinders University, Adelaide, Australia
| | - Richard Midford
- Charles Darwin University and the Menzies School of Health Research, Darwin, Australia
| | - William Gilmore
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Simon Lenton
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Wenbin Liang
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Belinda Lloyd
- Turning Point and Monash University, Melbourne, Australia
| | - Alexandra Aiken
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Richard Mattick
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Lucinda Burns
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Dan I Lubman
- Turning Point and Monash University, Melbourne, Australia
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Liskola J, Haravuori H, Lindberg N, Niemelä S, Karlsson L, Kiviruusu O, Marttunen M. AUDIT and AUDIT-C as screening instruments for alcohol problem use in adolescents. Drug Alcohol Depend 2018; 188:266-273. [PMID: 29803033 DOI: 10.1016/j.drugalcdep.2018.04.015] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 04/14/2018] [Accepted: 04/16/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND The Alcohol Use Disorders Identification Test (AUDIT) is commonly used in adults to screen for harmful alcohol consumption but few studies exist on its use among adolescents. Our aim was to validate the AUDIT and its derivative consumption questionnaire (AUDIT-C) as screening instruments for the detection of problem use of alcohol in adolescents. METHODS 621 adolescents (age-range, 12-19 years) were drawn from clinical and population samples who completed the AUDIT questionnaire. Psychiatric diagnoses were assessed using K-SADS-PL. A rating based on the K-SADS-PL was used to assess alcohol use habits, alcohol use disorders, screening and symptom criteria questions. Screening performance of the AUDIT and AUDIT-C sum scores and Receiver Operating Characteristic (ROC) curves were calculated. The diagnostic odds ratios (dOR) were calculated to express the overall discrimination between cut-offs. RESULTS Comparisons of ROC between the AUDIT and AUDIT-C pairs indicated a slightly better test performance by AUDIT for the whole sample and in a proportion of the subsamples. Optimal cut-off value for the AUDIT was ≥5 (sensitivity 0.931, specificity 0.772, dOR 45.22; 95% CI: 24.72-83.57) for detecting alcohol problem use. The corresponding optimal cut-off value for the AUDIT-C was ≥3 in detecting alcohol problem use (sensitivity 0.952, specificity 0.663, dOR 39.31; 95% CI: 19.46-78.97). Agreement between the AUDIT and AUDIT-C using these cut-off scores was high at 91.9%. CONCLUSIONS Our results for the cut-off scores for the early detection of alcohol problem use in adolescents are ≥5 for AUDIT, and ≥3 for AUDIT-C.
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Affiliation(s)
- Joni Liskola
- Forensic Psychiatry, University of Helsinki and Helsinki University Hospital, Välskärinkatu 8, 00260, Helsinki, Finland; National Institute for Health and Welfare, Mental Health Unit, Mannerheimintie 160, 00300, Helsinki, Finland.
| | - Henna Haravuori
- National Institute for Health and Welfare, Mental Health Unit, Mannerheimintie 160, 00300, Helsinki, Finland; Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, 00260, Helsinki, Finland
| | - Nina Lindberg
- Forensic Psychiatry, University of Helsinki and Helsinki University Hospital, Välskärinkatu 8, 00260, Helsinki, Finland
| | - Solja Niemelä
- Department of Neurosciences, University of Oulu, Pentti Kaiteran katu 1, PL 8000, Oulu, Finland; Department of Psychiatry, Lapland Hospital District, Totontie 9, 97140, Muurala, Finland
| | - Linnea Karlsson
- Department of Child Psychiatry, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland
| | - Olli Kiviruusu
- National Institute for Health and Welfare, Mental Health Unit, Mannerheimintie 160, 00300, Helsinki, Finland
| | - Mauri Marttunen
- Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, 00260, Helsinki, Finland
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Ngo QM, Eisman AB, Walton MA, Kusunoki Y, Chermack ST, Singh V, Cunningham R. Emergency Department Alcohol Intervention: Effects on Dating Violence and Depression. Pediatrics 2018; 142:peds.2017-3525. [PMID: 29871891 PMCID: PMC6317550 DOI: 10.1542/peds.2017-3525] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2018] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES With this study, we examined secondary outcomes of an emergency department (ED)-based brief intervention (BI) on dating violence perpetration and victimization and depression symptoms over 3, 6, and 12 months. METHODS ED patients (14-20 years) were screened for risk drinking. Patients who received positive screen results were randomly assigned to a computer BI (n = 277), therapist BI (n = 278), or control condition (n = 281). After the 3-month assessment, participants were randomly assigned to receive the post-ED BI or control condition. BIs were used to address alcohol consumption and consequences (eg, dating violence and depression symptoms) by using motivational interviewing. RESULTS A total of 836 patients were enrolled in the randomized controlled trial of 4389 patients screened and 1054 who reported risky drinking. Regression models were used to examine longitudinal effects of the alcohol BI on dating violence perpetration, dating violence victimization, and depression symptoms. The therapist BI resulted in a significant reduction of dating violence perpetration up to 12 months (incidence rate ratio [IRR] = 0.53; 95% confidence interval [CI]: 0.37-0.77) and depression symptoms up to 3 months (IRR = 0.85; 95% CI: 0.72-1.00) after the intervention. Computer BI resulted in a reduction of dating violence perpetration (IRR = 0.52; 95% CI: 0.35-0.76) and depression symptoms (IRR = 0.78; 95% CI: 0.66-0.94) 6 months postintervention. Post-ED BIs were associated with lower perpetration at 12 months and lower victimization at 6 and 12 months, irrespective of BI intervention randomization at baseline; however, they did not affect depression symptoms. CONCLUSIONS A single-session ED BI revealed previously to show promise in reducing underage drinking also demonstrates promise in preventing dating violence perpetration and depression symptoms. These technology-enhanced BIs could be particularly helpful given the potential for more efficient resource usage and ease of future implementation.
