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Objectives: The purpose of this retrospective study is to further the limited body of evidence regarding the effects of a group-based boxing intervention for those with Parkinson's disease (PD). Design: A retrospective cohort study was performed analyzing data collected on outcome measures at 6-month intervals up to 2 years. Individuals participated in the standardized "Rock Steady Boxing" (RSB) program for up to 24 months. Every 6 months, measures were taken of balance (Fullerton Advanced Balance [FAB] Scale), functional mobility (Timed-Up and Go [TUG]), lower extremity strength (30-second Chair Stand [30CST]), and gait speed (10 Meter Walk Test [10MWT]). Methods: Statistical significance (P <.05) was determined by a two-tailed t test. Data were collected from RSB-affiliated programs at 4 locations across the southeastern United States. Current and/or past participants in RSB with baseline and at least one subsequent outcome measure were included, resulting in 68 participants (54 male, 14 female, and mean age of 71.2 years ± 8.56 standard deviation). Results: Statistically significant improvements in FAB scale, TUG, and 30CST over time were found at both 6- and 12-month time points. Significant changes continued through 18 months for FAB and 30CST. No significant changes in 10MWT were observed; however, a moderate effect size was observed at the 1-year point. Conclusions: Participants with PD were able to achieve statistically significant improvements in standard measures of functional mobility, balance, and strength within the timeline of this study. Limitations include the retrospective nature, an inability to monitor adherence, and lack of control over pharmaceutical or other interventions. [ABSTRACT FROM AUTHOR]

Background: Behavioral dyscontrol occurs commonly in the general population and in United States service members and Veterans (SM/V). This condition merits special attention in SM/V, particularly in the aftermath of deployments. Military deployments frequently give rise to posttraumatic stress disorder (PTSD) and deployment-related mild TBI traumatic brain injury (TBI), potentially leading to manifestations of behavioral dyscontrol. Objective: Examine associations among PTSD symptom severity, deploymentrelated mild traumatic brain injury, and behavioral dyscontrol among SM/V. Design: Secondary cross-sectional data analysis from the Long-Term Impact of Military-Relevant Brain Injury Consortium -- Chronic Effects of Neurotrauma Consortium prospective longitudinal study among SM/V (N = 1,808). Methods: Univariable and multivariable linear regression models assessed the association and interaction effects between PTSD symptom severity, as assessed by the PTSD Checklist for the Diagnostic and Statistical Manual, 5th edition (PCL- 5), and deployment-related mild TBI on behavioral dyscontrol, adjusting for demographics, pain, social support, resilience, and general self-efficacy. Results: Among the 1,808 individuals in our sample, PTSD symptom severity (B = 0.23, 95% CI: 0.22, 0.25, p < 0.001) and deployment-related mild TBI (B = 3.27, 95% CI: 2.63, 3.90, p < 0.001) were significantly associated with behavioral dyscontrol in univariable analysis. Interaction effects were significant between PTSD symptom severity and deployment mild TBI (B = 0.03, 95% CI: -0.06, -0.01, p = 0.029) in multivariable analysis, indicating that the effect of mild TBI on behavioral dyscontrol is no longer significant among those with a PCL-5 score > 22.96. Conclusion: Results indicated an association between PTSD symptom severity, deployment-related mild TBI, and behavioral dyscontrol among SM/V. Notably, the effect of deployment-related mild TBI was pronounced for individuals with lower PTSD symptom severity. Higher social support scores were associated with lower dyscontrol, emphasizing the potential for social support to be a protective factor. General self-efficacy was also associated with reduced behavioral dyscontrol. [ABSTRACT FROM AUTHOR]

Introduction: The classic psychedelic psilocybin, found in some mushroom species, has received renewed interest in clinical research, showing potential mental health benefits in preliminary trials. Naturalistic use of psilocybin outside of research settings has increased in recent years, though data on the public health impact of such use remain limited. Methods: This prospective, longitudinal study comprised six sequential automated web-based surveys that collected data from adults planning to take psilocybin outside clinical research: at time of consent, 2  weeks before, the day before, 1–3  days after, 2–4  weeks after, and 2–3  months after psilocybin use. Results: A sample of 2,833 respondents completed all baseline assessments approximately 2  weeks before psilocybin use, 1,182 completed the 2–4  week post-use survey, and 657 completed the final follow-up survey 2–3  months after psilocybin use. Participants were primarily college-educated White men residing in the United States with a prior history of psychedelic use; mean age  =  40  years. Participants primarily used dried psilocybin mushrooms (mean dose  =  3.1 grams) for “self-exploration” purposes. Prospective longitudinal data collected before and after a planned psilocybin experience on average showed persisting reductions in anxiety, depression, and alcohol misuse, increased cognitive flexibility, emotion regulation, spiritual wellbeing, and extraversion, and reduced neuroticism and burnout after psilocybin use. However, a minority of participants (11% at 2–4  weeks and 7% at 2–3  months) reported persisting negative effects after psilocybin use (e.g., mood fluctuations, depressive symptoms). Discussion: Results from this study, the largest prospective survey of naturalistic psilocybin use to date, support the potential for psilocybin to produce lasting improvements in mental health symptoms and general wellbeing. [ABSTRACT FROM AUTHOR]

For a searchable version of these abstracts, please visit www.acrabstracts.org. [ABSTRACT FROM AUTHOR]

Background: The use of ketamine, a controlled dissociative anesthetic, has become more widespread in recent years with recreational/nonmedical use increasing and ketamine becoming more widely available in clinics to treat depression. Aims: We examined recent trends in adverse effects related to ketamine use. Methods: US National Poison Control data were examined, focusing on ketamine exposures among those aged ⩾13 between 2019 and 2021 (n = 758). We examined quarterly trends in exposure and delineated correlates of patients experiencing a major adverse effect or death. Results: The number of reported exposures increased 81.1% from 2019 Quarter 1 through 2021 Quarter 4, from 37 to 67 (p = 0.018). The majority of patients were male (57.1%), and the plurality of cases involved intentional misuse or "abuse" (39.5%), followed by suspected suicide attempt (19.7%) and unintentional exposure (18.9%). A fifth (19.6%) experienced a major adverse effect or death. A third (33.4%) co-used other drugs; the drugs most commonly co-used were benzodiazepines (14.6%), alcohol (10.3%), and opioids (8.7%). Co-use of gamma- hydroxybutyrate (GHB; adjusted prevalence ratio (aPR) = 3.43, 95% confidence interval (CI): 1.57–7.46) and opioids (aPR = 2.44, 95% CI: 1.46–4.08) was associated with increased risk for a major adverse effect or death, as was injection-only administration (aPR = 2.68, 95% CI: 1.21–5.92). Conclusions: Although still rare, poisonings involving ketamine have increased in recent years. Polydrug use—particularly with opioids or GHB—appears to be a particular risk factor for more serious adverse effects. As prevalence of use increases, it is important to monitor adverse effects and co-occurring behaviors to inform timely prevention and harm reduction as needed. [ABSTRACT FROM AUTHOR]

Research Findings: Talking about emotions with their caregivers help young children develop emotional competence, and is particularly beneficial for children who display elevated externalizing behaviors. However, prior descriptive work has shown that teacher-child emotion talk in preschool classrooms is scarce. As children are spending increasing amounts of time in preschool programs, there is value in understanding the factors associated with teacher-child emotion talk for supporting these types of interactions. In this study, child and teacher factors associated with teacher-child emotion talk frequency were examined. Participants included 183 preschool teachers and 470 children rated by their teachers as displaying elevated externalizing behaviors in a mix of federally funded (Head Start), state funded, and private preschool programs within two eastern states in the United States. Emotion talk frequency was observed in the context of a standardized, dyadic teacher-child storybook reading task. Results from a multilevel model showed that emotion talk frequency was primarily explained by differences between teachers. Particularly, teachers talked with children about emotions more often when they (1) held an early childhood major and (2) were observed to engage in more responsive teaching. Policy or Practice: Results identify malleable teacher factors linked to teacher-child emotion talk frequency. Findings also highlight the role of preschool teachers as socializers of young children's emotions and suggest the need for future research to understand how the quality of emotion talk varies between and within teachers. [ABSTRACT FROM AUTHOR]

