Primary prevention of prescription stimulant misuse in first-year college students

Objective: Eight percent of college students report past year prescription stimulant misuse (nonmedical use of stimulants defined as taking stimulants in a manner other than prescribed). Despite this high prevalence rate, primary prevention efforts are lacking on college campuses. Participants and Methods: A prescription stimulant misuse primary prevention intervention targeting first-year college students was developed, refined, and pilot tested. Existing substance use treatment (motivational interviewing) and time management (cognitive behavioral therapy for adult ADHD) techniques were integrated into the novel brief prevention intervention. Focus groups provided feedback to help refine the prevention intervention. Following refinements, 484 first-year college students were randomly assigned to condition (327 treatment, 157 control) and followed for 3 months. Results: Participants rated the intervention as satisfactory. After controlling for time invariant covariates, condition significantly predicted prescription stimulant misuse. There was a lower rate of past 3-month prescription stimulant misuse reported in the intervention group (4.9%) compared to the control group (11.5%). Academic expectancies remained stable in the intervention group yet increased in the control condition over time. Time management skill ratings remained stable in both groups. Changes in academic expectancies, yet not time management skills, were a partial mediator of the prevention efficacy in prescription stimulant misuse at 3-month follow-up. Conclusions: These results provide preliminary support for the acceptability and efficacy of a brief primary prevention intervention for college student prescription stimulant misuse. Changes in positive prescription stimulant expectancies, yet not time management skills, appear to be potential targets for future preventive efforts.

Race, cortisol, and subclinical cardiovascular disease in 9- to 11-year-old children

BACKGROUND

Non-Hispanic Black Americans have a greater risk for certain subtypes of cardiovascular disease (CVD; e.g., stroke and heart failure) relative to non-Hispanic White Americans. Moreover, Black relative to White adults consistently show elevated cortisol, a CVD risk. The impact of race, environmental stress, and cortisol on subclinical CVD has yet to be fully researched in children.

METHOD

We assessed diurnal salivary cortisol slopes and hair cortisol in a sample of 9- to 11-year-old children (N = 271; 54% female) with roughly half self-identifying as either Black (57%) or White (43%). Two subclinical CVD indicators were assessed: carotid-femoral pulse wave velocity (cfPWV) and carotid intima-media thickness (cIMT). We assessed numerous environmental stress indicators.

RESULTS

After adjusting for covariates, we found that Black children had significantly flatter diurnal cortisol slopes, higher hair cortisol, and thicker IMT than White children. Significant pathways were found: race → salivary cortisol slope → cfPWV (effect = -0.059, 95% CI [-0.116, -0.002]) and race → hair cortisol → cIMT (effect = -0.008, [-0.016, -0.002]). Black children also experienced significantly more environmental stress than White children; however, only income inequality served as a significant indirect pathway from race to salivary cortisol (effect = 0.029, [0.003, 0.060]).

CONCLUSIONS

Relative to White children, Black children had significantly greater hair cortisol and flatter diurnal slopes which, in turn, were associated with greater subclinical CVD. As suggested by a significant indirect pathway, income inequality might partially explain the race-cortisol association. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Perspectives on contingency management for alcohol use and alcohol-associated conditions among people in care with HIV

BACKGROUND

Contingency management (CM) is an evidence-based approach for reducing alcohol use; however, its implementation into routine HIV primary care-based settings has been limited. We evaluated perspectives on implementing CM to address unhealthy alcohol use and associated conditions for people with HIV in primary care settings.

METHODS

From May 2021 to August 2021, we conducted two focus groups with staff involved in delivering the intervention (n = 5 Social Workers and n = 4 Research Coordinators) and individual interviews (n = 13) with a subset of participants involved in the multi-site Financial Incentives, Randomization, and Stepped Treatment (FIRST) trial. Qualitative data collection and analyses were informed by the Promoting Action on Research Implementation in Health Service (PARIHS) implementation science framework, including evidence (perception of CM), context (HIV primary care clinic and CM procedures), and facilitation (feasibility outside the research setting).