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Affiliation(s)
- Quyen M. Ngo
- Department of Emergency Medicine,,Injury Prevention Center, University of Michigan Medical School, Ann Arbor, Michigan;,Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan
| | - Andria B. Eisman
- Injury Prevention Center, University of Michigan Medical School, Ann Arbor, Michigan;,Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Maureen A. Walton
- Department of Psychiatry, Addiction Research Center,,Injury Prevention Center, University of Michigan Medical School, Ann Arbor, Michigan
| | - Yasamin Kusunoki
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan;,Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Stephen T. Chermack
- Department of Psychiatry, Addiction Research Center,,Department of Veterans Affairs, Veterans Affairs Healthcare System, Ann Arbor, Michigan; and
| | - Vijay Singh
- Departments of Family Medicine and Internal Medicine, Division of Hospital Medicine,,Department of Emergency Medicine,,Injury Prevention Center, University of Michigan Medical School, Ann Arbor, Michigan
| | - Rebecca Cunningham
- Department of Emergency Medicine,,Injury Prevention Center, University of Michigan Medical School, Ann Arbor, Michigan;,Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan;,Hurley Medical Center, Flint, Michigan
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Davis AK, Arterberry BJ, Bonar EE, Chermack ST, Blow FC, Cunningham RM, Walton MA. Predictors of positive drinking outcomes among youth receiving an alcohol brief intervention in the emergency department. Drug Alcohol Depend 2018; 188:102-108. [PMID: 29758380 PMCID: PMC6261455 DOI: 10.1016/j.drugalcdep.2018.03.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/30/2018] [Accepted: 03/31/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Reducing underage drinking is a public health priority given increased risk for injury and other consequences. Emergency department (ED) visits offer a potential "teachable moment" to initiate interventions among youth engaged in risky drinking. Given mixed findings for alcohol brief interventions (BIs), this paper examined baseline markers of BI response in order to inform future interventions. METHOD We conducted secondary analyses of data from a randomized controlled trial of an alcohol BI delivered to youth in an ED. Among 475 participants (Mage = 18.6, SD = 1.4; 48.7% Female, 78.6% White/Caucasian) receiving a computer or therapist BI, we examined baseline characteristics (i.e., demographic, substance use, mood, risk/protective factors, and readiness to change) that predicted positive intervention response (i.e., BI responder) at 3-month follow-up using AUDIT-C scores (cut offs: <3 for ages 14-17; <4 for ages 18-20). RESULTS Mediated logistic regression analysis (controlling for demographics) showed that greater readiness to change at baseline was positively related to BI response and baseline alcohol consumption was negatively related to BI response. Having a mentor was indirectly related to BI response via baseline alcohol consumption. Baseline readiness to change and alcohol consumption mediated the association between positive peer influences and BI response, whereas readiness to change mediated the relation between depression and BI response. CONCLUSION Findings suggest that BI response is influenced by protective social factors, such as positive peers and mentors, and depression, via baseline alcohol severity indicators (i.e., readiness to change, consumption), thus providing clues for enhancing the content and dose of early interventions.
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Affiliation(s)
- Alan K Davis
- Behavioral Pharmacology Research Unit, Department of Psychiatry, Johns Hopkins School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA; University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA.
| | - Brooke J Arterberry
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Erin E Bonar
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA; University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI, 48109, USA
| | - Stephen T Chermack
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Frederic C Blow
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA; HSR and D Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, 2800 Plymouth Road, Building 16, Floor 2, Ann Arbor, MI, 48109, USA
| | - Rebecca M Cunningham
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI, 48109, USA; Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd Bldg 10-G080, Ann Arbor, MI, 48109-2800, USA
| | - Maureen A Walton
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA; HSR and D Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, 2800 Plymouth Road, Building 16, Floor 2, Ann Arbor, MI, 48109, USA
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Walton MA, Ngo QM, Chermack ST, Blow FC, Ehrlich PF, Bonar EE, Cunningham RM. Understanding Mechanisms of Change for Brief Alcohol Interventions Among Youth: Examination of Within-Session Interactions. J Stud Alcohol Drugs 2018; 78:725-734. [PMID: 28930060 DOI: 10.15288/jsad.2017.78.725] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Alcohol brief interventions (BIs) for youth are efficacious, but effect sizes found have been modest. This article presents secondary data analyses from a randomized controlled trial of motivational interviewing-based (MI) alcohol BIs among youth in an emergency department, examining within-session predictors of alcohol outcomes at 3 months among those receiving BIs. METHOD Risky drinkers (ages 14-20) received either a computer BI (n = 277) or therapist BI (n = 278). Within-session measures were obtained via computer metrics (therapist and computer BIs) and coding of audiotapes (therapist BI only). Parallel structural equation models examined direct and indirect effects of BI components on 3-month alcohol consumption and consequences, with posttest precursors of behavior change (e.g., importance, readiness, and intentions) as potential mediators. Components examined included reasons to avoid or reduce drinking, strengths, strategies for change, benefits of change, and leisure activities (computer BI only), and MI global ratings and MI-adherent behaviors (therapist BI only). RESULTS For both BIs, greater number of strategies directly predicted greater posttest scores, with posttest scores mediating the relationship between strategies and alcohol consumption at 3 months. Greater number of strengths directly predicted fewer alcohol-related consequences at 3 months for both BIs; however, strengths also indirectly predicted greater consumption, mediated by posttest scores. Greater number of reasons to avoid or reduce drinking directly predicted greater alcohol consumption for the therapist BI only. CONCLUSIONS These findings suggest ways to optimize the content and efficacy of alcohol BIs. Reviews of strategies such as refusal skills, protective behavioral strategies, and coping with negative affect may be particularly salient for reducing alcohol misuse.
