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In 2009, 'Don't forget the children' guideline recommended that all new HIV-positive patients attending adult HIV services should have any existing children identified and tested for HIV alongside a coherent documentation process. A retrospective case note review was performed on 173 HIV-positive women registered at the Royal South Hants adult HIV service until 31 January 2014. Data were assessed as a whole (n = 173) and, in addition, two comparator groups were formulated: (a) pre-guidelines (n = 108) and (b) post-guidelines (n = 65). Out of 80 children eligible for HIV testing, only 43 (54%) had clear documentation of a test result, and in the remaining 37 (46%), it was either not considered or not followed through. Documentation of need for testing increased significantly from 67% in pre-guideline group to 100% in the post-guideline group (p < 0.001). The median time from recognition of need to test to actual testing remained 24 months in both groups. Although this audit demonstrated improvement in identification of at-risk children and their testing, there is still need for improvement. [ABSTRACT FROM AUTHOR]

PURPOSE: This study evaluated whether diabetes patients with depressive symptoms are more likely than other diabetes patients to report symptoms of glucose dysregulation, and whether this relationship is mediated by the impact of depressive symptoms on patients' adherence to their diabetes self-care regimen. METHODS: Participants were English- and Spanish-speaking adults with type 2 diabetes. Interviewers assessed participants' depressive symptoms and diabetes-related symptoms at baseline. Self-care behaviors and diabetes symptoms were measured at a 1-year follow-up. Structural equation models were used to determine whether depression affected diabetes symptoms by limiting patients' ability to adhere to self-care recommendations. RESULTS: An initial model identified direct effects of baseline depressive symptoms on self-care and diabetes symptoms at follow-up. The relationship between self-care behaviors and physical symptoms of poor glycemic control were assessed using a second model. Results explained the relationship between depressive symptoms at baseline and diabetes symptoms at 1 year. CONCLUSIONS: Depressive symptoms impact subsequent physical symptoms of poor glucose control by influencing patients' ability to adhere to their self-care regimen. More aggressive management of depression among patients with diabetes may improve their physical health as well as their mental health. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to identify and elucidate the differences between highly affiliated and low/non-affiliated participants in Alcoholics Anonymous (AA) meetings. Methods: A qualitative study of 24 participants was conducted in Romania between March and June 2021. Data were collected by means of in-depth interviews. Thematic analysis was used to obtain a comprehensive synthesis of the data collected. Findings: Highly affiliated individuals are those who identify themselves as AA members, are sober, have worked the 12 Steps, are satisfied with their lives, experience a state of well-being, accept the Higher Power, have hit the bottom, have a strong desire for abstinence, attend AA meetings on a regular basis, and are committed to both AA and their sobriety. Conclusion: Although there are common themes among both highly and low/non-affiliated individuals, the results suggest that addiction specialists should pay more attention to organisational commitment, spirituality, well-being and addiction-related concepts as it seems some of them may determine successful AA affiliation, while others may reflect on recovery outcomes. These findings could prove useful to motivate individuals who struggle with alcohol addiction and are reluctant in joining AA, since high AA affiliation is associated with a wide range of recovery benefits. [ABSTRACT FROM AUTHOR]

Background: Opioid overdoses decrease when communities have access to naloxone. Clinicians play a key role in offering naloxone to high-risk chronic opioid patients. Managed care pharmacists within our health plan noted disproportionate processing for claims of opioid utilizers compared to claims of naloxone prescriptions. Objective: To increase naloxone access and prescribing to members who classify at a dosage with a higher risk for opioid overdose, defined as over 90 morphine milligram equivalents (MME). Methods: Multiple system-wide initiatives were implemented to improve naloxone access. A claims file was pulled monthly to identify members on opioids meeting MME criteria >90 MME per day excluding members with cancer, sickle cell disease, or on hospice. A separate report was then matched to naloxone claims and prescribing percentages calculated. Results: 12 444 utilizing members on opioids were identified from June 2019 prescription claims data. Of these, 131 were on opioids exceeding 90 MME per day, or 1.05% of utilizers, and the percentage of members exceeding 90 MME per day prescribed naloxone was 6.87%. By May 2023, the percentage of opioid utilizers exceeding 90 MME per day decreased to 0.58%. Naloxone prescribing increased to 41.18%. Conclusion: A multi-pronged approach to improve access to naloxone and continued educational efforts by our health plan increased naloxone prescribing in members on opioids exceeding 90 MME per day. [ABSTRACT FROM AUTHOR]

Background: Unhealthy alcohol use is one of the leading preventable causes of mortality in the U.S. Despite evidence of the growing burden of alcohol-associated mortality and disease, treatment is severely underutilized. Prior literature has often focused on assessing treatment among patients with severe alcohol use. Objectives: Assess factors associated with uptake of treatment for alcohol use among a broad population of those regularly exceeding U.S. guidelines for alcohol use. Design: Cross-sectional study. Methods: Using data from the National Epidemiologic Survey on Alcohol and Related Conditions – Wave III (NESARC-III) collected April 2012 to June 2013, weighted descriptive statistics were used to describe the U.S. population who self-reported regularly exceeding U.S. guidelines for moderate alcohol use at least monthly. Weighted multivariable regression was used to assess the association of individual-level factors with receipt of help for unhealthy alcohol use. Results: In weighted analyses of 6467 NESARC-III participants, 17% of the U.S. population reported regular engagement in unhealthy alcohol use (76% use exceeding guidelines, 14% binge drinking, 11% heavy drinking) and were predominantly male (62%), below age 65 (93%), non-Hispanic White (65%), and had lower levels of education and income. Half (53%) met criteria for alcohol use disorder. Only 5% reported receipt of help for their alcohol use. Compared to non-Hispanic White individuals, non-Hispanic Asian/Native Hawaiian or Other Pacific Islander (odds ratio [OR] 0.40, 95% confidence interval [CI] 0.18-0.90) and non-Hispanic Black (OR 0.68, 95% CI 0.48-0.96) individuals were less likely to receive help for alcohol use. Factors associated with greater receipt of help included being older, educational attainment, Medicaid insurance, concomitant drug use, liver disease, acute healthcare utilization, and greater alcohol-related problems. Conclusion: Identification of the factors associated with receipt of alcohol-related treatment, including race and ethnicity, age, education, insurance, and drug use can inform interventions to increase treatment receipt. [ABSTRACT FROM AUTHOR]

