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The causes of substance use disorders (SUDs) are largely unknown and the effectiveness of their treatments is limited. One crucial impediment to research and treatment progress surrounds how SUDs are classified and diagnosed. Given the substantial heterogeneity among individuals diagnosed with a given SUD (e.g., alcohol use disorder [AUD]), identifying novel research and treatment targets and developing new study designs is daunting.In this article, we review and integrate two recently developed frameworks, the National Institute on Drug Abuse's Phenotyping Assessment Battery (NIDA PhAB) and the Hierarchical Taxonomy of Psychopathology (HiTOP), that hope to accelerate progress in understanding the causes and consequences of psychopathology by means of deep phenotyping, or finer-grained analysis of phenotypes.NIDA PhAB focuses on addiction-related processes across multiple units of analysis, whereas HiTOP focuses on clinical phenotypes and covers a broader range of psychopathology. We highlight that NIDA PhAB and HiTOP together provide deep and broad characterizations of people diagnosed with SUDs and complement each other in their efforts to address widely known limitations of traditional classification systems and their diagnostic categories. Next, we show how NIDA PhAB and HiTOP can be integrated to facilitate optimal rich phenotyping of addiction-related phenomena. Finally, we argue that such deep phenotyping promises to advance our understanding of the neurobiology of SUD and addiction, which will guide the development of personalized medicine and interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Background Currently, ≤5% of bystanders witnessing an opioid overdose (OD) in the US administer antidote to the victim. A possible model to mitigate this crisis would be a system that enables 9-1-1 dispatchers to both rapidly deliver naloxone by drone to bystanders at a suspected opioid OD and direct them to administer it while awaiting EMS arrival. Methods A simulated 9-1-1 dispatcher directed thirty subjects via 2-way radio to retrieve naloxone nasal spray from atop a drone located outside the simulation building and then administer it using scripted instructions. The primary outcome measure was time from first contact with the dispatcher to administration of the medication. Results All subjects administered the medication successfully. The mean time interval from 9 -1-1 contact until antidote administration was 122 [95%CI 109–134] sec. There was a significant reduction in time interval if subjects had prior medical training (p = 0.045) or had prior experience with use of a nasal spray device (p = 0.030). Five subjects had difficulty using the nasal spray and four subjects had minor physical impairments, but these barriers did not result in a significant difference in time to administration (p = 0.467, p = 0.30). A significant number of subjects (29/30 [97%], p = 0.044) indicated that they felt confident they could administer intranasal naloxone to an opioid OD victim after participating in the simulation. Conclusions Our results suggest that bystanders can carry out 9-1-1 dispatcher instructions to fetch drone-delivered naloxone and potentially decrease the time interval to intranasal administration which supports further development and testing of a such a system.

Individuals with substance use disorders are besieged by stigma, within their community and also the broader social context. This stigma may also pervade interactions with health care professionals, preventing individuals with SUD from seeking treatment for medical and/or psychiatric conditions. Given the current opioid crisis, providers must be equipped with the skills to diagnose and treat individuals with SUD, as well as the ability to communicate in an empathic, nonjudgmental manner. While training in addictions has often been absent from medical school curriculum, increasing numbers of programs are incorporating such training. Simulation methods have been underutilized in mental health and addiction training. The present study sought to examine learner knowledge, perceptions, and confidence in treating patients with SUD and build upon existing findings regarding the utility of simulations in addictions. Although research in this area is scant, the existing evidence supports the value of simulations to enhance clinical skills, learner confidence, and perceptions of individuals with SUD. Results of the present pilot study appear to support previous findings. Simulation training methods appear to be a viable option to train providers to identify and treat individuals with SUD, while potentially combating stigma and increasing provider confidence and empathy.

The widespread incidence of morbidity and mortality associated with opioid use disorder (OUD) has resulted in a national crisis. One component of this public health epidemic includes a lack of an adequately trained healthcare workforce to provide opioid case management, prescribing, and dispensing. The Extension for Community Healthcare Outcomes (Project ECHO) is a tele-mentoring, guided practice model, which provides knowledge exchange from specialists and subspecialists to enable primary care providers and clinicians to deliver best practice care for complex health conditions like OUD. Project ECHO is considered a promising strategy to address the trained healthcare workforce shortage, especially in remote and traditionally underserved areas. We conducted a systemic review of the literature to evaluate the impact of Opioid /Addiction Treatment Project ECHO programs on participant (healthcare provider) and patient outcomes. Overall, studies show increases in provider self-efficacy and knowledge gains after participation in Project ECHO. Benefits and barriers to participation in Project ECHO clinics are discussed. Project ECHO for OUD is an effective telehealth practitioner training and support model that promotes advances in provider knowledge and self-efficacy. Further research examining evidence on cost-effectiveness, practitioner, and patient outcomes is needed.

Positive social connections are crucial for recovery from Substance Use Disorder (SUD). Of interest is understanding potential social information processing (SIP) mediators of this effect. To explore whether persons with different SUD show idiosyncratic biases toward social signals, we administered an emotional go-nogo task (EGNG) to 31 individuals with Cocaine Use Disorder (CoUD), 31 with Cannabis Use Disorder (CaUD), 79 with Opioid Use Disorder (OUD), and 58 controls. Participants were instructed to respond to emotional faces (Fear/Happy) but withhold responses to expressionless faces in two task blocks, with the reverse instruction in the other two blocks. Emotional faces as non-targets elicited more “false alarm” (FA) commission errors as a main effect. Groups did not differ in overall rates of hits (correct responses to target faces), but participants with CaUD and CoUD showed reduced rates of hits (relative to controls) when expressionless faces were targets. OUD participants had worse hit rates [and slower reaction times (RT)] when fearful faces (but not happy faces) were targets. CaUD participants were most affected by instruction effects (respond/“go” vs withhold response/“no-go” to emotional face) on discriminability statistic A. Participants were faster to respond to happy face targets than to expressionless faces. However, this pattern was reversed in fearful face blocks in OUD and CoUD participants. This experiment replicated previous findings of the greater salience of expressive face images, and extends this finding to SUD, where persons with CaUD may show even greater bias toward emotional faces. Conversely, OUD participants showed idiosyncratic behavior in response to fearful faces suggestive of increased attentional disruption by fear. These data suggest a mechanism by which positive social signals may contribute to recovery.

