Search

Statement of purpose To use longitudinal data collected from youth presenting to an urban emergency department to determine predictors of within-person changes in alcohol and prescription opioid same day use frequency. Methods/Approach Research assistants recruited youth age 14–24 reporting past-six-month substance use into the Flint Youth Injury study from 11/2009–9/2011 (n=599; 349 violently-injured at baseline). Participants self-administered validated measures of alcohol use severity, cannabis use severity, mental health symptoms, social support/influences, and violent injury at baseline and four biannual follow-ups. In addition, participants completed Time Line Follow Back calendars (baseline: 30-days; follow-ups: 90-days) which allowed ascertainment of same day use of alcohol and prescription opioids. We calculated the prevalence of same day alcohol and prescription opioid at each follow-up, and used negative binomial regression with person-level fixed effects to isolate within-person predictor effects on same-day use frequency. Results Between 2.0% (baseline) and 5.7% (18-month follow-up) of youth reported same-day use of alcohol and prescription opioids across follow-ups, with 19.9% reporting same-day use in at least one follow-up. Within-person increases in alcohol use severity, cannabis use severity, and depression and anxiety symptoms all corresponded to increases in same day alcohol and prescription opioid use frequency. Increased exposure to positive peer influences, and decreased exposure to delinquent peers, both coincided with lower same day alcohol and prescription opioid use frequency. Conclusions Same day use of alcohol and prescription opioids is common in this population, and within-person changes are predictable. Interrupting worsening trajectories of substance use severity and mental health symptoms, and enhancing social support and reducing delinquent peer exposures, may reduce same day use frequency. Significance Co-use of alcohol and prescription opioids dramatically increases acute risks (e.g., overdose) associated with each; understanding within-person predictors of same day use may point to catalysts for behavior change.

Statement of purposePreventing opioid misuse and opioid use disorder (OUD) is necessary given the opioid epidemic Prevention programs for adolescents/young adults are needed to alter risk trajectories We developed interventions using telemedicine (synchronous video conference) and a patient portal-like messaging system to address risk factors for opioid misuse/OUD among young Emergency Department (ED) patients Our presentation describes these promising interventions and their feasibility and acceptability Methods/ApproachIn Spring 2020, N = 40 ED patients ages 16–30 who were at risk for opioid misuse/OUD enrolled in a pilot trial involving screening/baseline assessments, motivational interviewing-based remote interventions (baseline telemedicine brief intervention [BI], 1-month of portal messaging), and a 1-month follow-up Before COVID-19, N = 10 enrolled in the ED (in-person cohort: IPC);during COVID-19, N = 30 recent ED patients enrolled via phone recruitment (remote cohort: RC) Feasibility data are presented by cohort;acceptability data are combined ResultsAmong the N=40, the sample had a mean age of 22 9 years Gender was: 70% female, 5% non-conforming, 25% male Race was: 75% White, 15% Black/African American, and 10% other racial identities;17 5% were Hispanic/Latinx Regarding feasibility, eligibility rates were similar (IPC: 17%, RC: 15%);consenting rates differed (IPC: 100%, RC: 56%), likely due to the RC’s telephone approach Portal engagement increased from the IPC (60%) to the RC (93%), possibly due to addressing technical difficulties and IPC user feedback BI and portal satisfaction were high (M = 9 3 on a 1–10 scale and M = 8 5, respectively) Interventions exceeded motivational interviewing fidelity thresholds (adapted for portal messaging) Follow-up rates were high (IPC: 80%, RC: 93%) SignificancePreventing opioid misuse is critical to avoiding escalation of opioid use and overdoses, and emergency department patients are at increased risk This study demonstrates the feasibility and acceptability of these intervention approaches via telemedicine for preventing future injuries

