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Abstract
It is estimated that up to 1 in 20 people in the United States are affected by fetal alcohol spectrum disorders (FASD), an array of cognitive, emotional, physical and social disorders caused by exposure to alcohol during prenatal development. Common diagnoses encompassed within FASD include mood and behavioral disorders, memory and central nervous system deficits, attention-deficit/hyperactivity disorder (ADHD), slow growth and low body weight. While this condition affects a broad range of individuals and families, it is of particular concern in the military community, where cultural factors including an increased prevalence of alcohol misuse pose a unique set of challenges. To shed light on these issues and provide an overview of the existing research, programs, and clinical practice guidelines surrounding FASD, the Uniformed Services University of the Health Sciences (USUHS), in conjunction with FASD United, hosted the Workshop on Fetal Alcohol Spectrum Disorders Prevention and Clinical Guidelines Research on 21 September 2022 in Washington, DC. More than 50 attendees from academia, healthcare, federal agencies, and consumer advocacy organizations gathered to share research findings, lived experiences, and strategies for improving FASD prevention, diagnosis, interventions, and support.The workshop began with a series of presentations on FASD risk factors and causes, strategies for diagnosis and interventions, and impacts and lived experiences. Individuals and families affected by FASD spoke about the ways FASD, its symptoms, and the social stigma associated with it influences their daily lives, experiences at school and work, and access to healthcare. Several speakers highlighted the work of non-profit organizations and advocacy groups in supporting families affected by FASD and other challenges faced by military families more broadly. The workshop closed with a discussion of federal agency perspectives highlighting initiatives aimed at advancing research and access to care for women and families at-risk and those currently affected by FASD.
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Affiliation(s)
- Tracey Pérez Koehlmoos
- Center for Health Services Research, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
| | - Elizabeth Lee
- Department of Pediatrics, Division of Pediatric Health Systems Research and Clinical Epidemiology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Building 61 Room E225, Bethesda, MD 20814 USA
| | - Jennifer Wisdahl
- FASD United, 1200 Eton Ct NW, 3rd Floor, Washington, DC 20007 USA
| | - Tom Donaldson
- FASD United, 1200 Eton Ct NW, 3rd Floor, Washington, DC 20007 USA
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Braciszewski JM, Colby SM, Franklin MJ, Stout RL, Vose-O'Neal A, Bock BC. Technology-Based Smoking Cessation for Youth Exiting Foster Care: A Pilot Randomized Trial. J Public Child Welf 2022; 18:61-79. [PMID: 38144460 PMCID: PMC10746146 DOI: 10.1080/15548732.2022.2155754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/28/2022] [Indexed: 12/26/2023]
Abstract
Despite high rates of cigarette use, little attention has been paid to screening and cessation services for youth in foster care. Study aims were to test the feasibility, acceptability, and preliminary efficacy of a technology-based smoking cessation intervention. Study enrollment, satisfaction, and engagement were high in the intervention arm, where readiness to change also significantly increased over time. Intervention and control participants significantly reduced cigarette use at 6-month follow up, though groups did not differ. Technology-based interventions appear to be attractive and offer a potentially scalable link to health care that this vulnerable population may not otherwise seek.
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Affiliation(s)
| | | | | | - Robert L Stout
- Pacific Institute for Research and Evaluation, Calverton, MD
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Braciszewski JM, Sala-Hamrick KJ, Zelenak L, Gootee J, Elsiss F, Ottolini J, Lanier A, Colby SM, Ahmedani BK. Reducing Smoking Cessation Disparities: Capacity for a Primary Care- and Technology-Based Approach Among Medicaid Recipients. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09925-1. [PMID: 36400987 DOI: 10.1007/s10880-022-09925-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 11/19/2022]
Abstract
While cigarette use among U.S adults has recently decreased, vulnerable subgroups continue to smoke at high rates, including individuals receiving Medicaid insurance. These individuals have also experienced treatment access disparities, highlighting the need for approaches that leverage their strong desire to quit. We conducted interviews with 100 adult primary care patients receiving Medicaid who were current tobacco users about their use, openness to technology-based interventions, and readiness to change. Most (92%) reported current cigarette use and readiness to change averaged 6.98 out of 10 (SD = 2.82). Nearly all were open to completing an iPad-based tobacco screening (95%) and brief intervention (90%) at their next appointment, while 91% and 88% were willing to talk with their provider or a cessation counselor, respectively, about the subsequent results. Results persisted across age, sex, and race/ethnicity. Openness to technology-based interventions in this population provides support for future work that may ultimately reduce disparities.