Attentional function in substance use disorder (SUD) is not well understood. To probe attentional function in SUD as a function of primary substance of abuse, we administered the attentional network task (ANT) to 44 individuals with Cocaine Use Disorder (CoUD), 49 individuals with Cannabis Use Disorder (CaUD), 86 individuals with Opioid Use Disorder (OUD), and 107 controls with no SUD, along with the stop-signal task (SST). The ANT quantifies the effects of (temporal) alerting cues and (spatial) orienting cues to reduce reaction time (RT) to targets, as well as probing how conflicting (target-incongruent) stimuli slow RT. The SST quantifies individuals' ability to inhibit already-initiated motor responses. After controlling for sex representation and age, OUD and CaUD participants showed blunted alerting effects compared to controls, whereas CaUD and CoUD participants showed greater stimulus conflict (flanker) effects. Finally, CoUD participants showed a trend toward increased orienting ability. In SST performance, no SUD group showed a prolonged stop-signal reaction compared to controls. However, the OUD group (and CoUD group at trend level) showed prolonged "go" RT to targets and reduced hit rates. These data indicate differences in attentional function in persons with SUD as a function of the primary substance use.

Background and objectives Current methods of classifying individuals with substance use disorder (SUD) result in vast heterogeneity among persons within a given diagnosis. These approaches, while clinically allowing for distinctions between patient groups, are less than ideal when attempting to recruit a neurobehaviorally defined subset of subjects into clinical trials. To address this gap, alternative strategies have been proposed, including behavioral phenotyping. The NIDA Phenotyping Assessment Battery (PhAB) is a modular package of assessments and neurocognitive tasks that was developed for use in clinical trials. The goal of the present study is to assess the feasibility of the NIDA PhAB with regard to ease of administration and time burden. Methods Healthy controls, persons with cocaine use disorder (CocUD), opioid use disorder (OUD), cannabis use disorder (CanUD), and combined opioid and cocaine use disorder (OCUD) were recruited from various sources (N = 595). Participants completed screening and one to three assessment visits. Time to complete the measures was recorded and a satisfaction interview was administered. Results Of the participants enrolled, 381 were deemed eligible. The majority of eligible participants (83%) completed all assessments. The average completion time was 3 hours. High participant satisfaction ratings were noted, with over 90% of participants endorsing a willingness to participate in a similar study and recommend the study to others. CONCLUSION AND SCIENTIFIC SIGNIFICANCE: These findings corroborate the ease with which the PhAB may be easily incorporated into a study assessment visit without undue participant burden. The PhAB is an efficient method for behavioral phenotyping in addiction clinical trials. (Am J Addict 2021;00:00-00).

BACKGROUND. Takotsubo syndrome (TS) is an acute, reversible form of heart failure, often mimicking an acute coronary syndrome (ACS). Data regarding racial differences in TS are inconsistent. The aim is to assess clinical features associated with unfavorable in-hospital outcomes between African American (AA) and Caucasian (CAU) patients. METHODS. A retrospective electronic health record query identified 44 AA patients and 110 CAU patients with a diagnosis of TS. Our primary outcome was a composite of death, stroke, and cardiogenic shock during hospitalization. Variables associated with an increased risk of the primary composite outcomes were included in a logistic regression model. RESULTS. Compared to CAU patients, AA patients were a more comorbid population, and presented a higher prevalence of history of illicit drug use (27.3% vs 13.6% p=0.044). There were no significant differences regarding in-hospital complication rates between AA and CAU patients. In the logistic regression model, infection was associated with greater risk of developing the primary outcome in AA patients (OR=7.26 95% CI [1.22–43.17], p=0.029), whereas angina was a protective factor (OR=0.11 95% CI [0.02–0.65], p=0.015). In CAU patients, severely depressed ejection fraction and worse peak creatinine during hospitalization increased risk of developing the primary outcome (OR=5.88 95% CI [2.01–17.17], p

In the USA, infant mortality remains a major public health concern, particularly for Black women and their infants who continue to experience disproportionately high mortality rates. Prenatal care is a key determinant of infant health, with inadequate prenatal care increasing risk for prematurity, stillbirth, neonatal loss, and infant death. The aim of the present study was to determine if concurrent delivery of patient navigation and behavioral incentives to at-risk Black pregnant women could improve prenatal care attendance and associated maternal and infant outcomes. Participants were 150 Black pregnant women recruited at first prenatal visit and screening at risk for adverse maternal and infant outcomes. Women were randomized to either the patient navigation + behavioral incentives intervention (PNBI) or assessment + standard care control (ASC) group. All were followed throughout pregnancy and 12-week postpartum. Group comparisons were made using intention-to-treat and per-protocol sensitivity analyses. While no group differences were found in prenatal care visits, the average number of visits for both groups (9.3 for PNBI and 8.9 for ASC) approached the American College of Obstetricians and Gynecologists (ACOG) recommended guidelines. There were also no group differences in maternal and infant outcomes. Both intention-to-treat and per-protocol sensitivity analyses, however, consistently found PNBI women attended more postpartum visits than ASC controls (p = 0.002). Given ACOG’s redefining of the postpartum period as the fourth trimester, study findings suggest PNBI may facilitate prevention and intervention efforts to more successfully reduce health disparities in outcomes for both mother and infant.

Stress cardiomyopathy is an acute reversible heart failure syndrome initially believed to represent a benign condition due to its self-limiting clinical course, but now recognized to be associated with a non-negligible rate of serious complications such as ventricular arrhythmias, systemic thromboembolism, and cardiogenic shock. Due to an increased awareness and recognition, the incidence of stress cardiomyopathy has been rising (15-30 cases per 100,000 per year), although the true incidence is unknown as the condition is likely underdiagnosed. Stress cardiomyopathy represents a form of neurocardiogenic myocardial stunning, and while the link between the brain and the heart is established, the exact pathophysiological mechanisms remain unclear. We herein review the proposed risk factors and triggers for the syndrome and discuss a practical approach to diagnosis and treatment of the patients with stress cardiomyopathy, highlighting potential challenges and unresolved questions.

