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Background Acceptance and mindfulness processes indicating psychological flexibility may be important mechanisms in chronic pain adaptation; however, their association with opioid analgesic misuse (OA) risk is unclear. The present study investigated the extent to which psychological flexibility is associated with OA misuse risk within a chronic low back pain population on long-term opioid therapy. Methods Participants were 156 patients presenting for treatment at an academic pain clinic. Aspects of psychological flexibility were assessed using the Mindfulness Attention Awareness Scale (MAAS) and the Acceptance and Action Questionnaire II (AAQ II). The Current Opioid Misuse Measure (COMM) determined heightened risk of opioid analgesic misuse. Participants were 59% female, 48.3 years old on average (SD = 9.8), and largely White, Hispanic. Results Nested multiple linear regression indicated that the higher mindfulness levels predicted opioid misuse risk while controlling for pain severity, pain-related interference, pain anxiety, and acceptance. The full regression model predicted 54% of the variance in OA misuse risk. Conclusion Results suggest that psychological flexibility, particularly mindfulness processes, may be important in predicting and mitigating OA misuse risks among chronic pain patients. Non-pharmacological interventions are critical to addressing the current opioid misuse crisis.

INTRODUCTION Short message service (SMS) is a widely accepted telecommunications approach used to support health informatics, including behavioral interventions, data collection, and patient-provider communication. However, SMS delivery platforms are not standardized and platforms are typically commercial "off-the-shelf" or developed "in-house." As a consequence of platform variability, implementing SMS-based interventions may be challenging for both providers and patients. Off-the-shelf SMS delivery platforms may require minimal development or technical resources from providers, but users are often limited in their functionality. Conversely, platforms that are developed in-house are often specified for individual projects, requiring specialized development and technical expertise. Patients are on the receiving end of programming and technical specification challenges; message delays or lagged data affect quality of SMS communications. To date, little work has been done to develop a generalizable SMS platform that can be scaled across health initiatives. OBJECTIVE We propose the Configurable Assessment Messaging Platform for Interventions (CAMPI) to mitigate challenges associated with SMS intervention implementation (e.g., programming, data collection, message delivery). METHOD CAMPI aims to optimize health data captured from a multitude of sources and enhance patient-provider communication through a technology that is simple and familiar to patients. Using representative examples from three behavioral intervention case studies implemented among diverse populations (pregnant women, young sexual minority men, and parents with young children), we describe CAMPI capabilities and feasibility. CONCLUSION As a generalizable SMS platform, CAMPI can be scaled to meet the priorities of various health initiatives, while reducing unnecessary resource utilization and burden on providers and patients. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

OBJECTIVES: To address the critical need for opioid use disorder (OUD) treatment by rapidly planning and implementing a statewide DEA X-waiver training initiative expanding office-based OUD treatment in Texas by: (1) facilitating access to buprenorphine waiver trainings to targeted regions and health care providers across the state; and (2) supporting completion of DEA X-waiver requirements. METHODS: We used a transdisciplinary and theory-driven approach to adapt and rapidly scale up an existing, previously successful DEA X-waiver initiative. Pre-implementation activities included a literature review to identify OUD treatment barriers and demographic analyses to identify high-need areas of the state. We used geospatial mapping methods to identify regions with highest point prevalence of opioid-overdose mortality and low access to a buprenorphine provider. The study team used the Replicating Effective Programs (REP) framework developed by the Centers for Disease Control and Prevention to support implementation of evidence-based practices. RESULTS: In six months, we trained 451 waiver eligible providers, 133 (29%) of whom received waivers by 6 months post-training. Of the 163 (36.1%) providers who completed the post-waiver evaluation, 97% reported that they were satisfied or very satisfied with the training. Our initiative delivered high quality education to providers and increased the number of waiver trainers in Texas from eight to thirteen. CONCLUSIONS: Despite recent changes to the DEA X-waiver process, barriers to treating OUD with buprenorphine remain. Lack of education and experience treating substance use disorders remains a significant factor in limiting clinician comfort in prescribing buprenorphine. The research team successfully adapted a Texas-wide initiative to increase the number of office-based providers eligible to prescribe buprenorphine for OUD from an existing single-site initiative. Attentiveness to barriers pre-implementation and to adaptations during implementation enabled moderate impact across a large network in a short time and facilitated program sustainment.