RESULTS

Several major themes were identified. Regarding the evidence, participants lacked prior experience with CM, but the intervention was well received and, by some, perceived to lead to lasting behavior change. Regarding the clinical context for the reward schedule, the use of biochemical testing, specifically fingerstick phosphatidylethanol testing, and the reward process were perceived to be engaging and gratifying for both staff and patients. Participants indicated that the intervention was enhanced by its co-location within the HIV clinic. Regarding facilitation, participants suggested addressing the intervention's feasibility for non-research use, simplifying the reward structure, and rewarding non-abstinence in alcohol use.

CONCLUSIONS

Among patients and staff involved in a clinical trial, CM was viewed as a helpful, positive, and feasible approach to addressing unhealthy alcohol use and related conditions. To enhance implementation, future efforts may consider simplified approaches to the reward structure and expanding rewards to non-abstinent reductions in alcohol consumption.

The Relationship of Alcohol to ART Adherence Among Black MSM in the U.S.: Is it Any Different Among Black MSM in the South?

Alcohol-using Black MSM (Men who have sex with men) are disproportionately impacted by HIV in the U.S.-particularly in the southern U.S.-despite the availability of antiretroviral therapy (ART). The purpose of this study was to summarize the current evidence on alcohol use and ART adherence among Black MSM in the U.S. and in the South and to identify future research needs. A systematic review was conducted using eight databases to identify relevant peer-reviewed articles published between January 2010 and April 2021. The authors also snowballed remaining studies and hand-searched for additional studies. Including both quantitative and qualitative studies, five published studies examined alcohol and ART adherence among Black MSM in the U.S. The search identified 240 articles, the study team reviewed 114 in full-text and determined that only five met the inclusion criteria. Three of the five included studies identified alcohol use as a barrier to ART adherence. In conclusions, the general lack of literature on HIV disparities among alcohol-using Black MSM in the U.S. (specifically in the South) indicates a critical need for research on this population's unique risks and needs to inform the development of tailored interventions.

Insomnia predicts treatment engagement and symptom change: a secondary analysis of a web-based CBT intervention for veterans with PTSD symptoms and hazardous alcohol use

Posttraumatic Stress Disorder (PTSD) and hazardous drinking are highly comorbid, and often more severe than PTSD or hazardous drinking alone. Integrated, web-based interventions for PTSD/hazardous drinking may increase access to care, but have demonstrated equivocal results in reducing PTSD and hazardous drinking. One factor that may explain treatment engagement and symptom change is the presence of insomnia symptoms. The current study conducted secondary data analysis of a randomized controlled trial of an integrated web-based intervention for PTSD symptoms and hazardous drinking to examine insomnia symptoms as predictors of PTSD symptoms, alcohol use, and treatment engagement. In the parent study, 162 veterans in primary care reporting PTSD symptoms and hazardous drinking were randomized to receive either the intervention or treatment as usual. The current study examined insomnia among veterans who received the intervention (n = 81). Regression models tested baseline insomnia symptoms as predictors of treatment engagement, follow-up PTSD symptoms, and alcohol use. Hierarchical regression models tested change in insomnia during treatment as a predictor of follow-up PTSD symptoms and alcohol use. Results showed baseline insomnia predicted treatment engagement and follow-up drinking days, but not PTSD symptoms or heavy drinking days. Although overall change in insomnia was small, it predicted follow-up PTSD and heavy drinking days, but not drinking days. Results are consistent with previous research highlighting the importance of identifying and treating insomnia in the course of integrated treatment for PTSD/hazardous drinking. Future research should investigate how to best integrate insomnia, PTSD, and/or hazardous drinking interventions to maximize treatment engagement.

