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Prior meta-analyses have suggested that eye-movement desensitization and reprocessing (EMDR) may be effective in alleviating the symptoms of post-traumatic stress disorder (PTSD). EMDR is now being recommended as a treatment for military combat veterans who suffer from PTSD. We provide a review of published outcome studies that appeared in print from 1987 - April, 2008 which examined the specific effects of EMDR on PTSD among military combat veterans. Studies were identified through electronic bibliographic databases, web sites, and manual searches of article reference lists. A total of six randomized controlled trials (RCTs) and three quasi-experimental studies met our inclusionary criteria and are reviewed. The evidence supporting the use of EMDR to treat combat veterans suffering from PTSD is sparse and equivocal, and does not rise to the threshold of labeling the therapy as an empirically supported treatment. It is premature to incorporate EMDR into routine care for veterans to alleviate combat-related PTSD. EMDR needs a considerably stronger evidentiary foundation which includes large-scale RCTs involving credible placebo controlled treatment conditions. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Purpose: Veteran empowerment may include connection, community impact, and personal growth. At least one valid and reliable tool has been developed to measure the aforementioned framework: the empowered veteran index (EVI). However, there is a need for a shorter measure to prevent survey fatigue., Materials and Methods: We recruited military veteran members of a nonprofit ( n  = 316), The Mission Continues, for participation in this cross-sectional online survey study. Participants completed the 35-item EVI. A short form of the EVI (EVI-SF) was developed through bifactor confirmatory factor analysis (CFA)., Results: The 10-item EVI-SF model demonstrated satisfactory performance (χ 2 p  = 0.68, SRMR = 0.02, RMSEA = 0.01, CFI = 0.99, TLI = 0.99). All factor loadings in this model were ≥ 0.30, providing evidence for the validity of the interval structure. Internal consistency reliability was good for all three subscales (omegas >0.7)., Discussion: Analysis of the EVI-SF showed that the instrument was valid and reliable. The EVI-SF contains 10 items with seven-point Likert scale response options. Use of the instrument may provide for the opportunity to measure empowerment of military veterans., Conclusion: This study provides preliminary psychometric validation of the EVI-SF.

Objective: This study utilizes geospatial analytic techniques to examine HIV hotspots in Alabama leveraging Medicaid utilization data., Methods: This cross-sectional study leveraged Medicaid utilization data from Alabama's 67 counties, averaging 9,861 Medicaid recipients aged > 18 years old per county. We used Alabama Medicaid administrative claims data from January 1, 2016, to December 31, 2020, to identify individuals with HIV. Using Microsoft SQL Server, we obtained the average annual count of HIV Medicaid claims in each of the 67 Alabama counties (numerator) and the number of adult Medicaid recipients in each county (denominator), and standardized with a multiplier of 100,000. We also examined several other area-level summary variables (e.g., non-high school completion, income greater than four times the federal poverty level, social associations, urbanicity/rurality) as social and structural determinants of health. County-boundary choropleth maps were created representing the geographic distribution of HIV rates per 100,000 adult Medicaid recipients in Alabama. Leveraging ESRI ArcGIS and local indicators of spatial association (LISA), results were examined using local Moran's I to identify geographic hotspots., Results: Eleven counties had HIV rates higher than 100 per 100,000. Three were hotspots. Being an HIV hotspot was significantly associated with relatively low educational attainment and less severe poverty than other areas in the state., Conclusions: Findings suggesting that the HIV clusters in Alabama were categorized by significantly less severe poverty and lower educational attainment can aid ongoing efforts to strategically target resources and end the HIV epidemic in U.S.' Deep South., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Females of reproductive age (FoRA; 15-49 years) are the demographic most likely to be diagnosed with a substance use disorder. Preventative treatment prior to or during pregnancy is critical. Stigma and social inequities can delay access to care. There is limited research examining social determinants of health (SDoH) and how they are related to substance use and treatment seeking in this demographic. Methods: We analyzed the 2016-2019 data from the United States National Survey on Drug Use and Health using multivariable logistic regression models. Statistically significant variables were conceptually linked to the Office of Disease Prevention and Health Promotion's (ODPHP's) SDoH framework's five domains. Results: From a total sample of 1,477,336 (weighted) pregnant people and 39,600,523 (weighted) FoRA, substance use was reported by 879,209 (2.14% [95% confidence interval = 2.13-2.15]). Pregnancy status was not associated with substance use or treatment seeking. Past-month substance use was associated with high educational attainment, an annual income <$20,000, a history of criminality, low religiosity, and having health insurance. Past-month treatment-seeking behavior was associated with older age, an annual income >$20,000, a history of criminality, and greater religiosity. Behavioral health support seeking in the past month was associated with some college education. Higher depression severity was associated with all the three models. Conclusions: Using the ODPHP's SDoH framework, we begin to elicit critical connections that can describe substance use and treatment-seeking practices in FoRA. We encourage additional research to inform public health, health care, behavioral health, and other support service programming.