School nurses are critical components of school-based interdisciplinary teams supporting student behavioral health. The purpose of the present study is to understand the extent to which school nurses in New Mexico across grade levels manage emergencies related to behavioral health, violence, and trauma. The study also seeks to identify which topics the school nurses received continuing education (CE) for, and which topics they consider to be important to their practice. Analyses of 2019 statewide survey data show a considerable number of school nurses in New Mexico provide management for behavioral health, violence, and trauma-related emergencies, and nurses in secondary schools are significantly more likely than nurses in primary schools to report managing these emergencies and to have received CE on behavioral health topics. Our findings reaffirm the essential role of school nurses in addressing emergent student health issues and underscore the need for practice- and competency-based behavioral health CE opportunities. [ABSTRACT FROM AUTHOR]

Introduction: In-person cognitive behavioral therapy (CBT) can reduce self-reported anxiety in older adults. However, studies are limited for remote CBT. We assessed the effectiveness of remote CBT in mitigating self-reported anxiety in older adults. Methods: We conducted a systematic review and meta-analysis based on a literature search of PubMed, Embase, PsycInfo, and Cochrane databases up to March 31, 2021, for randomized controlled clinical trials comparing the effectiveness of remote CBT versus non-CBT controls on mitigating self-reported anxiety in older adults. We calculated within-group pre-to-post-treatment standardized mean difference using Cohen's d, obtained the difference between a remote CBT group and a non-CBT control group as our effect size for cross-study comparison, and conducted a random-effects meta-analysis. Changes in scores on self-reported anxiety symptoms (Generalized Anxiety Disorder-7 item Scale, Penn State Worry Questionnaire, or Penn State Worry Questionnaire – Abbreviated), and self-reported depressive symptoms (Patient Health Questionnaire-9 item Scale or Beck Depression Inventory) were primary and secondary outcomes, respectively. Results: Six eligible studies, containing 633 participants with a pooled mean age of 66.6 years, were included in the systematic review and meta-analysis. There was a significant mitigating effect of intervention on self-reported anxiety, favoring remote CBT over non-CBT controls (between-group effect size: −0.63; 95% CI: −0.99 to −0.28). We also found a significant mitigating effect of intervention on self-reported depressive symptoms (between-group effect size: −0.74; 95% CI: −1.24 to −0.25). Discussion: Remote CBT is more effective in reducing self-reported anxiety and depressive symptoms than non-CBT control in older adults. [ABSTRACT FROM AUTHOR]

This study assesses the development of proactive control strategies in 100 Syrian refugee families (394 individuals) with 6- to 18-year-old children currently living in Turkish communities. The results demonstrate that children's age and their mothers' post-traumatic stress symptoms were associated with the degree of proactive control in their children, with worse mental health being associated with a larger reliance on reactive control and lesser reliance on proactive, future-oriented, control (measured via d′ in the AX-CPT task). None of the following factors contributed to children's performance: fathers' experience with post-traumatic stress, parents' exposure to potentially traumatic war-related events, perceived discrimination, a decline in socio-economic status, religious beliefs, parents' proactive control strategies, or the education or gender of the children themselves. The association between mothers' mental health and proactive control strategies in children was large (in terms of effect size), suggesting that supporting mothers' mental health might have clear effects on the development of their children. [ABSTRACT FROM AUTHOR]

During early adolescence, individuals can refine their use of cognitive reappraisal as an emotion regulation strategy while experiencing instability of psychological well-being through changes to positive affect, negative affect and life satisfaction. This scoping review aimed to identify and summarise the key findings from studies that have examined early adolescent cognitive reappraisal and psychological well-being. Using Arksey and O'Malley's scoping review methodology, this review yielded 63 studies; 58 studies found a positive relationship between cognitive reappraisal and psychological well-being. Most studies that examined age found no association between the frequency of reappraisal use and age. Findings connected to sex differences and contrasts between discrete emotions were inconsistent. The positive association between cognitive reappraisal and well-being indicates that cognitive reappraisal should be actively promoted in youth contexts. Future research should specify the direction of this relationship, how it develops and how effective the relationship is across sexes and discrete emotions. [ABSTRACT FROM AUTHOR]

We explored the intergenerational transmission effects of maternal adverse childhood experiences (ACEs) and infant neglect from multiple perspectives. The study included a sample of postpartum mothers and infants (N = 550) from the outpatient child health care department of a tertiary hospital in Jinan, Shandong Province, China. Our investigation followed three main lines of inquiry. First, the association of overall maternal ACEs with infant neglect was estimated. Secondly, the cumulative and independent effects of maternal ACEs on infant neglect were explored using the Adverse Childhood Experience Questionnaire-Revised (ACEQ-R) with 14 types of ACEs. Finally, the different patterns of 14 maternal ACEs were identified, and the association between the different patterns and infant neglect was explored. There were three main findings. First, infants born to mothers with ACEs experienced higher levels of neglect compared to those born to mothers without ACEs. Second, infants born to mothers with three or more subtypes of ACEs experienced the greatest levels of neglect, with maternal childhood physical neglect emerging as a particularly influential factor. Third, infants in the "median maternal ACEs" and "high maternal neglect and poor peer relationship" groups experienced more severe neglect than those in the "low maternal ACEs" group. These results suggest that early life experiences substantially shape future parenting behaviors, such as infant neglect. [ABSTRACT FROM AUTHOR]

Background: Recent research found that the COVID-19 pandemic and the measures to contain it had a largely negative impact on well-being. In addition, a vast number of studies have shown significantly increased levels of traumatization and behavioural problems amongst URM, pointing out the vulnerability of this population. This study aimed at evaluating both the adaptive functioning and life satisfaction of URM, as well as the impact of the COVID-19 pandemic on life satisfaction. Methods: 101 URM completed the questionnaires. Results: URM had higher levels of trauma symptoms (t(100) = 8.69; p <.001) and more behavioural problems (t(100) = 6.83; p <.001) as compared to Belgian peers. Nevertheless, we did find higher levels of resilience (t(100) = 2.33; p <.05) amongst our sample. In addition, the COVID-19 pandemic negatively impacted both experiences and satisfaction across all life domains. Conclusions: These findings all point out that the development of URM is at risk even after arrival in the host country and that the likelihood of mental health problems is high also in the host country. Offering professional mental healthcare and facilitating social bonds and integration is important. In addition, given the negative impact of the COVID-19 pandemic on wellbeing, extra attention and support should go out to more vulnerable populations, such as URM, during times of (inter)national crisis. [ABSTRACT FROM AUTHOR]