Statement of Purpose A randomized clinical trial demonstrated efficacy of an Emergency Department-based Motivational Interviewing-based (MI) intervention reducing opioid overdose risk. We sought to develop a user-friendly online toolkit (OPT-IN), to aid translation of the intervention combined with naloxone distribution. As part of an iterative development process we completed stakeholder interviews to inform toolkit development. The current presentation details toolkit feedback received in qualitative end-user interviews. Methods/Approach We conducted n=15 qualitative interviews lasting about 30 minutes with staff at varied clinical settings and non-profits to obtain feedback on feasibility of toolkit components. Additional interviews are ongoing. The toolkit contains an intervention guide, interactive training videos, and other resources. The online toolkit was updated in real time when end-users shared ideas for website improvement. Results To date, interviewees indicated that a 15-minute intervention would be most feasible in practice. They shared preferences for inclusion of brief worksheet-based options for the intervention and screening questions. Interviewees provided suggestions for website layout and functionality. In addition to the OPT-IN intervention training, some expressed interest in MI training. Additional results will be reported pending completion of final interviews and website images will be shown. Conclusion Translating an evidenced based research project to an online toolkit is enhanced by an iterative approach. Research therapists are involved in intensive training and supervision that is not always practical for real world implementation. The OPT-IN Toolkit, through the qualitative interviews, went through an iterative refinement to adapt and optimize the intervention translation across settings. Significance/Contribution to Injury and Violence Prevention The initial study indicated that this intervention can reduce opioid overdose risk with a brief 30-minute intervention. The iteratively refined OPT-IN Toolkit increase the dissemination of this intervention to reduce opioid overdose risk and related deaths. Funded by The Center for Disease Control and Prevention: # R49 CE002099.

Statement of Purpose In 2018, Michigan was the 10th state to pass a recreational cannabis law. The purpose of this report is to provide insight into cannabis-related indicators before recreational cannabis laws were enacted, and serve as the baseline for future evaluations following cannabis legalization in Michigan. Methods/Approach Existing data were compiled across areas (e.g., use, hospitalizations, legal charges, etc.) that potentially affect the public’s health and well-being. The report notes key findings, highlights data limitations, and elaborates priorities for tracking cannabis-related trends over time. Results An estimated one in nine Michigan residents (11.6%) used cannabis in the past month, which has increased by over 60% from 2002–2003 to 2016–2017. Overall, the rate of annual fatal motor vehicle crashes per 100 million vehicle mile traveled decreased from 1.04 in 2004 to 0.92 in 2017, while the number of drug tests administered to drivers of fatal crashes doubled simultaneously. The rate of hospitalizations for cannabis poisoning increased from 2010 (2.5 per 100,000 persons) to 2017 (3.7 per 100,000 persons). Cannabis-related legal charges increased by 2.4% from 2012 to 2018, peaking in 2016. However, the percentage of cannabis-related convictions out of all criminal convictions was highest in 2014 (4.2%) and lowest in 2018 (3.2%). Conclusions Cannabis use prevalence is higher in Michigan than in the Midwest and the United States. Better characterization of the potential involvement of cannabis in driving-related outcomes is needed. Data on cannabis-related hospitalizations highlight the need for prevention programs focusing on reducing poisonings, especially as higher potency cannabis-containing products become available. Changes in cannabis-related criminal justice data warrant monitoring over time. Significance and Contributions to Injury and Violence Prevention Science Examining changes in cannabis-related indicators over time will allow stakeholders and public health officials to best understand the potential impacts of recreational cannabis on public health and well-being. Funded by The Center for Disease Control and Prevention R49 CE002099