Objectives: Studies suggests that pregnancy can alter the maternal neurological function of the brain (i.e., result in cognitive decline) in a way that remains prevalent well into middle and older adulthood. However, little research has explored these changes and how they might affect behavioral health outcomes, such as substance use and depression., Methods: We merged data from the 2016, 2017, and 2018 Behavioral Risk Factor Surveillance System (BRFSS) surveys, with a final analytic sample of 1330 female participants (649 participants were mothers). Chi-square tests or t-tests were used to examine differences in demographic and health characteristics of the sample by subjective cognitive decline (SCD) status. To test the study hypotheses, three generalized linear mixed models were estimated with a logit link., Results: SCD was not associated with alcohol misuse among mothers (aOR = 0.27, p = 0.23). Mothers with SCD were more likely to smoke (aOR = 3.33, p = 0.01) and experience mental distress (aOR = 6.59, p < 0.001) than those without SCD., Conclusion: Interventions aimed at supporting mothers should consider how existing mental health and tobacco cessation programs can be adapted to better serve this population and should aim to identify those that may have early signs of early signs of neurodegenerative conditions., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Among military service members and veterans (SMVs), factors unique to military service may contribute to an elevated risk of experiencing intimate partner violence (IPV) victimization. Although rurality has been established as a risk factor for IPV, differences in IPV victimization by rural- urban dwelling location, SMV status, and sex have not been explored. The purpose of this study was to estimate the rate of IPV victimization in rural and urban areas in the United States by SMV status and sex. We obtained Behavioral Risk Factor Surveillance System data (BRFSS; n = 18,755); fit a mixed-effects, multilevel generalized linear model to the data for IPV victimization; and linked the model to U.S. Census Bureau population count data. We generated predicted estimates of IPV for SMVs and civilians separately by sex in rural and urban areas. The direct IPV victimization prevalence rate for the entire BRFSS sample was 16.90%. Substantial variation in model-based IPV prevalence was observed across subgroups. Female SMVs (rural = 23.54%, 95% confidence interval [CI] [17.33, 30.02]; urban = 23.34%, 95% CI [17.48, 30.17]) had higher IPV victimization rates than female civilians (rural = 14.55%, 95% CI [13.06, 16.37]; urban = 14.50%, 95% CI [13.19, 16.34]), whereas male civilians (rural = 8.06%, 95% CI [7.19, 9.08]; urban = 8.02%, 95% CI [7.27, 9.02]) had higher IPV victimization rates than male SMVs (rural = 7.21%, 95% CI [6.03, 8.47]; urban = 7.17%, 95% CI [6.00, 8.41]). Programming for preventing and assisting in recovering from IPV exposure should target rural-dwelling female SMVs.

Objectives: Doulas are a potential resource for addressing substance use and mental health challenges that pregnant and postpartum individuals experience. We sought to review peer-reviewed literature that examines Doulas' role in addressing these challenges to highlight the need for more research in this area., Methods: We conducted a scoping review (2001-2021) to identify articles that examine the way in which Doulas address maternal substance use and mental health challenges in their clients. The articles were reviewed by two members of the research team., Results: Nine articles describing Doulas' role in addressing substance use and mental health challenges were identified. Six described Doulas' role in addressing mental health, five of which saw positive mental health outcomes due to Doula involvement. One additional article recommended Doulas be considered in the future to address mental health challenges. While the minority of articles addressed substance use (n = 2), it was reported that Doulas were a positive addition to interdisciplinary teams addressing substance use challenges with pregnant individuals., Conclusions: While the literature showed that Doulas can improve substance use and mental health outcomes among pregnant or postpartum individuals, a significant gap remains in research, practice, and peer-reviewed literature addressing this issue., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: This study utilizes a machine learning model to predict unhealthy alcohol use treatment levels among women of childbearing age., Methods: In this cross-sectional study, women of childbearing age (n = 2397) were screened for alcohol use over a 2-year period as part of the AL-SBIRT (screening, brief intervention, and referral to treatment in Alabama) program in three healthcare settings across Alabama for unhealthy alcohol use severity and depression. A support vector machine learning model was estimated to predict unhealthy alcohol use scores based on depression score and age., Results: The machine learning model was effective in predicting no intervention among patients with lower Patient Health Questionnaire (PHQ)-2 scores of any age, but a brief intervention among younger patients (aged 18-27 years) with PHQ-2 scores >3 and a referral to treatment for unhealthy alcohol use among older patients (between the ages of 25 and 50) with PHQ-2 scores >4., Conclusions: The machine learning model can be an effective tool in predicting unhealthy alcohol use treatment levels and approaches., (© The Author(s) 2023. Medical Council on Alcohol and Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

This study aimed to identify any differences between veterans and non-veterans in the importance of domains of the Good Death Inventory. Participants were recruited from Amazon Mechanical Turk to complete a Qualtrics survey on the importance of the 18 domains of the Good Death Inventory scale. Logistic regression models were then used to analyze any differences between veterans ( n  = 241) and nonveterans ( n  = 1151). Results showed that veterans (mostly aged 31-50, men, and White) were more likely to indicate that pursuing all treatment possible and maintaining their pride were important aspects of a good death. The results support other studies that have found military culture to be a significant factor in the way veterans view preferences at the end of life. Interventions may include increasing access to palliative care and hospice services for military members and veterans and providing education/training on end-of-life care for healthcare providers who work with this population.

