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A series of large earthquakes in 1899 affected southeastern Alaska near Yakutat and Disenchantment Bays. The largest of the series, a MW 8.2 event on 10 September 1899, generated an ~12-m-high tsunami and as much as 14.4 m of coseismic uplift in Yakutat Bay, the largest coseismic uplift ever measured. Several complex fault systems in the area are associated with the Yakutat terrane collision with North America and the termination of the Fairweather strike-slip system, but because faults local to Yakutat Bay have been incompletely or poorly mapped, it is unclear which fault system(s) ruptured during the 10 September 1899 event. Using marine geophysical data collected in August 2012, we provide an improved tectonic framework for the Yakutat area, which advances our understanding of earthquake hazards. We combined 153 line km of 2012 high-resolution multichannel seismic (MCS) reflection data with compressed high-intensity radar pulse (Chirp) profiles, basin-scale MCS data, 2018 seafloor bathymetry, published geodetic models and thermochronology data, and previous measurements of coseismic uplift to better constrain fault geometry and subsurface structure in the Yakutat Bay area. We did not observe any active or concealed faults crossing Yakutat Bay in our high-resolution data, requiring faults to be located entirely onshore or nearshore. We interpreted onshore faults east of Yakutat Bay to be associated with the transpressional termination of the Fairweather fault system, forming a series of splay faults that exhibit a horsetail geometry. Thrust and reverse faults on the west side of the bay are related to Yakutat terrane underthrusting and collision with North America. Our results include an updated fault map, structural model of Yakutat Bay, and quantitative assessment of uncertainties for legacy geologic coseismic uplift measurements. Additionally, our results indicate the 10 September 1899 rupture was possibly related to stress loading from the earlier Yakutat terrane underthrusting event of 4 September 1899, with the majority of 10 September coseismic slip occurring on the Esker Creek system on the northwest side of Yakutat Bay. Limited (~2 m) coseismic or postseismic slip associated with the 1899 events occurred on faults located east of Yakutat Bay.

Firearm injury is a significant public health concern among youth living in the United States. Youth with exposure to violence (ETV) are more susceptible to carrying and using a firearm. Few researchers, however, have examined psychological mechanisms undergirding the association between ETV and firearm aggression. Retaliatory attitudes have been discussed as a potential mediator linking ETV with firearm aggression. Moreover, organized activity participation may disrupt direct and indirect pathways connecting ETV to firearm aggression. We tested: (a) the mediating role of retaliatory attitudes in the ETV-firearm aggression link, and (b) the moderating role of organized activity participation among 570 youth with past year illicit drug use and seeking emerging department care in an urban emergency department (ages 14-24; 58.8% males). Using multigroup path analysis, ETV indirectly influenced firearm aggression through retaliatory attitudes for youth not involved organized activities. Organized activities also buffered the association between retaliatory attitudes (mediator) and firearm aggression (outcome). Organized activities may, therefore, prevent firearm aggression by reducing retaliatory attitudes among youth contending with ETV. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

BACKGROUND: High-intensity drinking (HID; 8+ U.S. standard drinks for women, 10+ men) is initiated during adolescence/emerging adulthood, increasing risk for negative outcomes, including blackouts. We examined baseline data from a study of risky drinking youth to identify factors associated with HID. METHODS: Risky drinkers (ages 16-24) were recruited online (positive 3-month AUDIT-C score) as part of a larger study to examine social media interventions for risky drinking. We used baseline survey data to examine HID in relation to demographics, substance use-related variables, and individual and social factors. RESULTS: Among 931 risky drinkers, 29.8% reported past-month HID, and those with HID reported greater substance use and consequences. In multivariable analysis, HID was associated with male sex; greater social motives, impulsivity, and motivation; lower self-efficacy; and greater likelihood of not living with parents, drinking with important peers, and parental disapproval of posting drinking pictures. When examining age group interactions (16-20; 21-24), underage drinkers with high sensation seeking scores and lower parental disapproval of posting drinking pictures on social media reported greater HID. CONCLUSIONS: Among risky drinking youth, male sex, social motives, impulsivity, higher motivation to and lower-self-efficacy to reduce drinking, living away from parents, more frequent drinking with important peers, and lower parental disapproval of posting drinking pictures on social media were positively associated with HID. Further, HID was associated with greater health consequences, underscoring the need for HID interventions. Such interventions may benefit from enhancing motivation and self-efficacy, particularly in social contexts, as well as increasing positive peer and leisure activities to reduce HID.

Objective Mobile technologies allow for accessible and cost-effective health monitoring and intervention delivery. Despite these advantages, mobile health (mHealth) engagement is often insufficient. While monetary incentives may increase engagement, they can backfire, dampening intrinsic motivations and undermining intervention scalability. Theories from psychology and behavioral economics suggest useful nonmonetary strategies for promoting engagement; however, examinations of the applicability of these strategies to mHealth engagement are lacking. This proof-of-concept study evaluates the translation of theoretically-grounded engagement strategies into mHealth, by testing their potential utility in promoting daily self-reporting. Method A microrandomized trial (MRT) was conducted with adolescents and emerging adults with past-month substance use. Participants were randomized multiple times daily to receive theoretically-grounded strategies, namely reciprocity (the delivery of inspirational quote prior to self-reporting window) and nonmonetary reinforcers (e.g., the delivery of meme/gif following self-reporting completion) to improve proximal engagement in daily mHealth self-reporting. Results Daily self-reporting rates (62.3%; n = 68) were slightly lower than prior literature, albeit with much lower financial incentives. The utility of specific strategies was found to depend on contextual factors pertaining to the individual's receptivity and risk for disengagement. For example, the effect of reciprocity significantly varied depending on whether this strategy was employed (vs. not employed) during the weekend. The nonmonetary reinforcement strategy resulted in different outcomes when operationalized in various ways. Conclusions While the results support the translation of the reciprocity strategy into this mHealth setting, the translation of nonmonetary reinforcement requires further consideration prior to inclusion in a full scale MRT. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Factors related to risky drinking (e.g., motives, protective behavioral strategies [PBS]) may vary between youth who engage in polysubstance use compared to those who consume alcohol only. We examined differences in factors among youth who consume alcohol only compared to alcohol with other substances (i.e., polysubstance use), and correlates associated with risky drinking between the groups.Participants (Most participants (70.4%,Among risky drinking youth, results indicated youth engaging in polysubstance use have greater comorbidities and individual-level factors associated with risky drinking than youth who consume alcohol only. These findings may inform the tailoring of interventions for individuals who engage in risky drinking and polysubstance use.