OBJECTIVE The primary objective was to evaluate the efficacy of commercially available mobile app-delivered mindfulness training (AMT), compared with waitlist control (WC), on quality of life (QOL) among women diagnosed with breast cancer. The secondary outcome was dispositional mindfulness. Enrollment, app utilization, and study completion are reported as feasibility objectives. METHODS Women diagnosed with breast cancer ≤5 years (n = 112) were randomized to AMT (n = 57) or WC (n = 55), over 8 weeks, with 4 weeks of follow-up. We conducted linear mixed effects models to examine group by observation interactions on QOL and dispositional mindfulness at baseline, during intervention (5-weeks), post-intervention (9-weeks), and follow-up (12-weeks post-baseline). RESULTS Participants assigned to AMT reported higher QOL, compared with those assigned to WC, from baseline through follow-up t(258.40) = 3.09, P

BACKGROUND: We explored pain, psychological flexibility, and continued substance use among 100 adults treated with methadone for opioid use disorder (OUD). All participants had co-occurring chronic pain. METHODS: Participants recruited from a community treatment center between 2009 and 2010 completed an interviewer-facilitated assessment. Chronic pain severity and interference, psychological flexibility (mindfulness, acceptance, values success), past 30-day substance use, and demographics were reported. We modeled a zero-inflated negative binomial regression to examine 1) the probability that an individual does not use illicit substances and 2) illicit substance use frequency among those expected to use. Pain severity and mindfulness were included as predictors in the logit (zero inflated) model. Pain interference, acceptance, and values success were included as predictors in the negative binomial (count) model. We controlled for age and gender in both models. RESULTS: Participants were predominantly (84%) Hispanic, and 64% used an illicit substance least once in the past 30 days. Greater degree of mindfulness significantly predicted the probability that an individual does not continue to use illicit substances (OR = 1.59, p < 0.05). Lower degree of values success significantly predicted greater illicit substance use frequency among those likely to use (IRR = 0.72, p < 0.01). No other variables were associated with continued substance use. CONCLUSIONS: Findings suggest psychological flexibility is associated with continued substance use in this predominantly Hispanic sample of adults treated for OUD with co-occurring chronic pain. Study findings may have implications for how to address the treatment needs of this complex population.

Wearables with embedded electrodes and sensors are capable of continuously performing Electrocardiography (ECG), recording electrical activity of the heart, while estimating heart-rate of the wearer. Recent advances in wearable technology have generated comfortable flexible sensors that conform to the contours of the body and can measure heart-rate in the field by capturing QRS complexes of ECG signals. Due to various activities of daily living (ADL), skin deformation by means of lateral, rotational or skin stretching can cause changes in the current pathways of the sensor creating noisy data. The challenge is to disentangle the noise from the usable data in order to accurately detect QRS complexes of ECG signals. In this paper we design a framework to capture noise from a miniaturized flexible sensor, the Biostamp1 (with 4 leads), worn on the chest of 16 participants performing a set of structured ADL in a home setting, and a baseball player (pitcher). We present a machine-learning framework using a consensus fusion classifier comprising a Support Vector Machine and Neural Network learned model to remove noise while preserving neighboring R-peaks. We evaluate the model using Leave One Subject Out (LOSO) and yield an average of 83% F-measure on the 17 participants (including the pitcher). The low false negative rate provides accurate heart-rate detection on a finegrained (every 5 seconds) level, in the presence of intermittent stretching of the skin. Our results increase the reliability of detecting heart-rate in real-world and player settings, increasing the utility of flexible ECG-based sensors in the field.

The number of individuals seeking treatment for prescription opioid dependence has increased dramatically, fostering a need for research on this population. The aim of this study was to examine reasons for prescription opioid use among 653 participants with and without chronic pain, enrolled in the Prescription Opioid Addiction Treatment Study, a randomized controlled trial of treatment for prescription opioid dependence. Participants identified initial and current reasons for opioid use. Participants with chronic pain were more likely to report pain as their primary initial reason for use; avoiding withdrawal was rated as the most important reason for current use in both groups. Participants with chronic pain rated using opioids to cope with physical pain as more important, and using opioids in response to social interactions and craving as less important, than those without chronic pain. Results highlight the importance of physical pain as a reason for opioid use among patients with chronic pain.