Objectives: The purpose of the study was to explore the extent to which prior military service may moderate the relationship between chronic disease multimorbidity and substance use among African American men in the United States., Design: Data for this cross-sectional study was downloaded from the 2016 -2019 United States (US) National Survey on Drug Use and Health. We estimated three survey-weighted multivariable logistic regression models, where use of each of the following substances served as the dependent variables: illicit drugs, opioids, and tobacco. Differences in these outcomes were examined along two primary independent variables: veteran status and multimorbidity (and an interaction term for these variables). We also controlled for the following covariates: age, education, income, rurality, criminal behavior, and religiosity., Results: From the 37,203,237 (weighted N) African American men in the sample, approximately 17% reported prior military service. Veterans with ≥ 2 chronic diseases had higher rates of illicit drug use (aOR = 1.37, 95% CI = 1.01, 1.87; 32% vs. 28%) than non-veterans with ≥ 2 chronic diseases. Non-veterans with one chronic disease had higher rates of tobacco use (aOR = 0.80, 95% CI = 0.69, 0.93; 29% vs. 26%) and opioid misuse (aOR = 0.49, 95% CI = 0.36, 0.67; 29% vs. 18%) than veterans with one chronic disease., Discussion: Chronic disease multi-morbidity appears to be a context in which African American veterans may be at greater risk for certain undesirable health behaviors than African American non-veterans and at lower risk for others. This may be due to exposure to trauma, difficulty accessing care, socio-environmental factors, and co-occurring mental health conditions. These complex interactions may contribute to higher rates of SUDs among African American veterans compared to African American non-veterans.

Opioid-related overdose deaths have significantly increased in the USA and in Alabama. Despite this, medications for opioid use disorder (MOUD) remains significantly underutilized. Thus, this study aims to gain a better understanding of clinicians' viewpoints on potential barriers and opportunities that are likely to impact and improve the access to MOUD, especially buprenorphine prescribing. A cross-sectional survey study was conducted with Alabama's clinicians ( n  = 492). The survey containing a QR code was mailed to clinicians throughout the state and was asked about their viewpoints and thoughts on prescribing buprenorphine. Multivariable linear regression was used to examine associations between OUD self-efficacy, beliefs about the effectiveness of MOUD, attitudes regarding whether or not MOUD is addictive, and positive affect surrounding the treatment of OUD patients. A minority of respondents (39.8%) reported that they have an active X-waiver for MOUD. Results showed that beliefs that MOUD is addictive were significantly inversely correlated with beliefs about MOUD being effective. Furthermore, both self-efficacy and positive affect were significantly and positively associated with beliefs that MOUD is effective. Furthermore, nurse practitioners were more likely than physicians to have higher scores on the "MAT is Addictive" construct. Self-efficacy with OUD patients was positively associated with the "MOUD is Effective" construct. Finally, results showed that X-waivered providers expressed greater positive affect toward OUD patients than providers who were not X-waivered ( b  = 2.9, p  < 0.001). Belief that MOUD is effective was also positively associated with higher scores on the positive affect construct ( b  = 0.5, p  < 0.001). Several barriers and opportunities were identified in our survey data which could be used to explore MOUD expansion, especially buprenorphine prescribing. Strategic plans in expanding MOUD access may include educational trainings on MOUD, motivating clinicians to utilize their capacity by implementing incentive plans, increasing provider self-efficacy, reducing stigma around MOUD, and providing more financial support to uninsured patients.

Objective: This study aimed to identify county-level hotspots and associated risk factors for opioid use disorder (OUD) in the state of Alabama., Methods: Using 2015 to 2019 Alabama Medicaid administrative claims data, Medicaid recipients with OUD were identified. We performed local indicators of spatial association analysis to identify hotspots of OUD rates. Using logistic regression, we examined county-level social determinants of health associated with county OUD hotspots., Results: There was a +14.13% percentage change from 2015 to 2019. The county level local indicators of spatial association analysis found that 5 counties in the northwestern part of Alabama remained "hotspots" throughout the entire study period. Results of the logistic regression model showed that location within the Appalachian region was an independent predictor of high OUD rates ( b = 2.58; adjusted odds ratio, 13.27, P = 0.04)., Conclusions: The high rates of OUD may reflect the economic distress and lack of access to resources germane to the Appalachian region in Alabama., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 American Society of Addiction Medicine.)

Introduction: Medication-assisted treatment (MAT) is a combination of behavioural therapy and medications to assist with recovery and has been administered to individuals with alcohol and opioid withdrawal symptoms. Military veterans seeking MAT could have barriers preventing them from receiving the care they desire. The present study sought to compare outcomes in individuals who received MAT or those who participated in self-help groups for opioid or alcohol use disorder. In addition, the present study sought to compare outcomes between veterans and non-military-connected individuals., Methods: We used the 2015-2017 United States Treatment Episode Data Set Discharges data from the Substance Abuse and Mental Health Services Administration. The data set included 138 594 unique discharges. A multinomial logistic regression model was used to examine differences in substance use outcomes for veterans/non-veterans in MAT and a self-help group., Results: Fewer veterans (2.58%) than non-veterans (4.28%) reported usage of MAT. Fewer veterans (38.94%) than non-veterans (40.17%) reported signing up for a self-help group. Finally, those who participated in MAT and a self-help group had a better outcome (66.64%)-defined as no substance use at discharge-than those who only received MAT (43.02%) and those who did not participate in MAT or self-help groups (34.84%)., Conclusions: Recommendations for future research on MAT and implementation for the veteran population would benefit the literature base., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Perinatal substance use is a clinical and public health concern. The purpose of the study was to understand the perspectives and experiences of perinatal healthcare providers serving pregnant people who receive Medicaid and are living with a substance use disorder., Design and Methods: We conducted a secondary data analysis of the responses from perinatal healthcare providers who completed a survey to assess the state of Alabama's capability to effectively identify and treat individuals with substance use disorder. We analyzed short answer responses using consensus coding., Findings: Nine-hundred and ninety-five Medicaid providers completed the survey, 36 of the respondents identified that they were employed in an obstetric practice. Health insurance limitations, a lack of time and resources, and limited treatment options were the primary barriers indicated in the participants' responses., Conclusions: Structural and health system barriers negatively impact the capacity of perinatal healthcare providers in Alabama to serve pregnant people who receive Medicaid and are living with a substance use disorder., Clinical Relevance: Perinatal healthcare providers need educational opportunities, training, and up-to-date resources to provide supportive, comprehensive care programming for perinatal populations with substance use disorders., (© 2023 Sigma Theta Tau International.)