To identify critical periods for just-in-time adaptive interventions (JITAIs), we measured time-varying correlates of drinking (e.g., stress, mood) daily to predict near-term alcohol use. Emerging adults (aged 17-24; n=51) who reported past-month alcohol use used SARA, an app use designed to assess substance use, for 30 days. Participants completed daily process measures of stress, mood, hopefulness, free time, fun, and loneliness. Candidate variables for prediction of next-day drinking included a contextual factor (day of the week), between-person factors (age, sex), and within-person factors (daily process measure responses) as well as daily process measure noncompletion. We compared two approaches to predict next-day use. From the daily process measure responses, Approach 1 used the current day’s survey responses; whereas, Approach 2 used the deviation of daily responses from the participant’s average response in prior days. Backward model selection identified candidate variables to include in the logistic model. Each model’s discriminatory power was determined using the area under the curve (AUC). Toward identifying critical periods for interventions, decision rules for when next day alcohol use was likely are reported for the better performing approach. Approach 1 included day of the week, hopefulness, stress, and participant sex (AUC=0.76). Approach 2 included day of the week, and deviation in hopefulness rating (AUC=0.71). Decisional cutpoints are provided for the better performing model. Approach 1 provided better prediction than Approach 2. Decisional tools for identification of near-term alcohol use in emerging adults opens the door for JITAIs to reduce drinking and prevent consequences of use.

Objective The presence of unlocked firearms in the home is associated with increased risk of suicide and unintentional injury in youth. We adapted an evidence-based program for promoting safe firearm storage, Safety Check, to enhance its acceptability as a universal suicide prevention strategy in pediatric primary care. Methods We applied ADAPT-ITT, an established adaptation framework, to guide iterative program adaptation with ongoing input from key stakeholders. The present study describes 2 phases of ADAPT-ITT: the Production phase (generating adaptations) and the Topical Experts phase (gathering stakeholder feedback on adaptations). After generating proposed program adaptations based on 3 inputs (stakeholder feedback collected in a prior study, the behavioral science literature, and best practices in pediatric medicine), we elicited feedback from stakeholders with firearm expertise. The adaptations included changes such as clarifying firearm ownership will not be documented in the medical record and offering follow-up reminders. We also crowdsourced feedback from 337 parents to select a new name and program logo. Results Saturation was reached with 9 stakeholders. Feedback confirmed the value of adaptations that: 1) considered context (eg, reason for ownership), 2) promoted parent autonomy in decision-making, and 3) ensured privacy. The most preferred program name was Suicide and Accident prevention through Family Education (SAFE) Firearm. Conclusions Guided by an established adaptation framework that prioritized multistage stakeholder feedback, adaptations to the original Safety Check were deemed acceptable. We plan to test the SAFE Firearm program as a universal suicide prevention strategy in pediatric primary care via a hybrid effectiveness-implementation trial.

Firearms are the leading cause of death for high-school age teens. To inform prevention efforts, we characterize the prevalence of healthcare provider (HCP) counseling of caregivers of teens around firearm safety, safety conversation elements, and caregiver receptivity towards counseling. A cross-sectional web survey (6/24/2020-7/22/2020) was conducted among caregivers (n = 2924) of teens (age:14-18). Weights were applied to generate nationally representative estimates. Bivariate analyses and multivariate regressions were examined. Among respondents, 56.0% were women, 75.1% were non-Hispanic White, and mean (SD) age was 47.4. Firearm safety was the least discussed topic among caregivers reporting their teen received HCP preventative counseling (14.9%). For caregivers receiving counseling, the most common issues discussed were household firearms screening (75.7%); storing firearms locked (66.8%); and storing firearms unloaded (53.0%). Only 24.6% of caregivers indicated firearm safety was an important issue for teen HCPs to discuss and only 21.9% trusted teen HCPs to counsel about firearm safety. Female caregivers (aOR = 1.86;95%CI = 1.25-2.78), those trusting their teen's HCP to counsel on firearm safety (aOR = 9.63;95%CI = 6.37-14.56), and those who received teen HCP firearm safety counseling (aOR = 5.14;95%CI = 3.02-8.72) were more likely to favor firearm safety counseling. Caregivers of teens with prior firearm safety training (aOR = 0.50;95%CI = 0.31-0.80) were less likely to agree that firearm safety was an important preventative health topic. In conclusion, few caregivers receive preventive counseling on firearm safety from their teen's HCP, with trust a key barrier to effective intervention delivery. Future research, in addition to understanding barriers and establishing effective strategies to increase safety practices, should focus on increasing provider counseling competency.

The Helping to End Addiction Long-Term (HEAL) Prevention Cooperative (HPC) is rapidly developing 10 distinct evidence-based interventions for implementation in a variety of settings to prevent opioid misuse and opioid use disorder. One HPC objective is to compare intervention impacts on opioid misuse initiation, escalation, severity, and disorder and identify whether any HPC interventions are more effective than others for types of individuals. It provides a rare opportunity to prospectively harmonize measures across distinct outcomes studies. This paper describes the needs, opportunities, strategies, and processes that were used to harmonize HPC data. They are illustrated with a strategy to measure opioid use that spans the spectrum of opioid use experiences (termed involvement) and is composed of common "anchor items" ranging from initiation to symptoms of opioid use disorder. The limitations and opportunities anticipated from this approach to data harmonization are reviewed. Lastly, implications for future research cooperatives and the broader HEAL data ecosystem are discussed.

