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Women with substance use disorders (SUDs) experience high rates of violence exposure and posttraumatic stress disorder (PTSD), which are associated with parenting anxiety and lower parenting satisfaction among mothers. Although social support may buffer the impact of violence and PTSD on parenting, violence exposure and PTSD may impair mothers' ability to create, perceive, and utilize social support. We examined the impact of violence exposure, trauma symptoms, and interpersonal support on parenting competence among 291 mothers with substance dependence, using ordinary least squares regression and path analysis. Greater violence exposure and trauma symptoms were associated with lower parenting competence. Greater interpersonal support was associated with greater parenting competence. Trauma symptoms and interpersonal support sequentially mediated the impact of violence exposure on parenting competence, suggesting one pathway through which violence exposure may affect parenting among substance-dependent mothers. Implications for practice include the need to utilize trauma-informed interventions that modify social support.

Introduction: A blended learning continuing education course may appeal to busy healthcare professionals because the primary content can be learned online while an in-person component can hone clinical skills. The current study assessed knowledge retention in a sample of healthcare professionals who participated in a nationwide sexual assault forensic examiner blended learning course (12-week online course and 2-day in-person patient simulation)., Methods: Participants' characteristics, motivation, and external barriers were collected through a precourse web-based survey. Participants' knowledge was assessed through pretests and posttests for 12 modules and a 3-month postcourse examination. Utilizing repeated measures analysis of variance, the study examined whether participants retained their knowledge at the 3-month follow-up point. Multiple linear regression was utilized to explore the factors associated with knowledge retention., Results: The results found a knowledge score from 77.92% to 68.83% correct. The findings indicate that participants who were interested in the blended learning course because of the 2-day patient simulation were more likely to retain knowledge. Learners with more years of experience also had slightly higher knowledge retention. Conversely, participants who were interested in becoming a sexual assault forensic examiner because of a sexual assault experience had lower knowledge retention. Participation in a past online course also was associated with a reduction in knowledge retention., Discussion: The findings indicate a modest knowledge loss 3 months after the blended learning course. Still, some participants experienced less knowledge retention than others. Postcourse activities such as a brief refresher course may be useful to help these participants maintain their knowledge gains.

Background: Cannabis policy is rapidly evolving in the United States as more states legalize medical and non-medical marijuana. Public opinion has shifted dramatically in favor of marijuana legalization., Objectives: This study examines the reasons that people support, oppose, or are unsure about marijuana legalization, focusing on the participants' own words., Methods: A statewide sample of adults (N = 2,608) in Michigan completed an online survey about marijuana legalization (August and September 2016). Participants indicated whether they supported, opposed, or were unsure about marijuana legalization, and were then prompted to complete an open-ended response explaining the main reasons for their view. Thematic analysis was then used to code the open-ended responses (n = 2,054) and analytic induction was used to evaluate the coding., Results: 48.1% of the sample supported cannabis legalization, 41.9% were opposed to legalization, and 10% were unsure. Harms associated with marijuana use were the most commonly given reasons for opposing legalization. Those who supported legalization were most likely to state that marijuana is less dangerous than other substances and has medical benefits. They also cited criminal justice reform and the potential for tax revenue as potential benefits of legalization. Reasons for supporting and opposing legalization differed based on gender, age, and recent marijuana use. Conclusions/Importance: Findings highlight nuances in public attitudes toward cannabis legalization. Many who support cannabis legalization recognize some potential negative consequences of these policy changes. Understanding views of cannabis is important as policies for marijuana use and sales become less restrictive.

Background: Although beneficial, few sexual assault patients seek follow-up healthcare or counseling after a medical forensic examination. Mobile technology interventions may help patients engage in postcare, but there is a dearth of research on patients' utilization of these interventions. The current study examines patients' engagement with a 4-week postassault text message program (iCare), which assessed patients' safety and well-being, if they needed assistance with accessing nonoccupational postexposure prophylaxis, or scheduling appointments for follow-up pregnancy and sexually transmitted infection testing, and their experience with the criminal justice system., Methods: This pilot study collected data from 40 adult patient records and texting communications between the nurse and patients. We utilized descriptive statistics to examine patient utilization of the program., Results: Sixty-five percent of the patients responded at least once during the program, but only two responded to every text. Nearly a quarter of the patients (22.5%) requested the texts to stop before the end of the program. A larger portion of the patients (42.5%) did not opt out but stopped replying by the third message. The program appeared to be helpful for increasing the amount of communication between the nurse and the patient, but patients rarely utilized the nurse's offers of assistance (e.g., counseling, advocacy)., Discussion: Text interventions appear to be effective for relaying information but may be limited for increasing postexamination service utilization for sexual assault patients. Future research should examine areas of patient needs in the weeks and months postexamination that can be addressed in text interventions.