Aims: To test separatel the efficacy of a web‐based and a peer‐based brief intervention (BI), compared with an expanded usual care control (EUC) group, among military reserve component members using alcohoI in a hazardous and harmful manner. Design: In the randomized controlled trial, participants were assigned to: [1] web‐based BI with web‐based boosters (BI + web), [2] web‐based BI with peer‐based boosters (BI + peer) or [3] enhanced usual care (EUC). Setting: Michigan, USA. Participants: A total of 739 Michigan Army National Guard members who reported recent hazardous alcohol use; 84% were male, the mean age was 28 years. Intervention: The BI consisted of an interactive program guided by a personally selected avatar. Boosters were delivered either on the web or personally by a trained veteran peer. A pamphlet, given to all participants, included information on hazardous alcohol use and military‐specific community resources and served as the EUC condition. Measurements The primary outcome measure was binge drinking episodes in the past 30 days, measured at 12 months after the BI. Findings All randomized participants were included in the outcome analyses. In adjusted analyses, BI + peer [beta = −0.43, 95% confidence interval (CI) = −0.56 to −0.31, P < 0.001] and BI + web (beta = −0.34, 95% CI = −0.46 to −0.23, P < 0.001) reduced binge drinking compared with EUC. Conclusion: This satudy was a web‐based brief intervention for hazardous alcohol use, with either web‐ or peer‐based boosters, reduced binge alcohol use among Army National Guard members. [ABSTRACT FROM AUTHOR]

The purpose of this investigation was to evaluate sex differences in health and fitness outcomes among United States Military Academy (USMA) graduates (class years 1980-2011). Subjects (n = 701 men, 641 women, age: 45.7 ± 9.3 years) were surveyed as a part of a larger investigation on risk and resiliency factors among USMA graduates. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ) short form and calculation of weekly metabolic equivalents (METs). Overweight and obesity status were assessed by body mass index (BMI). Significance for the study was set at p ≤ 0.05. Obesity rates for men (30.1%) were significantly higher than for women (16.6%). Men reported significantly higher (p = 0.01) vigorous METs·wk-1 (1,214.6 ± 1,171.6) than women (1,046.8 ± 1,133.2) despite significantly higher (p = 0.00) BMI values (28.75 ± 4.53 kg·m-2) than women (25.90 ± 5.48 kg·m-2). Women were 89% more likely to have ever been on a diet and reported higher (15.2%) Army Body Composition Program enrollment rates than men (6.3%). Obesity rates among men reflect trends seen in the broader military, Veteran, and U.S. adult populations, whereas obesity rates among women were lower. Men may be at a greater risk for obesity later in life despite higher self-reported physical activity; however, lean body mass and self-report bias should be considered. Because lifetime obesity may be influenced by factors other than physical activity, health initiatives should use a comprehensive approach early in the career of military officers. [ABSTRACT FROM AUTHOR]

Recent events have led to concerns about whether U.S. service members are "ready" to engage in combat operations. With most discussions now focused on military readiness, attention paid to warfighter readiness may have fallen behind. Service members typically receive extensive training in the tactical, physical, mental, social, and behavioral aspects of readiness, while the spiritual aspects are often ignored. This review examines (1) recent concerns over warfighter readiness, (2) mental health problems that are common among members of the U.S. military, (3) definitions and determinants of "spiritual readiness" (SR), (4) the impact of SR on human flourishing (HF) and warfighter readiness, (5) research on the effects of religious/spiritual involvement on HF, and (6) those responsible for building and sustaining SR in the military. An extensive body of research over the past 30 years has documented the impact of religious/spiritual (R/S) involvement on many aspects of human flourishing, thereby affecting the warfighter's readiness to perform duties at the highest level. Military chaplains, mental health professionals, and medical providers all play important roles in building and sustaining the spiritual readiness of those in the U.S. military, thereby ensuring that these individuals perform in a way that maximizes their success during combat operations. [ABSTRACT FROM AUTHOR]

Policy PointsPublic health science regarding alcohol consumption and problems, alcohol's role in equity and social justice, and identification of effective policy interventions has grown steadily stronger in the past 30 years.Progress on effective alcohol policies has stalled or gone backward in the United States and much of the world.Because alcohol influences at least 14 of the 17 sustainable development goals, as well as more than 200 disease and injury conditions, reducing alcohol problems should offer a platform for collaboration across public health silos but will require that public health itself respect and follow its own science. [ABSTRACT FROM AUTHOR]

Pre-migration trauma, a psychological risk factor for refugees, is often measured using cumulative indices. However, recent research suggests that trauma subtypes, rather than cumulative trauma, may better predict psychological outcomes. This study investigated the predictive utility of trauma subtypes in the assessment of refugee mental health. Multiple regression was used to determine whether cumulative trauma or trauma subtypes explained more variance in depression, anxiety, and post-traumatic stress disorder (PTSD) symptom scores in 70 Syrian and Iraqi refugees. Subtype models performed better than cumulative trauma models for PTSD (cumulative R2 = 0.138; subtype R2 = 0.32), anxiety (cumulative R2 = 0.061; subtype R2 = 0.246), and depression (cumulative R2 = 0.041; subtype R2 = 0.184). Victimization was the only subtype significantly associated with PTSD (p < 0.001; r2 = 0.210), anxiety (p < 0.001; r2 = 0.162), and depression (p = 0.002; r2 = 0.140). Cumulative trauma was predictive of PTSD symptoms only (p = 0.003; r2 = 0.125). Trauma subtypes were more informative than cumulative trauma, indicating their utility for improving predictive efforts in research and clinical contexts. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, various restrictions forced people around the world to socially isolate. People were asked to stay at home and were largely unable to do many of the activities that they derived meaning from. Since meaning is often related to mental health, these restrictions were likely to decrease mental health. The current study aimed to examine these effects and additionally benefit individuals' mental health by making their meaning salient. Specifically, the goal of the research was to design an intervention that could counter the potential negative effects of social distancing. We recruited a total of 96 U.S.A. residents (Mage = 34.45, 92.7% Female) and assigned them to either the control group or to a meaning salience intervention. That is, participants either focused on the meaning of their daily activities (n = 45) or did not participate in any study-related activities during the week (n = 51). They completed various measures of mental health before and after this experimental period. Results suggested that the control group reported significantly greater anxiety, depression, and stress at the end of the week. In contrast, the experimental group reported less anxiety and trended toward less depression and stress at the end of that same week. In all, results suggest that simply focusing on one's daily activities and the meaning found in them protected people from the otherwise detrimental effects of the restrictions. This provides a promising and simple intervention that may assist both individuals and practitioners aiming to improve mental health, especially in challenging times. [ABSTRACT FROM AUTHOR]

Although peer-facilitated social support interventions have been developed across populations with different areas of need,[23]-[25] prior to the Women Veterans Network (WoVeN), there was no national peer support network specifically designed to meet the unique needs of women Veterans. Mental and physical health conditions in US combat veterans: results from the National Health and Resilience in Veterans Study. Women veterans report: The past, present, and future of women veterans [Internet]. Since the program's inception in 2017, WoVeN has trained 298 Peer Leaders who have led 215 groups, serving 1444 women Veterans (see Fig. [Extracted from the article]