Cannabis use is common among emerging adults (ages 18-25), yet few prevention interventions have targeted this unique developmental period. Physical activity (PA) is an under-utilized intervention target for cannabis use, despite research showing its potential utility. Based on prior promising social media-delivered interventions targeting cannabis and PA separately, we developed and piloted, in a randomized controlled feasibility trial (NCT04901910), interventions for emerging adults who use cannabis that focused on PA.Using social media, we recruited 60 emerging adults (Mean age=21.7 years; 63.3% female sex) who used cannabis (=3 times/week for the past month) and could engage in PA. We randomized participants into one of 3 conditions (PA-Only; PA+Cannabis, Attention-Control) that each lasted 8 weeks and were delivered in secret Facebook groups by health coaches. We collected follow-up data at 3- and 6-months post-group start. Outcomes are presented descriptively given the pilot nature and limited sample size.The interventions were rated favorably, with ratings of the content in each condition averaging around 3 on a 5-point scale. Both intervention groups demonstrated larger reductions in cannabis consequences and cannabis-impaired driving over time than the control condition. Findings were mixed regarding patterns of change in cannabis use in the intervention conditions. Proportions of group members reporting increased PA ranged from 38.9% to 80.0% across time.Interventions targeting PA and delivered via social media to emerging adults who regularly use cannabis offer a novel intervention target. These interventions warrant future investigation in larger trials over a longer follow-up period.

Firearm possession increases the likelihood of hospital visits among adolescents and emerging adults for both males and females. To better inform prevention practices, we examine data among adolescents and emerging adults (A/EAs; ages 16 to 29) presenting to an urban emergency department for any reason to understand the differences in firearm possession between males and females (N = 1312; 29.6% male; 50.5% Black). Regression identified firearm possession correlates, such as male sex (AOR = 2.26), firearm attitudes (AOR = 1.23), peer firearm possession (AOR = 9.84), and community violence exposure (AOR = 1.02). When stratified by sex (e.g., male vs female), regression results yielded differences in correlates for firearm possession: in males, peer firearm possession (AOR = 8.96) were significant, and in females, firearm attitudes (AOR = 1.33) and peer firearm possession (AOR = 11.24) were significant. An interaction between sex and firearm attitudes demonstrated that firearm attitudes were differentially associated with firearm possession between female and male A/EAs (AOR = 1.28). Overall, we found that females are more likely to endorse retaliatory firearm attitudes, and both males and females are highly influenced by their perception of peer firearm possession. These results help inform prevention strategies across multiple settings, especially for hospital-based violence interventions, and suggest that tailored approaches addressing differences between male and female A/EAs are appropriate when addressing firearm violence and injury risk among A/EAs.

PURPOSE: Alcohol use among adolescents and emerging adults is an important public health issue requiring prevention approaches. Herein, we describe outcomes from a randomized controlled trial testing the efficacy of group-based social media interventions targeting risky drinking among youth. PROCEDURES: Using social media advertisements to screen potential participants, we recruited 955 youth (ages 16–24) reporting recent risky drinking. After completing a baseline assessment, participants were randomized to 8-week secret Facebook group conditions: Social Media Intervention + Incentives for engagement, Social Media Intervention only, and attention-placebo control. Electronic coaches trained in motivational interviewing facilitated interaction in intervention groups. Primary outcomes include past 3-month alcohol use and consequences over 3-, 6-, and 12-month follow-ups. Secondary outcomes include other drug use, consequences, and impaired driving. We also measured intervention engagement and acceptability. RESULTS: The interventions were well-received, with significantly greater acceptability ratings and engagement in the SMI+I condition relative to other groups. In adjusted analyses, there were no significant differences between interventions and control on alcohol-related outcomes, with all groups showing reductions. Regarding secondary outcomes (70.4% used other drugs), compared to control, the incentivized group reduced other drug use, consequences, and cannabis-impaired driving; the non-incentivized group did not significantly differ from the control condition. CONCLUSIONS: Among this predominantly poly-substance using sample, findings were mixed, with significant effects of the incentive social media intervention on drug (but not alcohol) outcomes. Future studies are needed to further refine social media-delivered interventions to reduce alcohol and other drug use. TRIAL REGISTRATION: ClinicalTrials.gov NCT02809586; University of Michigan HUM#00102242.

SummaryBackgroundTwin revolutions in wearable technologies and smartphone-delivered digital health interventions have significantly expanded the accessibility and uptake of personalized interventions in multiple domains of health sciences. Gamification, the application of gaming elements to increase enjoyment and engagement, has the potential to improve the effectiveness of digital health interventions. However, the effectiveness of competition gamification components remains poorly understood, challenging informed decisions on the potential adoption of these components in future studies and trial designs. We aimed to evaluate the effect of smartphone-based gamified team competition intervention on daily step count and sleep duration via a micro-randomized trial.MethodsWe recruited first-year medical residents (interns) in the US, who downloaded the study app, provided consent, wore a wearable device, and completed a baseline survey. Teams were formed based on participating residents’ institutions and specialties, and subsequently randomized weekly to the competition or non-competition arms. In the competition arm, opponent teams and competition type (step count or sleep duration) were also randomly selected. Competition participants had access to the current competition scoreboard and competition history via the study app; they also received scheduled competition-related push notifications in a competition week. We estimated the main and moderated causal effects of competition on proximal daily step count and sleep duration. This trial is registered with ClinicalTrials.gov (NCT05106439).FindingsBetween April and June 2020, we enrolled 2,286 medical interns from 263 institutions, of whom 1,936 were formed into 191 teams that met the criteria for participation in competitions between July 6 and September 27, 2020. 1,797 participants who had pre-internship baseline information were included in the analysis. Relative to the no competition arm, competition intervention significantly increased the mean daily step count by 111·5 steps (SE 40·4, p=0·01), while competition did not significantly affect the mean daily sleep minutes (p=0·69). Secondary moderator analyses indicated that, for each additional week-in-study, the causal effects of competition on daily step count and sleep minutes decreased by 9·1 (11·6) steps (p=0·43) and 1·9 (0·6) minutes (p=0·003), respectively. Intra-institutional competition negatively moderated the causal effect of competition upon daily step count by −114.9 (93·7) steps (p=0·22).InterpretationGamified competition delivered via mobile app significantly increased daily physical activity which suggests that team competition can function as a mobile health intervention tool to increase short-term physical activity level.Research in contextEvidence before this studyWe searched PubMed for studies of mobile health intervention with gamified components: (“mobile health intervention”, “mHealth intervention”, “mobile health gamification”). We evaluated studies published before November 30, 2021. The search was not limited by language. Previous work affirmed that in mobile health interventions, gamification is effective for improving user’s physical activity and mental health. Most of previous work used feedback, reward, and progress bar as game mechanics, while none have rigorously examined the effectiveness of gamified team competition.Added value of this studyThis study provides evidence that the gamified team competition has a positive effect on physical activity. The data that was intensively collected as part of this study can be used for further investigation.Implications of all the available evidenceThe results of this study indicate that gamified team competition has the potential to improve the effectiveness of and engagement with mobile health interventions.