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Affiliation(s)
- Maureen A Walton
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.,Injury Center, University of Michigan, Ann Arbor, Michigan
| | - Quyen M Ngo
- Injury Center, University of Michigan, Ann Arbor, Michigan.,Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan.,Institute on Women and Gender Studies, University of Michigan, Ann Arbor, Michigan
| | - Stephen T Chermack
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.,Mental Health Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Frederic C Blow
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.,Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.,Mental Health Innovation, Services, and Outcomes Section, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Peter F Ehrlich
- Injury Center, University of Michigan, Ann Arbor, Michigan.,Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, Michigan
| | - Erin E Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Rebecca M Cunningham
- Injury Center, University of Michigan, Ann Arbor, Michigan.,Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan.,School of Public Health, University of Michigan, Ann Arbor, Michigan
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de Freitas Ferreira M, de Moraes CL, Braga JU, Reichenheim ME, da Veiga GV. Abusive alcohol consumption among adolescents: a predictive model for maximizing early detection and responses. Public Health 2018; 159:99-106. [PMID: 29559184 DOI: 10.1016/j.puhe.2018.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 02/06/2018] [Accepted: 02/08/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To present a predictive model of alcohol abuse among adolescents based on prevalence projections in various population subgroups. STUDY DESIGN Cross-sectional study. METHODS The sample consisted of 785 adolescents enrolled in the second year of high school in Rio de Janeiro, Brazil. Alcohol consumption was assessed using the Alcohol Use Disorder Identification Test. Socio-economic, demographic, family, individuals, and school-related variables were examined as potential predictors. The logit model was used to estimate the prevalence projections. Model fitting was examined in relation to the observed data set, and in a subset, that was generated from 200 subsamples of individuals via a bootstrap process using general fit estimators, discrimination, and calibration measures. RESULTS About 25.5% of the adolescents were classified as positive for alcohol abuse. Being male, being 17-19 years old, not living with mothers, presenting symptoms suggestive of binge eating, having used a strategy of weight reduction in the last 3 months, and, especially, being a victim of family violence were important predictors of abusive consumption of alcohol. While the model's prevalence projection in the absence of these features was 8%, it reaches 68% in the presence of all predictors. CONCLUSIONS Knowledge of predictive characteristics of alcohol abuse is essential for screening, early detection of positive cases, and establishing interventions to reduce consumption among adolescents.
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Affiliation(s)
- M de Freitas Ferreira
- Department of Epidemiology, Institute of Social Medicine, Rio de Janeiro State University, Rua São Francisco Xavier 524 7° Andar, Rio de Janeiro, RJ 20559-900, Brazil.
| | - C L de Moraes
- Department of Epidemiology, Institute of Social Medicine, Rio de Janeiro State University, Rua São Francisco Xavier 524 7° Andar, Rio de Janeiro, RJ 20559-900, Brazil; Medical School, Estácio de Sá University, Rua Riachuelo 27, Rio de Janeiro, RJ 20230-010, Brazil
| | - J U Braga
- Department of Epidemiology, Institute of Social Medicine, Rio de Janeiro State University, Rua São Francisco Xavier 524 7° Andar, Rio de Janeiro, RJ 20559-900, Brazil; Professor Helio Fraga Reference Center, National School of Public Health, Fiocruz, Rio de Janeiro, Brazil
| | - M E Reichenheim
- Department of Epidemiology, Institute of Social Medicine, Rio de Janeiro State University, Rua São Francisco Xavier 524 7° Andar, Rio de Janeiro, RJ 20559-900, Brazil
| | - G V da Veiga
- Department of Nutrition Josué de Castro, Health Sciences Center, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho 373, Bloco J, 2° andar, Ilha do Fundão, Rio de Janeiro, RJ 21941-590, Brazil
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Rytilä-Manninen M, Haravuori H, Fröjd S, Marttunen M, Lindberg N. Mediators between adverse childhood experiences and suicidality. CHILD ABUSE & NEGLECT 2018; 77:99-109. [PMID: 29324274 DOI: 10.1016/j.chiabu.2017.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 11/29/2017] [Accepted: 12/04/2017] [Indexed: 05/26/2023]
Abstract
We investigated whether psychiatric symptomatology, impulsivity, family and social dysfunction, and alcohol use mediate the relationship between adverse childhood experiences (ACEs) and suicidality. The study population comprised 206 adolescent psychiatric inpatients and 203 age- and gender-matched adolescents from the community. ACEs and suicidality were assessed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime version, the Life Events Checklist, and a structured background data collection sheet. Psychiatric symptomatology was measured using the Symptom Checklist -90. Impulsivity, social dysfunction, and family dysfunction were measured using the Offer Self-Image Questionnaire, and alcohol use was assessed with the Alcohol Use Disorders Identification Test. A simple mediation test and multiple mediation analyses were conducted. A positive direct effect of ACEs on suicidality was observed. Also seen was a positive indirect effect of ACEs on suicidality through psychiatric symptomatology, impulsivity, and family and social dysfunctions. Alcohol misuse did not, however, mediate the relationship between ACEs and suicidality. According to the multiple mediation analyses, psychiatric symptomatology was the most significant mediator, followed by impulsivity. Psychiatric symptoms, impulsivity, and family and social dysfunctions are factors that should be taken into consideration when assessing suicidality in adolescents.