Objectives: This study investigates the associations between five types of childhood interpersonal trauma (CIT) and depression in mid-later life, as well as the mediation roles of social integration in the associations. Methods: Two waves of data from a nationally representative survey in China were used, with participants aged 45 years and older (N = 14,180). Measures of CIT included physical abuse, physical neglect, emotional neglect, bullying victimization, and exposure to interparental violence. Binary logistic regression and Karlson–Holm–Breen mediation analysis were used as statistical methods. Results: People who were bullied, physically abused, and witnessed interparental violence during childhood were more likely to develop depression in mid-later years. The associations between CIT and depression were mediated by satisfaction with marriage, satisfaction with children, and perceived social support. Discussion: Although CIT elevates the risk of depression in later life, effective interventions that strengthen integration across family and social domains could benefit mental health. [ABSTRACT FROM AUTHOR]

During COVID and lockdown, many prisoners have not only been affected by infection transmission in crowded and ill-equipped institutions, they have also been separated from a range of supports, including loss of family and professional supports and support for prisoners with addiction and/or mental health problems has been disrupted. This paper reports on evidence of how peer-based recovery organizations have attempted to mitigate these adverse effects, based on a case study of one prison in the North-West of England, using a range of routine reporting data and original research data. The paper shows how prison-based peer recovery support has not only continued through lockdown but grown both in the prison and in continuing care on release. The key conclusion is that Lived Experience Recovery Organizations (LEROs) have a vital role to play in offering continuing care to prison populations both to support early recovery and to sustain change around release back into the community, in COVID but also more generally. [ABSTRACT FROM AUTHOR]

Quiet ego is a relatively novel, increasingly studied, multi-dimensional concept characterized by a compassionate, interdependent worldview and an adaptive balance between self-interest and concern for others. Quiet ego has been associated with a range of characteristics that can promote relationship quality, responding effectively in the face of challenges, and greater well-being. However, it is currently unknown to what extent quiet ego translates across cultures and settings. The present research leverages cultural and organizational theories to evaluate the conceptual and structural validity of quiet ego for Latinx/Hispanic individuals in the U.S. and to examine relationships among quiet ego, work supervisor relationship quality, and goals in the workplace. Employed college student participants (n = 831; nLatinx/Hispanic = 305) completed an online survey, and collected data were subjected to confirmatory factor analysis and path analysis. Findings confirmed the overall structural model of quiet ego with four primary dimensions (perspective taking, inclusive identity, detached awareness, and growth-mindedness) and indicated that this structure did not differ between Latinx/Hispanic and non-Latinx/Hispanic subsamples. Further, results cohered with the proposed model suggesting that quiet ego might facilitate relationship quality with a workplace supervisor, which, in turn could foster balanced, intrinsically motivating perceptions that one's work goals benefit both oneself and others (mutual gain motivation). The study suggests that quiet ego may be a construct with meaning and utility in Latinx/Hispanic populations and in employment settings. However, further research is needed, and specific suggestions for future study are discussed. [ABSTRACT FROM AUTHOR]

With the widespread use of masks in the COVID-19 pandemic, it is crucial to understand how emotion recognition is affected by partial face covering. Since individuals with autism spectrum condition often tend to look at the lower half of the face, they are likely to be particularly restricted in emotion recognition by people wearing masks, since they are now forced to look at the upper half of the face. This study compared the recognition of basic and complex emotions in individuals with and without autism spectrum condition, when faces were presented uncovered, with face masks, or with sunglasses. We also used eye tracking to examine group differences in gaze patterns during emotion recognition. Individuals with autism spectrum condition were less accurate at recognizing emotions in all three conditions. Averaged across the three stimulus types, individuals with autism spectrum condition had greater difficulty recognizing anger, fear, pride, and embarrassment than control group. There was no group difference in emotion recognition between the three conditions. However, compared to individuals without autism spectrum condition, there was no evidence of either gaze avoidance or preference for the mouth region. Our results suggest that emotion recognition is reduced in individuals with autism spectrum condition, but this is not due to differences in gaze patterns. In the COVID-19 pandemic, wearing face masks became mandatory to prevent the spread of the virus. However, they restrict the ability to recognize emotions to the upper part of the face. Since individuals with autism spectrum condition often tend to look at the lower half of the face, they may be particularly restricted in emotion recognition by people wearing masks, since they are now forced to look at the upper half of the face. The current study compared the recognition of facially expressed emotions between individuals with and without autism spectrum condition. Each photo was shown in three types, once uncovered, once with face mask, and once with sunglasses. Our results revealed a reduction in accuracy of individuals with autism spectrum condition at recognizing emotions in all three stimulus types and exhibited more difficulties distinguishing anger, fear, pride, and embarrassment. During the emotion recognition task, there was no difference in which facial areas the groups looked at. We did not find evidence that the disadvantages of individuals with autism spectrum condition in emotion recognition were due to looking at different areas of the face. [ABSTRACT FROM AUTHOR]

Background: A risk-stratified breast screening program could offer low-risk women less screening than is currently offered by the National Health Service. The acceptability of this approach may be enhanced if it corresponds to UK women's screening preferences and values. Objectives: To elicit and quantify preferences for low-risk screening options. Methods: Women aged 40 to 70 y with no history of breast cancer took part in an online discrete choice experiment. We generated 32 hypothetical low-risk screening programs defined by 5 attributes (start age, end age, screening interval, risk of dying from breast cancer, and risk of overdiagnosis), the levels of which were systematically varied between the programs. Respondents were presented with 8 choice sets and asked to choose between 2 screening alternatives or no screening. Preference data were analyzed using conditional logit regression models. The relative importance of attributes and the mean predicted probability of choosing each program were estimated. Results: Participants (N = 502) preferred all screening programs over no screening. An older starting age of screening, younger end age of screening, longer intervals between screening, and increased risk of dying had a negative impact on support for screening programs (P < 0.01). Although the risk of overdiagnosis was of low relative importance, a decreased risk of this harm had a small positive impact on screening choices. The mean predicted probabilities that risk-adapted screening programs would be supported relative to current guidelines were low (range, 0.18 to 0.52). Conclusions: A deintensified screening pathway for women at low risk of breast cancer, especially one that recommends a later screening start age, would run counter to women's breast screening preferences. Further research is needed to enhance the acceptability of offering less screening to those at low risk of breast cancer. Highlights: Risk-based breast screening may involve the deintensification of screening for women at low risk of breast cancer. Low-risk screening pathways run counter to women's screening preferences and values. Longer screening intervals may be preferable to a later start age. Work is needed to enhance the acceptability of a low-risk screening pathway. [ABSTRACT FROM AUTHOR]