We tested the null hypothesis of equal likelihood of cigarette use among parents with a military connection and parents without a military connection, and independently compared risk factors for cigarette use. We obtained National Health Interview Survey (NHIS) data from 2015 to 2019 survey waves. We delimited analysis to 2-parent households who reported children aged <18 years living with them. After a 2:1 nonparametric age matching procedure, our sample included 1106 civilian parents and 553 parents with a military connection. Using the NHIS survey-design weights, we estimated a design-based F statistic for differences in cigarette use by military connection status. We also estimated population-stratified, survey-weighted multivariable logistic regression models to determine risk factors for parent cigarette use. Whereas 6.87% parents with a military connection used cigarettes, 16.64% of age-matched civilian parents reported cigarette use. This difference was significant even after adjustment for covariates (aOR = 0.49, 95% CI = 0.32, 0.74). Recommendations for programing and policy are provided., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

A good death is one where a patient's preferences and wishes are fully respected. The purpose of this study was to determine which aspects of a good death are most important to Black/Indigenous, and/or people of color (BIPOC). Participants were recruited from Amazon Mechanical Turk, and then directed to complete a quantitative survey indicating the importance of each item on the Good Death Inventory. A logistic regression model was used to identify any differences in the importance of each item based on the racial background of the respondent. After accounting for other independent variables, the results showed that BIPOC were more likely to indicate that factors such as life completion, receiving all treatment possible, and religious/spiritual support were important aspects of a good death. Results indicate the need for culturally tailored tools that account for cultural differences in what constitutes a good death., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Little is known about differences in vision loss prevalence among service members or veterans (SMVs) and civilians; further, no study has compared vision loss risk factors in these two populations. As such, we seek to fill this gap in the literature., Methods: In this cross sectional study, we obtained data on 106 SMVs and 1572 civilians from the 2013-2018 National Health and Nutrition Examination Surveys. We compared the prevalence of or mean values of vision loss risk factors between SMVs and civilians using the Wald χ 2 statistic or Kruskal-Wallis test. Further, we examined the relative strength of 17 vision loss risk factors in predicting self-reported vision loss via Firth's logistic regression., Results: SMVs had a significantly higher prevalence of illicit drug use (20.75% vs 13.62%) and HIV (1.89% vs 0.41%), while civilians had a higher prevalence of poor dietary habits (7.61% vs 13.21%). SMVs also had higher mean values of systolic blood pressure (125.85 vs 122.53 mmHg), pack years of cigarette smoking (8.29 vs 4.25), and sedentary minutes per day (379.15 vs 337.07 min). More SMVs (8.49%) self-reported vision loss than civilians (4.48%). After adjustment for covariates, illicit drug use (adjusted β coefficient=0.72, p=0.02) was associated with self-reported vision loss., Conclusions: This study indicates that self-reported vision loss among SMVs is more prevalent than among civilians, and vision loss in SMVs is associated with severe or prolonged illicit drug use., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Access to screening, brief intervention and referral to treatment programmes for alcohol use have been shown to be effective; however, little is known about access to these services among service members and veterans. We examined the association of service member or veteran rural-dwelling area and the following outcomes: recent general health check-up, alcohol screening and alcohol brief intervention., Methods: Data on 5080 military service members and veterans were obtained from the 2017 Behavioural Risk Factor Surveillance System of the USA. We estimated rural-urban disparities in the receipt of a recent voluntary general health check-up, as well as the receipt of alcohol screening and brief intervention, using a mixed logit model., Results: Of the 5080 participants in the study, a total of 4666 (90.49%, 95% CI 89.39% to 91.48%) reported a general health check-up in the last 2 years. Results showed 7.48% of the sample (95% CI 6.64% to 8.41%) exhibited heavy alcohol consumption patterns. Of the 414 participants who did not undergo a general health check-up, 13.80% (95% CI 9.63% to 19.41%) exhibited a pattern of heavy alcohol consumption. Rural individuals were less likely to report a recent health check-up (adjusted OR=0.82, 95% CI 0.79 to 0.87). Rurality was also independently associated with decreased likelihood of receiving an alcohol screening and brief intervention., Conclusion: Greater access to telehealth or other geographically flexible screening and brief intervention programmes is needed in rural areas for service members and veterans., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