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Affiliation(s)
- Minna Rytilä-Manninen
- Adolescent Psychiatry, Helsinki University and Helsinki University Hospital, Helsinki, Finland.
| | - Henna Haravuori
- Adolescent Psychiatry, Helsinki University and Helsinki University Hospital, Helsinki, Finland; National Institute for Health and Welfare, Department of Health, Mental Health Units, Helsinki, Finland
| | - Sari Fröjd
- University of Tampere, School of Health Sciences, Tampere, Finland
| | - Mauri Marttunen
- Adolescent Psychiatry, Helsinki University and Helsinki University Hospital, Helsinki, Finland; National Institute for Health and Welfare, Department of Health, Mental Health Units, Helsinki, Finland
| | - Nina Lindberg
- Forensic Psychiatry, Helsinki University and Helsinki University Hospital, Helsinki, Finland
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Puuskari V, Aalto-Setälä T, Komulainen E, Marttunen M. Suicidal ideation, suicide attempts, and psychological distress among intoxicated adolescents in the pediatric emergency department. Nord J Psychiatry 2018; 72:137-144. [PMID: 29126365 DOI: 10.1080/08039488.2017.1400099] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Studies have emphasized screening for psychiatric disorders, especially suicide risk in emergency departments. Psychiatric disorders and experimentation with alcohol increase in adolescence and intoxications among patients challenge the staff in emergency departments. AIMS This study examined the degree of suicidal ideation (SI) and suicidal behavior in adolescents, and the extent to which they differed from non-suicidal patients in terms of alcohol use, psychological distress, self-esteem, and perceived social support. METHODS The study comprised 120 adolescents, a mean age of 14.2 years. Of them 60% were females. We collected data on the clinical characteristics and assessed the patient's psychiatric status using self-report scales and analyzed blood samples for alcohol. A consulting psychiatrist interviewed each patient before discharge to evaluate potential SI or suicide attempt (SA) using structured and semi-structured scales. RESULTS Of the 120 patients 20% had SI or had made a SA. High psychological distress in girls, low blood alcohol levels (BALs), as well as low scores on self-esteem, on social support and on familial support were associated with patients with SI/SA. Logistic regression showed that the most significant variables with suicidal patients included low BAL and low self-esteem and high alcohol consumption. Psychological distress had a direct and mediational role in the suicidal patients. CONCLUSIONS Adolescents referred to the pediatric emergency department with intoxication displaying high psychological distress and low self-esteem represent a high-risk group of teens. In this group, careful assessment of mental health status, screening for suicidal ideation, and SAs seems warranted.
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Affiliation(s)
- Varpu Puuskari
- a Adolescent Psychiatry , Helsinki University Hospital, University of Helsinki , Helsinki , Finland
| | - Terhi Aalto-Setälä
- b The Social Insurance Institute , Helsinki , Finland.,c Mental Health Unit , National Institute for Health and Welfare , Helsinki , Finland
| | - Erkki Komulainen
- d Department of Behavioural Sciences , University of Helsinki , Helsinki , Finland
| | - Mauri Marttunen
- a Adolescent Psychiatry , Helsinki University Hospital, University of Helsinki , Helsinki , Finland.,c Mental Health Unit , National Institute for Health and Welfare , Helsinki , Finland
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Carter PM, Walton MA, Goldstick J, Epstein-Ngo QM, Zimmerman MA, Mercado MC, Williams AG, Cunningham RM. Violent firearm-related conflicts among high-risk youth: An event-level and daily calendar analysis. Prev Med 2017; 102:112-119. [PMID: 28729199 PMCID: PMC5774663 DOI: 10.1016/j.ypmed.2017.07.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 04/17/2017] [Accepted: 07/12/2017] [Indexed: 12/14/2022]
Abstract
Firearm homicide is the leading cause of violence-related youth mortality. To inform prevention efforts, we analyzed event-level data to identify unique precursors to firearm conflicts. Youth (ages:14-24) seeking Emergency Department (ED) treatment for assault or for other reasons and reporting past 6-month drug use were enrolled in a 2-year longitudinal study. Time-line follow-back substance use/aggression modules were administered at baseline and each 6-month follow-up. Violent non-partner conflicts were combined across time-points. Regression analyzed: a)antecedents of firearm-related conflicts (i.e., threats/use) as compared to non-firearm conflicts; and b)substance use on conflict (vs. non-conflict) days for those engaged in firearm conflict. During the 24-months, we found that 421-youth reported involvement in violent non-partner conflict (n=829-conflicts;197-firearm/632-non-firearm). Among firearm conflicts, 24.9% involved aggression and 92.9% involved victimization. Retaliation was the most common motivation for firearm-aggression (51.0%), while "shot for no reason" (29.5%) and conflicts motivated by arguments over "personal belongings" (24.0%) were most common for firearm-victimization. Male sex (AOR=5.14), Black race (AOR=2.75), a ED visit for assault (AOR=3.46), marijuana use before the conflict (AOR=2.02), and conflicts motivated by retaliation (AOR=4.57) or personal belongings (AOR=2.28) increased the odds that a conflict involved firearms. Alcohol (AOR=2.80), marijuana (AOR=1.63), and prescription drugs (AOR=4.06) had a higher association with conflict (vs. non-conflict) days among youth reporting firearm conflict. Overall, we found that firearm conflicts are differentially associated with substance use and violence motivations. Addressing substance use, interrupting the cycle of retaliatory violence, and developing conflict resolution strategies that address escalation over infringement on personal belongings may aid in decreasing and preventing adolescent firearm violence.