Background: Chronic cough (CC) affects about 10% of adults, but opioid use in CC is not well understood. Objectives: To determine the use of opioid-containing cough suppressant (OCCS) prescriptions in patients with CC using electronic health records. Design: Retrospective cohort study. Methods: Through retrospective analysis of Midwestern U.S. electronic health records, diagnoses, prescriptions, and natural language processing identified CC – at least three medical encounters with cough, with 56–120 days between first and last encounter – and a 'non-chronic cohort'. Student's t -test, Pearson's chi-square, and zero-inflated Poisson models were used. Results: About 20% of 23,210 patients with CC were prescribed OCCS; odds of an OCCS prescription were twice as great in CC. In CC, OCCS drugs were ordered in 38% with Medicaid insurance and 15% with commercial insurance. Conclusion: Findings identify an important role for opioids in CC, and opportunity to learn more about the drugs' effectiveness. [ABSTRACT FROM AUTHOR]

This study used the National Survey on Drug Use and Health to assess a nationally representative sample (N = 4596) weighted to represent 35.2 million adults with DSM-5 criteria-determined substance use disorders (SUDs). This study explored substance use treatment utilization in 2020, emphasizing populations with high vulnerability (e.g., criminal justice involvement (CJI) through parole or probation, polysubstance use, severe mental illness, and HIV/STI). Substance use treatment was broadly defined (any inpatient, outpatient/doctor's office, self-help/other for alcohol/drugs). Our results indicated that among adults with SUDs in 2020, 7 million (20%) had multiple SUDs, 1.75 million (5%) had CJI, 5.3 million (15%) had a severe mental illness, and 1.8 million (5%) had a diagnosis of HIV/STI in the last year. Only 7% of individuals with SUD sought any substance use treatment in the past year. CJI (aOR: 13.39, 95% CI: [7.82, 22.94]), serious mental illness (aOR: 3.27, 95% CI: [1.93, 5.55]), and having both 2 (aOR: 2.10, 95% CI: [1.29, 3.42]) or 3 or more SUDs (aOR: 3.46, 95% CI: [1.82, 6.58]) were all associated with a greater likelihood of receiving treatment. Marriage (aOR: 0.43, 95% CI: [0.25, 0.74]) and having an income twice the poverty threshold (aOR: 0.53, 95% CI: [0.29, 0.94]) were associated with reduced odds of receiving any substance use treatment. Compared to those 18 to 25, older individuals had increased odds (2-4 times) of receiving treatment. Interventions are crucially needed to increase access to treatment among those with SUDs. [ABSTRACT FROM AUTHOR]

Aim: This exploratory study analyses the interplay between the treatment philosophies of Alcoholics Anonymous (AA) and Relapse Prevention (RP) in personal stories of addiction. While the basic ideas of AA and RP are compatible in many ways, they also carry some fundamental differences. Methods: The data consisted of interviews with 12 individuals recovering from substance use problems, who had experience of both AA and RP. The analysis drew on a dialogical narrative perspective, and the concept polyphony was used to shed light on the interplay between different treatment philosophies in personal stories of relapse. Findings: Although sometimes resulting in incoherence, the treatment philosophies were combined idiosyncratically, in ways that appeared productive for the participants' self-images and recovery journeys. Conclusion: The combination of AA and RP philosophies in narratives of relapse and recovery may reflect a new treatment discourse where individualisation and responsibilisation stand in a complicated relationship with collectivism and surrendering to so-called addicting processes. [ABSTRACT FROM AUTHOR]

Significant morbidity and mortality from COVID-19-related illnesses have been observed among people of color within the United States. While theories involving healthcare inequity and political division have emerged to explain this observation, the role of chronic stress and inflammation is also being explored. Toxic stress is experienced disproportionately by race, ethnicity, and socioeconomic status and increases frailty and vulnerability to diseases such as COVID-19. C-reactive protein (CRP) is a biomarker associated with the inflammatory response that is typically elevated due to exposure to acute or chronic traumatic stress, as well as COVID-19. This study explored the relationship between CRP and Hispanic/non-Hispanic ethnicity among adults hospitalized with COVID-19 via a secondary analysis of retrospective electronic health record (EHR) data collected from a community healthcare system in Southern California. A total of 1,744 cases representing hospitalized adults with COVID-19 were reviewed. Data were extracted from the EHR to reflect demographics, medical diagnoses, medications, CRP, and comorbidity burden. Frequencies, percentages, and measures of central tendency were assessed to understand the distribution of data. Associations were conducted using Pearson's r and the chi-square test of independence. Differences between groups were examined via independent samples t -tests. The sample was 52% Hispanic, 56% male, and the mean age was 62 years (SD = 16.1). The mean age of Hispanic cases was younger than non-Hispanic cases (p <.001, η = 0.289). Serum CRP was significantly higher in the Hispanic cases, with a high degree of association (p <.001, η = 0.472). In addition, higher CRP levels were significantly associated with the need for mechanical ventilation (p <.001, φc = 0.216). No significant relationships were found between CRP and age, body mass index (BMI), or comorbidity burden. Findings challenge the assumption that the disproportionate morbidity and mortality suffered by the Hispanic population due to COVID-19 was due to age, BMI, or comorbidities such as metabolic syndrome or heart disease. CRP in the Hispanic population should be further investigated to understand its relationship to chronic stress, frailty, and risk for COVID-19 in this population. [ABSTRACT FROM AUTHOR]

Objectives: Veterans with substance use disorder (SUD) can show high severity and are at high risk of relapse due to trauma histories and other comorbid conditions. However, evidence-based SUD therapies may not be available to many veterans due to geographic or transportation constraints. Telehealth approaches have shown promise to improve access to different SUD therapy formats but have not been well-studied in open (rolling-admission) group therapy of in-person patients as administered by a single on-screen therapist. Methods: Social distancing required by the COVID-19 pandemic forced the transition of delivery of Transcending Self Therapy (TST) from an in-person therapist to a single remote (on-screen) therapist. In this virtual model, veterans continued to receive TST but the therapist was off site and provided therapy to veterans who were together in the same room during a 28 day residential Veterans Affairs treatment program. In a program evaluation, we compared their changes in quality of life (QoL), treatment satisfaction ratings and group therapy treatment outcomes with those of Veterans who received TST from an in-person therapist. Results: In both groups, there was a significant increase in QoL Inventory scores from baseline to post-treatment, with no difference in improvement between treatment modalities (i.e., in-person group vs telehealth-delivered group). Veterans professed knowledge of therapy-driven skills at the end of treatment in both groups and overwhelmingly rated TST as helpful and understandable. Conclusions: These data extend previous findings of patient acceptability of remotely-delivered SUD treatment, here with a remote therapist administering open group therapy, as evidenced by improvement in QoL and positive patient feedback about the remote intervention. [ABSTRACT FROM AUTHOR]