Substance use is an alarming public health issue, associated with morbidity, mortality, and significant societal costs. Mobile phone apps are a promising data collection and intervention delivery tool for research with substance-using youth, as most teens (73%) and young adults (92%) own a smartphone; yet, existing mobile apps in the substance use field lack data collection capabilities and require a therapist to push intervention content. Our team has developed a prototype Android mobile phone app called SARA (Substance Abuse Research Assistant), which features a customizable suite of data collection methods (e.g., sensors, ecological momentary assessments, cognitive/behavioural tasks) and allows for add-on intervention delivery components (e.g., text messages, intervention videos). To mitigate the challenges of long-term app use, SARA creates a game-like environment in which participants can earn non-financial rewards for completing assessments, such as unlocking fish to populate a virtual aquarium on the app’s home screen. In May-August 2017, SARA will be field tested with 60 participants recruited from the University of Michigan Health System Emergency Department. Screened participants will be eligible if they are 14–24 years old, report past-month binge drinking (4/5 drinks tailored by gender) or recreational cannabis use, can download SARA, and provide written consent/assent. Enrolled participants will complete a baseline survey, use the app for 30 days to complete daily and weekly assessments, and provide feedback about the app at follow-up. Key findings will include: assessment compliance rates; participants’ interaction with SARA during field testing; and participants’ feedback about SARA, including their comfort answering sensitive questions via the app. Our findings will indicate the feasibility and acceptability of using SARA as a data collection and intervention delivery tool with substance-using youth in behavioural research.

Purpose Sexual violence (SV) is a significant public health concern with substantial economic and psychosocial tolls on both individuals and communities. Among adults in the United States, an estimated 19.3% of females and 1.7% of males experience rape, and 43.9% of females and 23.4% of males experience other types of sexual violence. Previous work suggests that risk for sexual violence perpetration onset increases during adolescence, and the majority of SV survivors are first victimised before age 25. Consequently, understanding the context in which sexual violence perpetration occurs among emerging adults (ages 18–25) is critical for developing effective multi-level intervention and prevention strategies. Methods A large national sample of 18–25 year olds is currently being recruited via advertisements appearing on Instagram and Facebook to complete an anonymous, online questionnaire about event-based characteristics of sexual violence perpetration. Survey items will inquire about participants’ own history of perpetrating three types of sexual violence (completed/attempted nonconsensual sex, incapacitated sex) against someone and whether they know someone who has completed/attempted nonconsensual sex. For each endorsed perpetration type, participants will receive event-specific questions about their most recent perpetration experience, including incident characteristics (e.g., location, relationship to victim), substance use within two hours of the incident, perpetration motives and tactics used. Results Analyses will highlight: prevalence rates for each SV type; demographic characteristics of perpetrators; and similarities/differences between SV types regarding incident characteristics, perpetration motives and tactics used. Significance By illuminating multiple intervention points in the sequence of events leading up to completed sexual violence incidents, our results can inform the development of tailored perpetrator-focused prevention programs that account for the real-world context in which sexual violence occurs.

Purpose Preventing sexual assault is a national priority within the United States considering there are approximately 3 21 500 survivors (aged 12 and older) of sexual assault per year. Previous work suggests that one promising measure for early intervention to mitigate the negative sequelae associated with sexual assault is routine screenings by healthcare providers for sexual assault history. Although the potential benefits of disclosing a sexual assault incident to a provider are well understood, much of the previous work in this area has been conducted with clinic-based samples of sexual assault survivors who encounter fewer barriers to accessing necessary healthcare. Less is known about whether sexual assault survivors from a population-based sample disclose sexual assault incidents to providers. In this study, we explore the prevalence of disclosure to healthcare providers and potential barriers to disclosure in a non-clinic sample. Methods A large sample of participants, ages 18–25, is currently being recruited for a survey study via sponsored advertisements appearing on Instagram and Facebook. Eligible participants complete online measures about their demographics, healthcare utilisation, and sexual violence history. Participants are asked about their history of sexual violence victimisation since the age of 16 and whether they have talked to a healthcare provider about the incident. Those who have not talked to a provider are asked to report reasons for not talking to a provider. Significance By highlighting barriers that prevent sexual assault survivors from talking about their victimisation experiences with a healthcare professional, this study can inform treatment and prevention efforts to attenuate the high healthcare costs associated with sexual assault.