Previous working memory (WM) studies found that relative to controls, subjects with cannabis use disorder (CUD) showed greater brain activation in some regions (e.g., left [L] and right [R] ventrolateral prefrontal cortex [VLPFC], and L dorsolateral prefrontal cortex [L-DLPFC]), and lower activation in other regions (e.g., R-DLPFC). In this study, effective connectivity (EC) analysis was applied to functional magnetic resonance imaging data acquired from 23 CUD subjects and 23 controls (two groups matched for sociodemographic factors and substance use history) while performing an n-back WM task with interleaved 2-back and 0-back periods. A 2-back minus 0-back modulator was defined to measure the modulatory changes of EC corresponding to the 2-back relative to 0-back conditions. Compared to the controls, the CUD group showed smaller modulatory change in the R-DLPFC to L-caudate pathway, and greater modulatory changes in L-DLPFC to L-caudate, R-DLPFC to R- caudate, and R-VLPFC to L-caudate pathways. Based on previous fMRI studies consistently suggesting that greater brain activations are related to a compensatory mechanism for cannabis neural effects (less regional brain activations), the smaller modulatory change in the R-DLPFC to L-caudate EC may be compensated by the larger modulatory changes in the other prefrontal-striatal ECs in the CUD individuals.

The coronavirus disease 2019 (COVID-19) pandemic exacerbated the opioid use disorder epidemic and accelerated alcohol and other substance use disorders. Sudden health care service delivery changes during the COVID-19 pandemic created both challenges and opportunities for all patients with substance use disorders including the use of virtual or telemedicine visits, medication access issues and ensuring access to naloxone when supplies cannot be handed out. Unique challenges for pregnant and post-partum patients with substance use disorders includes some evidence of reduced access to medication to treat opioid use disorders and changes in delivery protocols that isolate birthing people from supports. Opportunities for all patients with substance use disorders include virtual platforms presenting positive opportunities for treatment. They are time efficient, eliminate transportation barriers, and potentially reduce childcare barriers. For pregnant and post-partum patients with substance use disorders, hybrid models of telemedicine and in-person visits reduced no-show visit rates and increased flexibility in medication dosing regimens. Thus, there is a unique opportunity to study the success of different virtual care models given the variety of implemented strategies. The COVID-19 pandemic provides an unprecedented opportunity to dramatically transform standard care approaches to help optimize care for all patients, including pregnant and post-partum people.

Smoking remains one of the most preventable causes of morbidity and mortality in the United States (1). A number of factors contribute to the initiation and maintenance of smoking behavior, including psychosocial influences (2,3), neurobehavioral traits (4), and genetic susceptibility (5-7). Prevalence rates of tobacco dependence among individuals with mental health issues are strikingly high when compared to the general population, particularly among individuals with depression and anxiety disorders (8). There are well-established relationships between impulsivity, cue reactivity, and tobacco use in the literature (9). However, the interaction between these relationships remains unclear. The primary goal of this paper is to provide an overview of the existing literature across these domains and explore their interrelationship and subsequent impact on smoking initiation and tobacco dependence. Further, the clinical implications regarding the development of potential targeted smoking cessation strategies for this population are presented.

Background Takotsubo (stress) cardiomyopathy is an acute reversible heart failure syndrome initially described in Japanese patients, but now well characterized in Caucasians patients in Europe or of European descent. An initial observation has suggested a lower incidence of Takotsubo in non-Caucasian subjects, particularly in the African-American (AA) population in the United States of America. The purpose of this study was to assess whether epidemiologic and clinical differences were present in Takotsubo in a large urban hospital in Virginia, USA. Methods We used an informatics-based system to query electronic health records (TriNetX, Cambridge, MA, USA) to search for cases of Takotsubo between 2010 and 2018 and a corresponding cohort of patients with non-ST segment elevation acute myocardial infarction (NSTEMI). We then performed a chart-level review of 160 cases and obtained additional clinical information including symptoms, risk factors, co-morbidities, and in-hospital outcomes. This retrospective study was approved by the Institutional Review Board of our institution. Results We identified 260 cases of Takotsubo and 6,270 of NSTEMI in the same time period (1:24, 4.2%). Being AA was associated with an odds ratio of Takotsubo versus NSTEMI of 0.38 [0.29–0.50] (P=0.0001). With further evaluation of patients with Takotsubo (N=160), AA (N=44, 27.2%) and Non-Hispanic Caucasian (C) (N=110, 67.9%) had no differences in age and sex. AA patients with Takotsubo however were more likely than C patients to be affected by type II diabetes mellitus (38.6% versus 14.5%, P=0.002, OR 3.70 [1.65–8.28]), have history of drug abuse (27.3% versus 9.1%, P=0.009, OR 3.75 [1.48–9.49]) and of cocaine use in particular (9.1% versus 0.9%, P=0.024, OR 11.0 [1.19–101.4]). The pattern of wall motion abnormality was not different between the 2 groups. AA patients presented with a lower ratio of brain natriuretic peptide (BNP) to troponin I (41.9 [12.7–258] pg./ml versus 281 [42–890] pg/ml, P=0.022). There was no significant difference of in-hospital mortality between the AA and C groups (9.1% versus 25%, respectively, OR 0.40 [0.13–1.24], P=0.11). Conclusions The incidence and clinical characteristics of Takotsubo (stress) cardiomyopathy appear to be different between African-American and Non-Hispanic Caucasian patients. African-American patients are more likely to have diabetes and illicit drug usage, but have a lower BNP/troponin I ratio. Both AA and Non-Hispanic Caucasian patients have similar in-hospital mortality.