Early childbearing is associated with high maternal stress and family violence. However, the long-term effects of rapid repeat pregnancy (RRP) in young motherhood on child outcomes remain largely unknown. This study examined the pathways between maternal RRP at young ages and child psychosocial problems and emergency room visits in later years. A total of 232 Chinese mother-child dyads provided baseline data in 2015 (Time 1; T1) and follow-up data 6 years later in 2021 (Time 2; T2). At T1, mothers completed questionnaires about child physical abuse frequency and family cohesion and reported their own stress levels. At T2, mothers were re-surveyed with the same questionnaires about child physical abuse frequency and family cohesion. Children's psychosocial problems were assessed through parent proxy-reports and records of emergency room visits were retrieved from hospital databases. After adjusting for demographic information, maternal history of RRP was associated with child physical abuse at T1 (β =.15, p <.05) and in turn linked to child physical abuse recurrence (β =.22, p <.01) and emergency room visits at T2 (β =.22, p <.001). Improved family cohesion over time did not break the link between maternal RRP and child physical abuse recurrence. Poor family dynamics can lead to child physical abuse recurrence and worsen developmental outcomes in children, particularly when coupled with other risk factors such as maternal RRP at young ages. Early interventions to enhance support and reduce vulnerabilities are important for preventing child physical abuse in at-risk families. [ABSTRACT FROM AUTHOR]

Background: Alcohol use disorder (AUD) is overrepresented within the United States. Naltrexone, a recommended treatment for AUD, is underutilized. However, the prescribing behaviors of advanced practice registered nurses (APRNs) regarding naltrexone for AUD patients have not been studied. The purpose of our study was to explore the prescriptive practices of a sample of APRNs. Aims: To describe and analyze survey responses of a sample of Ohio APRNs with training in medication for addiction treatment (MAT) for substance use disorders (as evidenced by DEA x-waiver receipt) regarding prescribing practices of naltrexone for AUD patients. Method: Public information collected from the first author's Nursing Board (list of APRNs in Ohio) was checked against the public information of x-waivered providers nationally from the Substance Abuse and Mental Health Services Administration's (SAMHSA) website. This generated a potential sample size of 824 APRNs, all of whom were sent email solicitations to complete a Qualtrics survey. After 3 weeks, 55 surveys were completed, and the data were analyzed. Descriptive statistics were generated as well as a logistic regression with five potential predictor variables against the outcome variable (defined as use of naltrexone for AUD patients). Results: Years practicing as an APRN was found to negatively predict naltrexone prescribing behavior for AUD patients. Practice setting and work experience with an addiction specialist physician were not found to predict naltrexone prescribing behavior for AUD patients. Conclusion: Implications for further study were discussed, with emphasis on regulatory variance between states. [ABSTRACT FROM AUTHOR]

Introduction: Emotion recognition plays a crucial role in our social interactions and overall well-being. The present cross-sectional study aimed to develop and validate Emotion Laden Sentences Toolbox for Emotion Recognition (ELSTER), that utilizes emotion-laden sentences as stimuli to assess individuals' ability to perceive and identify emotions conveyed through written language. Methods: In Phase I, a comprehensive set of emotion-laden sentences in English language were validated by 25 (eight males and 17 females) qualified mental health professionals (MHPs). In Phase II, the sentences that received high interrater agreement in Phase I were selected and then a Hindi version of the same sentences was also developed. The English and Hindi database was then validated among 50 healthy individuals (30 males and 20 females). Results: The percentage hit rate for all the emotions after exclusion of contempt was 84.3% with a mean kappa for emotional expression being 0.67 among MHPs. The percentage hit rate of all emotion-laden sentences across the database was 81.43% among healthy lay individuals. The mean hit rate percentage for English sentences was similar to Hindi sentences with a mean kappa for emotional expression being 0.63 for the combined English and Hindi sentences. Conclusion: The ELSTER database would be useful in the Indian context for researching textual emotion recognition. It has been validated among a group of experts as well as healthy lay individuals and was found to have high inter-rater reliability. [ABSTRACT FROM AUTHOR]

There is scant data about the prevalence and correlates of ADHD in middle-income countries. Objective: The aim of this study was to investigate the prevalence and psychiatric correlates of symptomatic ADHD in a large metropolitan area of a middle-income country. Methods: An in-person household survey with randomly selected 2,297 adults aged 19 to 60 from Rio de Janeiro, Brazil, assessed by trained lay interviewers. The Adult Self-Rating Scale Screener (ASRS-6) was used. Chi-square and logistic regression were conducted. Results: ADHD prevalence was 4.59 (95% CI [3.56, 5.44]). Those with ADHD were younger and more often unemployed; they displayed more psychiatric symptoms (depression, anxiety, and alcohol abuse) and a history of bullying and sexual abuse. They also had worse physical health indicators. Findings remained significant when controlling for socioeconomic variables. Conclusion: Adults with symptomatic ADHD from a large metropolitan area in Brazil show a pattern of findings consistent with what has been observed in higher-income countries [ABSTRACT FROM AUTHOR]

Many studies focus on problematic peer functioning in attention deficit/hyperactivity disorder (ADHD) but loneliness has been studied less. This paper examined (1) The loneliness level differences between young people (below 25 years old) with ADHD and those without ADHD, and (2) The association between loneliness and mental health difficulties in young people with ADHD. Six electronic databases were searched and 20 studies were included. A random effects meta-analysis was carried out in RStudio using the metafor package for the first question, while a narrative synthesis summarized the findings for the second question. The meta-analysis (n = 15) found that young people with ADHD reported significantly higher loneliness than those without ADHD, with a small-to-medium weighted pool effect (Hedges' g = 0.41) and high heterogeneity (I 2 = 75.1%). For the second question (n = 8), associations between loneliness and mental health difficulties in ADHD was found (r = 0.05–0.68). Targeted research and interventions on loneliness in young people with ADHD is needed. [ABSTRACT FROM AUTHOR]