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Affiliation(s)
- Patrick M Carter
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States; Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States.
| | - Maureen A Walton
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States; Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States; University of Michigan Addiction Research Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Rd., Ann Arbor, MI 48109, United States
| | - Jason Goldstick
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States; Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States
| | - Quyen M Epstein-Ngo
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States; Institute for Research on Women and Gender, University of Michigan, 204 S. State Street, Ann Arbor, MI 48109, United States
| | - Marc A Zimmerman
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States; Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States; Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, MI 48109, United States
| | - Melissa C Mercado
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop F-64, Atlanta, GA 30341-3717, United States
| | - Amanda Garcia Williams
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop F-64, Atlanta, GA 30341-3717, United States; Epidemic Intelligence Service, Epidemiology Workforce Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-92, Atlanta, GA 30329-4027, United States
| | - Rebecca M Cunningham
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States; Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States; Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, MI 48109, United States; Hurley Medical Center, Department of Emergency Medicine, 1 Hurley Plaza, Flint, MI 48503, United States
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Buu A, Massey LS, Walton MA, Cranford JA, Zimmerman MA, Cunningham RM. Assessment methods and schedules for collecting daily process data on substance use related health behaviors: A randomized control study. Drug Alcohol Depend 2017. [PMID: 28651151 PMCID: PMC5548619 DOI: 10.1016/j.drugalcdep.2017.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Interactive voice response (IVR) and short message service (SMS) systems have been used to collect daily process data on substance use. Yet, their relative compliance, use patterns, and user experiences are unknown. Furthermore, recent studies presented the potential of a hybrid weekly protocol requiring recall of behaviors in past week right after the weekend, in order to reduce the concerns about low compliance and measurement reactivity associated with daily data collection and also provide high quality data on the peak of use. METHODS This study randomized substance users to four (2×2) assessment groups with different combinations of assessment methods (IVR or SMS) and schedules (daily or weekly). The compliance rates and use patterns during the experimental period of 90days and user experiences reported after the period were compared across the groups. RESULTS When IVR was assigned, the weekly schedule generated a higher compliance rate than the daily schedule. When SMS was used, however, the assessment schedule did not have an effect on compliance. While both the daily and weekly surveys via IVR can be completed within a short time, the weekly survey administered via SMS took much longer than its daily counterpart. Such an increased time consumption may offset the benefit of a less frequent assessment schedule. CONCLUSIONS IVR is a better choice for delivering the hybrid protocol of weekly collection of daily process data because of its higher compliance rate, shorter duration, and lower likelihood of interruption during data collection.
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Affiliation(s)
- Anne Buu
- Department of Health Behavior and Biological Sciences, University of Michigan, 400 North Ingalls, Ann Arbor, MI 48109, USA.
| | - Lynn S. Massey
- Addiction Research Center, Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Maureen A. Walton
- Addiction Research Center, Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - James A. Cranford
- Addiction Research Center, Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Marc A. Zimmerman
- Department of Health Behavior and Health Education, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109
| | - Rebecca M. Cunningham
- Department of Emergency Medicine, University of Michigan, 2800 Plymouth Rd, Bldg 10-G080, Ann Arbor, MI 48109
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Buckley L, Bonar EE, Walton MA, Carter PM, Voloshyna D, Ehrlich PF, Cunningham RM. Marijuana and other substance use among male and female underage drinkers who drive after drinking and ride with those who drive after drinking. Addict Behav 2017; 71:7-11. [PMID: 28231494 DOI: 10.1016/j.addbeh.2017.02.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 02/07/2017] [Accepted: 02/09/2017] [Indexed: 11/28/2022]
Abstract
The study sought to describe the occurrence of adolescent driving after drinking (DD) and riding with a driver who had been drinking (RWDD) and associations with substance use for both males and females. As part of screening for a randomized controlled trial, we surveyed 16-20year olds (N=3418) recruited from an emergency department (ED) and analyzed data from those reporting past-year alcohol consumption (n=2150, 58% females). DD was reported by 22% of females and 28% of males and RWDD was reported by 39% of females and 38% of males, also in the past year. In regression models, risky alcohol use and past-year marijuana use were associated with increased odds of DD and RWDD for females and males. Marijuana use was a strong predictor, with odds increased by 2.3 and 1.7 times for DD among females and males respectively and 1.4 times for RWDD for females and males. Prescription drug misuse was also associated with RWDD for females and for both males' and females' reported DD. The findings highlight the alarming rate of DD and RWDD among both males and females and suggest ED-based injury prevention efforts consider such risky road behavior as well as consider their substance use. Future research might also further examine the effects of driving under influence of substances, particularly marijuana, and the negative synergistic effects of co-ingestion prior to driving.
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Affiliation(s)
- Lisa Buckley
- University of Michigan Transportation Research Institute, Ann Arbor, MI, United States; University of Michigan Injury Center, Ann Arbor, MI, United States.
| | - Erin E Bonar
- University of Michigan, Department of Psychiatry, Addiction Center, Ann Arbor, MI, United States
| | - Maureen A Walton
- University of Michigan Injury Center, Ann Arbor, MI, United States; University of Michigan, Department of Psychiatry, Addiction Center, Ann Arbor, MI, United States
| | - Patrick M Carter
- University of Michigan Injury Center, Ann Arbor, MI, United States; University of Michigan, Department of Emergency Medicine, Ann Arbor, MI, United States; Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Diana Voloshyna
- V.N. Karazin Kharkiv National University, Department of Psychiatry, Narcology, Neurology and Medical Psychology, Kharkiv, Ukraine
| | - Peter F Ehrlich
- University of Michigan Injury Center, Ann Arbor, MI, United States; University of Michigan Health System, C.S. Mott Children's Hospital, Department of Surgery, Section of Pediatric Medicine, Ann Arbor, MI, United States
| | - Rebecca M Cunningham
- University of Michigan Injury Center, Ann Arbor, MI, United States; University of Michigan, Department of Emergency Medicine, Ann Arbor, MI, United States; Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, MI, United States; Department of Health Behavior Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States
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Gamarel KE, Nelson KM, Brown L, Fernandez MI, Nichols S. The Usefulness of the CRAFFT in Screening for Problematic Drug and Alcohol Use Among Youth Living with HIV. AIDS Behav 2017; 21:1868-1877. [PMID: 27981399 PMCID: PMC5472507 DOI: 10.1007/s10461-016-1640-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Substance use is highly prevalent among youth living with HIV (YLWH) and negatively impacts HIV care. This study sought to determine whether the CRAFFT (Car, Relax, Alone, Forget, Friends, and Trouble), designed to screen for problematic substance use, is reliably associated with substance use behaviors among YLWH. A cross-sectional sample of 2216 youth (ages 12-26) were recruited through the adolescent medicine trials network for HIV/AIDS Interventions. Participants completed a self-administered survey. Over half screened positive on the CRAFFT (i.e., ≥2). Among frequent substance users, those older in age, behaviorally infected, with history of incarceration or unstably housed were more likely to screen positive on the CRAFFT. Study findings suggest that the CRAFFT reliably identifies youth who use substances. Thus, screening measures such as the CRAFFT should be utilized routinely in HIV clinical settings for youth.