Introduction: Participant attrition is a major concern for online continuing education health care courses. The current study sought to understand what factors predicted health care professionals completing the online component of a sexual assault forensic examiner (SAFE) blended learning training program (12-week online course and 2-day in-person clinical skills workshop)., Methods: The study used a Web-based survey to examine participant characteristics, motivation, and external barriers that may influence training completion. Hierarchical logistic regression was utilized to examine the predictors of training completion, while the Cox proportional hazards (Cox PH) regression model helped determine the factors associated with the timing of participant attrition., Results: Results show that 79.3% of the enrolled professionals completed the online component. The study also found that clinicians who work in rural communities and those who were interested in a 2-day clinical skills workshop were more likely to complete the online course. In terms of when attrition occurred, we found that participants who were motivated by the 2-day clinical workshop, those who worked in a rural community, and participants interested in the training program because of its online nature were more likely to complete more of the online course., Discussion: Blending an online course with a brief in-person clinical component may serve as a motivator for completing an online course because it provides the opportunity to develop clinical skills while receiving immediate feedback. Participant attrition appears to be less of a concern for rural clinicians because this modality can reduce their barriers to accessing continuing education., (© 2015 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.)

Aims: To examine the efficacy of a brief intervention delivered by a therapist (TBI) or a computer (CBI) in preventing cannabis use among adolescents in urban primary care clinics., Design: A randomized controlled trial comparing: CBI and TBI versus control., Setting: Urban primary care clinics in the United States., Participants: Research staff recruited 714 adolescents (aged 12-18 years) who reported no life-time cannabis use on a screening survey for this study, which included a baseline survey, randomization (stratified by gender and grade) to conditions (control; CBI; TBI) and 3-, 6- and 12-month assessments., Measurements: Using an intent-to-treat approach, primary outcomes were cannabis use (any, frequency); secondary outcomes included frequency of other drug use, severity of alcohol use and frequency of delinquency (among 85% completing follow-ups)., Findings: Compared with controls, CBI participants had significantly lower rates of any cannabis use over 12 months (24.16%, 16.82%, respectively, P < 0.05), frequency of cannabis use at 3 and 6 months (P < 0.05) and other drug use at 3 months (P < 0.01). Compared with controls, TBI participants did not differ in cannabis use or frequency, but had significantly less other drug use at 3 months (P < 0.05), alcohol use at 6 months (P < 0.01) and delinquency at 3 months (P < 0.01)., Conclusions: Among adolescents in urban primary care in the United States, a computer brief intervention appeared to prevent and reduce cannabis use. Both computer and therapist delivered brief interventions appeared to have small effects in reducing other risk behaviors, but these dissipated over time., (© 2013 Society for the Study of Addiction.)

Background: Polysubstance use during adolescence is a significant public health concern. However, few studies have investigated patterns of substance use during this developmental window within the primary care setting., Objectives: This study used an empirical method to classify adolescents into substance use groups, and examines correlates of the empirically defined groups., Methods: Data came from patients, ages 12-18 years, presenting to an urban, primary care community health clinics (Federally Qualified Health Centers) in two cities in the Midwestern United States (n = 1664). Latent class analysis (LCA) was used to identify classes of substance users. Multinomial logistic regression was used to examine variables associated with class membership., Results: LCA identified three classes: class 1 (64.5%) exhibited low probabilities of all types of substance use; class 2 (24.6%) was characterized by high probabilities of cannabis use and consequences; and class 3 (10.9%) had the highest probabilities of substance use, including heavy episodic drinking and misuse of prescription drugs. Those in class 2 and class 3 were more likely to be older and have poorer grades, poorer health, higher levels of psychological distress and more sexual partners than those in class 1. Individuals in class 3 were also less likely to be African-American than those in class 1., Conclusion: Findings provide novel insight into the patterns of substance use among adolescents presenting to low-income urban primary care clinics. Future research should examine the efficacy of interventions that address the complex patterns of substance use and concomitant health concerns among adolescents.