In the United States, tobacco use, alcohol consumption and substance use disorders are more prevalent among veterans when compared to nonveterans. This is also seen in Alabama, which led the researchers to review county level data to examine possible links between substance use, mental health and suicide by veteran status. This study sought to evaluate behavioural health outcomes and impacting factors for military veterans and nonveterans living in rural and urban areas of Alabama. In phase one, we developed Alabama-specific behavioural health outcomes at the state and county level for military veterans and nonveterans. In phase two, we examined county-level correlates of behavioural health outcomes among veterans and nonveterans. The data were retrieved from the 2015-2018 National Surveys on Drug Use and Health (NSDUH) and the United States Census Bureau. Regarding tobacco use rates at the county level, nonveteran rates ranged from 23.93% to 34.56% while veteran rates ranged from 24.47% to 38.56%. Nonveteran illicit drug use rates ranged from 9.40% to 13.15% while veteran illicit drug use rates ranged from 5.50% to 10.67%. Nonveteran heavy alcohol use rates ranged from 4.54% to 7.92% while veteran heavy alcohol use rates ranged from 4.59% to 8.41%. Lastly, nonveteran suicidal ideation rates ranged from 3.64% to 4.60% while veteran suicidal ideation rates ranged from 3.16% to 4.51%. Veterans have a significantly higher potential of having suicidal ideations. We showed that illicit drug use and suicidal ideation have increased in Alabama among veterans and nonveterans. Behavioural health programmes and policies aimed at eliminating disparities between veterans and nonveterans are needed in Alabama., (© 2021 John Wiley & Sons Ltd.)

The purpose of this study was to explore the association between psychological resilience and cognitive function in military veterans. We obtained public-use data from the Health and Retirement Study (HRS) for this cross-sectional study of military veterans aged 52 to 101 years ( n = 150). We estimated a multivariable linear regression model in which cognitive function served as the dependent variable and psychological resilience served as the independent variable. After controlling for demographics, health conditions, and health behaviors, veterans who had higher psychological resilience scores had better cognitive function (b = 0.22, p = 0.03). Our findings suggest that psychological resilience may be associated with cognitive function among veterans. These findings highlight the importance of assessing psychological resilience in gerontological social work practice., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Objective: Caregiver stress is the term used to define the adverse effects of caregiving, and its prevalence among caregivers of people with traumatic brain injury (TBI) is amplified by the suddenness of brain injury. This systematic review aimed to identify whether remote interventions can be helpful in minimizing those financial, emotional, and physical stressors associated with caring for a person with TBI., Method: Studies were located by searching the following databases: PsycINFO, PubMed, Science Direct, Web of Science, Academic Search Premier, CINAHL, Medline, and Cochrane Central Register of Controlled Trials. Studies were included if they met the following criteria: (a) The study must be published in English, (b) The study must be published in a peer-reviewed journal, (c) The study must implement a remote intervention specific to caregivers of people with TBI, and (d) One or more symptoms of caregiver stress must be measured as an outcome., Results: After the review process, 12 articles met the inclusion criteria for the study. Most of the studies were randomized controlled trials, used an online problem-solving module, and targeted parents of children/adolescents with a TBI. Ten out of the 12 studies (83.3%) found that remote/online interventions improved caregiver stress outcomes and only two studies did not find improvement in caregiver stress outcomes., Conclusion: Results from this systematic review indicate that online interventions can be as effective as in-person interventions in reducing the symptoms of caregiver stress for caregivers of people with TBI. Implications for practice, research, and policy are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background: Alcohol misuse among older adults is an emerging public health issue. Older veterans are particularly at risk of developing substance use dependency due to the enduring impacts of military service. The purpose of this study was to test the theory of intersectionality on alcohol misuse by veteran status and age, veteran status and sex, and veteran status and race., Methods: Combined data from the 2016, 2017, and 2018 Brief Risk Factor Resilience Survey (BRFSS) from the Centers for Disease Control and Prevention (CDC) were used in this cross-sectional study. The BRFSS is conducted annually with adults via landline or cellular telephones in all 50 states in the United States, as well as in the District of Columbia, Puerto Rico, and Guam. Alcohol misuse among individuals aged 65+ was examined by veteran status and the interaction between age, race, and sex using survey-weighted logistic regression models., Results: Results show no interaction between veteran status and age or sex. For the interaction between veteran status and race, significant disparities were found. Black/Other race veterans were significantly more likely to engage in binge drinking and heavy drinking compared to nonveterans of the same race, White veterans, and White nonveterans., Conclusion: Older veterans who are also Black, Indigenous and/or people of color (BIPOC) are at great risk of engaging in alcohol misuse due to the combined stressors from their intersectional identities. Interventions targeting this population should consider the historical, cultural, and systemic factors that contribute to a disproportionally higher rate of binge drinking and heavy drinking among BIPOC veterans.

Objective: The purpose of this study was to explore (a) current utilization rates of university mental health services among American Indian/Alaskan Native/Native Hawaiian (AI/AN/NH) student veterans and (b) predictors of mental health service utilization among AI/AN student veterans. Participants: Data for this cross-sectional study were obtained from the American College Health Association (ACHA)'s 2011-2014 National College Health Assessment II ( n  = 103). Methods: University mental health service utilization rates were calculated as a percentage for AI/AN/NH student veterans. Multivariable logistic regression was used to determine predictors of mental health service utilization. Results: Results showed that 14% of AI/AN/NH student veterans have used university mental health services. Predictors of mental health service utilization in this population included financial stress, lack of deployment during service, suicidal ideation, and a diagnosis of depression, model χ 2 (13) = 162. 128, p  < 0.001, Nagelkerke R 2  = 0.130. Conclusion: This research identified gaps in service provision for AI/AN service member and veteran students on college campuses and provided possible models for intervention development.