Sex-related marijuana expectancies as predictors of sexual risk behavior following smoked marijuana challenge

Marijuana use has been associated with sexual risk behavior, but the mechanisms that underlie this relationship are not well understood. The present study examined whether marijuana acutely increased sexual risk on a behavioral decision-making task and whether sex-related marijuana outcome expectancies influenced sexual risk decisions after marijuana administration. Participants were heterosexual marijuana users (n = 126) who were randomly assigned to 1 of 4 study conditions using a 2 × 2 factorial design crossing drug administration (received 2.8% delta-9-tetrahydrocannabinol [THC] or 0% THC) with instructional set (told THC or told placebo). Participants completed a self-report measure of sex-related marijuana outcome expectancies at baseline and estimated likelihood of using condoms with a new and a steady partner in an interactive sexual role-play task (SRT) after smoking. In gender-specific analyses, there was a significant interaction of drug administration by sex-related outcome expectancies, such that for men in the received-placebo conditions, more salient sex-related marijuana outcome expectancies were associated with increased likelihood for sex without a condom with a new partner. Among women, there was no interaction or main effect of drug administration but more salient sex-related marijuana outcome expectancies were associated with increased likelihood of sex without a condom with a steady but not new partner. Findings suggest marijuana does not acutely increase risk for engaging in sexual risk behaviors. By contrast, sex-related marijuana outcome expectancies may play a more significant role in sexual decision-making process among marijuana users. (PsycINFO Database Record

Alcohol Policies and Suicide: A Review of the Literature

Both intoxication and chronic heavy alcohol use are associated with suicide. There is extensive population-level evidence linking per capita alcohol consumption with suicide. While alcohol policies can reduce excessive alcohol consumption, the relationship between alcohol policies and suicide warrants a critical review of the literature. This review summarizes the associations between various types of alcohol policies and suicide, both in the United States and internationally, as presented in English-language literature published between 1999 and 2014. Study designs, methodological challenges, and limitations in ascertaining the associations are discussed. Because of the substantial between-states variation in alcohol policies, U.S.-based studies contributed substantially to the literature. Repeated cross-sectional designs at both the ecological level and decedent level were common among U.S.-based studies. Non-U.S. studies often used time series data to evaluate pre-post comparisons of a hybrid set of policy changes. Although inconsistency remained, the published literature in general supported the protective effect of restrictive alcohol policies on reducing suicide as well as the decreased level of alcohol involvement among suicide decedents. Common limitations included measurement and selection bias and a focus on effects of a limited number of alcohol policies without accounting for other alcohol policies. This review summarizes a number of studies that suggest restrictive alcohol policies may contribute to suicide prevention on a general population level and to a reduction of alcohol involvement among suicide deaths.

Selection of film clips and development of a video for the investigation of sexual decision making among men who have sex with men

Experimental research on sexual decision making is limited, despite the public health importance of such work. We describe formative work conducted in advance of an experimental study designed to evaluate the effects of alcohol intoxication and sexual arousal on risky sexual decision making among men who have sex with men. In Study 1, we describe the procedures for selecting and validating erotic film clips (to be used for the experimental manipulation of arousal). In Study 2, we describe the tailoring of two interactive role-play videos to be used to measure risk perception and communication skills in an analog risky sex situation. Together, these studies illustrate a method for creating experimental stimuli to investigate sexual decision making in a laboratory setting. Research using this approach will support experimental research that affords a stronger basis for drawing causal inferences regarding sexual decision making.

The Veterans Aging Cohort Study: observational studies of alcohol use, abuse, and outcomes among human immunodeficiency virus-infected veterans

This article represents the proceedings of a symposium at the 2003 annual meeting of the Research Society on Alcoholism in Fort Lauderdale, FL. The organizers/chairs were Joseph Conigliaro and Amy Justice. The presentations were (1) Introduction, by Joseph Conigliaro and Tamra Madenwald; (2) Alcohol and HIV/AIDS: the importance of integrative and translational research, by Kendall Bryant; (3) Alcohol use and abuse among patients with HIV infection, by Joseph Conigliaro and Stephan Maisto; (4) Severity of comorbid alcohol use/abuse in HIV infection, by Amy Justice and Jeffrey Samet; (5) Estimating the impact of alcohol use on long-term HIV outcomes, by Scott Braithwaite and Amy Justice; (6) Homelessness, drug & alcohol use among HIV+ veterans, by Adam Gordon and Robert Cook; and (7) Hepatitis C & alcohol in the VACS 3 study, by Shawn Fultz and Kevin Kraemer. The symposium concluded with a discussion led and facilitated by Diedra Roach.