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Affiliation(s)
- Kristi E Gamarel
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02129, USA.
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02129, USA.
| | - Kimberly M Nelson
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Centers for Behavioral and Preventative Medicine, The Miriam Hospital, Providence, RI, USA
| | - Larry Brown
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | - M Isabel Fernandez
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Sharon Nichols
- Department of Neurosciences, University of California, San Diego, CA, USA
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Two-Year Trajectories of Sexual Risk Behaviors Among Drug-Using Adolescents and Emerging Adults in an Urban Community. AIDS Behav 2017; 21:2069-2078. [PMID: 27714523 DOI: 10.1007/s10461-016-1570-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Among 14-24 year-olds who used drugs and were recruited from an emergency department, we examined 2-year trajectories of sexual risk behaviors. We hypothesized that those in higher risk trajectories would have more severe substance use, mental health concerns, and dating violence involvement at baseline. Analyses identified three behavioral trajectories. Individuals in the highest risk trajectory had a more severe profile of baseline alcohol use, marijuana use, dating violence involvement, and mental health problems. Future research will examine longitudinal differences in risk factors across trajectories. Understanding risk factors for sexual risk behavior trajectories can inform the delivery and tailoring of prevention interventions.
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Goldstick JE, Carter PM, Walton MA, Dahlberg LL, Sumner SA, Zimmerman MA, Cunningham RM. Development of the SaFETy Score: A Clinical Screening Tool for Predicting Future Firearm Violence Risk. Ann Intern Med 2017; 166:707-714. [PMID: 28395357 PMCID: PMC5697901 DOI: 10.7326/m16-1927] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Interpersonal firearm violence among youth is a substantial public health problem, and emergency department (ED) physicians require a clinical screening tool to identify high-risk youth. OBJECTIVE To derive a clinically feasible risk index for firearm violence. DESIGN 24-month prospective cohort study. SETTING Urban, level 1 ED. PARTICIPANTS Substance-using youths, aged 14 to 24 years, seeking ED care for an assault-related injury and a proportionately sampled group of non-assault-injured youth enrolled from September 2009 through December 2011. MEASUREMENTS Firearm violence (victimization/perpetration) and validated questionnaire items. RESULTS A total of 599 youths were enrolled, and presence/absence of future firearm violence during follow-up could be ascertained in 483 (52.2% were positive). The sample was randomly split into training (75%) and post-score-construction validation (25%) sets. Using elastic-net penalized logistic regression, 118 baseline predictors were jointly analyzed; the most predictive variables fell predominantly into 4 domains: violence victimization, community exposure, peer influences, and fighting. By selection of 1 item from each domain, the 10-point SaFETy (Serious fighting, Friend weapon carrying, community Environment, and firearm Threats) score was derived. SaFETy was associated with firearm violence in the validation set (odds ratio [OR], 1.47 [95% CI, 1.23 to 1.79]); this association remained (OR, 1.44 [CI, 1.20 to 1.76]) after adjustment for reason for ED visit. In 5 risk strata observed in the training data, firearm violence rates in the validation set were 18.2% (2 of 11), 40.0% (18 of 45), 55.8% (24 of 43), 81.3% (13 of 16), and 100.0% (6 of 6), respectively. LIMITATIONS The study was conducted in a single ED and involved substance-using youths. SaFETy was not externally validated. CONCLUSION The SaFETy score is a 4-item score based on clinically feasible questionnaire items and is associated with firearm violence. Although broader validation is required, SaFETy shows potential to guide resource allocation for prevention of firearm violence. PRIMARY FUNDING SOURCE National Institute on Drug Abuse R01024646.