Purpose : The objective of this study was to examine the incidence of false-negative screening results on a tool measuring alcohol use - the United States Alcohol Use Disorder Identification Test Consumption (US-AUDIT-C). Method : A sample of patients (n = 4,023) in Alabama completed the US-AUDIT-C prior to a medical visit as part of a screening, brief intervention, and referral to treatment (AL-SBIRT) program. We calculated the incidence of false negative US-AUDIT-C screens based on recommendations for safe alcohol consumption. Results : The false negative screening rate on the US-AUDIT-C was 1%. The false negative screening rate for (a) males aged > 65 years in the AL-SBIRT program was 0.64%, (b) males aged 18-65 years was 2.79%, and (c) all females was 2.29%. Discussion & Conclusions : Increasing alcohol-consumption-related health education and reducing the stigma of discussing alcohol consumption habits is an important step toward improving patient health. Clinicians can more accurately screen and provide brief intervention services for alcohol misuse by training on US-AUDIT-C response patterns.

Posttraumatic stress disorder commonly occurs among U.S. military veterans. Therapeutic horseback riding (THR) has emerged as an adjunct therapy. We explored 20 veterans' perceived benefits, drawbacks and views of a 6-week THR program. Participants had confirmed diagnoses of posttraumatic stress disorder, traumatic brain injury, or both. Veterans rode the same horse weekly, the same day, at the same time. Data were collected as part of a randomized clinical trial testing the effects of THR on Post-Traumatic Stress Disorder. Veterans responded to an open-ended questionnaire. Content analysis was used for data analysis. Benefits were "Connection to the Horse," "Relaxing," "180 Degree Change," and "Meeting New People." Drawbacks were "None," "Struggle to Get There," "Pain," "Too Short," and "It is Structured." Overall perceptions were "I Absolutely Loved It," "Feel Again," "The Horse," "The People," and "No Worries." Participants viewed THR as positive. Findings may elucidate why THR may be clinically beneficial.

Opioid use and misuse are a widespread problem across the United States. Identifying and targeting social determinants of opioid use may help to identify predictive factors to influence intervention and policy. The purpose of this study was to identify social determinants of opioid use frequency among patients seeking primary care in rural Alabama healthcare facilities. This survey-based study focused on a patient population located in rural west Alabama surveyed for a screening, brief intervention, and referral to treatment program. The screening tool contained demographic information and questions regarding the social determinants of health and opioid use, among others. Adjusted incidence rate ratios (IRRs) for the relationship between social determinants of health and opioid use frequency (in days/month) were estimated in Poisson regression models. Eleven percent of the population self-reported opioid use in the past 30 days. Three social determinants of health measured (level of education, housing stability, and employment status) were identified as having a significant association with the frequency of opioid use. Targeting certain social determinants of health may allow for further predictive interventions to mitigate opioid misuse and potential fatality or mortality.

Objectives: Alcohol use during pregnancy is a critical public health issue that results in several adverse outcomes for both mother and child. While the prevalence of and consequences of binge drinking among pregnant women is well-documented in the literature, little is known about the intersectional effect of racial/ethnic identity and veteran status. The purpose of this study was to examine the prevalence of binge drinking among pregnant women using the intersectionality of racial/ethnic identity and veteran status., Methods: This study utilized combined data from the 2016, 2017 and 2018 Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is a telephone survey that collects health-related risk behaviors, chronic health conditions and use of preventative services among U.S residents. Generalized linear mixed models were used to examine the prevalence of binge drinking using the interaction between race/ethnicity and veteran status., Results: Overall binge drinking prevalence was 3.60% among the sample of 6101 pregnant women. Binge drinking prevalence was the highest among racial/ethnic minority veterans at 17.42%, compared to 5.34% among white veterans, 4.05% among non-veteran racial/ethnic minorities and 3% among non-veteran whites, supporting the theory of intersectionality., Conclusions: Intersectionality Theory suggests that the stressors from membership in two vulnerable groups may lead to increased disparities. The results of this study highlight the unique experience of being a veteran and identifying as a member of a racial/ethnic minority group. This calls for a need to customize preventative measures that address the combined impact of both racial/ethnic minority group status and veteran status., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: The purpose of this study was to estimate opioid use disorder prevalence rates at the county level among veterans in Alabama and to determine hotspots of said rates. Methods: By combining data from the National Survey on Drug Use and Health and the American Community Survey, we developed a mixed-effects generalized linear model of opioid use disorder and modeled probabilities onto veteran-specific population counts at the county level in Alabama. Results : The average model-based estimate for opioid use disorder prevalence among veterans in Alabama from 2015 to 2017 was 0.79% ( SD  = 0.16), with a minimum of 0.52% (i.e., Lowndes county, Alabama) and a maximum of 1.10% (Dale county, Alabama). Hotspot analysis revealed a significant cluster of "high-high" veteran opioid use disorder prevalence in neighboring Marion, Winston, and Cullman counties. Conclusions : The application of the statistical technique presented in this study can provide feasible, cost-effective, and practical county-level prevalence estimates of veteran-specific opioid use disorder and should be widely applied by states and counties so that they can more accurately and efficiently allocate resources to caring for veterans with an opioid use disorder.

Background: Communication plays an important role in the prevention of suicide, a leading cause of death in the United States. Prior research suggests people who die by suicide often communicate their intent to more than one member of their social network. The ubiquity of social media in modern society means an individual's social network may be larger than ever before, which has contributed to a proliferation of colloquial terms and phrases to describe suicide., Aims: The present study collected and validated suicide-related terms from the U.S. English language in 2018-2019. By validating clinical and lay terms with people on the front lines of suicide prevention, the study provides a necessary foundation for lexical analyses of suicide communication on social media., Method: 98 terms related to suicide were collected from online, academic, and other sources. Mental health professionals and members of the electronic mailing list of the American Association of Suicidology were asked to validate terms., Results: The survey validated common terms used to communicate about suicide., Limitations: The lexicon did not capture international phrases. It also did not document less direct language, such as expressions of emotion.