ObjectivesTo evaluate motivations for firearm possession among urban young adults and determine if differences emerge between parents and non-parents, and to identify if storage practices differed according to motivation for firearm possession and parenting status.MethodsWe used cross-sectional data among young adults seeking urban emergency department treatment at Hurley Medical Center between 2017 and 2018. Our analyses, completed in 2020, included 194 firearm-possessing young adults, 95 of whom were young parents.ResultsFirearm-possessing parents were more likely to have a firearm for protection, than for any other motivation, compared with firearm-possessing non-parents (OR: 2.38, 95% CI 1.06 to 5.46). A significant interaction between parenting status and motivation for possession indicated the association between protective motivations and locked storage was significantly different between parents and non-parents, whereby there was a decreased odds of locked storage among non-parents who were motivated to possess a firearm for protection compared with any other motivation, but this association did not exist for parents (interaction OR=10.57, pConclusionParental motivation for possessing a firearm most often lies in the desire to protect families. This motivation, however, does not necessitate unsafe storage.

Catalina Basin, located within the southern California Inner Continental Borderland (ICB), United States, is traversed by two active submerged fault systems that are part of the broader North America–Pacific plate boundary: the San Clemente fault (along with a prominent splay, the Kimki fault) and the Catalina fault. Previous studies have suggested that the San Clemente fault (SCF) may be accommodating up to half of the ∼8 mm/yr right-lateral slip distributed across the ICB between San Clemente Island and the mainland coast, and that the Catalina fault (CF) acts as a significant restraining bend in the larger transform system. Here, we provide new high-resolution geophysical constraints on the seabed morphology, deformation history, and kinematics of the active faults in and on the margins of Catalina Basin. We significantly revise SCF mapping and describe a discrete releasing bend that corresponds with lows in gravity and magnetic anomalies, as well as a connection between the SCF and the Santa Cruz fault to the north. Subsurface seismic-reflection data show evidence for a vertical SCF with significant lateral offsets, while the CF exhibits lesser cumulative deformation with a vertical component indicated by folding adjacent to the CF. Geodetic data are consistent with SCF right-lateral slip rates as high as ∼3.6 mm/yr and transpressional convergence of

OBJECTIVE: Same day use of alcohol and cannabis is prevalent among emerging/young adults and increases the risk for negative consequences. Although motives for alcohol and cannabis use are well-documented, specific motives on co-use days are under-investigated. We examined differences in motives on single substance use (i.e., alcohol or cannabis) versus co-use days in a sample of primarily cannabis-using emerging/young adults. METHODS: Participants (N=97) aged 18–25 (M(age)=22.2) were recruited from an urban Emergency Department (55.7% female, 46.4% African American, 57.7% public assistance) for a prospective daily diary study about risk behaviors. Participants received prompts for 28 daily text message assessments (up to 2716 surveys possible) of substance use and motives (social, enhancement, coping, conformity). We divided use days into three groups: alcohol use only (n=126), cannabis use only (n=805), and co-use (n=237). Using fixed effects regression modeling, we fit models to estimate within-person effects of alcohol and cannabis motives on day type (alcohol/cannabis co-use versus single use). RESULTS: In adjusted models, greater cannabis-related enhancement and social motives were associated with increased likelihood of co-use days compared to cannabis-only days. In contrast, greater alcohol-related social motives were associated with co-use days versus alcohol-only days in unadjusted, but not in adjusted models. CONCLUSIONS: Findings suggest that cannabis use motives associated with increasing positive affect may be most compelling for those engaging in alcohol/cannabis use on a given day. Intervention programs for alcohol/cannabis use should address alcohol and cannabis use motives in relation to increasing positive affect and engaging in social situations.

Same-day alcohol and cannabis use is relatively common in adolescents and young adults, constituting a higher-risk behavior relative to single-substance use. However, the association between quantity of alcohol and cannabis use on co-use days is understudied. We examined the association between the quantity of alcohol and same-day cannabis use with a multilevel regression analysis in a sample of youth (16-24 years old) with risky alcohol use. Participants reported one or more days of alcohol and cannabis over the past month (N = 468). Quantity of cannabis use was highest on heavy drinking days [M = 0.91 grams, SD = 0.68] followed by moderate drinking days (M = 0.78 grams, SD = 0.63), and lowest on days without alcohol use (M = 0.74 grams, SD = 0.64, p < 0.001). In multilevel modeling analyses, adjusted for clustering within individuals, greater quantity of drinking on a given day was associated with greater cannabis use (estimate = 0.03, p < 0.001). When using alcohol and cannabis on the same day, greater alcohol use was associated with greater cannabis use. Preventing days of heavy use of multiple substances, particularly among at-risk drinkers, may complement interventions addressing co-use generally to prevent substance-related consequences.