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Affiliation(s)
- Jason E Goldstick
- From University of Michigan School of Medicine and University of Michigan School of Public Health Ann Arbor, Michigan; Centers for Disease Control and Prevention, Atlanta, Georgia; and Hurley Medical Center, Flint, Michigan
| | - Patrick M Carter
- From University of Michigan School of Medicine and University of Michigan School of Public Health Ann Arbor, Michigan; Centers for Disease Control and Prevention, Atlanta, Georgia; and Hurley Medical Center, Flint, Michigan
| | - Maureen A Walton
- From University of Michigan School of Medicine and University of Michigan School of Public Health Ann Arbor, Michigan; Centers for Disease Control and Prevention, Atlanta, Georgia; and Hurley Medical Center, Flint, Michigan
| | - Linda L Dahlberg
- From University of Michigan School of Medicine and University of Michigan School of Public Health Ann Arbor, Michigan; Centers for Disease Control and Prevention, Atlanta, Georgia; and Hurley Medical Center, Flint, Michigan
| | - Steven A Sumner
- From University of Michigan School of Medicine and University of Michigan School of Public Health Ann Arbor, Michigan; Centers for Disease Control and Prevention, Atlanta, Georgia; and Hurley Medical Center, Flint, Michigan
| | - Marc A Zimmerman
- From University of Michigan School of Medicine and University of Michigan School of Public Health Ann Arbor, Michigan; Centers for Disease Control and Prevention, Atlanta, Georgia; and Hurley Medical Center, Flint, Michigan
| | - Rebecca M Cunningham
- From University of Michigan School of Medicine and University of Michigan School of Public Health Ann Arbor, Michigan; Centers for Disease Control and Prevention, Atlanta, Georgia; and Hurley Medical Center, Flint, Michigan
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Donoghue K, Rose H, Boniface S, Deluca P, Coulton S, Alam MF, Gilvarry E, Kaner E, Lynch E, Maconochie I, McArdle P, McGovern R, Newbury-Birch D, Patton R, Phillips CJ, Phillips T, Russell I, Strang J, Drummond C. Alcohol Consumption, Early-Onset Drinking, and Health-Related Consequences in Adolescents Presenting at Emergency Departments in England. J Adolesc Health 2017; 60:438-446. [PMID: 28110867 DOI: 10.1016/j.jadohealth.2016.11.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 10/15/2016] [Accepted: 11/16/2016] [Indexed: 01/05/2023]
Abstract
PURPOSE Globally, alcohol use is the leading cause of ill health and life years lost in adolescents, although its clinical impact is often overlooked, particularly in England where most research is based in schools. This study aims to examine the prevalence of alcohol consumption and the association between alcohol consumption and age of onset with health and social consequences among adolescents presenting to emergency departments (EDs). METHODS Consecutive attenders (n = 5,576) aged 10-17 years at 10 EDs were included. Information was collected on general health and functioning, quality of life, alcohol use, and alcohol-related health and social consequences. RESULTS Nearly 40% of adolescents reported the consumption of alcohol that was more than a sip in their lifetime. Age of the first alcohol consumption before the age of 15 years was associated with tobacco use (p < .001), lower quality of life (p = .003), and evidence of an alcohol use disorder (p = .002). It was also associated with general social functioning (problems with conduct p = .001 and hyperactivity p = .001) and alcohol-related health and social consequences (accident p = .046, problems with a parent p = .017, school p = .0117, or police p = .012). CONCLUSIONS Rates of alcohol consumption in adolescents presenting to the ED were similar to those reported in schools in England and globally. Associations of alcohol consumption and earlier onset of drinking with poorer health and social functioning were observed. The ED can offer an opportunity for the identification of hazardous alcohol use in adolescents.
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Affiliation(s)
- Kim Donoghue
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
| | - Hannah Rose
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Sadie Boniface
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Paolo Deluca
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Simon Coulton
- Centre for Health Services Studies, University of Kent, Canterbury, Kent, United Kingdom
| | | | - Eilish Gilvarry
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, United Kingdom
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
| | - Ellen Lynch
- Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
| | - Ian Maconochie
- Paediatric Emergency Medicine, Imperial College London, United Kingdom
| | - Paul McArdle
- Health Economics and Policy Research Unit, University of South Wales, Pontypridd, United Kingdom
| | - Ruth McGovern
- Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
| | - Dorothy Newbury-Birch
- School of Health and Social Care, Teesside University, Middlesbrough, United Kingdom
| | - Robert Patton
- School of Psychology, University of Surrey, Guildford, United Kingdom
| | - Ceri J Phillips
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, United Kingdom
| | - Thomas Phillips
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Humber NHS Foundation Trust, Willerby, United Kingdom
| | - Ian Russell
- Swansea University Medical School, Swansea, United Kingdom
| | - John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Colin Drummond
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Ranney ML, Fletcher J, Alter H, Barsotti C, Bebarta VS, Betz ME, Carter PM, Cerdá M, Cunningham RM, Crane P, Fahimi J, Miller MJ, Rowhani-Rahbar A, Vogel JA, Wintemute GJ, Shah MN, Waseem M. A Consensus-Driven Agenda for Emergency Medicine Firearm Injury Prevention Research. Ann Emerg Med 2017; 69:227-240. [PMID: 27998625 PMCID: PMC5272847 DOI: 10.1016/j.annemergmed.2016.08.454] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/17/2016] [Accepted: 08/22/2016] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVE To identify critical emergency medicine-focused firearm injury research questions and develop an evidence-based research agenda. METHODS National content experts were recruited to a technical advisory group for the American College of Emergency Physicians Research Committee. Nominal group technique was used to identify research questions by consensus. The technical advisory group decided to focus on 5 widely accepted categorizations of firearm injury. Subgroups conducted literature reviews on each topic and developed preliminary lists of emergency medicine-relevant research questions. In-person meetings and conference calls were held to iteratively refine the extensive list of research questions, following nominal group technique guidelines. Feedback from external stakeholders was reviewed and integrated. RESULTS Fifty-nine final emergency medicine-relevant research questions were identified, including questions that cut across all firearm injury topics and questions specific to self-directed violence (suicide and attempted suicide), intimate partner violence, peer (nonpartner) violence, mass violence, and unintentional ("accidental") injury. Some questions could be addressed through research conducted in emergency departments; others would require work in other settings. CONCLUSION The technical advisory group identified key emergency medicine-relevant firearm injury research questions. Emergency medicine-specific data are limited for most of these questions. Funders and researchers should consider increasing their attention to firearm injury prevention and control, particularly to the questions identified here and in other recently developed research agendas.