Objective: Despite community colleges accounting for 34% of all undergraduate enrollment, research on substance-use patterns among community college students is limited. Community college students may engage in substance use differently than their 4-year university counterparts due to differences in psychosocial factors and decreased availability of mental health services. The current study aimed to elucidate risk factors underlying non-medical use of prescription simulants (NMUS) and nicotine use by community college students. Methods: A web-based survey was administered to 10 of 13 community colleges within a southeastern state's Board of Regents school system. The survey included questions related to NMUS, nicotine use, alcohol use, mental health diagnosis, and demographics. Results: Overall, 9% of the participants reported NMUS, and 24.6% used nicotine. Multivariate analysis of variance and χ2 tests revealed group differences among individuals using only nicotine, only NMUS, both nicotine and NMUS, and neither nicotine nor NMUS. Post-hoc 2 × 2 χ2 tests indicated that individuals using both nicotine and NMUS had higher incidence of mental health diagnoses, were more likely to live in urban areas, reported higher weekly alcohol consumption, and were more likely to be male as compared to individuals using neither substance. Attention-deficit hyperactivity disorder (ADHD) symptoms were higher in individuals using only NMUS and both NMUS and nicotine as compared to those using only nicotine or neither substance. Conclusions: These findings provide insight into demographic and psychological variables associated with NMUS and nicotine use among community college students that could be benefitted by greater access to affordable mental health services. [ABSTRACT FROM AUTHOR]

Research has documented high rates of exposure to violence in urban African American adolescents together with their negative effects on psychosocial adjustment. Coping with violence exposure may be facilitated by disclosure of these experiences to others, but little is known about the extent to which youth disclose their various experiences with violence. This study examined the prevalence of disclosure of violence experienced as a witness or victim in different contexts or locations to parents, friends, siblings, teachers, counselors, and relatives. Urban African American adolescents from Southeastern U.S. were interviewed at three time points (N = 81; average ages 13.3, 16.1, and 17.8). Across the three time points, 90% to 91% witnessed violence and 64% to 81% were victimized in the last year. Of these youth, 40% to 53% disclosed experiences of witnessing violence and 29% to 52% disclosed experiences of victimization. The results showed that disclosure of violence most often involved parents and friends, with fewer youth disclosing to teachers and counselors. Disclosure of violence victimization increased from early to late adolescence. Experiences of dating violence victimization were less likely to be disclosed by adolescents, especially among males. These findings support the need for more research on adolescents' disclosure of violence exposure and its links to adjustment, with implications for interventions aimed at improving coping in youth exposed to violence. [ABSTRACT FROM AUTHOR]

There is a wealth of evidence to suggest that childhood maltreatment is a major risk factor contributing to non-suicidal self-injury (NSSI) among adolescents. However, how and under what conditions childhood maltreatment is related to NSSI remains largely unclear. This study examined the indirect effect of depressive symptoms in the relation between childhood maltreatment and non-suicidal self-injury, as well as the moderating role of cognitive reappraisal and emotion reactivity in those associations. A sample of 1,984 Chinese adolescents (Mage = 12.84, SD = 1.27, 47.9% girls) completed self-report questionnaires. The results of path analysis showed that childhood maltreatment was significantly related to NSSI and that depressive symptoms play an indirect effect in the relation between them. Cognitive reappraisal mitigated the effect of childhood maltreatment on depressive symptoms, and emotion reactivity strengthened the effect of depressive symptoms on non-suicidal self-injury. The results further showed that the indirect effect of depressive symptoms was more prominent for youths with lower levels of cognitive reappraisal and greater emotion reactivity. Interventions that enhance cognitive reappraisal and reduce emotion reactivity may interrupt the pathway from childhood maltreatment to NSSI via depressive symptoms. [ABSTRACT FROM AUTHOR]

There have been countless efforts to improve academic achievement in public schools across the United States, especially in urban school districts. Few efforts, however, use rigorous analytic modeling tools to anticipate and prevent the potential side effects of change. This chapter proposes the application of system dynamics on educational reform efforts by offering a conceptual model, literature review, and research agenda to identify and mitigate the potential side effects of reform. The model is based on interviews and workshops with public school leaders, teachers, and parents in a midsized midwestern urban city. We identify a "capability trap" that may lead to policy resistance with educational reforms. Limitations to this approach are noted, and future areas of research are identified. [ABSTRACT FROM AUTHOR]

Background: Research examining the potential effects of stimulant exposure in childhood on subsequent development of substance use disorder (SUD) have focused on differences in the brain reward system as a function of risk. Methods: 18 drug naïve children ages 7 to 12 years (11 High Risk [ADHD + ODD/CD]; 7 Low Risk [ADHD only]), underwent fMRI scans before and after treatment with mixed amphetamine salts, extended release (MAS-XR). We examined correlations between clinical ratings and fMRI activation at baseline and following treatment as a function of risk status. Results: High Risk children had higher activation than Low Risk children at baseline during both the Reward and Surprising Non-Reward conditions. Treatment produced strong differential effects on brain activation pertinent to group and reward outcome. Conclusions: Findings support the hypothesized role of reward mechanisms in SUD risk, and suggest that stimulant treatment may have differential effects on reward processing in relation to SUD risk. [ABSTRACT FROM AUTHOR]

Objective: To compare neurofunctional responses in emotional and attentional networks of psychostimulant-free ADHD youth with and without familial risk for bipolar I disorder (BD). Methods: ADHD youth with (high-risk, HR, n = 48) and without (low-risk, LR, n = 50) a first-degree relative with BD and healthy controls (n = 46) underwent functional magnetic resonance imaging while performing a continuous performance task with emotional distracters. Region-of-interest analyses were performed for bilateral amygdala (AMY), ventrolateral (VLPFC) and dorsolateral (DLPFC) prefrontal cortex, and anterior (ACC) and posterior cingulate cortex (PCC). Results: Compared with HC, HR, but not LR, exhibited predominantly left-lateralized AMY, VLPFC, DLPFC, PCC, and rostral ACC hyperactivation to emotional distractors, whereas LR exhibited right VLPFC and bilateral dorsal ACC hypoactivation to attentional targets. Regional responses correlated with emotional and attention symptoms. Conclusion: Aberrant neurofunctional responses during emotional and attentional processing differentiate ADHD youth with and without a family history of BD and correlate with relevant symptoms ratings. [ABSTRACT FROM AUTHOR]