At the end of life, individuals may re-engage with earlier life trauma as they reflect on life experiences and confront their mortality. As such, posttraumatic stress disorder (PTSD) symptoms at the end of life may worsen the quality of death experience. This is a concern for military veterans, who tend to have more trauma exposures and higher rates of PTSD, and particularly for veterans receiving care in rural areas where access to PTSD specialty services is limited. To better understand this issue, we conducted 10 focus groups with clinicians serving veterans in rural communities across five U.S. states. The aims of this project were to evaluate: (1) do hospice and palliative care providers/staff observe PTSD symptoms in veterans at the end of life? (2) if so, how are symptoms similar to and different from existing DSM-5 criteria for PTSD? We used qualitative content analysis with mixed deductive and inductive approaches to code 151 anonymized statements. Analyses found descriptions of PTSD symptoms aligned broadly with existing diagnostic nomenclature, but descriptions revealed specific presentations relevant to the end of life setting such as resistance to care, agitation, restlessness, and effects of delirium. In addition, some veterans expressed pride in service and openness to discussing military experiences. Further, clinicians noted that PTSD symptoms were relevant to family dynamics. Future research should further characterize these symptom differences through direct patient assessment and develop resources to improve quality of death experience for veterans with PTSD symptoms. [ABSTRACT FROM AUTHOR]

This study assessed the Moral Injury Symptoms Scale – Military Version – Short Form's (MISS-M-SF) factor structure and construct validity. Participants included 3650 combat-deployed U.S. veterans who answered all 10 MISS-M-SF items from the sixth wave of The Veterans Metric Initiative (TVMI). EFA results suggested a two-factor solution, based on item wording, fit best. CFA results indicated a bifactor model (one general factor and two method factors, based on item wording) fit best. Further investigation revealed that a one-factor model could be used despite the data's multidimensionality. Item-level analyses revealed four items represented the general factor exceptionally well, potentially simplifying assessment in research and clinical applications. Construct validity was also demonstrated through moderate to high correlations with conceptually related measures. [ABSTRACT FROM AUTHOR]

The latent structure of Post-Traumatic Stress Disorder (PTSD) symptomology is the subject of ongoing deliberation. The cognitive vulnerabilities of Negative Affect, Anxiety Sensitivity and Intolerance of Uncertainty have been shown to explain symptoms clusters in multiple anxiety and mood disorders, and may be able to offer further insight to explain PTSD symptomology. Using structural equation modelling, this study examines whether a hierarchical model consisting of the general cognitive factor of Negative Affect and the transdiagnostic risk factors of Anxiety Sensitivity and Intolerance of Uncertainty can explain variability among PTSD symptom clusters as defined by the DSM-5 and/or Dysphoria models of PTSD. Anxiety Sensitivity and Intolerance of Uncertainty were tested as mid-level factors between Negative Affect and the PTSD symptom constructs. The hierarchical model fit the data well in both the DSM-5 and Dysphoria models. Negative Affect consistently showed significant direct effects on each symptoms cluster in both models. Anxiety Sensitivity served as a significant mediator of Negative Affect for several symptom clusters in both models. Intolerance of Uncertainty was non-significant either as a direct effect or as a mediator of Negative Affect in all analyses. This study demonstrates how the hierarchical model of Negative Affect, Anxiety Sensitivity and Intolerance of Uncertainty may fit upon multiple PTSD symptom constructs and offers new directions for conceptualizing this disorder. [ABSTRACT FROM AUTHOR]

Although HIV and substance use disorders (SUDs) constitute a health syndemic, no research to date has examined the perceived negative impacts of different SUDs for people with HIV (PWH). In May 2019, 643 stakeholders in the U.S., representing clients of AIDS service organizations (ASOs), ASO staff, and HIV/AIDS Planning Council members, participated in an innovative Stakeholder-Engaged Real-Time Delphi (SE-RTD) survey focused on the prevalence and individual-level negative impact of five SUDs for PWH. The SE-RTD method has advantages over conventional survey methods by efficiently sharing information, thereby reducing the likelihood that between-group differences are simply due to lack of information, knowledge, and/or understanding. The population-level negative impacts were calculated by weighting each SUD's individual-level negative impact on indicators of the HIV Care Continuum and other important areas of life by the perceived prevalence of each SUD. Overall, we found these SUDs to have the greatest population-level negative impact scores (possible range 0–24): alcohol use disorder (population-level negative impact = 6.9; perceived prevalence = 41.9%), methamphetamine use disorder (population-level negative impact = 6.5; perceived prevalence = 3.2%), and opioid use disorder (population-level negative impact = 6.4; perceived prevalence = 34.6%). Beyond further demonstration of the need to better integrate SUD services within HIV settings, our findings may help inform how finite funding is allocated for addressing the HIV-SUD syndemic within the U.S. Based on our findings, such future efforts should prioritize the integration of evidence-based treatments that help address use disorders for alcohol, methamphetamine, and opioids. [ABSTRACT FROM AUTHOR]

Background: In August 2017, Hurricane Harvey disrupted the lives of millions in the Houston/Galveston gulf coast region, causing injury, loss, and major uncertainty of wellbeing. Natural disasters can influence parent mental health and parenting behaviors, though less is known about how these factors might be associated with parenting accommodations provided to children immediately following a disaster. OBJECTIVE: This study examined parental anxiety, depression, and post-traumatic stress symptoms (PTSS), as well as pre-existing parenting practices (i.e., positive parenting, supervision, discipline) as clinical predictors of parenting accommodations (PA) in the aftermath of Hurricane Harvey. Method: Parents of children ages 2–17 (n = 130) completed self-report measures approximately one month after Hurricane Harvey. Results: A three-step hierarchical multiple regression was conducted to predict PA from demographic variables (age, income, gender), parental levels of anxiety, depression, and PTSS, and parenting practices. Results indicated that families with lower income, higher rates of inconsistent discipline, and higher levels of parental anxiety reported engaging in greater PA following Hurricane Harvey. Conclusions: Accommodations may be explained in the context of reactive parenting practices aimed at reducing child and parent distress following a natural disaster. Consistent routines, limit-setting, and other positive parenting practices may be important treatment targets to reduce parenting accommodations following a natural disaster. [ABSTRACT FROM AUTHOR]

This study examines whether accountability to God is positively associated with four measures of psychological well-being—happiness, mattering to others, dignity, and meaning—among US adults. It also tests the possibility that prayer moderates these associations. Data from the 2017 Values and Beliefs of the American Public Survey (n = 1251) were analyzed using multivariate regression. Findings provided support for an association between accountability to God and mattering to others, dignity, and meaning in fully controlled models, and for happiness when religious controls were excluded. They also showed that these relationships were stronger among those who prayed frequently compared with those who did not. Overall, these findings shed light on a new concept—accountability to God—including its association with psychological well-being. [ABSTRACT FROM AUTHOR]

In times of crisis, communication by leaders is essential for mobilizing an effective public response. During the COVID-19 pandemic, compliance with public health guidelines has been critical for the prevention of infections and deaths. We assembled a corpus of over 1500 pandemic-related speeches, containing over 4 million words, delivered by all 50 US state governors during the initial months of the COVID-19 pandemic. We analyzed the semantic, grammatical and linguistic-complexity properties of these speeches, and examined their relationships to COVID-19 case rates over space and time. We found that as COVID-19 cases rose, governors used stricter language to issue guidance, employed greater negation to defend their actions and highlight prevailing uncertainty, and used more extreme descriptive adjectives. As cases surged to their highest levels, governors used shorter words with fewer syllables. Investigating and understanding such characteristic responses to stress is important for improving effective public communication during major health crises. [ABSTRACT FROM AUTHOR]