Sublingual buprenorphine, with and without naloxone, is indicated for the treatment of opioid use disorders. Although not approved for pain, some evidence suggests it may be a safe and effective alternative to conventional opioid analgesics, particularly for those with addiction problems. This study surveyed pain specialists to examine the extent to which sublingual buprenorphine was prescribed for chronic pain and explore associated clinician attitudes and characteristics.A 36-item survey examining clinician attitudes and characteristics related to sublingual buprenorphine and other opioids was distributed to 1307 members of the American Pain Society, a multidisciplinary professional group. Members were provided a paper copy of the survey and URL to an online version. A follow-up letter was mailed after 2 weeks.Overall, 230 completed surveys were returned (18.5%). Of clinicians who prescribed opioids for chronic pain (92.5%), 19.7% reported prescribing sublingual buprenorphine for chronic pain at least once; of these prescribers, 39.6% did not have a DEA X-waiver to prescribe sublingual buprenorphine for opioid dependence. Prescribers were more likely than nonprescribers to find sublingual buprenorphine effective for chronic pain. Prescribers were also significantly more likely to view sublingual buprenorphine as safer than full agonists in terms of addiction, overdose, and drug interaction. No differences emerged between prescribers and nonprescribers regarding perceptions of potential for drug diversion or in terms of overall opioid prescribing behaviors.Results suggest that sublingual buprenorphine is indeed being used to treat chronic pain; however, the circumstances when this occurs are not entirely clear.

A1 Introduction to the 8th Annual Conference on the Science of Dissemination and Implementation: Optimizing Personal and Population Health David Chambers1, Lisa Simpson2 1Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, 20850, USA; 2AcademyHealth, Washington, DC, 20036, USA For the second year in a row, we are pleased to be able to share the proceedings of the Annual Conference on the Science of Dissemination and Implementation in Health, a large meeting reflecting the expanding and evolving research field that seeks to optimize the use of evidence, interventions, and tools from health research within the myriad of settings where people receive health care, make health-related decisions, and increase knowledge of influences on the health of the population. We once again benefitted from a strong partnership, co-led by AcademyHealth and the National Institutes of Health (NIH), with co-sponsorship from the Agency for Healthcare Research and Quality (AHRQ), the Patient Centered Outcomes Research Institute (PCORI), the Robert Wood Johnson Foundation (RWJF), the US Department of Veterans Affairs (VA), and the WT Grant Foundation. In addition, we benefitted from the collaboration of staff from the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). NIH and AcademyHealth again co-led the program planning committee, which focused on the development of the plenary sessions, and convened a scientific advisory panel to suggest speakers and advise on the overall conference development. The planning committee identified four key areas around which to focus the plenary panels and keynote address. Dr. America Bracho, M.D., M.P.H., Executive Director of Latino Health Access in Orange County, California, spoke about the opportunities for implementation science to inform efforts to improve community health and engage underserved populations. The three plenary panels each focused on a significant future direction for dissemination and implementation (D & I) research: the interface between D&I science and population health, emerging opportunities for global implementation science, and the challenges around implementation of precision medicine. The plenary sessions were complemented by facilitated lunchtime discussions on the same three topics, which offered participants an opportunity to identify key research questions for each and brainstorm next steps. Synopses of the lunchtime discussions are included in this supplement. Given the overwhelming success of the 2014 conference and the large number of abstracts received in 2014 (660), the program planning committee identified eight program tracks for abstract submitters to respond to, and through which the concurrent sessions of the conference would be organized. These tracks—Behavioral Health, Big Data and Technology for Dissemination and Implementation Research, Clinical Care Settings, Global Dissemination and Implementation, Promoting Health Equity and Eliminating Disparities, Health Policy Dissemination and Implementation, Prevention and Public Health, and Models, Measures and Methods— were designed to enable conference participants to follow a consistent theme across the multiple sessions of the conference and form the structure of this supplement. The call for abstracts, including individual paper presentations, individual posters and panel presentations, resulted in 515 submissions, spread across the eight thematic tracks. Over one hundred reviewers devoted their time to ensuring a comprehensive and expert review, and reviews were conducted within each track and coordinated by the track leads. For the final program, 64 oral presentations, 12 panels, and 263 posters were presented over the two-day meeting. Slides for the oral presentations and panels (with the agreement of the authors) were posted on the conference website (http://diconference.academyhealth.org/archives/2015archives) and all abstracts were included on the conference webapp (https://academyhealth.confex.com/academyhealth/2015di/meetingapp.cgi). This supplement has compiled the abstracts for presented papers, panel sessions, and lunchtime discussions from the 8th Annual Meeting on the Science of Dissemination and Implementation in Health: Optimizing Personal and Population Health. We are pleased to have the abstracts from the conference together in one volume once again, and look forward to the 9th Annual meeting, scheduled for December in Washington, D.C.