BackgroundAlthough tobacco smoke has been associated with many infections, little is known of its association with human papillomavirus (HPV) infections among young adult women. The aim of the study was to explore the association of tobacco smoke exposure on HPV infections in young adult women in the United States. It was hypothesized that tobacco smoke exposure (both active and passive) as objectively measured by cotinine levels was associated with increased HPV infection in a national sample of 18 and 26 year-old women in the United States.Study methods and findingsThe NHANES 2007-2012 dataset was used in the analyses. A national representative sample of women 18 to 26 year old (N = 1,414) was included in the study. Infection with any HPV was determined by PCR while tobacco smoke exposure was determined by measuring serum cotinine levels. Women with cotinine levels = 0.05 were considered as exposed. Exposed women were further categorized as passive smokers (cotinine levels 0.05- 10ng/mL). Data were analyzed by descriptive statistics and multiple logistic regression analysis. Exposed women (passive smokers with cotinine levels > = 0.05ng/mL-10ng/mL) were almost 2 times (64% vs 35%) more likely to be infected with any HPV type than their unexposed counterparts (cotinine levels = 10 ng/mL) were more than twice more likely (75%) to be infected with the virus than the unexposed counterparts. The relationship held true even after controlling for various socio-demographics. Indeed in the multiple regression analyses controlling for the various confounders, compared to their unexposed counterparts, women exposed to second hand smoke were more than twice more likely to have HPV infections (OR: 2.45; 95% C.I = 1.34-4.48). When compared to their unexposed counterparts, actively smoking women were more than 3.5 times more likely to be infected with HPV (OR = 3.56; 95% CI 1.23-10.30). Finally, a strong dose-response relationship was further demonstrated with increasing risk of HPV with each quartile of cotinine levels even after controlling for various confounders. The risk of HPV was lowest in the lowest quartile (Referent OR = 1) and increased steadily with each quartile of cotinine levels until the risk was highest among women with cotinine levels in the 4th quartile (OR = 4.16; 95% C.I. = 1.36-12.67).ConclusionBoth passive and active tobacco smoking were strongly associated with any HPV infection in 18 to 26 year old young women with a significant dose-response relationship. Future studies should explore the effect of tobacco smoke exposure among younger women less than 18 years of age.

The goal of the present study was to examine the relationship between family history of alcohol and illicit drug abuse and impulsivity in cocaine users and healthy controls. One hundred and thirty-five individuals recruited for a larger study (58 cocaine users and 77 healthy controls) with and without family history of substance misuse participated in the study. Individuals completed a computer-administered interview regarding family history of substance misuse and neurobehavioral measures of impulsivity and attentional bias. Family history of substance misuse was found to be associated with greater attentional bias to cocaine-related stimuli, regardless of personal drug use status (cocaine user versus healthy control). These findings suggest that drug cues may be more salient to first degree relatives of substance users. However, the nature of this relationship to genetic and/or environmental factors is unknown.

Close peer networks can affect adolescents’ health behaviors by altering their social environments, and thus their risk for and protection against substance use involvement. We tested a 20 minute intervention named Peer Network Counseling that integrates Motivational Interviewing and peer network strategies with 119 urban adolescents who reported occasional or problem substance use. Adolescents presenting at primary care clinic were randomized to intervention or control conditions and followed for 6 months. Mixed-effect latent growth models were used to evaluate intervention effects on trajectories of alcohol and marijuana use, offers to use substances, and moderation models to test for interactions between intervention condition and peer network characteristics. A significant intervention effect was found for boys for offers to use alcohol from friends (p

To measure common psychiatric conditions after military deployment with blast exposure and test relationships to post-concussion syndrome (PCS) symptoms and mild traumatic brain injury (mTBI) history.Cross-sectional.Service members or Veterans (n = 107) within 2 years of blast exposure underwent structured interviews for mTBI, post-traumatic stress disorder (PTSD) and multiple mood and anxiety diagnoses.MTBI history and active PTSD were both common, additionally 61% had at least one post-deployment mood or anxiety disorder episode. Psychiatric diagnoses had a high degree of comorbidity. Most dramatically, depression was 43-times (95% CI = 11-165) more likely if an individual had PTSD. PCS symptoms were greater in those with post-deployment PTSD or mood diagnosis. However, neither mTBI nor blast exposure history had an effect on the odds of having PTSD, mood or anxiety condition.These findings support that psychiatric conditions beyond PTSD are common after military combat deployment with blast exposure. They also highlight the non-specificity of post-concussion type symptoms. While some researchers have implicated mTBI history as a contributor to post-deployment mental health conditions, no clear association was found. This may partly be due to the more rigorous method of retrospective mTBI diagnosis determination.

Background This paper describes the development of an urban adolescent text messaging tobacco cessation intervention and preliminary findings from a randomized, controlled trial. The authors successfully adapted a face-to-face intervention into a personalized, automated, and interactive 5-day texting protocol. Methods Respondent-driven sampling was used beginning at a community substance abuse facility. Seventy-two tobacco-dependent adolescents were randomized into an automated computer texting program that delivered either the experimental condition of 30 motivational interviewing– and social network counseling–based personalized messages or the attention control condition consisting of a texting program covering general (non–smoking-related) health habits. All teens were provided smartphones for the study and were assessed at baseline and at 1, 3, and 6 months post intervention. Analyses examined condition × time interactions. Results At 6 months, the experimental condition decreased the number of cigarettes smoked in the past 30 days, increased intentions not to smoke in the future, and increased peer social support compared with controls. Effect sizes were moderate to large. Conclusions These findings are unique, as they target urban adolescents with a mobile health format and add to the growing literature on the efficacy of text-delivered interventions.