The classical two-arm randomized clinical trial (RCT) is designed to test the efficacy or effectiveness of an intervention, which may consist of one or more components. However, this approach does not enable the investigator to obtain information that is important in intervention development, such as which individual components of the intervention are efficacious, which are not and possibly should be removed, and whether any components interact. The Multiphase Optimization Strategy (MOST) is a new framework for development, optimization, and evaluation of interventions. MOST includes the RCT for purposes of evaluation, but inserts a phase of research before the RCT aimed at intervention optimization. The optimization phase requires one or more separate trials similar in scope to an RCT, but employing a different experimental design. The design of the optimization trial is selected strategically so as to maximize the amount of scientific information gained using the available resources. One consideration in selecting this experimental design is the type of intervention to be optimized. If a fixed intervention, i.e. one in which the same intervention content and intensity is provided to all participants, is to be optimized, a factorial experiment is often appropriate. If an adaptive intervention, i.e. one in which intervention content or intensity is varied in a principled manner, is to be optimized, a sequential multiple-assignment randomized trial (SMART) is often a good choice. The objective of this article is to describe MOST and the scientific rationale for its use; describe two current applications of MOST in emergency medicine research, one using a factorial experiment and the other using a SMART; and discuss funding strategies and potential future applications in studying the care of individuals with acute illness, injury, or behavioral disorders.

Background and objectivesYouth violence is an alarming public health problem, yet, violence screening and interventions are not systematically offered in primary care (PC). This paper describes data from a pilot effectiveness-implementation trial of an efficacious youth violence prevention programme (SafERteens).MethodsThe study was conducted in two PC clinics: a university-affiliated satellite clinic and a community health centre. In phase 1, we obtained stakeholder feedback to customise the SafERteens package and enrolled a comparison group of adolescents (age 14–18) seeking care in two clinics. In phase 2, clinical staff delivered the SafERteens-PC intervention with adolescents, which is a single, behavioural health therapy session delivered one-on-one from clinic providers to youth patients, followed by text message (TM) reminders. In phase 3, we assessed planned maintenance. All participants reported past-year violent behaviour at intake and completed a 3-month follow-up assessment.ResultsBased on stakeholder interviews (n=13), we created a web-based SafERteens-PC programme package, including a three-item past-year violence screen, 30 min motivational interviewing-based brief intervention delivery tool, training videos and 2 months of TM boosters. We enrolled a comparison group (n=49) first, then an intervention group (n=61). Intervention delivery characteristics varied by clinic, including completion of intervention (75.9%; 62.5%), modality (100% delivered via telehealth; 60% via telehealth/40% in-person) and enrolment in TMs (81.8%; 55.0%); 91.8% completed the follow-up. Using an intention-to-treat approach, the intervention group showed significantly greater reductions in severe peer aggression (pConclusionsIf these challenges could be addressed, routine provision of behavioural health services for violence prevention in PC could have high impact on health outcomes for adolescents.

Background Alcohol misuse is a major health concern among military members. Reserve component members face unique barriers as they live off base with limited access to behavioral health services. Web and app-based brief interventions are a promising means to improve access to treatment for those who misuse alcohol, with the use of booster sessions to enhance effectiveness, solidify gains, and reinforce changes. However, little is known about who will engage in booster sessions. Objective This study aims to evaluate booster engagement across booster delivery modalities (Web and Peer) and identify participant-specific factors associated with booster session engagement. Methods Following a brief web-based alcohol misuse intervention in National Guard members (N=739), we examined engagement in a series of three booster sessions. Using unadjusted and adjusted models, demographic and clinical characteristics that may serve as predictors of booster session engagement were examined across the 2 arms of the trial with different types of booster sessions: peer-delivered (N=245) and web-delivered (N=246). Results Booster session completion was greater for Peer than Web Booster sessions, with 142 (58%) service members in the Peer Booster arm completing all three boosters compared with only 108 (44%) of participants in the Web Booster arm (χ23=10.3; P=.006). In a model in which the 2 groups were combined, socioeconomic factors predicted booster engagement. In separate models, the demographic and clinical predictors of booster engagement varied between the 2 delivery modalities. Conclusions The use of peer-delivered boosters, especially among subsets of reserve members at risk of lack of engagement, may foster greater uptake and improve treatment outcomes. Trial Registration ClinicalTrials.gov NCT02181283; https://clinicaltrials.gov/ct2/show/NCT02181283

OBJECTIVE: Campus sexual assault (SA) prevention programs are widely implemented, despite few having strong empirical support. To inform the development and refinement of prevention programs, we collected pilot qualitative data to capture undergraduates’ perspectives regarding desirable program characteristics. PARTICIPANTS: Undergraduates completed an audio-taped interview (n=19) or a focus group (n=16) in June – November 2016. METHODS: We double-coded transcripts for a priori and emerging themes using NVivo 11. A third coder resolved disagreements; we assessed intercoder reliability using Cohen’s Kappa. RESULTS: Participants preferred SA prevention programming to be delivered in-person to small, co-ed groups of unfamiliar students. Students preferred programming with peer-facilitated, candid conversation about SA outcomes and prevention strategies. Participants also preferred for the tone of these training sessions to match the serious subject matter. CONCLUSIONS: Students’ perceptions of desirable program characteristics differ somewhat from current evidence-based programs in several ways, highlighting important future directions for SA prevention research.

Cannabis-using youth are a large epidemiologic subgroup whose age and smoking-related risks underscore the importance of examining the impact of the COVID-19 pandemic in this population. Within a clinical trial (n = 36 received an intervention prior to data collection reported herein), we surveyed cannabis-using emerging adults (ages 18–25) about perceived COVID-19 impacts. Participants (n = 141) reporting weekly cannabis use (M = 18.6 use days in the past 30) were enrolled and completed online surveys as part of either their baseline or 3 month assessment. COVID-19-related measures included symptoms, substance use, mood, etc. Participants were 57% female (mean age = 21, standard deviation = 2.2), with 21% Hispanic/Latinx, 70% White, 20% Black/African American, and 10% of other races. Most participants (86%) reported quarantine/self-isolation (M = 59 days). Several had COVID-19 symptoms (16%), but none reported testing COVID-19 positive. Many respondents felt their cannabis use (35%–50%, across consumption methods) and negative emotions (e.g., loneliness, stress, and depression; 69.5%, 69.5%, and 61.8%, respectively) increased. They reported decreased in-person socialization (90.8%) and job losses (23.4%). Reports of increased cannabis smoking were associated with increased negative emotions. On an open-response item, employment/finances and social isolation were frequently named negative impacts (33.3% and 29.4%, respectively). Although cannabis-using emerging adults’ reports of increases in cannabis use, coupled with mental health symptoms and social isolation, are concerning, the full impact of the pandemic on their health and well-being remains unknown. Future studies examining the relationship between social isolation, mental health, and cannabis use among young people are needed.