Objective: Opioid use is a continuing problem for the United States. Individuals who use opioids have a high risk of misuse, especially with prescription opioids. Substances that are often used in combination with opioids include methamphetamines, sedatives, and benzodiazepines, as well as tobacco, alcohol, and marijuana, but not in a medical setting. We sought to determine (a) the relationship between various drugs (eg, methamphetamine, benzodiazepines) and opioid use, as well as (b) the relationship between polysubstance use and opioid use., Design: We created a screening instrument that requested the patients seeking medical care at Federally Qualified Health Centers (FQHC) and Veterans Affairs (VA) hospitals in West Alabama self-report their substance usage., Setting: This study took place in outpatient primary care settings (FQHCs and VA hospitals) in west Alabama., Participants: De-identified electronic health records for 346 adults were obtained from consenting medical facilities. Missing data were found in 33 of the records obtained. The final usable sample for this study was 311., Main Outcome Measure: The screening tool was comprised of five sections: demographics, tobacco use, alcohol abuse, drug use, and mental health. The primary outcome measure of this study was the number of days of opioid use in the past 30 days., Results: Thirteen individuals (4.18 percent) reported opioid use in the last 30 days. While polysubstance or dual sub-stance use was not in the majority of the participant responses, the significant substances that were used in conjunction with opioids were methamphetamine, hallucinogens, and benzodiazepines., Conclusions: Individuals who are polysubstance users have a higher likelihood of opioid use. Interventions that target opioid use would serve the population stronger by including screenings and potential treatments for polysubstance use additionally.

Objectives: In the current study, we aimed to compare the levels of and factors associated with mental health attitude between males and females. Of particular interest was ascertaining the degree to which mental health literacy was related to mental health attitude and whether this relationship would vary by gender. Methods: A total of 732 participants aged 18 years or more were recruited from attendees at the 2016 Minnesota State Fair. We used the Mental Health Literacy Scale (MHLS) to measure attitude toward and literacy of mental health. Results: Our multivariate analysis reported that males' mental health attitude was significantly lower than females. Some factors associated with mental health attitude differed by gender as well. Among men, receiving more social support, experiencing higher levels of depression, and being married predicted greater mental health attitude. Among women, older age was associated with lower mental health attitude levels. However, mental health literacy was the strongest factor regardless of gender. Men and women with greater mental health literacy had a more positive mental health attitude. Conclusions: Provision of tailored mental health literacy education both for males and females could potentially improve the public's mental health attitude toward mental illness.

Objective: The purpose of this study was to assess participation rates in civic volunteering among service member and veteran students. Participants: Data for the present cross-sectional study were obtained from the American College Health Association's (ACHA) 2011-2014 National College Health Assessment II (NCHA). Methods: Demographic characteristics of the study sample were explored by calculating frequencies and percentages by military service status. Research questions were explored with either Fisher's exact test or maximum likelihood multiple logistic regression. Results: Service member and veteran students were more likely to engage in volunteerism than their non-veteran counterparts. Additionally, student veterans and non-veteran students reported that engagement in volunteer efforts both reduces their feelings of depression and increases their use of mental health services. Conclusion: The findings of this research suggest that the promotion of civic engagement and participation in volunteerism for service member and veteran students on college campuses might contribute to successful reintegration outcomes.

Objective: The purpose of this study was to explore differences in oral health among students by military service status in postsecondary settings. Participants: Secondary data were obtained from the American College Health Association's 2011-2014 National College Health Assessment II. Method: Demographic characteristics of the study sample were explored by calculating frequencies and percentages by military service status. Research questions were explored with maximum likelihood multiple logistic regression. Results: Service member and veteran students are at greater risk for neglecting health behaviors associated with positive oral health, including that they were less likely to get dental exams and that those who deployed in the past were the least likely to be practicing good oral health. Conclusions: The results suggest that improving oral health will contribute to improving health and mental health outcomes in this population, and provide important information for health specialists working with service members and veterans on college campuses.

Purpose: This study aims to measure associated factors of Mental Health Literacy (MHL) among Minnesotans by using the Mental Health Literacy Scale and Andersen's Health Behavior Model., Design and Methods: This study utilized cross-sectional survey data with 732 participants., Findings: Participants in higher education groups showed higher MHL levels than those who have less education. Non-Latino Whites had higher MHL levels than any other racial group. Participants who engaged in social groups had higher MHL levels. Interestingly, the relationship between health literacy and MHL was the most substantial factor., Practice Implications: Interventions aiming to improve health literacy seems beneficial to increase MHL. In addition, a variety of programs should be implemented, such as social programs that target those with less social group interaction., (© 2019 Wiley Periodicals, Inc.)

The aim of the present study was to estimate the prevalence of mental distress at the county-level for the service member or veteran (SMV) population in Illinois. Multilevel small-area estimation methodology (SAE) was used to estimate and map the prevalence of SMV mental distress in Illinois counties using data from the 2016 Behavioral Risk Factor Surveillance System. Furthermore, local indicators of spatial association analysis (LISA) was conducted in order to identify hotspots of SMV mental distress in Illinois. For 2016, the average model-based mental distress rate for SMVs in Illinois counties was 8.6%. LISA analysis revealed a significant cluster (p < 0.01) of "high-high" SMV mental distress prevalence in St. Clair County and Clinton County. These findings highlight the importance of examining SMV health from a population perspective and reveal the need for further examination of geographic-based SMV health disparities.