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Janzow GE, Harding C, Flores M, Borodovsky J, Steinkamp J, Marsch LA, Schuman-Olivier Z. Assessing the feasibility, usability and acceptability of the MySafeRx platform among individuals in outpatient buprenorphine treatment: Lessons learned from a pilot randomized controlled trial. Drug Alcohol Depend Rep 2022; 3:100045. [PMID: 36845988 PMCID: PMC9949338 DOI: 10.1016/j.dadr.2022.100045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/12/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Abstract
Background Increasing buprenorphine/naloxone (B/N) access for opioid use disorder (OUD) is essential yet ensuring adherence and preventing diversion remains challenging. This study examines the feasibility, usability, and acceptability of MySafeRx, a mobile platform integrating motivational coaching, adherence monitoring, and electronic dispensing during office-based B/N treatment. Methods In this multi-site randomized controlled trial, MySafeRx provided coaching and supervised self-administration of B/N by mobile recovery coaches (MRCs) via videoconference. Referred adults (ages 18-65) with OUD were randomized to 1) 42-days of adjunctive MySafeRx treatment (n = 13) or 2) a standard care control group (n = 14). Results The randomized sample was 63% female and 100% White. Twelve of 13 MySafeRx participants completed at least one MRC session. The mean system usability score reported by MySafeRx participants was 78.4 (n = 12). Participants indicated they would recommend MySafeRx to a friend (mean= 4.1 of 5), and that the dispenser (4.1 of 5) and videoconferencing (4.2 of 5) were easy to use. The MRC component had the highest acceptability (4.4 of 5). MRCs observed B/N self-administration for an average of 64.3% of the required study days (men: 68.9%; women: 57.9%). On average, men (n = 4) met with MRCs on 32±14 days versus 47±6 days for women (n = 8). Exploratory analyses did not show significant differences between intervention and control groups. Conclusions Despite the small sample, this study supports usability and acceptability of MySafeRx. Increased adherence monitoring, even with remote coaching had limited appeal, which impacted feasibility due to slow recruitment, especially as community prescribing with relaxed monitoring requirements became more widespread.
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Affiliation(s)
- Grace E. Janzow
- Cambridge Health Alliance, Harvard Medical School, Department of Psychiatry, 1035 Cambridge Street, Suite 21A – CMC, Cambridge, MA 02141, United States
| | - Cassandra Harding
- Cambridge Health Alliance, Harvard Medical School, Department of Psychiatry, 1035 Cambridge Street, Suite 21A – CMC, Cambridge, MA 02141, United States
| | - Michael Flores
- Cambridge Health Alliance, Harvard Medical School, Department of Psychiatry, 1035 Cambridge Street, Suite 21A – CMC, Cambridge, MA 02141, United States
| | - Jacob Borodovsky
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, EverGreen Center, Suite 315, NH 03766, Lebanon
| | - Jackson Steinkamp
- Cambridge Health Alliance, Harvard Medical School, Department of Psychiatry, 1035 Cambridge Street, Suite 21A – CMC, Cambridge, MA 02141, United States
| | - Lisa A. Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, EverGreen Center, Suite 315, NH 03766, Lebanon
| | - Zev Schuman-Olivier
- Cambridge Health Alliance, Harvard Medical School, Department of Psychiatry, 1035 Cambridge Street, Suite 21A – CMC, Cambridge, MA 02141, United States
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, EverGreen Center, Suite 315, NH 03766, Lebanon
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Marcu G, Ondersma SJ, Spiller AN, Broderick BM, Kadri R, Buis LR. Barriers and Considerations in the Design and Implementation of Digital Behavioral Interventions: Qualitative Analysis. J Med Internet Res 2022; 24:e34301. [PMID: 35353043 PMCID: PMC9008531 DOI: 10.2196/34301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/09/2021] [Accepted: 12/30/2021] [Indexed: 12/25/2022] Open
Abstract
Background Digital behavioral interventions have become increasingly popular for their ability to support patient diagnosis and treatment, chronic disease self-management, behavior change, and adherence to recommended care. However, digital intervention development is impeded by challenges such as limited technical skills, limited access to developers, and cost. The purpose of this study is to elicit in-depth qualitative feedback from intervention developers who have interest in digital behavioral interventions but lack programming skills regarding the barriers they experience and key considerations in the design and implementation of digital interventions. Objective This study aims to understand barriers in the design and implementation of digital behavioral interventions, as well as to identify key considerations for researchers who are developing these interventions. Methods We conducted semistructured qualitative interviews with 18 researchers who had experience either designing (but not coding) digital