Background: There is a high prevalence of traumatic brain injury (TBI) among those with substance dependence. However, TBI often remains undiagnosed in these individuals, due to lack of routine screening in substance use treatment settings or due to overlap in some of the cognitive sequelae (ex. impulsivity, disinhibition) of TBI and cocaine dependence. Methods: The prevalence of self-reported mild to moderate TBI in a group of cocaine-dependent (na 95) and a group of healthy volunteers (na 75) enrolled at the same facility was assessed. Additionally, the relationship between TBI and clinically relevant correlates, including impulsivity, cocaine use history, and treatment outcome in the cocaine-dependent group was also examined. Results: A higher proportion of individuals with cocaine dependence (29.5%) reported having suffered a TBI in their lifetime compared to controls (8%) on a Closed Head Injury scale. Among cocaine users, the average age of sustaining TBI was significantly lower than the age of initiating cocaine use. Presence of TBI was not associated with higher impulsivity on the Barratt Impulsiveness Scale-11 or selfreported years of cocaine use. No differences were noted on treatment outcome for cocaine dependence as measured by treatment effectiveness scores (TES) between cocaine users with TBI and their non-TBI counterparts. Conclusions: These results are the first to highlight the high prevalence of TBI among individuals with cocaine dependence. This study underscores the possible role of TBI history as a risk factor for onset of cocaine use, however, more research is needed to determine the impact of co-morbid TBI as a complicating factor in the substance abuse treatment setting. (Am J Addict 2015;XX:XX –XX)

Although adolescent tobacco use has declined in the last 10 years, African American high school seniors' past 30-day use has increased by 12 %, and as they age they are more likely to report lifetime use of tobacco. Very few urban youth are enrolled in evidenced-based smoking prevention and cessation programming. Therefore, we tested a text messaging smoking cessation intervention designed to engage urban youth through an automated texting program utilizing motivational interviewing-based peer network counseling. We recruited 200 adolescents (90.5 % African American) into a randomized controlled trial that delivered either the experimental intervention of 30 personalized motivational interviewing-based peer network counseling messages, or the attention control intervention, consisting of text messages covering general (non-smoking related) health habits. All adolescents were provided smart phones for the study and were assessed at baseline, and at 1, 3, and 6 months post intervention. Utilizing repeated measures general linear models we examined the effects of the intervention while controlling for race, gender, age, presence of a smoker in the home, and mental health counseling. At 6 months, participants in the experimental condition significantly decreased the number of days they smoked cigarettes and the number of cigarettes they smoked per day; they significantly increased their intentions not to smoke in the future; and significantly increased peer social support among girls. For boys, participants in the experimental condition significantly reduced the number of close friends in their networks who smoke daily compared to those in the control condition. Effect sizes ranged from small to large. These results provide encouraging evidence of the efficacy of text messaging interventions to reduce smoking among adolescents and our intervention holds promise as a large-scale public health preventive intervention platform.

Striking racial disparities in infant mortality exist in the United States, with rates of infant death among African Americans (AA) nearly twice the national average. Community-based participatory research (CBPR) approaches have been successful in fostering collaborative relationships between communities and researchers focused on developing effective and sustainable interventions and programs targeting needs of the community. The current paper details use of the Perinatal Period of Risk (PPOR) model as a method to engage communities by identifying factors influencing racial disparities in infant mortality and examining changes in those factors over a ten year period.

Employment difficulties are common among American Indian individuals in substance abuse treatment. To address this problem, the Southwest Node of NIDA's Clinical Trials Network conducted a single-site adaptation of its national Job Seekers Workshop study in an American Indian treatment program, Na'Nizhoozhi Center (NCI). 102 (80% men, 100% American Indian) participants who were in residential treatment and currently unemployed were randomized to (1) a three session, manualized program (Job seekers workshop: JSW) or (2) a 40-minute Job Interviewing Video: JIV). Outcomes were assessed at 3-month follow up: 1) number of days to a new taxed job or enrollment in a job-training program, and 2) total hours working or enrolled in a job-training program. No significant differences were found between the two groups for time to a new taxed job or enrollment in a job-training program. There were no significant differences between groups in substance use frequency at 3-month follow-up. These results do not support the use of the costly and time-consuming JSW intervention in this population and setting. Despite of the lack of a demonstrable treatment effect, this study established the feasibility of including a rural American Indian site in a rigorous CTN trial through a community-based participatory research approach.

Background.The objective is to analyze and compare Virginia suicide data from 2003 to 2012 to US suicide data.Methods.Suicide trends by method, age, gender, and race were obtained from Virginia’s Office of the Chief Medical Examiner’s annual reports.Results.Similar to US suicide rates, suicide rates in Virginia increased between 2003 and 2012 from 10.9/100,000 people to 12.9/100,000 people. The most common methods were firearm, asphyxia, and intentional drug overdose, respectively. The increase in asphyxia (r=0.77,P≤0.01) and decrease in CO poisoning (r=-0.89,P≤0.01) were significant. Unlike national trends, intentional drug overdoses decreased (r=-0.55,P=0.10). Handgun suicides increased (r=0.61,P=0.06) and are the most common method of firearm suicide. Hanging was the most common method of asphyxia. Helium suicides also increased (r=0.75,P=0.05). Middle age females and males comprise the largest percentage of suicide. Unlike national data, the increase in middle age male suicides occurred only in the 55–64-year-old age group (r=0.79,P≤0.01) and decreased in the 35–44-year-old age group (r=-0.60,P=0.07) and 10–14-year-old age group (r=-0.73,P=0.02). Suicide in all female age ranges remained stable. Caucasians represent the highest percentage of suicide.Conclusion.There has been a rise in suicide in Virginia and suicide rates and trends have closely resembled the national average albeit some differences. Suicide prevention needs to be enhanced.