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Affiliation(s)
- Megan L. Ranney
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI
| | - Jonathan Fletcher
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI
| | - Harrison Alter
- Department of Emergency Medicine, Highland Hospital-Alameda Health System, Oakland, CA
| | | | - Vikhyat S. Bebarta
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Marian E. Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Patrick M. Carter
- Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, MI
| | - Magdalena Cerdá
- Department of Emergency Medicine, University of California, Davis, Sacramento, CA
| | - Rebecca M. Cunningham
- Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, MI; University of Michigan Injury Center, University of Michigan, Ann Arbor, MI
| | - Peter Crane
- Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Jahan Fahimi
- Department of Emergency Medicine, University of California, San Francisco, CA
| | - Matthew J. Miller
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology and Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
| | - Jody A. Vogel
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO; Denver Health Medical Center, University of Colorado School of Medicine, Aurora, CO
| | - Garen J. Wintemute
- Department of Emergency Medicine, University of California, Davis, Sacramento, CA
| | - Manish N. Shah
- Berbee Walsh Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
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Spirito A, Bromberg JR, Casper TC, Chun TH, Mello MJ, Dean JM, Linakis JG. Reliability and Validity of a Two-Question Alcohol Screen in the Pediatric Emergency Department. Pediatrics 2016; 138:peds.2016-0691. [PMID: 27940674 PMCID: PMC5127060 DOI: 10.1542/peds.2016-0691] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE A multisite study was conducted to determine the psychometric properties of the National Institute of Alcohol Abuse and Alcoholism (NIAAA) 2-question alcohol screen within pediatric emergency departments (PEDs). METHODS Participants (N = 4838) included 12- to 17-year-old subjects treated in 1 of the 16 participating PEDs across the United States. A criterion assessment battery (including the NIAAA 2-question alcohol screen and other measures of alcohol, drug use, and risk behaviors) was self-administered on a tablet computer. A subsample (n = 186) was re-administered the NIAAA 2-question screen 1 week later to assess test-retest reliability. RESULTS Moderate to good test-retest reliability was demonstrated. A classification of moderate risk or higher on the screen had the best combined sensitivity and specificity for determining a diagnosis of alcohol use disorder (AUD) for all students. Any past year drinking among middle school students increased the odds of a diagnosis of an AUD according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria, whereas the optimal cutoff for high school ages was ≥3 drinking days in the past year. The optimal cutoff for drinking days determining a positive Alcohol Use Disorders Identification Test score among middle school subjects was ≥1 drinking day, whereas the optimal cutoff for high school subjects was ≥2 drinking days. CONCLUSIONS The NIAAA 2-question screen is a brief, valid approach for alcohol screening in PEDs. A positive screen suggests that referral for further evaluation is indicated to determine if an adolescent has an AUD.
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Affiliation(s)
| | - Julie R. Bromberg
- Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island;,Department of Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island; and
| | - T. Charles Casper
- Department of Pediatrics & PECARN Data Coordinating Center, University of Utah, Salt Lake City, Utah
| | - Thomas H. Chun
- Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island;,Department of Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island; and
| | - Michael J. Mello
- Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island;,Department of Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island; and
| | - J. Michael Dean
- Department of Pediatrics & PECARN Data Coordinating Center, University of Utah, Salt Lake City, Utah
| | - James G. Linakis
- Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island;,Department of Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island; and
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D’Amico EJ, Parast L, Meredith LS, Ewing BA, Shadel WG, Stein BD. Screening in Primary Care: What Is the Best Way to Identify At-Risk Youth for Substance Use? Pediatrics 2016; 138:peds.2016-1717. [PMID: 27940696 PMCID: PMC5127067 DOI: 10.1542/peds.2016-1717] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND It is important to improve primary care providers' capability to identify youth at risk for alcohol and other drug use. To our knowledge, this is the first study to use Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria to compare screeners for youth for both alcohol and marijuana, given that these are the most frequently used substances by this age group. METHODS We compared the psychometric performance of 4 screeners: the National Institute on Alcohol Abuse and Alcoholism Screening Guide (NIAAA SG), the Alcohol Use Disorders Identification Test, the Car-Relax-Alone-Forget-Family and Friends-Trouble (CRAFFT) screener, and the Personal Experience Screening Questionnaire Problem Severity Scale (PESQ-PS) in identifying alcohol and marijuana use outcomes. Youth age 12 through 18 (N = 1573; 27% black, 51% Hispanic) were screened with the NIAAA SG, followed by a Web survey that included the other screeners and outcomes. RESULTS Sensitivity for alcohol outcomes indicated that the NIAAA SG (0.87) did not perform as well as the CRAFFT (0.97) or PESQ-PS (0.97) screeners but performed better than the Alcohol Use Disorders Identification Test (0.70). The pattern for sensitivity across screeners for marijuana outcomes was similar. CONCLUSIONS An important tradeoff in primary care settings is precision versus practicality. Because of brevity and focus on frequency of drinking, the NIAAA SG offers ease of administration and is good at identifying youth with probably problematic drinking levels. The PESQ-PS and the CRAFFT correctly identify more at-risk youth for alcohol and marijuana than the NIAAA SG. Future work is needed to elucidate how to efficiently and accurately identify at-risk youth in the primary care setting, including determining the best cutoff points to use to increase sensitivity.
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50
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Heinrich A, Schumann G, Flor H, Nees F. Identification of Key Items Regarding Personality, Environment, and Life Events to Assess Risk and Resilience Factors for Harmful Alcohol Drinking in Adolescents. Alcohol Alcohol 2016; 51:710-715. [PMID: 27001996 DOI: 10.1093/alcalc/agw012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 02/17/2016] [Indexed: 11/14/2022] Open
Abstract
AIMS Alcohol misuse often develops during adolescence involving interacting factors deriving from personality, environment and life events that can be assessed with well-established instruments. However, for specific research purposes, involving the assessment of large data sets, it may be beneficial having a short tool of key items representing the most important risk factors. METHODS We identified a set of key items from standard questionnaires assessed in about 2000 adolescents. In our longitudinal study we identified important items on personality, environment, and life events explaining alcohol drinking behaviour at the age of 14 years and the increase of alcohol consumption 2 years later. RESULTS The key items explained 33.4% of variance in alcohol drinking behaviour (vs. 34.8% for original battery) and can be completed in six minutes. CONCLUSIONS Our item list represents a powerful easy-to-use tool for the examination of alcohol drinking behaviour in adolescents.
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Affiliation(s)
- Angela Heinrich
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Gunter Schumann
- Department of Institute of Psychiatry, King's College London, London, UK
| | - Herta Flor
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frauke Nees
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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