behavioral interventions or running research studies with them. Participants were a convenience sample of users of the Computerized Intervention Authoring System platform, an existing no-code development platform for building digital intervention content, and were recruited through either direct email solicitation or snowball sampling. All interviews were conducted and recorded over videoconference between February and April 2020. Recordings from interviews were transcribed and thematically analyzed by multiple coders. Results Interviews were completed with 18 participants and lasted between 24 and 65 (mean 46.9, SD 11.3) minutes. Interviewees were predominantly female (17/18, 94%) and represented different job roles, ranging from researcher to project/study staff. Three key barriers in the development of digital behavior interventions were identified during interviews: lack of cross-disciplinary understanding; variability in recipients’ technology access, infrastructure, and literacy; and the idea that evidence-based in-person interactions do not translate directly to digital interactions. Interviewees identified several key considerations that interventionists learned to prioritize, which have the potential to overcome these barriers and lead to successful interventions. Conclusions Barriers in the development of digital behavioral interventions are often created by a lack of cross-disciplinary understanding, which can lead to difficulties conceptualizing interventions, unrealistic expectations in terms of cost, and confusion about the development process. Moreover, concerns about research study participant characteristics and access to technology, as well as the translation of in-person interventions to digital, are apparent. Appropriate training in how to work with software development teams may help future digital behavior intervention creators overcome these barriers and may lead to new, exciting innovations in this space.
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Affiliation(s)
- Gabriela Marcu
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Steven J Ondersma
- Department of Obstetrics, Gynecology, & Reproductive Biology and the Division of Public Health, Michigan State University, East Lansing, MI, United States
| | - Allison N Spiller
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | | | - Reema Kadri
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Lorraine R Buis
- School of Information, University of Michigan, Ann Arbor, MI, United States.,Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
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Brown JE, Halpern J. AI chatbots cannot replace human interactions in the pursuit of more inclusive mental healthcare. SSM - Mental Health 2021; 1:100017. [DOI: 10.1016/j.ssmmh.2021.100017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Wouldes TA, Crawford A, Stevens S, Stasiak K. Evidence for the Effectiveness and Acceptability of e-SBI or e-SBIRT in the Management of Alcohol and Illicit Substance Use in Pregnant and Post-partum Women. Front Psychiatry 2021; 12:634805. [PMID: 34025470 PMCID: PMC8131659 DOI: 10.3389/fpsyt.2021.634805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/17/2021] [Indexed: 12/12/2022] Open
Abstract
Alcohol and illicit psychoactive drug use during pregnancy have increased worldwide, putting women and their children's health and development at risk. Multiple drug use, comorbid psychiatric disorders, sexual and physical abuse are common in women who use alcohol and drugs during pregnancy. The effects on the mother include poor reproductive and life-long health, legal, family, and social problems. Additionally, the exposed child is at increased risk of long-term physical health, mental health, and developmental problems. The stigma associated with substance use during pregnancy and some clinicians' reticence to inquire about substance use means many women are not receiving adequate prenatal, substance abuse, and mental health care. Evidence for mHealth apps to provide health care for pregnant and post-partum women reveal the usability and effectiveness of these apps to reduce gestational weight gain, improve nutrition, promote smoking cessation and manage gestational diabetes mellitus, and treat depression and anxiety. Emerging evidence suggests mHealth technology using a public health approach of electronic screening, brief intervention, or referral to treatment (e-SBIRT) for substance use or abuse can overcome the typical barriers preventing women from receiving treatment for alcohol and drug use during pregnancy. This brief intervention delivered through a mobile device may be equally effective as SBIRT delivered by a health care professional in preventing maternal drug use, minimizing the effects to the exposed child, and providing a pathway to therapeutic options for a substance use disorder. However, larger studies in more diverse settings with women who have co-morbid mental illness and a constellation of social risk factors that are frequently associated with substance use disorders are needed.