Short-term fluctuations in steroid hormones such as estradiol (E2) and progesterone (P) can affect the concentration of hippocampal dendritic spines in adult, cycling nulliparous female rats. Pregnancy is characterized by a significantly longer duration of substantially elevated E2 and P compared to the estrous cycle. Thus, even greater changes than those reported during estrus may be evident. In two experiments, we examined the extent to which reproductive and hormonal state altered the concentration of apical neuronal dendritic spines of the CA1 region of the hippocampus in the following age-matched groups (N's = 7–10/group) of rats: in Exp. 1., CA1 dendritic spine density was examined in nulliparous diestrus (DES), proestrus (PRO), and estrus (ES) females, and late-pregnant (LP) (day 21) and lactating (day 5–6; LACT) females. In Exp. 2, the effects on spine density of a regimen mimicking pregnancy (and that stimulates maternal behavior) were examined, using ovariectomized, no hormone-exposed (OVX-minus) vs. sequential P&E2-treated (OVX + P&E2) groups. For both experiments, brains were removed, Golgi-Cox-stained and the most lateral tertiary branches of the apical dendrite of completely-stained hippocampal CA1 pyramidal neurons were traced with oil-immersion at ×1600 and dendritic spine density (# spines/10 μ dendritic segment) recorded. In Exp. 1, spine density was increased in LP and LACT females (which were not different) compared to the other virgin groups, including PRO females, who had more spines than DES and ES. In Exp. 2, OVX + P&E2 displayed significantly more dendritic spines per 10 μ than OVX-minus females (and had numbers that were similar to those of LP and LACT from Exp. 1). Pregnancy and its attendant hormonal fluctuations, therefore, may alter hippocampal neurons that regulate some non-pup-directed components of maternal behavior (e.g., nest building) or behaviors that support maternal behavior (e.g., foraging, associative memory).

Objectives To determine the appropriateness of using physicians to estimate the functional abilities of patients with chronic pain. Specific objectives included the following: (1) to compare the physician's predicted performance on functional assessment with actual performance, and (2) to compare the physician's predicted effort during functional assessment with an objective measure of effort. Design A total of 201 outpatients with chronic pain completed this prospective, multicenter, cohort study. Fifteen physicians, who were trained to administer the standardized evaluation, performed the evaluations and predicted performance and effort on functional assessment. Therapists, blinded to the physician's evaluation, administered a functional assessment (maximal and sustained lifts [n = 3 types]; repetitive activities [n = 4 types]) and a grip dynamometry test (effort measure) on each subject. Results Pearson's correlation testing demonstrated significant correlations between the physician's predicted performance and the observed performance for all lifting items and repetitive activities in both men (0.52, 0.50, 0.55) and women (0.36, 0.40, 0.18). Analysis of variance and post hoc t tests showed agreement between the physician's predicted effort and the dynamometry effort measure in only a small subset of patients (men were predicted to put forth absolutely no effort; n = 4). Conclusions A trained physician, performing a standardized evaluation, can estimate with reasonable accuracy the work-related functional ability in patients with chronic pain. The prediction of effort seems to be more problematic.

Walker WC, Keyser-Marcus LA, Cifu DX, Chaudhri M. Inpatient interdisciplinary rehabilitation after total hip arthroplasty: a comparison of revision and primary total hip arthroplasty. Arch Phys Med Rehabil 2001;82:129-33. Objectives: To describe outcomes of revision total hip arthroplasty (THA) patients who underwent interdisciplinary inpatient rehabilitation, and to compare them with primary THA patients. Design: Descriptive and case-control study. Setting: Forty-bed, community-based, freestanding rehabilitation hospital. Patients: Thirty-nine revision THA subjects, gender- and age-matched with 39 primary THA controls. Intervention: Inpatient interdisciplinary rehabilitation. Main Outcome Measures: FIM™ instrument, length of stay, hospital charges, and disposition location. Results: The average revision THA patient stayed 10.5 days, improved from an admission FIM score of 89 to a discharge FIM score of 110, and incurred a hospital charge of $10,600. Of the revision THA patients, 98% were discharged home, and orthopedic-related complications were uncommon. No significant differences existed between revision and primary THA patients in any outcome measures. A trend toward higher rehabilitation charges ($12,400 vs $9500, p =.07) was found in revision THA patients who wore a hip orthosis. Otherwise, no differences were found in outcome measures based on the type of revision surgery, the presence of weight-bearing restrictions, or the presence of orthopedic complications. Conclusions: THA patients selected for inpatient rehabilitation have favorable short-term functional outcomes. The type of THA (primary vs revision) is not an independent differentiating factor. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Pain is an important consideration in the performance of needle electromyography (EMG). Prior investigations have suggested that pain is greater with a concentric needle electrode (CNE) than monopolar needle electrode (MNE). This prospective randomized study tested this hypothesis using improved methodology and disposable rather than reusable needle electrodes. Ninety consecutive outpatients were enrolled and randomized to CNE (diameter = 0.46 mm) or MNE (diameter = 0.41 mm) arms. Subjects underwent a standardized 4 limb-muscle needle EMG protocol during which pretest and posttest verbal analog pain scale (0-10) measures were obtained. As anticipated, EMG-induced pain was significantly higher (P < 0.001) than pre-EMG baseline pain. However, analysis of variance (ANOVA) revealed no significant differences in pain ratings between the CNE and MNE arms. Among other factors analyzed, only gender significantly influenced EMG-induced pain, with females reporting higher levels than males. Thus, pain is not an important selection criterion for type of disposable needle electrode.

OBJECTIVE To determine the impact of acute lower extremity (LE) deep venous thrombosis (DVT) on functional outcome after traumatic brain injury (TBI). SETTING Tertiary university medical center rehabilitation unit. SUBJECTS Ninety-two TBI rehabilitation patients (46 patients with DVT and 46 patients without DVT). Forty-six TBI patients with a diagnosis of LE DVT were 1:1 matched with non-DVT TBI patients. Matching criteria included: primary diagnosis of TBI, admission Functional Independence Measure (FIM), Glasgow Coma Scale (GCS), and age. OUTCOME MEASURES FIM (admission, discharge, change, and efficiency), FIM subscores (activities of daily living [ADL], mobility, cognition), length of stay ([LOS] acute and rehabilitation), and discharge living disposition. DESIGN Cohort study utilizing prospectively collected data. DVT diagnoses were made upon rehabilitation admission using color flow duplex Doppler ultrasonography. Descriptive statistics were run on demographic variables. Analyses of variance (ANOVAs) were performed on the sample with regard to outcome measures, including FIM scores, FIM subscores, and LOS (acute and rehabilitation). RESULTS No significant between-group differences were found concerning LOS, rehabilitation costs, FIM total, or FIM subgroup scores. Chi-squared analyses revealed significant differences between groups with regard to discharge living disposition (chi(2) = 4.7, P