OBJECTIVE: Cannabis use is broadly associated with risky sexual behaviors, but evidence regarding how cannabis is related to condomless sex at the individual level is mixed. A better understanding of the context in which cannabis use is occurring, that is, why individuals are using cannabis on a particular day, could help clarify these relationships. Accordingly, we examined whether same-day cannabis use motives were associated with condomless sex on cannabis use days in a sample of unmarried, urban emerging adults from a resource-poor community. METHOD: Participants (N = 86; mean age = 22.0 years; 52.4% female) were recruited from an emergency department. They provided data over 28 days on cannabis use, cannabis use motives, and sexual behaviors via text message surveys. Multilevel, multinomial regression was then used to examine the associations between cannabis use motives and condomless sex at both the within-day and between-person levels. RESULTS: Results suggested that individuals who more frequently endorse conformity motives for cannabis use are more likely to engage in condomless sex, whereas individuals who more frequently endorse social cannabis use motives are less likely to engage in condomless sex. CONCLUSIONS: These findings help illuminate some of the factors related to the co-occurrence of cannabis use and condomless sex, which is important for informing interventions to prevent sexually transmitted infections for cannabis-using individuals. The results here specifically indicate that interventions targeting co-occurring cannabis and risky sex behaviors might benefit by incorporating cannabis use motives as markers of vulnerability.

“Stealthing” is a form of sexual violence wherein a sexual partner purposefully removes a condom during penetration without the receptive partner’s knowledge. Given the role of substance use in sexual violence broadly, we examined demographic and substance use correlates of stealthing perpetration (SP) and victimization (SV) among emerging adults. Participants comprised 2,550 18- to 25-year-olds ( M age = 20.8, SD = 2.3), recruited via social media (48% female; 53.9% non-Hispanic White; 46.0% had another racial/ethnic identity; 67.4% heterosexual; 85.3% had some college education). Unadjusted analyses ( t tests, χ2 analysis) and adjusted logistic regression analyses examined associations between demographics (age, education, race/ethnicity, sexual orientation) and substance use (binge drinking, marijuana use, other illegal drug use, and prescription drug misuse) with male SP and male and female SV. Five percent of males and 18.9% of females reported SV; 6.1% of males reported SP. In adjusted analyses, significant correlates of SP were: non-Hispanic White race/ethnicity (odds ratio [OR] = 0.39), binge drinking (OR = 1.39), cannabis use (OR = 1.37), and other drug use (OR = 1.43). Significant correlates of male SV were: non-Hispanic White race/ethnicity (OR = 0.28), non-heterosexual orientation (OR = 0.24), binge drinking (OR = 1.49), and other illegal drug use (OR = 1.79). Significant correlates of female SV were: older age (OR = 1.13), non-Hispanic White race/ethnicity (OR = 0.57), binge drinking (OR = 1.28), cannabis use (OR = 1.29), and other drug use (OR = 1.22). Consistent with literature linking alcohol to sexual violence, binge drinking correlated with both SV and SP, with other substance use also playing a role. Data are needed to explore these relationships using longitudinal, event-level assessments to investigate the influence of acute intoxication. Interventions to reduce sexually transmitted infections, unintended pregnancy, and sexual assault should include content on stealthing and substance use.

BACKGROUND AND AIMS: Despite their high comorbidity, the effects of brief interventions (BI) to reduce cannabis use, alcohol use, and anxiety symptoms have received little empirical attention. The aims of this study were to examine whether a therapist-delivered BI (TBI) or computer-guided BI (CBI) to address drug use, alcohol consumption (when relevant) and HIV risk behaviors, relative to enhanced usual care (EUC), was associated with reductions in parallel trajectories of alcohol use, cannabis use, and anxiety symptoms, and whether demographic characteristics moderated reductions over time. DESIGN: Latent growth curve modeling was used to examine joint trajectories of alcohol use, cannabis use, and anxiety symptoms assessed at 3-, 6-, and 12-months after baseline enrollment. SETTING: Hurley Medical Center Emergency Department (ED) in Flint, Michigan, USA. PARTICIPANTS: The sample was 780 drug-using adults (18–60 years old; 56% female; 44% White) randomly assigned to receive either a TBI, CBI, or EUC through the HealthiER You study. INTERVENTIONS AND COMPARATOR: ED-delivered TBI and CBIs involved touchscreen-delivered and audio-assisted content. The TBI was administered by a Master’s-level therapist, whereas the CBI was self-administered using a virtual health counselor. EUC included a review of health resources brochures in the ED. MEASUREMENTS: Assessments of alcohol use (10-item Alcohol Use Disorders Identification Test), cannabis use (past 30-day frequency) and anxiety symptoms (Brief Symptom Inventory-18) occurred at baseline, and 3-, 6-, and 12-month follow-up. FINDINGS: TBI, relative to EUC, was associated with significant reductions in cannabis use (B=−.49, SE=.20, p

Risk and protective factors for firearm assault (FA) have been established, but little is known about factor preceding transitions in FA behavior. We modeled covariate effects on individuals’ transitions in FA behavior (Yes/No) using inhomogeneous, continuous-time, Markov Chains. 3287 assessments were made across five initial biannual follow-ups, and two additional biannual follow-ups (an average of 2.2 years later) from a follow-on study; 2687 pairs of transitions were observed (2414 No-FA → No-FA; 89 No-FA → FA; 121 FA → No-FA; 63 FA → FA). Non-firearm peer violence (HR = 2.31, 95% CI [1.28,4.21]), firearm victimization (HR = 2.57, 95% CI [1.31,5.04]), and marijuana ASSIST sum (HR = 1.27, 95% CI [1.05,1.54]) all preceded transitions into FA, but not transitions out of FA. Delinquent peer associations both hastened transitions into FA (HR = 1.19, 95% CI [1.00,1.40]) and slowed transitions out of FA (HR = 0.84, 95% CI:[0.72,1.00]), with analogous findings regarding attitudes favoring retaliation. Efforts to prevent FA initiation should focus on those currently reporting firearm violence victimization, and on factors indicating an escalating delinquency trajectory (e.g. non-firearm violence, substance use), while programs focusing on peer influences and social norms may be effective at preventing FA regardless of current FA status.