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Affiliation(s)
- Trecia A Wouldes
- Department of Psychological Medicine, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
| | - Andi Crawford
- Department of Psychological Medicine, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
- Te Ara Manapou, Parenting and Pregnancy Service, Hawke's Bay District Health Board, Hastings, New Zealand
| | - Suzanne Stevens
- Department of Psychological Medicine, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
| | - Karolina Stasiak
- Department of Psychological Medicine, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
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Olmstead TA, Martino S, Ondersma SJ, Gilstad-Hayden K, Forray A, Yonkers KA. The short-term impact on economic outcomes of SBIRT interventions implemented in reproductive health care settings. J Subst Abuse Treat 2020; 120:108179. [PMID: 33298305 DOI: 10.1016/j.jsat.2020.108179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 09/02/2020] [Accepted: 10/13/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To estimate the impact of screening, brief intervention, and referral to treatment (SBIRT) administered in reproductive health care settings on a variety of economic outcomes, including general health care utilization, criminal activity, and motor vehicle crashes. Whether and by how much SBIRT affects economic outcomes are important unanswered questions related to the economic impact of this technique. METHODS We collected data as part of a randomized clinical trial that examined whether SBIRT delivered electronically (e-SBIRT) or by a clinician (SBIRT) is superior to enhanced usual care (EUC) for substance misuse. Participants were a convenience sample of 439 women from two reproductive health care centers who used cigarettes, risky amounts of alcohol, illicit drugs, or misused prescription medication. For each participant, we measured economic outcomes by self-report 6 months pre- and post-intervention. We used difference-in-differences regression models to estimate the impact of e-SBIRT and SBIRT, compared to EUC, on changes in each of the economic outcomes from pre- to post-intervention. RESULTS None of the difference-in-differences estimates weas statistically significant after adjusting for multiple comparisons. CONCLUSION In a population of women receiving routine care in reproductive health care settings, we did not find a significant effect of either e-SBIRT or SBIRT, compared to EUC, on general health care utilization, criminal activity, or motor vehicle outcomes. However, individual trials are typically underpowered to detect effects that are small but important from a public health perspective. These results may be crucial for future systematic reviews and meta-analyses to determine the economic impact of SBIRT programs from a variety of perspectives.
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Affiliation(s)
- Todd A Olmstead
- The University of Texas at Austin, Lyndon B. Johnson School of Public Affairs, 2300 Red River Street, Austin, TX, 78701, USA.