Background: Suicide is one of the leading causes of death worldwide and rates within the United States have risen over the past two decades. Hence, there is a critical need for novel tools to treat suicidal ideation and related mental health conditions. 3,4-Methylenedioxymethamphetamine (MDMA)/ecstasy and classic psychedelics may be two such tools. Aims: The aim of this study was to assess non-causal associations between MDMA/ecstasy and classic psychedelic use and psychological distress and suicide risk. Methods: In this study, we examined the aforementioned associations among 484,732 adult participants in the National Survey on Drug Use and Health (2008–2019). Results: Lifetime MDMA/ecstasy use was associated with reduced odds of past year suicidal thinking (10% reduced odds; odds ratio (OR) = 0.90; 95% confidence interval, CI = (0.84–0.97); p < 0.01) and past year suicidal planning (OR = 0.88; 95% CI = (0.78–0.99); p < 0.05). Furthermore, lifetime psilocybin use was associated with reduced odds of past month psychological distress (OR = 0.78; 95% CI = (0.73–0.84); p < 0.001) and past year suicidal thinking (OR = 0.90; 95% CI = (0.83–0.96); p < 0.01). Finally, lysergic acid diethylamide (LSD) was associated with increased odds of past year suicidal thinking (OR = 1.07; 95% CI = (1.00–1.15); p < 0.05). Conclusion: MDMA/ecstasy and psilocybin use are associated with reduced odds of suicidal thinking and related outcomes—though experimental studies are needed to determine whether these associations are causal. These findings call for more research into the efficacy of MDMA/ecstasy and classic psychedelics for treating psychological distress and suicidal thoughts and behaviors, and for updated drug legislation that allows for further investigation into these substances. [ABSTRACT FROM AUTHOR]

Introduction: Reducing cigarette use is a major public health goal in the United States. Questions remain, however, about the potential for the social environment in the adult years-particularly in the 30s and beyond-to influence cigarette use. This study tested pathways hypothesized by the social development model to understand the extent to which social environmental factors at age 33 (eg, involvement with smokers or with physically active people) contribute to changes in cigarette use from age 30 to age 39. Both combustible and electronic cigarette use were investigated.Methods: Data were from the Seattle Social Development Project, a longitudinal study of 808 diverse participants with high retention. Self-reports assessed social developmental constructs, combustible and electronic cigarette use, and demographic measures across survey waves.Results: At age 30, 32% of the sample reported past-month cigarette use. Using structural equation modeling, results showed high stability in cigarette use from age 30 to 39. After accounting for this stability, cigarette-using social environments at age 33 predicted personal beliefs or norms about smoking (eg, acceptability and social costs), which in turn predicted combustible cigarette use at age 39. Cigarette-using environments, however, directly predicted electronic cigarette use at age 39, with no significant role for beliefs about smoking.Conclusions: Cigarette use was highly stable across the 30s, but social environmental factors provided significant partial mediation of this stability. Pathways were different for combustible and electronic cigarette use, however, with personal smoking norms playing an important role for the former but not the latter.Implications: This study addresses the need for longitudinal investigation of social mechanisms and cigarette use in the 30s. Findings reinforce efforts to prevent the uptake of cigarettes prior to the 30s because, once started, smoking is highly stable. But social environmental factors remain viable intervention targets in the 30s to disrupt this stability. Addressing personal norms about smoking's acceptability and social costs is likely a promising approach for combustible cigarette use. Electronic cigarettes, however, present a new challenge in that many perceived social costs of cigarette use do not readily translate to this relatively recent technology. [ABSTRACT FROM AUTHOR]

Aims To demonstrate that early adolescent binge drinking (BD) increases the risk for and/or severity of psychopathology in post-9/11 Veterans and determine if mild traumatic brain injury (mTBI) modifies risk. Methods Post-9/11 Veterans (n = 375) were classified into two groups: 57 Veterans with a history of early adolescent BD (E-BD; age of onset <15) and 318 who did not BD until age 15 or older (late-BD or L-BD; age of onset ≥15). History of military mTBI and mental health disorders were also assessed following military service. Results Logistic regression and analysis of variance (ANOVA) analyses revealed that the E-BD's had significantly higher prevalence of alcohol use disorders (AUDs) and more severe symptoms of AUD, substance use disorder (SUD), depression and stress. Two-way ANOVAs showed that history of military mTBI was differentially associated with posttraumatic stress disorder (PTSD) incidence and severity among Veterans who had engaged in early adolescent BD. Specifically, Veterans with a history of both early adolescent BD and military mTBI were at greater risk for a PTSD diagnosis and had more severe symptoms of PTSD than those with only a history of adolescent BD. The greater PTSD symptom severity in the comorbid group was driven by hyperarousal symptoms. Conclusions A history of BD during early adolescence is prevalent among Veterans and is related to higher risk for AUD and more severe AUD, SUD, mood and stress symptoms later in life. Veterans with early BD and military mTBI showed greater incidence and severity of PTSD, indicating that mTBI, a common comorbidity among post-9/11 Veterans, exacerbates risk. [ABSTRACT FROM AUTHOR]

United States (U.S.) veterans are substantially older than their non-veteran counterparts. However, nationally representative, population-based data on the unique health needs of this population are lacking. Such data are critical to informing the design of large-scale outreach initiatives, and to ensure the effectiveness of service care delivery both within and outside of the Veterans Affairs healthcare system. The National Health and Resilience in Veterans Study (NHRVS) is a contemporary, nationally representative, prospective study of two independent cohorts (n = 3,157 and n = 1,484) of U.S. veterans, which is examining longitudinal changes, and key risk and protective factors for several health outcomes. In this narrative review, we summarize the main findings of all NHRVS studies (n = 82) published as of June 2020, and discuss the clinical implications, limitations, and future directions of this study. Review of these articles was organized into six major topic areas: post-traumatic stress disorder, suicidality, aging, resilience and post-traumatic growth, special topics relevant to veterans, and genetics and epigenetics. Collectively, results of these studies suggest that while a significant minority of veterans screen positive for mental disorders, the majority are psychologically resilient. They further suggest that prevention and treatment efforts designed to promote protective psychosocial characteristics (i.e., resilience, gratitude, purpose in life), and social connectedness (i.e., secure attachment, community integration, social engagement) help mitigate risk for mental disorders, and promote psychological resilience and post-traumatic growth in this population. [ABSTRACT FROM AUTHOR]

This study examines the ways in which emerging adults in the United States narratively constructed identities in relation to their conceptions of the good life. What does it mean to be a good person? Am I living a good life? How can I lead a better life? All of these variations of the Who-am-I question––in relation to Who-I-should-be and Who-I-want-to-be––were investigated in this qualitative study. In-depth, life-story interviews (N = 24) were conducted with individuals between the ages of 18 and 29 across the U.S. The findings of a discursive thematic analysis indicate that emerging adults highly value subjectivity, independence, and interdependence when considering what makes a person and a life good. More than any one particular belief system, emerging adults expressed the values of individualism, idiosyncrasy, pluralism, and relativism when considering the features of a good life. They placed particular importance on deciding these beliefs on their own, and that there is not one answer to the question of what makes a life good. Results indicate that these values are fundamental to the master narrative of emerging adulthood in the U.S. [ABSTRACT FROM AUTHOR]

Employer-sponsored health insurance is the most widely spread form of medical coverage in the United States. Substantial portion of the premiums' costs is covered by employers, thus contributing to labor costs for organizations. Although worker health and well-being have become increasingly important for businesses, most of them do not see a direct link between their health and well-being investments and work output and quality of work of their employees. This study aimed to estimate the cost of inefficiencies at work with emphasis on their internal causes, i.e., sick-related absenteeism and distraction at work. With data from 3,258 employees (2,775 office and 483 manufacturing) from a major US manufacturer with revenue of $6 billion, monetary loss in productivity due to sick-related absenteeism and distraction among office and factory floor employees was assessed. The Work Productivity and Activity Impairment scale and the Health-related Lost Productivity Time tool (both already validated) were used to estimate the cost of productivity loss. Survey data on health-related absenteeism and distraction time at work, together with company pay records, were used. A secondary analysis, using survey data collected from 615 Polish apparel factory workers at a major global brand complemented with their payroll records (absenteeism and salary), was conducted to validate the main findings. Results of the primary analysis indicated that annual productivity loss to the organization amounted to approximately $300 m. Distraction contributed to 93.6% of the annual productivity loss of the US manufacturer, while only 6.4% resulted from health-related absenteeism, implying that distraction at work cost this organization almost 15 times more than health related absenteeism, reducing the overall return on sales by over 6 pp. The secondary analysis corroborated the dominance of distraction induced productivity costs over the cost of health-related absenteeism. Evidence from the regression analysis conducted on cross-sectional data indicated that regardless of the type of work, work engagement and auditory privacy were evidently highly bound with productivity loss. For manufacturing workers, job security was also negatively correlated with productivity loss, while for office employees, better social relationships and lack of work-family conflict were positively associated with productivity. Despite being based on two case studies, our results are informative of the magnitude of distraction and health related productivity costs. They also show that workers with deficiencies in their well-being at work present a substantial opportunity for growth to companies in terms of reduced efficiency. [ABSTRACT FROM AUTHOR]