Aim: This Norwegian case study examines groups at risk of drug overdose deaths, evidence-based harm reduction interventions, low-threshold services and treatment implemented, as well as trends in drug overdose deaths between 2010 and 2021. We aimed to explore the relevance of interventions for at-risk groups and discuss their potential impact on drug overdose trends. Method/data: Using an ecological approach, we analysed the following: (1) groups identified through latent profile analysis (LPA) among a sample of 413 high-risk drug users collected in 2010–2012, supplemented with other relevant studies up to 2021; (2) published information on harm-reduction interventions, low-threshold services and treatment in Norway; and (3) nationwide drug overdose mortality figures supplemented with published articles on the topic. Results: High-risk drug users in 2010–2012 commonly engaged in frequent illegal drug use, injecting and poly-drug use (including pharmaceutical opioids), which continued into following decade. The interventions implemented between 2010 and 2021 were relevant for at-risk groups identified in the surveys. However, there was no decrease in the trend of drug overdose deaths up to 2021. While relevant interventions may have mitigated a theoretical increase in mortality, new at-risk groups may have contributed to fatal outcomes associated with pharmaceutical opioids. Conclusion: The interventions were relevant to the risk groups identified among high-risk drug users and potentially effective in preventing an increase in drug overdose trends. However, tailored interventions are needed for individuals at risk of death from prescribed opioids. Comprehensive studies encompassing all at-risk populations, including both legal and non-medical users of prescription opioids, are needed. [ABSTRACT FROM AUTHOR]

The Mother-to-Infant Bonding Scale (MIBS) is among the most popular measurement tools to evaluate caregiver-infant attachment. We carried out a meta-analysis study to explore the generalizability of the reliability coefficients for the MIBS in different studies. The literature review yielded a total of 702 studies investigating caregiver-infant attachment. After removing duplicate studies, we also excluded compilations, meta-analyses, qualitative studies, those using different measurement tools, studies published in a language other than English, citations, and those whose full texts could not be accessed. Eventually, we considered a total of 26 studies with 33 Cronbach's alpha coefficients that satisfied the inclusion criteria. We normalized the alpha coefficients using Bonett's transformation, and the analyses were performed using a 95% confidence interval. The findings revealed a Cronbach's alpha (n = 33) coefficient of 0.73 (CI = 0.68–0.77); hence, the present reliability generalization study provides evidence that the reliability scores produced after measurements with the MIBS in previous studies are acceptable across samples. Overall, further studies may reliably utilize the MIBS to evaluate mother-infant attachment. [ABSTRACT FROM AUTHOR]

Objectives: To examine relationships between polypharmacy and level of healthcare service use among prescription opioid poisoning cases age 50 and older. Methods: Data came from the American Association of Poison Control Center's National Poison Data System, 2015-2020. We used multinomial logistic regression to examine the study questions. Results: Of the 77 946 cases with prescription opioid exposures, 64.5% were managed at a healthcare facility (HCF). Of HCF-managed cases, 41.2% were treated/evaluated and released and 21.3% and 37.5% were admitted for noncritical care and critical care, respectively. Medications for cardiovascular disease, benzodiazepines, other types of sedatives/hypnotics, antipsychotics, muscle relaxants, acetaminophen, and gabapentin were associated with increased risk of admission to both noncritical and critical care compared to treatment/evaluation and release. Acetaminophen use had the highest relative risk ratios (RRRs) for noncritical care (1.70, 95% CI = 1.51-1.91) and critical care (1.56, 95% CI = 1.39-1.76). Each additional medication/substance used was associated with 1.14 (95% CI = 1.11-1.17) and 1.19 (95% CI = 1.16-1.22) greater risk of noncritical and critical care admissions, respectively. Conclusions: Among older-adult poison control center cases for prescription opioid exposures, co-use of several commonly prescribed/used medicines was associated with increased risk of admissions to both noncritical and critical care units. Careful monitoring of medication use among older adults who use prescription opioids may reduce the risk of unintentional and intentional opioid poisoning. [ABSTRACT FROM AUTHOR]

Objective: ADHD is associated with stigma, but whether stimulant medication use contributes to this is unknown. We examined how perception of a young woman may be influenced by visible ADHD symptoms and/or prescribed stimulant medication use (PSMU). Method: Three-hundred-fourteen undergraduates were randomly assigned to watch one of four videos: a woman portraying (a) neither symptoms of ADHD nor PSMU, (b) no ADHD symptoms but disclosing PSMU, (c) ADHD symptoms but no PSMU, or (d) both ADHD symptoms and PSMU. Participants then completed measures of their liking of and desire for affiliation with the woman. Results: Analyses suggest that visible symptoms of ADHD were perceived negatively and are associated with less liking and desire for affiliation. PSMU was associated with negligible additive stigma. Conclusion: This supports that noticeable ADHD symptoms may be the primary driver of the stigma associated with the disorder, and specifically that directed at young women with ADHD. [ABSTRACT FROM AUTHOR]

Background: There has been limited exploration of the relationship between ADHD and vision impairment, especially in relation to ADHD medication regimens and age. This study aims to examine trends in visual disorders in young patients with ADHD. Methods: We analyzed deidentified patient records from TriNetX database. Patients under 22 years old were divided into cohorts based on ADHD status and medication regimen. We compared prevalence of vision disorders between cohorts. Results: We studied over 1 million patients. The ADHD cohort had higher rates of all visual disorders than their non-ADHD peers. Medication usage was found to have a slight impact, with non-stimulants associating with higher rates for all outcomes. Discussion: Our findings suggest that the higher occurrence of visual disorders in ADHD is not primarily due to misdiagnosis or medication effects. There is a need for regular eye care in ADHD patients and further investigation into the role of ADHD medications in eye health. [ABSTRACT FROM AUTHOR]

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The article discusses the current overdose crisis, which is a significant public health challenge in the field of mental health and substance use disorder care. The increase in mortality is primarily due to changing drug markets and patterns of substance use, as well as an ill-prepared system of care. Fentanyl has become the dominant drug of choice among many people who use drugs, and the rise in overdose deaths in North America has been dramatic. The article explores the concept of "safe supply," which involves providing high-potent psychotropic substances outside of a therapeutic context to reduce overdose risk. However, there is a lack of large-scale effectiveness studies on safe supply, and caution is expressed by experts regarding the potential risks and lack of evidence for its benefits. The article emphasizes the importance of integrating pharmacotherapy and psychosocial care, as well as learning from successful approaches in other countries such as Portugal and Switzerland. It also highlights the lessons that can be learned from the COVID-19 pandemic, emphasizing the importance of evidence-based approaches in addressing public health crises. Overall, the article calls for a comprehensive and evidence-based strategy to address the overdose crisis, taking into account the complexities and diverse needs of individuals with substance use disorders. [Extracted from the article]