Objectives: This study estimated county-level human papillomavirus (HPV) vaccination initiation rates in Alabama and determined whether disparities existed between counties in the Mississippi Delta region (MDR) and Appalachian region (AR)., Study Design: This study used an observational cross-sectional design., Methods: We used small area estimation methodology to estimate rates of medical provider-verified HPV vaccine initiation among school-age children in Alabama. Data for the study were retrieved from the 2015 National Immunization Survey (n = 22,205) and the US Census Bureau., Results: The predictive model results showed that older age (odds ratio [OR] = 1.22, 95% confidence interval [CI] = 1.16, 1.29) was positively associated with vaccination initiation and black (OR = 0.79, 95% CI = 0.71, 0.87), white (OR = 0.56, 95% CI = 0.52, 0.60), and 'other' race/ethnicities (OR = 0.78, 95% CI = 0.70, 0.86), compared with Hispanics, and was negatively associated with vaccination initiation. The median (x̃)-modeled HPV vaccination initiation rate for all Alabama counties was 50.83% (interquartile range = 5.00%). Modeled HPV vaccination initiation rates were lowest in AR counties (x̃ = 49.81%), followed by counties not in the AR or MDR (x̃ = 53.26%) and MDR counties (x̃ = 54.90%)., Conclusions: Culturally sensitive school-based HPV vaccine delivery programs are needed for children living in AR counties in Alabama., (Copyright © 2019 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

The purpose of the study was to determine whether veteran students and non-veteran students differed in their sexual behaviors and health practices and, furthermore, whether or not those differences were gender specific. Demographic characteristics of the study sample were explored by calculating frequencies and percentages by military service status. Research questions were explored with maximum likelihood multiple logistic regression. Results showed that student veterans were more likely than non-veteran students to have sex with multiple partners, with males and transgender students more likely than females to report multiple sexual partners. Student veterans were more likely than non-veterans to perform a self-examination for either breast cancer or testicular cancer, with transgender students more likely than females to report having engaged in a self-examination. Student veterans were also more likely than non-veterans to have been vaccinated against HPV or Hepatitis B, with male students more likely than females to have been vaccinated. Furthermore, transgender student veterans were less likely than female veterans to have been vaccinated. Finally, male student veterans were more likely than female veterans to report an STI-related doctor visit, with transgender student veterans more likely than female veterans to report an STI-related doctor visit. College campuses are increasingly implementing student veteran-specific programs and services; however, little if any research specifically has explored ways in which safety and health can be promoted within university settings. We recommend that institutions of higher education make concerted efforts to promote safety and health among its student veteran population.

Objective : Little is known about the health status of the diverse population of student service members and veterans (SSM/V) enrolling in higher education in great numbers. The objective of this study was to explore the differences in physical health characteristics by sexual orientation among a national sample of SSM/V. Methods : Using secondary data, a series of maximum likelihood (ML) logistic regression models were estimated to explore physical health characteristics by sexual orientation in a sample of SSM/V. Results : SSM/V that identify as lesbian or gay reported higher rates of treatment and diagnosis for some physical health matters (respiratory illness and HIV) when compared with their heterosexual counterparts. Conclusions : Our findings support the need for campus health officials and policymakers to develop services to address the physical health needs of this population that differ from their peers.

Objective: The purpose of this study was to assess the current state of postsecondary educational settings' outreach to military women who become students postservice. Participants: Data for the present cross-sectional study were obtained from the American College Health Association's (ACHA) 2011-2014 National College Health Assessment II (NCHA). Methods: Demographic characteristics of the study sample were explored by calculating frequencies and percentages by military service status. Research questions were explored with Fisher's exact test, maximum likelihood multiple logistic regression, as appropriate. Results: Women service member and veteran students received health information from their university/college less often than women students with no military experience on the following topics: alcohol and other drug use, depression and anxiety, sexual assault and relationship violence prevention, and stress reduction. Conclusions: The findings of this research identified clear gaps in service provision for women student veterans on college campuses and provided some possible models for intervention development.

Objective: In response to the well-documented need for evidence-based cancer caregiver support, we examined the feasibility of problem-solving therapy for family caregivers of cancer patients receiving outpatient palliative care and investigated the impact of problem-solving therapy on family caregivers' anxiety, depression, and quality of life., Methods: We conducted a feasibility study of a structured problem-solving therapy intervention delivered to family caregivers of cancer patients receiving outpatient palliative care from an academic health center in the Midwestern United States. Participants (N = 83) were randomly assigned to receive usual care or usual care plus a problem-solving therapy intervention, which was delivered over three sessions via web-based videoconferencing or telephone. Descriptive statistics were used to determine feasibility relative to recruitment, retention, and fidelity to core intervention components. Outcome data were analyzed using ordinary least squares multiple regression., Results: Problem-solving therapy for family caregivers of patients with cancer was found to be highly feasible in the outpatient palliative care setting. Caregivers who received problem-solving therapy reported less anxiety than those who received only usual care (P = 0.03). No statistically significant differences were observed for caregiver depression (P = 0.07) or quality of life (P = 0.06)., Conclusions: Problem-solving therapy is a feasible and promising approach to reducing cancer family caregivers' anxiety in the outpatient palliative care setting. Further testing in multiple sites is recommended., (© 2018 John Wiley & Sons, Ltd.)