Novel psychoactive substances (NPS) are synthetic drugs that pose serious public health and safety concerns. A multitude of NPS have been identified in the United States, often implicated in forensic investigations. The most common and effective manner for identifying NPS is by use of mass spectrometry and the true utility lies within nontargeted acquisition techniques. During this study, a liquid chromatography quadrupole time‐of‐flight mass spectrometry (LC‐QTOF‐MS) assay was developed, validated, and implemented for forensic toxicology testing. A SCIEX TripleTOF™ 5600 + with SWATH® acquisition was used. Resulting data were compared against an extensive library database containing more than 800 compounds. The LC‐QTOF‐MS assay was applied to the reanalysis of biological sample extracts to discover emergent NPS. More than 3,000 sample extracts were analyzed, and more than 20 emerging NPS were detected for the first time. Among these were isopropyl‐U‐47700, 3,4‐methylenedioxy‐U‐47700, fluorofuranylfentanyl, N‐methyl norfentanyl, 2F‐deschloroketamine, 3,4‐methylenedioxy‐alpha‐PHP, eutylone, and N‐ethyl hexedrone. [ABSTRACT FROM AUTHOR]

Background: Post-traumatic stress disorder (PTSD) can be exacerbated by subsequent trauma, but it is unclear if symptoms are worsened by impending death. PTSD symptoms, including hyperarousal, negative mood and thoughts, and traumatic re-experiencing, can impact end-of-life symptoms, including pain, mood, and poor sleep. Thus, increased symptoms may lead to increased end-of-life healthcare utilization.Objectives: To determine if veterans with PTSD have increased end-of-life healthcare utilization or medication use and to examine predictors of medication administration.Design: Secondary analysis of a stepped-wedge design implementation trial to improve end-of-life care for Veterans Affairs (VA) inpatients. Outcome variables were collected via direct chart review. Analyses included hierarchical, generalized estimating equation models, clustered by medical center.Subjects: Veterans, inpatient at one of six VA facilities, dying between 2005 and 2011.Main Measures: Emergency room (ER) visits, hospitalizations, and medication administration in the last 7 days of life.Key Results: Of 5341 veterans, 468 (8.76%) had PTSD. Of those, 21.4% (100/468) had major depression and 36.5% (171/468) had anxiety. Veterans with PTSD were younger (mean age 65.4 PTSD, 70.5 no PTSD, p < 0.0001) and had more VA hospitalizations and ER visits in the last 12 months of life (admissions: PTSD 2.8, no PTSD 2.4, p < 0.0001; ER visits: 3.2 vs 2.5, p < 0.0001). PTSD was associated with antipsychotic administration (OR 1.52, 95% CI 1.06-2.18). Major depression (333/5341, 6.2%) was associated with opioid administration (OR 1.348, 95% CI 1.129-1.609) and benzodiazepines (OR 1.489, 95% CI 1.141-1.943). Anxiety disorders (778/5341, 14.6%) were only associated with benzodiazepines (OR 1.598, 95% CI 1.194-2.138).Conclusions: PTSD's association with increased end-of-life healthcare utilization and increased antipsychotic administration in the final days of life suggests increased symptom burden and potential for terminal delirium in individuals with PTSD. Understanding the burden of psychiatric illness and potential risks for delirium may facilitate the end-of-life care for these patients.Trial Registration: NCT00234286. [ABSTRACT FROM AUTHOR]

The impacts of invertebrate RNA virus population dynamics on virulence and infection outcomes are poorly understood. Deformed wing virus (DWV), the main viral pathogen of honey bees, negatively impacts bee health, which can lead to colony death. Despite previous reports on the reduction of DWV diversity following the arrival of the parasitic mite Varroa destructor, the key DWV vector, we found high genetic diversity of DWV in infested United States honey bee colonies. Phylogenetic analysis showed that divergent US DWV genotypes are of monophyletic origin and were likely generated as a result of diversification after a genetic bottleneck. To investigate the population dynamics of this divergent DWV, we designed a series of novel infectious cDNA clones corresponding to coexisting DWV genotypes, thereby devising a reverse-genetics system for an invertebrate RNA virus quasispecies. Equal replication rates were observed for all clone-derived DWV variants in single infections. Surprisingly, individual clones replicated to the same high levels as their mixtures and even the parental highly diverse natural DWV population, suggesting that complementation between genotypes was not required to replicate to high levels. Mixed clone–derived infections showed a lack of strong competitive exclusion, suggesting that the DWV genotypes were adapted to coexist. Mutational and recombination events were observed across clone progeny, providing new insights into the forces that drive and constrain virus diversification. Accordingly, our results suggest that Varroa influences DWV dynamics by causing an initial selective sweep, which is followed by virus diversification fueled by negative frequency-dependent selection for new genotypes. We suggest that this selection might reflect the ability of rare lineages to evade host defenses, specifically antiviral RNA interference (RNAi). In support of this hypothesis, we show that RNAi induced against one DWV strain is less effective against an alternate strain from the same population. [ABSTRACT FROM AUTHOR]

Background: Meta-analysis of randomized studies using lysergic acid diethylamide (LSD) for alcohol use disorder (AUD) showed large, significant effects for LSD efficacy compared to control conditions. Clinical studies suggest potential anti-addiction effects of LSD and mechanistically-related classic psychedelics for alcohol and other substance use disorders.Aims: To supplement clinical studies, reports of psychedelic use in naturalistic settings can provide further data regarding potential effects of psychedelics on alcohol use.Methods: An anonymous online survey of individuals with prior AUD reporting cessation or reduction in alcohol use following psychedelic use in non-clinical settings.Results: 343 respondents, mostly White (89%), males (78%), in the USA (60%) completed the survey. Participants reported seven years of problematic alcohol use on average before the psychedelic experience to which they attributed reduced alcohol consumption, with 72% meeting retrospective criteria for severe AUD. Most reported taking a moderate or high dose of LSD (38%) or psilocybin (36%), followed by significant reduction in alcohol consumption. After the psychedelic experience 83% no longer met AUD criteria. Participants rated their psychedelic experience as highly meaningful and insightful, with 28% endorsing psychedelic-associated changes in life priorities or values as facilitating reduced alcohol misuse. Greater psychedelic dose, insight, mystical-type effects, and personal meaning of experiences were associated with a greater reduction in alcohol consumption, controlling for prior alcohol consumption and related distress.Conclusions: Although results cannot demonstrate causality, they suggest that naturalistic psychedelic use may lead to cessation or reduction in problematic alcohol use, supporting further investigation of psychedelic-assisted treatment for AUD. [ABSTRACT FROM AUTHOR]

Due to successful public health campaigns, breast cancer has successfully transformed from a highly stigmatized illness to a philanthropically supported disease in the United States. However, Chinese American breast cancer survivors continue to experience high levels of self-stigma and associated negative mental health outcomes. In the present study, we examined the relations between self-stigma and depressive symptoms, and further tested individual difference variables such as ambivalence over emotional expression and intrusive thoughts that may exacerbate the harmful effects of self-stigma among this population. One hundred and twelve foreign-born Chinese breast cancer survivors living in the United States completed questionnaires measuring self-stigma, depressive symptoms, AEE, and intrusive thoughts. We found significant AEE × self-stigma and intrusive-thought × self-stigma interaction effects in predicting depressive symptoms. Specifically, the relationships between self-stigma and depressive symptoms were exacerbated among individuals with high levels of AEE and intrusive thoughts. Self-stigma represents a significant predictor of depressive symptoms among Chinese breast cancer survivors, and particularly so for individuals with higher levels of AEE and intrusive thoughts. The findings suggest that for interventions designed to reduce the negative mental health outcomes associated with self-stigma, targeting risk factors such as AEE and intrusive thoughts might be promising. [ABSTRACT FROM AUTHOR]