This study focuses on sources of youth decision-making and examines paths through which these factors may affect delinquent behavior. Using longitudinal Add Health data, we explore the mediating mechanisms linking several antecedents of decision-making, thoughtfully reflective decision-making (TRDM), and crime. We find that various adverse factors (i.e., family and school stressful conditions, depression, sleep problems) reduce the ability of adolescents to be thoughtful and reflective, which leads to higher levels of criminal behavior. By contrast, involvement in conventional activities (i.e., hobbies, religious activities) is found to foster TRDM, which reduces delinquency. Our study calls for an integration of perspectives in criminology, cognitive psychology, and neuroscience to better explain the relationship between decision-making and crime. Policy implications are discussed. [ABSTRACT FROM AUTHOR]

Background: Alcohol consumption is a leading cause of morbidity and mortality worldwide, disproportionately affecting young men. Heavy episodic drinking is particularly prevalent among men, with this behavior peaking between the ages of 20 and 24. Aims: We sought to identify dimensions of decision-making in men that would predict the development of hazardous alcohol use through emerging adulthood. Methods: This prospective observational study profiled value-based decision-making in 198 healthy men at age 18 and assessed their alcohol involvement annually until age 24. Latent growth curve modeling estimated individual variability in trajectories of alcohol involvement and regressed this variability on five choice dimensions. Results: Low loss aversion predicted sustained heavy episodic drinking from age 18 to 24. Both high delay discounting and risk-seeking for gains independently predicted a considerably higher cumulative alcohol use during these 6 years, with high delay discounting indicating escalating consumption from age 21. Risk-seeking for gains additionally predicted meeting more criteria for Alcohol Use Disorder in these 6 years. Risk-seeking for losses was not significantly related to alcohol outcomes. Choice preferences were largely independent of each other but were correlated with choice consistency, with low consistency predicting heavy episodic drinking from age 18 to 24 beyond these associations. Conclusions: The predictive effects collectively suggest that overvaluing immediate and probabilistic incentives, rather than underestimating harm, drives hazardous drinking in young men. The differential relations of choice preferences and consistency to alcohol involvement through emerging adulthood provide distinct cognitive-behavioral patterns that warrant consideration in the development of harm reduction interventions. [ABSTRACT FROM AUTHOR]

It is often assumed that the recognition of facial expressions is impaired in autism. However, recent evidence suggests that reports of expression recognition difficulties in autistic participants may be attributable to co-occurring alexithymia—a trait associated with difficulties interpreting interoceptive and emotional states—not autism per se. Due to problems fixating on the eye-region, autistic individuals may be more reliant on information from the mouth region when judging facial expressions. As such, it may be easier to detect expression recognition deficits attributable to autism, not alexithymia, when participants are forced to base expression judgements on the eye-region alone. To test this possibility, we compared the ability of autistic participants (with and without high levels of alexithymia) and non-autistic controls to categorise facial expressions (a) when the whole face was visible, and (b) when the lower portion of the face was covered with a surgical mask. High-alexithymic autistic participants showed clear evidence of expression recognition difficulties: they correctly categorised fewer expressions than non-autistic controls. In contrast, low-alexithymic autistic participants were unimpaired relative to non-autistic controls. The same pattern of results was seen when judging masked and unmasked expression stimuli. In sum, we find no evidence for an expression recognition deficit attributable to autism, in the absence of high levels of co-occurring alexithymia, either when participants judge whole-face stimuli or just the eye-region. These findings underscore the influence of co-occurring alexithymia on expression recognition in autism. [ABSTRACT FROM AUTHOR]

Objective: Chronic pain is a major problem for patients with Charcot-Marie-Tooth (CMT) disease. This exploratory study examined patient reported efficacy of medical cannabis for pain management in this population. Methods: Participants (N = 56; 71.4% female; Age = 48.9, SD = 14.6; 48.5% CMT1) were recruited though the Hereditary Neuropathy Foundation. The online survey contained 52 multiple choice questions about demographics, medical cannabis use, symptomology, efficacy, and adverse effects. Results: Nearly all (90.9%) of respondents reported experiencing pain, including all (100%) females and 72.7% of males (chi-square P <.05) with 91.7% of respondents indicating cannabis provided at least 50% pain relief. The most frequent response was an 80% reduction in pain. Moreover, 80.0% of respondents reported using less opiates, 69% noted using less sleep medication, and 50.0% reported using less anxiety/antidepressant medications. Negative side effects were noted by 23.5% of respondents. However, almost all (91.7%) of that subgroup did not have plans to stop consuming cannabis. One-third (33.9%) possessed a medical cannabis certificate. Patient perceptions of their physicians' attitudes regarding patient medical cannabis use greatly impacted whether respondents informed their providers of their usage. Conclusion: The vast majority of patients with CMT reported that cannabis was effective to manage pain symptoms. These data support the need for prospective, randomized, controlled trials using standardized dosing protocols to further delineate and optimize the potential use of cannabis to treat pain related to CMT. [ABSTRACT FROM AUTHOR]

Background: Emergency responders are the most frequent overdose responders, however, little is known about the impact of supervised injection facility (SIF) location on first responders. The purpose of this study was to determine whether firefighter/paramedic attitudes about being stationed near an SIF were related to burnout, secondary traumatic stress, and compassion satisfaction. Methods: Firefighter/paramedics from Vancouver Fire and Rescue Services (n = 54) completed an online survey. General linear models were used to assess differences in burnout, secondary traumatic stress, and compassion satisfaction based on attitudes regarding being stationed near an SIF while controlling for occupational stress. Findings: Firefighters with negative attitudes regarding station placement near an SIF experienced more burnout compared with those with neutral/mixed attitudes and less compassion satisfaction compared with those with positive attitudes. There were no differences between those with positive and neutral/mixed attitudes. Conclusions: These findings have implications for education and training of emergency responders stationed near SIFs. They also highlight the need for more research into the effects of and possible clinical opportunities needed to support first responders' work near an SIF. Application to Practice: While these findings represent early exploratory evidence, increased burnout and reduced compassion satisfaction may be common reactions among first responders who experience negative attitudes toward SIFs. Prevention efforts could incorporate programs to enhance health and well-being of first responders and education regarding substance use and harm reduction, while workforce surveillance for signs of distress or burnout could be implemented to trigger additional mental health services and interventions. while policymakers should remain aware of SIF-related impacts on all stakeholders, including first responders. [ABSTRACT FROM AUTHOR]