| | - Steve Martino
- Yale School of Medicine, Department of Psychiatry, Division of Substance Abuse, 950 Campbell Avenue, West Haven, CT 06516, USA; VA Connecticut Healthcare System, Psychology Service, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Steven J Ondersma
- Wayne State University, Department of Psychiatry & Behavioral Neurosciences and Merrill-Palmer Skillman Institute, 71 East Ferry St., Detroit, MI 48202, USA
| | - Kathryn Gilstad-Hayden
- Yale School of Medicine, Department of Psychiatry, 40 Temple Street, New Haven, CT 06510, USA
| | - Ariadna Forray
- Yale School of Medicine, Department of Psychiatry, 40 Temple Street, New Haven, CT 06510, USA
| | - Kimberly A Yonkers
- Yale University School of Epidemiology and Public Health, Division of Chronic Disease, 60 College Street, New Haven, CT 06520, USA; Yale School of Medicine, Department of Obstetrics, Gynecology, & Reproductive Sciences, 333 Cedar Street, New Haven, CT 06520, USA; Yale School of Medicine, Department of Psychiatry, 40 Temple Street, New Haven, CT 06510, USA
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Yonkers KA, Dailey JI, Gilstad-Hayden K, Ondersma SJ, Forray A, Olmstead TA, Martino S. Abstinence outcomes among women in reproductive health centers administered clinician or electronic brief interventions. J Subst Abuse Treat 2020; 113:107995. [PMID: 32359666 DOI: 10.1016/j.jsat.2020.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/07/2020] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
Treatment of substance use in women seeking reproductive healthcare is crucial for the health of both women and their offspring. Although abstinence from all substance use during pregnancy is optimal, it is difficult to achieve. This secondary analysis reports abstinence outcomes from a randomized clinical trial of screening, brief intervention, and referral to treatment (SBIRT) for substance use among women seeking reproductive healthcare services. Women who screened positive for substance use were randomly assigned to either clinician-administered SBIRT, an electronically-administered brief intervention (e-SBIRT), or an enhanced usual care condition. At a 6-month follow-up assessment, compared to enhanced usual care, the clinician-administered SBIRT increased 1-month point prevalence of abstinence from the primary substance by 7.7%, and e-SBIRT increased abstinence by 12.8%. Both brief interventions were more useful than enhanced usual care and could increase substance use abstinence rates among women in reproductive healthcare clinics. The electronic brief intervention is particularly attractive given that it appears as efficacious as, but requires fewer resources than, clinician-delivered brief interventions.
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Affiliation(s)
- Kimberly A Yonkers
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA; Department of Epidemiology and Public Health, Yale School of Medicine, 60 College Street, New Haven, CT 06510, USA.
| | - Jason I Dailey
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Kathryn Gilstad-Hayden
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA.
| | - Steven J Ondersma
- Wayne State University, Merrill Palmer Skillman Institute, 71 E. Ferry Ave, Detroit, MI 48202, USA.
| | - Ariadna Forray
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA.
| | - Todd A Olmstead
- University of Texas at Austin, PO Box Y, Austin, TX 78713, USA.
| | - Steve Martino
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA; VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA.
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Fodor MC, Grekin ER, Beatty JR, McGoron L, Ondersma SJ. Participant Satisfaction with Computer-Delivered Intervention Components and Its Relation to Alcohol Outcomes. Subst Use Misuse 2020; 55:2332-2340. [PMID: 32865079 PMCID: PMC7654716 DOI: 10.1080/10826084.2020.1811343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Few computer-delivered brief intervention (CDBI) studies have evaluated participant satisfaction with individual elements of the intervention, or whether participant satisfaction impacts intervention outcomes. Purpose: This factorial trial examined whether subjective reactions to a CDBI for heavy drinking (1) varied depending on the presence versus absence of an animated narrator, a spoken voice, empathic reflections, and motivational interviewing (MI) strategies and (2) were associated with drinking outcomes at 3-month follow-up. Methods: Participants were 352 heavy drinking university students. All participants were randomly assigned to one of 16 versions of a CDBI. After finishing the CDBI, participants completed measures of intervention likability and perceived empathy. Alcohol use outcomes were assessed at 3-month follow-up. Results: CDBI characteristics had minimal effects on participant ratings of likeability and perceived empathy. However, higher likeability ratings were associated with decreases in alcohol use outcomes over the 3-month assessment period. Conclusions: Results indicate that subjective reactions to CDBIs can have important effects on alcohol use outcomes.