Cannabis is the third most used psychoactive drug worldwide. Despite being legally scheduled as a drug with high harm potential and no therapeutic utility in countries like the USA, evidence shows otherwise and legislative changes and reinterpretations of existing ambiguous laws make this drug increasingly available by legal means. Nevertheless, this substance is able to generate clear addiction syndromes in some individuals who use it, which are accompanied by brain alterations resembling those caused by other addictive drugs. Moreover, there is no available pharmacological treatment for this disorder. This fact motivates a deep study and comprehension of the neural basis of addiction-relevant cannabinoid effects. Interestingly, the cerebellum, a hindbrain structure which involvement in functions not related to motor control and planning is being increasingly recognized in the last decades, seems to be involved in the effects of addictive drugs and addiction-related processes and also presents a high density of cannabinoid receptors. Preclinical research on the involvement of the cerebellum in cannabis' effects has focused in the drug's motor incoordinating actions, potentially underestimating its participation in addiction. Therefore, this review addresses the studies reporting cerebellar involvement in cannabis effects both in experimental animals and human subjects and the possible relevance of these changes for addiction. Additionally, future experimental approaches will be proposed and hopefully this work will stimulate research on the cerebellum in cannabis addiction and help recognizing it as an important part of the neural circuitry affected in cannabis-related disorders. [ABSTRACT FROM AUTHOR]

Background: The tripartite model of mental well-being offers a comprehensive account of the nature of mental well-being. According to this model, mental well-being is composed of three distinct yet related dimensions of subjective (hedonic), psychological and social well-being. Aims: The present study investigated the structural and discriminant validity of the three well-being factors. Methods: A large American sample (N = 2732) was used. Data were analyzed using both Confirmatory Factor Analysis (CFA) and Exploratory Structural Equation Modeling (ESEM). Results: It was found that the well-being variables loaded on three separate factors, indicating that the tripartite model was consistent with the data. Discriminant validity was further evidenced by moderate correlations between the latent factors, and differential relationships with the Big Five personality traits. ESEM proved to be a more appropriate approach for analyzing the data given the presence of cross-loadings. Conclusions: These results support adequate structural and discriminant validity for the dimensions of the tripartite model. [ABSTRACT FROM AUTHOR]

Through the potency monitoring program at the University of Mississippi supported by National Institute on Drug Abuse (NIDA), a total of 18108 samples of cannabis preparations have been analyzed over the last decade, using a validated GC/FID method. The samples are classified as sinsemilla, marijuana, ditchweed, hashish, and hash oil (now referred to as cannabis concentrate). The number of samples received over the last 5 years has decreased dramatically due to the legalization of marijuana either for medical or for recreational purposes in many US states. The results showed that the mean Δ9-THC concentration has increased dramatically over the last 10 years, from 8.9% in 2008 to 17.1% in 2017. The mean Δ9-THC:CBD ratio also rose substantially from 23 in 2008 to 104 in 2017. There was also marked increase in the proportion of hash oil samples (concentrates) seized (0.5-4.7%) and their mean Δ9-THC concentration (6.7-55.7%) from 2008 to 2017. Other potency monitoring programs are also present in several European countries such as The Netherlands, United Kingdom, France, and Italy. These programs have also documented increases in Δ9-THC concentrations and Δ9-THC:CBD ratios in cannabis. These trends in the last decade suggest that cannabis is becoming an increasingly harmful product in the USA and Europe. [ABSTRACT FROM AUTHOR]

Greater perceived and actual generative, or contributory, engagement predicts more favorable psychosocial and physical well-being with advancing age. Although theoretical formulations of prosocial behavior suggest self-enhancement, social connectedness, and positive emotion pathways might underlie such links, empirical examination of these connections remains limited. These associations were examined using data from the National Study of Daily Experiences (n = 1747) in the National Survey of Midlife Development in the United States. Multilevel regression models examined person-level and day-level indicators of three forms of generative activity (volunteering, emotional support, informal help) as predictors of daily self-enhancement, social connectedness, and positive affect states over an 8-day period, controlling for sociodemographic factors. At the daily level, both volunteering and giving informal help were found to be associated with greater feelings of self-enhancement and social connectedness. Though the between-person effects of informal help were not significant, individuals who volunteered more, on average, also experienced greater average feelings of positive affect and social connectedness than those who volunteered less or not at all. In contrast, giving emotional support to others was associated with slightly lower levels of these cognitive-affective correlates on a given day, and on average. Observed daily cognitive-affective correlates of different generative activities suggest potential pathways through which such activities may be linked to well-being over time. [ABSTRACT FROM AUTHOR]

Objective: Over the past few decades, women's roles in the United States military have expanded significantly. Currently women encounter more wartime experiences during deployment than in the past. Previous research with male service members has linked exposure to wartime events to subsequent development of post-traumatic stress disorder (PTSD) symptoms. However, because of the unique experiences of military women, research is needed to better understand the link between wartime experiences and mental health in female personnel. Methods: We examined the wartime experiences of deployed, active-duty female Airmen and their relations to PTSD. A large representative sample of active-duty female Air Force personnel, who responded to the U.S. Air Force Community Assessment Survey (CAS), was used to determine the relationships between wartime experiences and symptoms of PTSD. Previous research suggests the possibility that factors, including unit cohesion and self-efficacy, may mediate these relations. Results: Descriptive analyses indicate that the percentage of personnel experiencing PTSD symptoms increased as the number of wartime experiences increased. Logistic regression analyses revealed that wartime experiences were positively related to subsequent PTSD-related symptoms. Both unit cohesion and self-efficacy were negatively related to PTSD symptoms, but neither variable was found to moderate the relationship between wartime experiences and PTSD. Conclusions: Women are experiencing greater numbers of wartime experiences. Like men, as the number of wartime experiences increases, PTSD symptoms increase as well. Self-efficacy and unit cohesion were found to lower these symptoms, indicating that these factors may help decrease the negative impact of wartime experiences. [ABSTRACT FROM AUTHOR]

Over five million children in the United States have a parent living with a serious mental illness. These offspring are at higher risk for developing mental health problems themselves due to a complex interplay of biological, psychological, and psychosocial factors. Life with a parent with psychiatric symptoms can be scary, confusing, overwhelming, and sad; children often blame themselves for their parent’s problems, find their parent’s behavior embarrassing, and struggle to explain the illness to their friends. Unfortunately, these children’s needs and experiences are often ignored by overwhelmed parents, worried family members and relatives, separate mental health systems of care for adults and children that often fail to coordinate care, and even well-intentioned health-care providers. Family medicine teams have an opportunity to detect and support these families in unique ways. We offer four recommendations for family medicine teams to help families managing parental mental illness including assessing functioning, treatment needs, and impacts on each family member; educating all family members about mental illness; instilling hope, noting the range of effective treatments for mental illness; and encouraging the use of supports and referral options. Providers can leverage family members’ strengths, work with community-based resources, and offer continuity to these families, as they struggle with an oftentimes chronic, relapsing disease that has ripple effects throughout the family system. [ABSTRACT FROM AUTHOR]