Aims: This paper describes outcomes from a randomized controlled trial examining the efficacy of brief interventions delivered by a computer (CBI) or therapist (TBI) among adolescents in urban primary care clinics., Methods: Patients (ages 12-18) self-administered a computer survey. Adolescents reporting past year cannabis use completed a baseline survey and were randomized to control, CBI or TBI, with primary (cannabis use, cannabis related consequences - CC) and secondary outcomes [alcohol use, other drug use (illicit and non-medical prescription drugs), and driving under the influence of cannabis (DUI)] assessed at 3, 6, and 12 months., Results: 1416 adolescents were surveyed; 328 reported past year cannabis use and were randomized. Comparisons of the CBI relative to control showed that at 3 months the group by time interaction (G × T) was significant for other drug use and CC, but not for cannabis use, alcohol use, or DUI; at 6 months, the G × T interaction was significant for other drug use but not for cannabis use, alcohol use, or CC. For analyses comparing the TBI to control, at 3 months the G×T interaction was significant for DUI, but not significant for cannabis use, alcohol use, or CC; at 6 months, the G×T interaction was not significant for any variable. No significant intervention effects were observed at 12 months., Conclusion: Among adolescent cannabis users presenting to primary care, a CBI decreased cannabis related problems and other drug use and a TBI decreased cannabis DUI in the short-term. Additional boosters may be necessary to enhance these reductions over time., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Despite efforts that have been made to develop and evaluate psychosocial interventions for youth with bipolar spectrum disorders (BPSDs), there has been limited evidence regarding treatment delivery and consumer experiences in clinical settings. Two parallel web-based surveys were conducted to assess clinicians' experiences with providing psychosocial treatments to youth with BPSD, and caregivers' experiences with accessing and receiving care for their youth with BSPD. Clinicians who were members of the American Psychological Association's Division 53 listserv were invited to report on (1) their training in and knowledge of BPSD among youth; (2) types of treatments they had provided and their perceived effectiveness; (3) treatment-related challenges; and (4) further training opportunities or resources they desire. Caregivers who were members of the Balanced Mind Foundation listserv were invited to participate in a separate survey. They were asked to report on both negative and positive experiences they had in their most recent experience with accessing and receiving psychosocial treatment for their youth with BPSD. Overall, the majority of clinician respondents reported receiving training in providing psychosocial treatments to youth with BPSD, though most reported desiring further training and greater access to resources (e.g., treatment manuals, workshops, case consultation). Caregivers indicated overall positive experiences with psychosocial treatments for their youth with BPSD. Positive experiences included those associated with nonspecific factors of therapy, and negative experiences included content-related factors and barriers to accessing treatments. Implications for enhancing treatment delivery and overall experience of psychosocial interventions among youth with BPSD are discussed.

Purpose: Data regarding sexual risk behaviors among adolescent patients presenting to urban emergency departments (EDs) are lacking. This article describes rates and correlates of sexual risk behaviors among adolescents screened in an urban ED., Methods: During a period of 1-year, a total of 1,576 patients aged 14-18 years, self-administered a computerized survey (57.6% female, 59.3% African American)., Results: Among sexually active adolescents (60%), 12% reported four or more partners; of those, 45.3% reported using a condom all the time and 14.7% reported using substances before sex. Regression analyses examined correlates of sexual risk behaviors on the basis of demographics, violence, and substance use. Males and younger teens were more likely to report condom use than females and older teens. Participants with poor grades were more likely to have had sex and used substances before sex, and were less likely to report condom use. Participants reporting dating violence were more likely to have had sex and less likely to have used condoms, whereas participants reporting peer violence and weapon carriage were more likely to report substance use before sex. Binge drinking and marijuana use were associated with all sex risk behaviors., Conclusions: The visit to an urban ED may provide an opportunity to deliver interventions to address sexual risk behaviors among adolescents., (Copyright © 2011 Society for Adolescent Health and Medicine. All rights reserved.)

Background: A web-based survey was developed to explore the effect of pharmacological and non-pharmacological interventions for sleep difficulties associated with Early-Onset Bipolar Spectrum Disorders (EBSD)., Method: Four hundred ninety four parents of 4-12 year-olds, identified by parents as being diagnosed with EBSD, provided information about which professionals were consulted regarding their child's EBSD-sleep problems and pharmacological and non-pharmacological interventions that helped or worsened sleep., Results: Most parents reported consulting at least one medical, mental health, and/or school professional regarding their child's sleep problems. Psychiatrists and other physicians were most often consulted. The majority of parents reported several medications/supplements as helpful, most commonly, atypical antipsychotics (54.4%). Over half identified various pharmacological agents that worsened sleep, most commonly, stimulants (35.0%). Most parents also reported several non-pharmacological interventions that aided sleep problems, most frequently, a sleep routine. Over two-thirds reported a variety of non-pharmacological interventions that worsened sleep, most notably, punishment (34.8%)., Limitations: The sample was non-random consisting of self-selected and web-savvy parents who self-identified their children as having EBSD and provided only parent derived data., Conclusions: Although exploratory and despite limitations, this is the first survey to report data on both pharmacological and non-pharmacological treatments for EBSD-sleep problems. It highlights clinical interventions that may improve or worsen EBSD-sleep and provides directions for future research.

This article is intended to provide parents perspective on bipolar disorder in children and adolescents as is gathered from the experience of countless parents who participate in the activities of the organization known as the Child & Adolescent Bipolar Foundation (CABF; www.bpkids.org).

Objective: As research on sleep difficulties associated with Early-Onset Bipolar Spectrum Disorders (EBSD) is limited, a web-based survey was developed to further explore these problems., Methods: 494 parents of 4-to-12 year-olds, identified by parents as being diagnosed with EBSD, completed a web survey about past and current EBSD-related sleep problems. The survey included Children's Sleep Habits Questionnaire (CSHQ) items and sleep problems from the International Classification of Sleep Disorders 2nd edition., Results: Nearly all parents reported some type of past or current EBSD-sleep problem. Most occurred during a worst mood period, particularly with mixed manic-depressive symptoms. Symptoms caused impairments at home, school, or with peers in 96.9% of the sample and across all three contexts in 64.0% of children. Sleep problems were also noted after three-day weekends and Spring and Fall Daylight Savings time changes., Conclusions: Findings, study limitations, and implications for treatment and etiology are discussed.