Appropriate allocation of rehabilitation resources requires that the rehabilitation professional have a knowledge of reliable predictors of functional outcome. To determine what influence pre-morbid demographic variables have on functional outcome following thromboembolic stroke, we analyzed prospectively collected demographic and functional data from consecutive patients admitted to rehabilitation at a tertiary university medical center. Data from 117 patients were statistically analyzed for correlations between demographic factors and functional outcome as measured by the FIM scale and hospital length of stay (LOS). While no significant correlations were found between race or gender and functional outcome, Caucasians were found to stay an average of 5 days longer in acute care than African-Americans. Non-married patients were found to have significantly longer rehabilitation LOS and return home following discharge less often. It is concluded that non-married status is a significant negative prognostic factor for functional outcome after thromboembolic stroke, while gender and race have no correlation.

Objective: A pilot randomized clinical trial (RCT) examined effectiveness of HIV/STD Safer Sex Skills Building + Alcohol (SSB+A) intervention for women with Alcohol Use Disorders (AUDs) in a residential treatment setting. Method: After randomizing thirty-six women with AUDs and reporting having intercourse with a male partner in the past 180 days to SSB+A or HE (standard HIV/STD education) groups, rates of penetrative intercourse with and without condoms at 60 day and 180 day follow-up were compared between SSB+A or HE groups. Results: There was a significant difference in mean number of sex acts with condoms between SSB+A and HE groups over time. Specifically, SSB+A and HE groups did not differ at 60 day follow-up, but at 180 day follow-up, mean sex acts with condoms among SSB+A group was significantly higher than HE. Conclusion: Pilot study findings affirm the effectiveness of the SSB+A in reducing sexual risk behaviors of AUD women and support the need for further research, testing the SSB+A intervention in a larger sample of women and across different treatment modalities. The present study also illustrates the critical link between practice and use of a step by step model of intervention research.

Poor pregnancy and birth outcomes are major problems in the United States, and maternal smoking during pregnancy has been identified as one of the most preventable risk factors associated with these outcomes. This study examines less explored risk factors of smoking among underserved African American pregnant women. A cross-sectional survey was conducted at an outpatient obstetrics-gynecology clinic of an inner-city university hospital in Virginia from March 2009 through January 2011 in which pregnant women (N = 902) were interviewed at their first prenatal care visit. Survey questions included items related to women’s sociodemographic characteristics as well as their pregnancy history; criminal history; receipt of social services; child protective services involvement; insurance status; and history of substance abuse, domestic violence, and depression. Multiple logistic regression was conducted to calculate odds ratios and 95 % confidence intervals depicting the relationship between these factors and smoking during pregnancy. The analysis reported that maternal age [OR = 1.08, 95 % CI = 1.05–1.12], less than high school education [OR = 4.30, 95 % CI = 2.27–8.14], unemployed [OR = 2.33, 95 % CI = 1.35–4.04], criminal history [OR = 1.66, 95 % CI = 1.05–2.63], receipt of social services [OR = 2.26, 95 % CI = 1.35–3.79] alcohol use [OR = 2.73, 95 % CI = 1.65–4.51] and illicit drug use [OR = 1.97, 95 % CI = 1.04–3.74] during pregnancy were statistically significant risk factors associated with smoking during pregnancy. In addition to the well known risk factors, public health professionals should be aware that criminal history and receipt of social services are important factors associated with smoking during pregnancy. Social service providers such as WIC and prisons and jails may offer a unique opportunity for education and cessation interventions during the preconception or interconception period.

The relationship between perceived need for mental health treatment, reasons for not receiving care, substance use, and race and gender among young adults was examined to identify barriers to mental health care.Data from the 2010 National Survey on Drug Use and Health for 14,718 adults ages 18 to 23 were used. Logistic regression analysis compared substance use among young adults with perceived mental health treatment need grouped by race and gender.A total of 7.6% of young adults wanted mental health treatment but did not receive care. Persons with perceived treatment need were more likely than recipients of treatment to smoke cigarettes, use marijuana, meet criteria for marijuana abuse or dependence, and engage in binge drinking, after analyses controlled for income and health insurance. White males with perceived need were 3.2 times more likely to smoke and to meet criteria for marijuana abuse or dependence and were 2.6 times more likely to engage in binge drinking. Hispanic males were 2.9 times more likely to smoke and meet criteria for marijuana abuse or dependence. White females were 1.7 times more likely than other subgroups to perceive need for mental health care.Young adults with perceived mental health treatment need are at high risk of substance abuse and dependence. Results support targeting knowledge and attitudes surrounding mental health services by race-ethnicity and gender to improve willingness to receive care.

Striking racial disparities in infant mortality exist in the United States, with rates of infant death among African Americans (AA) nearly twice the national average. Community-based participatory research (CBPR) approaches have been successful in fostering collaborative relationships between communities and researchers focused on developing effective and sustainable interventions and programs targeting needs of the community. The current paper details use of the Perinatal Period of Risk (PPOR) model as a method to engage communities by identifying factors influencing racial disparities in infant mortality and examining changes in those factors over a ten year period.

PURPOSE To determine the prevalence of environmental tobacco smoke (ETS) exposure, to explore the relationship between ETS exposure and the use of health services, and to examine the degree to which pediatric residents document ETS exposure status and counsel parents. METHOD In 2006, the authors recruited dyads of children (0-12 years old) and their mothers from an inner-city pediatric group practice clinic. Mothers completed a survey, and the authors searched the children's medical charts. The authors compared ETS-exposed children with nonexposed children using chi-square, t test, and ANOVA analyses. They also ran logistic regression analyses to examine the relationship between the use of health services and selected child and maternal variables. RESULTS More than 60% (142/232) of children were exposed to ETS, and more than 69% (99/142) of those children had a mother who smoked. ETS exposure significantly predicted the overall number of sick visits, even after controlling for sociodemographic confounders (odds ratio = 7.44; 95% confidence internal = 1.21-44.55). About 80% (187/232) of mothers reported that their child's pediatrician had counseled them on the dangers of ETS exposure. Less than half (105/232) of the children's charts included their ETS exposure status. CONCLUSIONS Although pediatric residents often counsel parents on the dangers of ETS exposure, educators should teach residents to regard ETS exposure status as a fifth vital sign. By screening for and documenting ETS exposure status, residents can identify at-risk children and parents, who could benefit from counseling.