Introduction: The biodegradable polymer drug-eluting stents were developed to improve vascular healing. However, further data are needed to confirm the safety and efficacy of these stents in patients with acute myocardial infarction (AMI). Aim: We sought to determine the 1-year clinical follow-up in patients with AMI treated with a thin strut biodegradable polymer-coated sirolimus-eluting stent (BP-SES) versus a durable coating everolimus-eluting stent (DP-EES). Material and methods: We analyzed patients with AMI (STEMI and NSTEMI) treated with either a BP-SES (ALEX, Balton, Poland, n = 886) or DP-EES (XIENCE, Abbott, USA, n = 1054) with available 1-year clinical follow-up using propensity score matching. Outcomes included target vessel revascularization (TVR) as the efficacy outcome and all-cause death, myocardial infarction, and definite/probable stent thrombosis as safety outcomes. Results: After propensity score matching 672 patients treated with BP-SES and 672 patients treated with DP-EES were selected. Procedural and clinical characteristics were similar between the groups. In-hospital mortality was similar in both tested groups. Oneyear follow-up demonstrated comparable efficacy outcome TVR (BP-SES 7.1% vs. DP-EES 5.2%, p = 0.14), as well as similar safety outcomes of all-cause death, myocardial infarction, and definite/probable stent thrombosis. Conclusions: The thin-strut biodegradable polymer coated sirolimus-eluting stent demonstrated comparable clinical outcomes at 1 year after implantation to the DP-EES. These data support the relative safety and efficacy of BP-SES in AMI patients undergoing percutaneous coronary intervention. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to assess utility of in vivo myelin imaging in combat Veterans with and without history of mild traumatic brain injury (mTBI). We hypothesized that those with history of mTBI would have lower myelin water fraction (MWF), a marker of myelin integrity and content, than those without, and lower MWF would be associated with worse speeded attention/processing speed. Research design: Combat Veterans (N = 70) with (n = 42) and without history of mTBI (n = 28) underwent neuroimaging including a novel myelin-sensitive magnetic resonance imaging technique (multicomponent-driven equilibrium single-pulse observation of T1/T2; mcDESPOT) and comprehensive neuropsychological assessment. Results: There were no group differences in MWF using a region-of-interest approach. An exploratory analysis applying limited spatial constraints, however, revealed significantly more 'potholes' (clusters of low MWF) in Veterans with history of mTBI compared to those without. Lower MWF across several ROIs was associated with worse performance on a speeded attention task across groups. Conclusion: Veterans in the post-acute period following mTBI showed limited and spatially heterogeneous MWF changes and myelin integrity was significantly related to processing speed. This preliminary evidence for usefulness of mcDESPOT in combat Veterans with history of mTBI warrants future research to determine mcDESPOT's relative utility compared to techniques such as diffusion tensor imaging. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editors discuss the contents within the issue, including articles on topics such as chronic effects of neurotrauma consortium, mild traumatic brain injuries (mTBI), and neuroimaging and neuropsychiatric.

Objectives: Disability evaluation is complex. The association between mild traumatic brain injury (mTBI) history and VA service-connected disability (SCD) ratings can have implications for disability processes in the civilian population. We examined the association of VA SCD ratings with lifetime mTBI exposure in three models: any mTBI, total mTBI number, and blast-related mTBI. Methods: Participants were 492 Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans from four US VA Medical Centers enrolled in the Chronic Effects of Neurotrauma Consortium study between January 2015 and August 2016. Analyses entailed standard covariate-adjusted linear regression models, accounting for demographic, military, and health-related confounders and covariates. Results: Unadjusted and adjusted results indicated lifetime mTBI was significantly associated with increased SCD, with the largest effect observed for blast-related mTBI. Every unit increase in mTBI was associated with an increase in 3.6 points of percent SCD. However, hazardous alcohol use was associated with lower SCD. Conclusions: mTBI, especially blast related, is associated with higher VA SCD ratings, with each additional mTBI increasing percent SCD. The association of hazardous alcohol use with SCD should be investigated as it may impact veteran health services access and health outcomes. These findings have implications for civilian disability processes. [ABSTRACT FROM AUTHOR]

Objectives: Determine if mild traumatic brain injury (mTBI) history is associated with balance disturbances. Setting: Chronic Effects of Neurotrauma Consortium (CENC) centres. Participants: The CENC multi-centre study enrols post-9/11 era Service Members and Veterans with combat exposure. This sample (n = 322) consisted of enrolees completing initial evaluation by September 2016 at the three sites conducting computerized dynamic post-urography (CDP) testing. Design: Observational study with cross-sectional analyses using structural equation modelling. Main Measures: Comprehensive structured interviews were used to diagnose all lifetime mild traumatic brain injuries (mTBIs). The outcome, Sensory Organization Test (SOT), was measured on CDP dual-plate force platform. Other studied variables were measured by structured interviews, record review and questionnaires. Results: The overall positive/negative mTBI classification did not have a significant effect on the composite equilibrium score. However, the repetitive mTBI classification showed lower scores for participants with ≥ 3 mTBI versus 1-2 lifetime mTBIs. For repetitive mTBI, pain interference acted as a mediator for the indirect effect, and a direct effect was evident on some sensory condition equilibrium scores. Conclusion: These findings show that repeated mTBI, partially mediated by pain, may lead to later balance disturbances among military combatants. Further study of CDP outcomes within this accruing cohort is warranted. [ABSTRACT FROM AUTHOR]

This study explored the differences in perceived unit cohesion, trauma symptoms, depression symptoms, and anxiety symptoms controlling for childhood trauma, based on attachment style in US military veterans. Previous studies have reported that higher levels of military unit cohesion, bonding through the social relationships between service members and their larger units, and secure attachment, are negatively associated with trauma symptoms, depression symptoms, and anxiety symptoms in veterans. This study examined mental health distress symptoms as well as military unit cohesion across attachment styles. Results suggest mean differences in trauma symptoms, depression symptoms, and anxiety symptoms across attachment styles. However, there was no difference in perceived unit cohesion across the four attachment styles. Those using fearful-avoidant attachment styles reported the highest mean trauma, depression, and anxiety symptoms followed by those using a dismissing-avoidant attachment style. Those using a secure attachment style reported the least mean trauma, depression, and anxiety symptoms. Implications for assessing and treating avoidant type attachment styles are discussed. [ABSTRACT FROM AUTHOR]

Objectives: To examine factors that account for women veterans' higher prevalence of past-year DSM-5 posttraumatic stress disorder (PTSD) compared to women civilians and men veterans.Methods: Cross-sectional analyses of the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). Face-to-face interviews with 379 women veterans, 20,007 women civilians, and 2740 men veterans were conducted. Trauma type (child abuse, interpersonal violence, combat or war zone, and other), number of trauma types, past-year stressful life events, current social support, and DSM-5 PTSD were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5. Generalized linear models were used that accounted for the complex survey design.Results: Women veterans had a higher unadjusted prevalence of past-year PTSD (11.40%) compared to their civilian (5.96%) and male (5.19%) counterparts. Individual predictor models indicated that the difference between women veterans' and civilians' prevalence of PTSD was attenuated when adjusting for number of trauma types, whereas the difference between men and women veterans was attenuated when adjusting for child abuse, interpersonal violence, and stressful life events. Nonetheless, while full adjustment in a multiple predictor model accounted for the difference in PTSD between women veterans and civilians, gender differences between men and women veterans remained.Conclusions: Number of trauma types, type of trauma, and social factors may together help explain women veterans' higher PTSD prevalence compared to women civilians, but do not fully account for differences between men and women veterans. Results highlight a need to explore additional explanatory factors and evaluate associations with longitudinal data. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to identify posttraumatic stress disorder (PTSD) symptom groups and assess their longitudinal progression during their first year of reintegration among United States (US) National Guard (NG) service members.Methods: A cohort of NG service members (n = 886) completed surveys at 6 and 12 months following their return from deployment to Iraq or Afghanistan. Latent class analysis (LCA) and latent transition analysis (LTA) were used to empirically derive groups based on their PTSD symptoms and examine their longitudinal course, respectively.Results: The best fitting model at both assessments was the four-class model, comprising an asymptomatic class (6 months = 54%; 12 months = 55%), a mild symptom class with elevated hyperarousal symptoms (6 months = 22%; 12 months = 17%), a moderate symptom class (6 months = 15%; 12 months = 15%), and a severe symptom class (6 months = 10%; 12 months = 13%). Based on LTA, stability of class membership at the two assessments was 0.797 for the asymptomatic class, 0.453 for the mild class, 0.560 for the moderate class, and 0.580 for the severe class. Estimated transition probabilities were greater with respect to transitioning to less severe, rather than more severe, classes over time.Conclusions: The four latent PTSD classes were distinguished primarily by severity; however, the mild symptom class was characterized by higher levels of hyperarousal than other symptoms. Although the absolute number of individuals within classes remained fairly constant between 6 and 12 months, there was movement between severity classes. Most NG service members without symptoms continued to do well during the first year, with only an estimated 7% moving to the moderate or severe class. [ABSTRACT FROM AUTHOR]