Statement of purpose Roughly one in five US women and one in sixteen US men are sexually assaulted while in college. Sexual assault contributes to a range of psychological sequelae -- from depression to social withdrawal and sleep disturbances -- that hinder students’ ability to learn and fully participate in college. Mitigating this gender inequality in higher education has recently become a national priority; in 2011 the Department of Education clarified that it may withhold federal funds from schools that fail to adequately address sexual violence. Campus sexual violence precludes equal access to education. Its prevention is therefore crucial to promoting individual and national psychosocial health. Methods This study relies on 19 interviews and 3 focus groups University of Michigan sophomores (n=38). We examine perspectives on existing campus anti’”sexual violence trainings. Our sample mirrors the demographics of the University by gender, race, sexual orientation, athletic status, and Greek-affiliation. Results Respondents frame sexual assault as ‘˜someone else’s problem.’ Non-Greek affiliates blame Greek affiliates. Students involved with Greek Life reference non-University perpetrators. Women blame men; men blame women. Collectively, respondents construct ‘sexual assault’ as simultaneously everywhere and nowhere. Contributions to Injury Prevention Programming The ‘˜everywhere and nowhere’ trend obfuscates a process of locating blame, and subsequently effective prevention efforts. Firstly, it muddles individuals’ self-reflection – if one does not conceptualise themselves as possible perpetrator, they are unlikely to critically evaluate their sexual experiences. Similarly, for potential victims, conceptually locating the issue elsewhere complicates one’s ability to interpret and label nonconsensual sexual encounters. Not understanding one’s own experiences as an assault can be a barrier to resources, recourse, and recovery. Prevention programming might take into account how sexual violence manifests differently across University sub-groups.

Purpose According to the Centres for Disease Control and the American College Health Association, a comprehensive strategy for campus-based sexual assault prevention should span individual, peer/partner, organisational, and community levels blended with universal, selective, and indicated approaches. Campus-based educational programs are one component of this broad strategy and are often implemented, but rarely evaluated. We present evaluation data from a theoretically-grounded sexual assault prevention program, Relationship Remix, administered on campus to first-year students at a large public university. Relationship Remix falls within the universal prevention domain and spans multiple socio-ecological levels by emphasising individual values and behaviour, including some content on bystander intervention, and being delivered by peers (e.g., trained student volunteers). Methods/Approach First-year students attended the 1.5 hour program in groups during the first semester at a large, public Midwestern university. Students completed web-based surveys immediately before and after attending Relationship Remix. Data regarding attitudes and knowledge are reported among 2305 first-year students who were 55.1% female, 70.7% White, and 90.6% heterosexual. Results On 8 of 10 questionnaire items assessing program-related knowledge and attitudes, students reported significantly more favourable responses at post-test. For example, students reported greater awareness of campus resources, ability to define consent, and confidence in communicating with partners. Conclusion and Significance/Contribution The findings suggest that Relationship Remix positively impacts students’ beliefs and attitudes related to consensual sex and prevention of sexual misconduct. Future research should examine behavioural outcomes and whether this program may be effective in reducing sexual misconduct within multi-pronged prevention strategies. This study provides critical information to inform future prevention programming strategies for campus sexual assault.

Statement of purpose Campus sexual assault is a significant public health issue, given its alarming prevalence and association with adverse physical, psychological, and economic outcomes. While many school-based sexual assault prevention intervention programs currently exist, few have strong empirical support in college settings. Consequently, there is a pressing need for formative research with undergraduate students to shape the development of relevant and effective, multi-pronged approaches for preventing sexual assault on college campuses. Methods Full-time undergraduate sophomores at the University of Michigan were recruited via two registrar emails and campus flyers to participate in audio-recorded, semi-structured, one-on-one interviews (n=19) in June-November 2016. Participants were asked to provide feedback about desirable characteristics of sexual assault prevention programming, including intervention content, program format, and delivery mechanism. Interview audio files were transcribed and codes were generated using thematic analysis. Two trained Research Assistants (RAs) independently coded each theme using NVivo 11. Inter-coder reliability was assessed and coding discrepancies were resolved by a third coder. Results Participant demographics (52.6% male, 57.96% White/Not Hispanic) resemble campus enrollment statistics. Further, 68.4% of participants reported lifetime sexual activity, and 42.1% were Greek Life-affiliated. Preliminary findings suggest that peer-based programming administered in-person to individuals or small, mixed-gender groups of unfamiliar students is more acceptable to undergraduates than other intervention formats (e.g., delivered in classes). Participants emphasised the importance of a forum where students can talk openly and seriously about sexual assault. Peer survivor testimonies and skits were mentioned as potentially effective ways to deliver content. Conclusions/Significance As part of their sexual assault prevention education, college students welcome opportunities for discussions led by relatable peers who understand the dynamics of campus life. Our findings warrant future studies examining the effectiveness of campus-based, discussion-oriented sexual assault prevention intervention programs.