Contingency management (CM) has shown promise for treating substance use disorders in pregnant women.A randomized clinical trial compared the relative efficacy of three conditions on the measures of opioid and cocaine abstinence and days retained in treatment. A total of 133 pregnant patients attending treatment for substance use disorders were randomized either to an escalating reinforcement condition, a fixed reinforcement condition, or an attendance control condition. Conditions were compared on drug abstinence rates and days retained in treatment.As expected, the pooled escalating + fixed conditions received a greater total amount of voucher money than the control condition mean [M = 392.40 (SE = 40.47) vs. 219.74 (SE = 39.78)], respectively; p.001. However, the escalating and fixed conditions did not differ on the outcome variables of drug abstinence and treatment retention.The CM conditions examined in the current study did not emerge as superior to the control condition. The lack of significant differences among study conditions may be attributed, in part, to study sample size. Additionally, methodological issues related to the CM intervention may also have compromised outcomes, including delay in reinforcement following the target behavior and limited contact with the reinforcer.This study highlights the importance of key CM implementation features, including immediate reinforcement, and adequate access to the reinforcer. It may also be that the reset feature for missing samples in CM interventions is an essential contingency for promoting behavior change.

s / Drug and Alcohol Dependence 156 (2015) e102–e182 e109 use factors, personality, psychopathology and problems related to MJ use. Methods: To that end, we used multiple correspondence analysis to identify relationships between MJ use motives (Marijuana Motives Measure) and age, age of onset of MJ use, frequency of MJ use, personality traits (NEO Five Factor Inventory), depression (Beck Depression Inventory), anxiety (Beck Anxiety Inventory), stress (Perceived Stress Scale), and, indicators of problematic MJ use (Marijuana Problem Scale) in 90 current, heavy MJ users (mean age=26.25, 62 males, mean duration of use =11.86 years). Bootstrap confidence intervals were calculated to determine significance. Results:The results indicatedfive significant components. Component 1 differentiated older (>30 years old), casual users from younger users with CUDs and who use MJ to cope with stress. Component 2 differentiated introverted users who use MJ to be social from thosewho useMJ to expand their creativity and awareness. Component 3 differentiated educated, introverted females who have social problems associated with MJ use from social, less educated males who use MJ to conform. Component 4 differentiated social users who have trouble fulfilling responsibilities from those with MJ withdrawal symptoms and who use MJ to cope with depression and anxiety. Component 5 differentiated older, educated women who started using MJ in their late teens from casual male users who started before the age of 13. Conclusions: These results demonstrate clear distinctions between various factors that promote MJ use and the effects that result from MJ use. In conclusion, effective treatment strategies should take into account individual factors that surround MJ use, including MJ use motives, age, age of onset, gender, personality, education, and mood. Financial support:NIDA K01 DA021632, awarded to Dr. Filbey. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.301 One for the road: The role of substance misuse on outcomes from traumatic brain injury Lori A. Keyser-Marcus2, Leroy Thacker3, Angela Starkweather3, Divya Ramesh1, F. Gerard Moeller4 1 Pharm Tox, VCU, Richmond, VA, United States 2 Psychiatry, VCU, Richmond, VA, United States 3 School of Nursing, VCU, Richmond, VA, United States 4 VCU IDAS, Richmond, VA, United States Aims: The relationship between substance use and TBI has been well established. Substanceuse is often implicated as a causal factor of TBI, with rates of intoxication at hospital admission ranging from 33 to 50% (Chen et al., 2012). Althoughmuch attention has focused on the relationship between TBI and comorbid substance misuse, fewer studieshaveexamined the relationshipbetweenpre-existing substancemisuse and outcomes. The present study seeks to further elucidate this relationship. Methods: Data for the present sample were abstracted from a trauma registry of individuals admitted to an urban, university based, Level I trauma center ED (N=2686). Inclusion criteria consisted of: ICD-9 diagnosis of TBI, between 18 and 65 years, and available alcohol and drug toxicology information (N=1872). Binary logistic regression and Poisson regression analyses, adjusting for age, gender, race, and general medical trauma severity, were run to compare TBI subjects with positive (TBIPOS) to TBI subjects with negative drug toxicology (TBINEG) on TBI outcome measures. Results: Individuals with TBI who screened positive for illicit drugs or alcohol on ED admission (TBIPOS, n=762), and those with negative screens (TBINEG, n=1110) were compared. The majority were male (67%), Caucasian (56%), and mild TBI (86%). Results of the regression analyses noted significant differences between groups on proportion of ICU admissions (p=0.0024), and TBI severity (p=0.0011), with TBIPOS subjects exhibiting worse outcomes. Further, results of the Poisson regression analyses revealed TBIPOS subjects had greater ICU lengths of stay (p= .009). No significant differences were noted between groups regarding hospital length of stay. Conclusions: Study findings demonstrate the negative impact of pre-existing substancemisuse on TBI outcomes. The lownumber of treatment referrals supports the need for a standardized system of screening and referral for this high-risk group. Financial support: Supported by VCU IDAS, U54DA038999. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.302 Childhood parental incarceration and HIV-related drug and sex risk over the young adult life course Maria R. Khan1, Susan McGorray2, Joy D. Scheidell 1, Krishna Vaddiparti 2, Laurie M. Brotman1 1 Population Health, New York University, New York, NY, United States 2 Colleges of Public Health & Health Professions and Medicine, University of Florida, Gainesville, FL