control participants (age = 20.85 ± 1.42 years, height = 177.02 ± 9.59 cm, mass = 74.61 ± 14.92 kg) at 7 clinical sites in the United States. All were varsity or club collegiate athletes, and all participants with SRC were tested within 72 hours of SRC. Main Outcome Measure(s): Balance performance was assessed using an inertial balance sensor. Two measures (root mean square sway and 95% ellipse sway area) were analyzed to represent a range of general balance measures. Balance assessments were conducted in double-legged, single-legged, and tandem stances. Results: A main effect for group was associated with the root mean square sway measure (F1,91 = 11.75, P = .001), with the SRC group demonstrating balance deficits compared with the control group. We observed group differences in the 95% ellipse sway area measure for the double-legged (F1,91 = 11.59, P = .001), single-legged (F1,91 = 6.91, P = .01), and tandem (F1,91 = 7.54, P = .007) stances. Sensitivity was greatest using a cutoff value of 0.5 standard deviations (54% [specificity = 71%]), whereas specificity was greatest using a cutoff value of 2 standard deviations (98% [sensitivity = 33%]). Conclusions: Inertial balance sensors may be useful tools for objectively measuring balance during acute SRC evaluation. However, low sensitivity suggests that they may be best used in conjunction with other assessments to form a comprehensive screening that may improve sensitivity. [ABSTRACT FROM AUTHOR]

Purpose: Little is known about the long-term, health-related quality of life (HRQOL) of those wounded in combat during Operations Enduring Freedom, Iraqi Freedom, and New Dawn. The present study described the overall HRQOL for a large group of US service members experiencing mild-to-severe combat-related injuries, and assessed the unique contribution of demographics, service- and injury-related characteristics, and mental health factors on long-term HRQOL.Method: The Wounded Warrior Recovery Project examines patient-reported outcomes in a cohort of US military personnel wounded in combat. Participants were identified from the Expeditionary Medical Encounter Database, a US Navy-maintained deployment health database, and invited to complete a web-based survey. At the time of this study, 3245 service members consented and completed the survey. Hierarchical linear regression analyses were conducted to assess the unique contribution of each set of antecedents on HRQOL scores.Results: HRQOL was uniquely associated with a number of demographics, and service- and injury-related characteristics. Nevertheless, screening positive for posttraumatic stress disorder (B = - .09; P < .001), depression (B = - .10; P < .001), or both as a set (B = - .19; P < .001) were the strongest predictors of lower long-term HRQOL.Conclusions: Postinjury HRQOL among service members wounded in combat was associated with service and injury experience, and demographic factors, but was most strongly linked with current mental health status. These findings underscore the significance of mental health issues long after injury. Further, findings reinforce that long-term mental health screening, services, and treatment are needed for those injured in combat. [ABSTRACT FROM AUTHOR]

Rationale: Consideration by the US Drug Enforcement Administration and Food and Drug Administration of placing kratom into Schedule I of the Controlled Substances Act (CSA) requires its evaluation of abuse potential in the context of public health.Objective: The objective of the study is to provide a review of kratom abuse potential and its evaluation according to the 8 factors of the CSA.Results: Kratom leaves and extracts have been used for centuries in Southeast Asia and elsewhere to manage pain and other disorders and, by mid-twentieth century, to manage opioid withdrawal. Kratom has some opioid effects but low respiratory depression and abuse potential compared to opioids of abuse. This appears due to its non-opioid-derived and resembling molecular structure recently referred to as biased agonists. By the early 2000s, kratom was increasingly used in the US as a natural remedy to improve mood and quality of life and as substitutes for prescription and illicit opioids for managing pain and opioid withdrawal by people seeking abstinence from opioids. There has been no documented threat to public health that would appear to warrant emergency scheduling of the products and placement in Schedule I of the CSA carries risks of creating serious public health problems.Conclusions: Although kratom appears to have pharmacological properties that support some level of scheduling, if it was an approved drug, placing it into Schedule I, thus banning it, risks creating public health problems that do not presently exist. Furthermore, appropriate regulation by FDA is vital to ensure appropriate and safe use. [ABSTRACT FROM AUTHOR]

Purpose: Combat-exposed soldiers are at an increased risk for health problems that diminish quality of life (QOL) and substance use. We explored the cross-sectional associations between combat exposure and two measures of QOL, and the effect of substance use on those associations.Methods: Data are from the baseline wave of Operation: SAFETY, an ongoing survey-based study of United States Army Reserve/National Guard (USAR/NG) soldiers and their partners. Our sample consisted of male USAR/NG soldiers with a history of deployment (N = 248). Limitations in usual activity due to physical and emotional problems were assessed using the 36-Item Short-Form Health Survey (SF-36).Results: Greater combat exposure was independently associated with limitations in usual activity due to physical (regression coefficient = -0.35, 95% CI -0.55 to -0.16, R 2 = 0.09; p < 0.01) and emotional (regression coefficient = -0.32, 95% CI -0.56 to -0.09, R 2 = 0.09; p < 0.01) problems. Combat exposure had a significant interaction with frequent heavy drinking on physical role limitations (regression coefficient = -0.65, 95% CI -1.18 to -0.12, R 2 = 0.12; p < 0.05) and emotional role limitations (regression coefficient = -0.83, 95% CI -1.46 to -0.19, R 2 = 0.12; p < 0.05). Combat exposure also had a significant interaction with lifetime non-medical use of prescription drugs on physical role limitations (regression coefficient = 0.81, 95% CI 0.18-1.45, R 2 = 0.11; p < 0.05).Conclusion: Combat is an unmodifiable risk factor for poor QOL among soldiers; however, frequent heavy drinking and non-medical use of prescription drugs modifies the relationship between combat exposure and QOL. Therefore, substance use is a potential point of intervention to improve QOL among soldiers. [ABSTRACT FROM AUTHOR]

Background: Women veterans in the United States, particularly those with posttraumatic stress disorder (PTSD) or a history of military sexual assault, have unique health care needs, but their minority status in the US Veterans Health Administration (VHA) has led to documented healthcare disparities when compared to men. This study's objective was to obtain a richer understanding of the challenges and successes encountered by women veterans with self-reported service-related trauma histories (particularly those with a history of military sexual assault and/or posttraumatic stress symptomology) receiving VHA care.Methods: Thirty-seven female Vietnam and post-Vietnam (1975-1998) era veterans were randomly selected from a cohort of PTSD disability benefit applicants to complete semi-structured interviews in 2011-2012. Grounded-theory informed procedures were used to identify interview themes; differences between veterans with and without a history of military sexual assault were examined through constant comparison.Results: At the time of the interviews, many women believed that VHA was falling short of meeting women veterans' needs (e.g., lack of women-only mental health programming). Also common, but particularly among those with a military sexual assault history, was the perception that VHA's environment was unwelcoming; being "surrounded by men" yielded emotions ranging from discomfort and mistrust to severe anxiety. A few veterans reported recent positive changes and offered additional suggestions for improvement.Conclusions: Findings suggest that while at the time of the interviews gains had been made in the delivery of gender-sensitive outpatient medical care, women veterans with a history of military sexual assault and/or posttraumatic stress symptomology perceived that they were not receiving the same quality of care as male veterans. [ABSTRACT FROM AUTHOR]