Statement of purpose Empirical studies of the relationship between aggression and playing violent video games have produced mixed results; one possible reason is the inattention to effect modifiers, such as sex. Our purpose is to analyse the relationship between serious violence perpetration and video gaming frequency among a sample of urban youth, and how that relationship varies by sex. Methods/Approach We analysed baseline data from a quasi-experimental intervention study of youth violence. Youth aged 14–20 were recruited at a Level 1 urban emergency department from October 2011 to March 2015. Participants self-administered a computerised survey including measures of demographics, substance use (alcohol/marijuana), violence perpetration, and number of hours per week of video gaming. The primary outcome was an indicator of any serious violence perpetration (e.g., weapon violence). Using logistic regression, we estimated the effect of gaming on serious violence perpetration, and how it varied by sex, while controlling for demographics, substance use, community violence exposure, and violence attitudes. Results 409 individuals (60.0% female) enrolled in the study. Males (M=2.5, SD=2.8) played video games more hours per week than females (M=0.8, SD=1.8); the majority in both sexes reported violent games (action/fighting/shooting games) as their favourite genre. Gaming was associated with serious violence perpetration in females (OR=1.36, 95% CI =[1.13, 1.71]), but not males (OR=1.03, 95% CI =[0.89, 1.18]); in the model including both males and females, the interaction between gaming and sex was significant (p=0.02). Conclusion Video gaming is more associated with excess risk of serious violence perpetration in females than males, possibly indicating that gaming is more normative among males, and more indicative of delinquency in females. Significance/Contribution Violence prevention efforts, particularly among females, should consider the role of video gaming. Studies of what drives video gaming frequency in females may provide information relevant to violence prevention.

Statement of purpose Alcohol misuse (i.e., risky drinking) during emerging adulthood is associated with injury, overdose, and academic and relationship problems. Better understanding of the factors influencing risky drinking could enhance alcohol interventions to reduce injury and other adverse outcomes. In this study, we evaluated whether the variables proposed by the dualistic model of passion (i.e., Obsessive Passion - alcohol use is so compelling that it conflicts with other activities or one’s values; and Harmonious Passion - alcohol use is an important but not overwhelming part of one’s life), were associated with alcohol consumption, motives, blackouts, and overdose. Methods Cross-sectional baseline data were analysed, which were collected as part of a larger randomised controlled trial of risky drinkers (i.e., AUDIT-C score >3 females,>4 males) recruited via Facebook advertisements. A canonical correlation analysis was conducted evaluating the dimensional relations between and within sets of independent and dependent variables, while controlling for the intercorrelations among all alcohol variables and sex. Results The sample (n=109) was mostly female (62%), Caucasian (73%), and young (Mage=22.7, SD=1.1). The first canonical variate indicated that Obsessive Passion was positively associated with frequency of alcohol consumption, binge-drinking, blackouts, and overdose, drinking to cope with negative affect, importance of reducing alcohol use, and was negatively associated with self-efficacy to reduce use. The second canonical variate revealed that Harmonious Passion was unrelated to any negative outcomes, was positively associated with frequency of alcohol use and negatively associated with drinking for conformity reasons. Conclusion Obsessive, but not Harmonious, passion is associated with several negative alcohol-related outcomes among emerging adults engaged in risky drinking. Future research should examine whether targeting obsessive passion in early interventions reduces consumption, overdose, and blackouts. Significance/contribution Findings could potentially enhance the efficacy of alcohol interventions among emerging adults engaged in risky drinking.