Background: Mindfulness training may improve quality of life (QoL) among women diagnosed with breast cancer, yet barriers associated with instructor-facilitated training (eg, cost, location, time) may limit uptake. Self-directed mindfulness training using smartphone apps may overcome these barriers. However, little is known about who may be most likely to engage in app-based mindfulness training (AMT) interventions. Objective: We examined baseline predictors of app engagement among women diagnosed with breast cancer (≤5 years) enrolled in a randomized controlled trial (RCT) of a commercially available AMT intervention (Headspace). Methods: Participants (n=57) received AMT as part of a 12-week RCT. Headspace was available for download from iTunes or Google Play. Participants were asked to complete app registration using a unique activation code and complete ≥ 1 mindfulness session; this was defined as “minimum dose.” Overall, AMT engagement was self-guided. Participants completed baseline measures of QoL (FACT-B), dispositional mindfulness (MAAS), pain severity and interference (BPI-sf), and demographics. Log data was obtained from the app developers at the end of the study. AMT engagement was characterized by: attaining minimum dose, number of mindfulness sessions completed, and duration (minutes) of overall mindfulness practice. Results: Overall, 34 participants completed app registration and ≥1 mindfulness session (minimum dose). Over the 12-week trial, the median number of mindfulness sessions completed was 11.50 with a range of 1-87 sessions completed. Median duration of overall mindfulness practice was 115 minutes, with a range of 10-1411 minutes. Participants who attained minimum dose had greater baseline physical well-being (mean 20.74 [SD 5.67]) compared to those who did not have any recorded engagement with AMT (mean 16.43 [SD 8.15]; t[36.2]=-2.20, P=.04). Pain severity was lower for participants who attained minimum dose (mean 3.12 (SD 1.69]) compared to those who did not (mean 4.61 [SD 2.05]; t[29]=2.20, P=.04). Other domains of QoL, dispositional mindfulness, pain-related interference, and demographics did not differ between groups. Among those who attained minimum dose, only pain-related interference was associated with fewer mindfulness sessions completed (P=.05). Conclusions: App engagement was not recorded for slightly fewer than half of participants (ie, did not complete registration and ≥1 mindfulness session). Although reasons for non-adherence are unclear, findings suggest physical well-being and pain-related factors may be associated with participant AMT engagement. Given mindfulness practice time is associated with mindfulness skills uptake, future studies should explore approaches to optimize AMT engagement among participants with greater physical well-being and pain-related concerns.

Impulsivity and sensation seeking have been associated with substance use disorders, including opioid use disorders. This pilot study sought to examine whether impulsivity and sensation seeking, as measured by the Barratt Impulsiveness Scale (BIS) and Sensation Seeking Scale (SSS), were associated with opioid analgesic misuse risk in chronic, low-back pain patients prescribed opioid analgesics. Participants were 42 chronic, low-back pain patients enrolled in a larger study examining problematic opioid analgesic use. Impulsivity was assessed using the BIS, sensation seeking was measured using the SSS, and opioid analgesic misuse risk was assessed using the Current Opioid Misuse Measure (COMM). Significant bivariate associations were found between the COMM and the following predictor variables: age and the three BIS subscales: Attentional Impulsiveness, Non-planning Impulsiveness, and Motor Impulsiveness. Using a multivariate linear regression, after controlling for age, the BIS subscales accounted for 29.0% of the variance in the COMM. Attentional Impulsiveness was the only significant BIS subscale. These results suggest a potential relationship between impulsivity, but not sensation seeking, and risk for opioid analgesic misuse. Impulsivity is not a prominent trait observed in chronic pain patients; however, it may be an important risk factor for opioid analgesic misuse for a subset of individuals with chronic pain. As such, these findings suggest that additional exploration of this potential risk factor is warranted.