Intentional and unintentional firearm injury is the second leading cause of death for youth, underscoring the need for effective primary prevention approaches that focus on increasing safe storage by caregivers and decreasing handling/carriage among youth. This article describes the state of the science for prevention of firearm injuries among children and adolescents. We applied PRISMA guidelines to present results from a scoping review using PubMed, Scopus, CINAHL, and CJ Abstracts for original research articles published between January 1, 1985 and March 1, 2018 in the U.S. focusing on primary screening or interventions for primary prevention of pediatric firearm injuries. In total, 46 articles met inclusion criteria: safe storage (23), screening (2), firearm handling/carriage/use (21). Across school, healthcare, and community settings, few evidenced-based programs exist, and data on firearm safety technologies are lacking. Programs have generally not employed rigorous designs, and/or assessed behavioral (e.g., carriage) or injury-related firearm outcomes. Evidenced-based prevention programs are needed to mitigate firearm morbidity and mortality among youth.

OBJECTIVE: To examine the efficacious components of a computer-delivered brief intervention (CBI) for reducing marijuana use among adults presenting to a low-income urban emergency department (ED), which a prior report found to decrease marijuana use at a 6-month follow-up. METHOD: Participants were 237 ED patients reporting recent drug use (46% male; 54% African-American; mean age, 30.7) who were randomized to receive a CBI consisting of an interactive program guided by a virtual health counselor. The primary outcome was past 30-day marijuana use at 6-month follow-up assessed using the Timeline Follow-Back (TLFB). Intervention components related to change in marijuana use at 6 month follow-up examined in the current study included participant responses to items within five CBI domains that were rooted in motivational interviewing: goals for change, strengths, evoking-change (concerns about use and benefits of change), challenges, and tools for change. RESULTS: The evoking-change domain was related to significant reductions in marijuana use at 6 months (B=−2.91, SE=1.10, p

Physical aggression (towards partners or non-partners) is common among patients in treatment for substance use disorders (SUDs), including among Veteran samples; however, few treatment programs provide adjunct intervention approaches targeting reduction or prevention of aggression. The primary objectives of this comparative efficacy study were to examine the impact of adjunct aggression interventions delivered during treatment on aggression and substance use outcomes, including: a) an acute treatment phase 6-session integrated Motivational Interviewing-Cognitive Behavioral Treatment intervention (MI-CBT) for aggression and substance use prevention, b) MI-CBT plus a 12-week telephone-based Continuing Care (MI-CBT + CC) intervention, and c) an acute phase single session control condition [including some discussion of violence prevention and local violence prevention resources (Enhanced Treatment as Usual (E-TAU))]. Participants (N = 180; 165 males and 15 females) were Veterans with SUD problems and past-year severe aggression who were randomized to one of three conditions: MI-CBT, MI-CBT + CC, or E-TAU. Primary 12-month outcomes included physical aggression and injury to partners, non-partners, and total aggression (collapsing across partner and non-partner relationships). Substance use outcomes included heavy drinking, marijuana use, cocaine use, and overall illicit substance use. Due to low representation in the sample (n = 4 women in each group at follow-up), women were excluded from primary analyses. According to unadjusted analyses of male participants, all groups showed similar significant declines in aggression over time, with the MI-CBT and MI-CBT + CC groups showing significant reductions in more substance use outcomes (heavy drinking, cocaine use, overall illicit drug use) than the E-TAU group. The only significant group x time interaction was for partner physical aggression by men (those in the MI-CBT + CC group showed a significantly greater decrease from baseline to follow-up). Also, neither the MI-CBT nor MI-CBT + CC groups reported any injuring of partners during the follow-up. For heavy drinking, cocaine, marijuana and overall illicit drug use, there were significant reductions over time, but no group by time interaction effects. The findings illustrate significant reductions in aggression and substance use over time for those involved in VA SUD treatment, and a potential modest benefit of additional integrated treatment approaches (MI-CBT, MI-CBT + CC) on reducing aggression. Future studies should examine dissemination efforts in the VA, cost-effectiveness, and moderators of outcome.

Background Driving under the influence of cannabis (DUIC) is a public health concern among those using medical cannabis. Understanding behaviors contributing to DUIC can inform prevention efforts. We evaluated three past 6-month DUIC behaviors among medical cannabis users with chronic pain. Methods Adults (N = 790) seeking medical cannabis certification or recertification for moderate/severe pain were recruited from February 2014 through June 2015 at Michigan medical cannabis clinics. About half of participants were male (52%) and 81% were White; their Mean age was 45.8 years. Participants completed survey measures of DUIC (driving within 2 h of use, driving while “a little high,” and driving while “very high”) and background factors (demographics, alcohol use, etc.). Unadjusted and adjusted logistic regressions were used to examine correlates of DUIC. Results For the past 6 months, DUIC within 2 h of use was reported by 56.4% of the sample, DUIC while a “little high” was reported by 50.5%, and “very high” was reported by 21.1%. Greater cannabis quantity consumed and binge drinking were generally associated with DUIC behaviors. Higher pain was associated with lower likelihood of DUIC. Findings vary somewhat across DUIC measures. Conclusions The prevalence of DUIC is concerning, with more research needed on how to best measure DUIC. Prevention messaging for DUIC may be enhanced by addressing alcohol co-consumption.