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Affiliation(s)
- Marina C Fodor
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Emily R Grekin
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Jessica R Beatty
- Merrill Palmer Skillman Institute, Wayne State University, Detroit, Michigan, USA
| | - Lucy McGoron
- Merrill Palmer Skillman Institute, Wayne State University, Detroit, Michigan, USA
| | - Steven J Ondersma
- Merrill Palmer Skillman Institute, Wayne State University, Detroit, Michigan, USA
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Olmstead TA, Yonkers KA, Ondersma SJ, Forray A, Gilstad-Hayden K, Martino S. Cost-effectiveness of electronic- and clinician-delivered screening, brief intervention and referral to treatment for women in reproductive health centers. Addiction 2019; 114:1659-1669. [PMID: 31111591 PMCID: PMC6684836 DOI: 10.1111/add.14668] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/01/2018] [Accepted: 05/13/2019] [Indexed: 12/29/2022]
Abstract
AIMS To determine the cost-effectiveness of electronic- and clinician-delivered SBIRT (Screening, Brief Intervention and Referral to Treatment) for reducing primary substance use among women treated in reproductive health centers. DESIGN Cost-effectiveness analysis based on a randomized controlled trial. SETTING New Haven, CT, USA. PARTICIPANTS A convenience sample of 439 women seeking routine care in reproductive health centers who used cigarettes, risky amounts of alcohol, illicit drugs or misused prescription medication. INTERVENTIONS Participants were randomized to enhanced usual care (EUC, n = 151), electronic-delivered SBIRT (e-SBIRT, n = 143) or clinician-delivered SBIRT (SBIRT, n = 145). MEASUREMENTS The primary outcome was days of primary substance abstinence during the 6-month follow-up period. To account for the possibility that patients might substitute a different drug for their primary substance during the 6-month follow-up period, we also considered the number of days of abstinence from all substances. Incremental cost-effectiveness ratios and cost-effectiveness acceptability curves determined the relative cost-effectiveness of the three conditions from both the clinic and patient perspectives. FINDINGS From a health-care provider perspective, e-SBIRT is likely (with probability greater than 0.5) to be cost-effective for any willingness-to-pay value for an additional day of primary-substance abstinence and an additional day of all-substance abstinence. From a patient perspective, EUC is most likely to be the cost-effective intervention when the willingness to pay for an additional day of abstinence (both primary-substance and all-substance) is less than $0.18 and e-SBIRT is most likely to be the cost-effective intervention when the willingness to pay for an additional day of abstinence (both primary-substance and all-substance) is greater than $0.18. CONCLUSIONS e-SBIRT could be a cost-effective approach, from both health-care provider and patient perspectives, for use in reproductive health centers to help women reduce substance misuse.
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Affiliation(s)
- Todd A. Olmstead
- The University of Texas at Austin, Lyndon B. Johnson School of Public Affairs, 2300 Red River Street, Austin, TX 78713, USA
| | - Kimberly A. Yonkers
- Yale University School of Medicine, Department of Psychiatry, 40 Temple Street, Suite 6B, New Haven, CT 06510, USA,Yale University School of Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, 333 Cedar Street, New Haven, CT 06510, USA,Yale University School of Epidemiology and Public Health, Division of Chronic Disease, 60 College Street, New Haven, CT 06520, USA
| | - Steven J. Ondersma
- Wayne State University, Department of Psychiatry & Behavioral Neurosciences & Merrill-Palmer Skillman Institute, 71 E. Ferry Ave., Detroit, MI 48202, USA
| | - Ariadna Forray
- Yale University School of Medicine, Department of Psychiatry, 40 Temple Street, Suite 6B, New Haven, CT 06510, USA
| | - Kathryn Gilstad-Hayden
- Yale University School of Medicine, Department of Psychiatry, 40 Temple Street, Suite 6B, New Haven, CT 06510, USA
| | - Steve Martino
- Yale University School of Medicine, Department of Psychiatry, 40 Temple Street, Suite 6B, New Haven, CT 06510, USA,VA Connecticut Healthcare System, 950 Campbell Avenue (116B), West Haven, CT 06516, USA
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