Aims Alcohol-related blackouts can result in acute injuries and other negative outcomes. Among underage risky drinkers, we examined longitudinal trajectories of blackout frequency following an emergency department (ED) visit, and identified baseline characteristics associated with blackout trajectory membership. Methods Participants (ages 14–20; N = 836) attending an ED who screened positive for risky drinking and enrolled in a randomized-controlled trial of brief alcohol interventions were assessed at baseline, 3-, 6-, and 12-months. We used group-based trajectory modeling to determine characteristic trajectories of blackout frequency over 12-months in relation to baseline characteristics: demographics, substance use, delinquency, depression/anxiety symptoms, sexual assault, dating violence, and peer and sibling influences. Results We identified four groups: No/Low blackouts (n = 248; 29.7%), Declining blackouts (n = 92; 11.0%), Moderate blackouts (n = 337; 40.3%) and High blackouts (n = 159; 19.0%); group membership did not differ based on intervention receipt. In adjusted analyses, compared to the No/Low group all other groups had higher odds of having an alcohol-related baseline ED visit. Female sex, alcohol consumption, prescription drug misuse, sexual assault while incapacitated due to substances, and negative peer influences were positively associated with membership in the High group; College/Greek life involvement was also highest. Negative peer influences and being in high school (vs. College/Greek life) also distinguished the Moderate group. Conclusion Blackout frequency was largely stable over time and riskier trajectories were marked by risk factors such as negative peer influences and college/Greek life involvement. Findings may inform targeted interventions, particularly for women who were in higher risk trajectories.

Background Youth violence is a leading cause of adolescent mortality, underscoring the need to integrate evidence-based violence prevention programs into routine emergency department (ED) care. Objectives To examine the translation of the SafERteens program into clinical care. Methods Hospital staff provided input on implementation facilitators/barriers to inform toolkit development. Implementation was piloted in a four-arm effectiveness-implementation trial, with youth (ages 14–18 years) screening positive for past 3-month aggression randomized to either SafERteens (delivered remotely or in-person) or enhanced usual care (EUC; remote or in-person), with follow-up at post-test and 3 months. During maintenance, ED staff continued in-person SafERteens delivery and external facilitation was provided. Outcomes were measured using the RE-AIM implementation framework. Results SafERteens completion rates were 77.6% (52/67) for remote and 49.1% (27/55) for in-person delivery. In addition to high acceptability ratings (e.g., helpfulness), post-test data demonstrated increased self-efficacy to avoid fighting among patients receiving remote (incidence rate ratio [IRR] 1.22, 95% confidence interval [CI] 1.09–1.36) and in-person (IRR 1.23, 95% CI 1.12–1.36) SafERteens, as well as decreased pro-violence attitudes among patients receiving remote (IRR 0.83, 95% CI 0.75–0.91) and in-person (IRR 0.87, 95% CI 0.77–0.99) SafERteens when compared with their respective EUC groups. At 3 months, youth receiving remote SafERteens reported less non-partner aggression (IRR 0.52, 95% CI 0.31–0.87, Cohen's d −0.39) and violence consequences (IRR 0.47, 95% CI 0.22–1.00, Cohen's d −0.49) compared with remote EUC; no differences were noted for in-person SafERteens delivery. Barriers to implementation maintenance included limited staff availability and a lack of reimbursement codes. Conclusions Implementing behavioral interventions such as SafERteens into routine ED care is feasible using remote delivery. Policymakers should consider reimbursement for violence prevention services to sustain long-term implementation.

Statement of purpose Estimate frequency of drug use disorder (DUD), multiple substance co-diagnosis network characteristics, and predictors of DUD among youth entering an urban emergency department (ED). Methods/Approach Drug-using youth age 14–24 (n=599; 349 assault-injured) presenting to a Level-1 ED were recruited. Participants were contacted at baseline and at 6-, 12-, 18-, and 24- months post-baseline and administered validated measures of peer/parental behaviors, violence/crime exposure, drug use self-efficacy, and alcohol use. Participants were administered the MINI neuropsychiatric interview to diagnose use disorder (abuse/dependence) with nine substances. Dependencies between co-DUD diagnosis were estimated using Ising network models. Repeated measures logistic regression models were used to determine predictors of DUD. Results Among 2,630 assessments, 1,128 (42.9%) were DUD diagnoses; 21.7% were co-diagnoses with multiple drugs. Cannabis use disorder was the most frequent diagnosis (n=1,050), with the cannabis/prescription sedative combination the most common co-diagnosis (n=112). The cocaine/prescription opioid combination showed the strongest partial correlation and was the most central element in the network. Regression models show positive peer behaviors and parental support to be protective factors for DUD diagnosis, while interpersonal violence exposure, community violence/crime exposure, alcohol use quantity, other mental health diagnoses, and drug use self-efficacy were DUD risk factors. Conclusions DUD is prevalent in this population and associated with personal, social, and community exposures. Among those with DUD, diagnosis with multiple drug use disorders was common; network analyses showed several large partial correlations between substances, with cocaine and prescription opioid use disorder co-diagnosis being the most strongly associated. Significance DUD is linked to a variety of injuries including suicide, partner violence, firearm violence, death by homicide, and violence/injury in general. Understanding the relationship between co-occurring DUDs and associated risk factors allow for targeted intervention strategies.

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

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

Background The need for effective interventions for psychiatrically hospitalized adolescents who have varying levels of postdischarge suicide risk calls for personalized approaches, such as adaptive interventions (AIs). We conducted a nonrestricted pilot Sequential, Multiple Assignment, Randomized Trial (SMART) to guide the development of an AI targeting suicide risk after hospitalization. Methods Adolescent inpatients (N = 80; ages 13-17; 67.5% female) were randomized in Phase 1 to a Motivational Interview-Enhanced Safety Plan (MI-SP), delivered during hospitalization, alone or in combination with postdischarge text-based support (Texts). Two weeks after discharge, participants were re-randomized in Phase 2 to added telephone booster calls or to no calls. Mechanisms of change were assessed with daily diaries for four weeks and over a 1- and 3-month follow-up. This trial is registered with clinicaltrials.gov (identifier: NCT03838198). Results Procedures were feasible and acceptable. Mixed effects models indicate that adolescents randomized to MI-SP + Texts (Phase 1) and those randomized to booster calls (Phase 2) experienced significant improvement in daily-level mechanisms, including safety plan use, self-efficacy to refrain from suicidal action, and coping by support seeking. Those randomized to MI-SP + Texts also reported significantly higher coping self-efficacy at 1 and 3 months. Although exploratory, results were in the expected direction for MI-SP + Texts, versus MI-SP alone, in terms of lower risk of suicide attempts (Hazard ratio = 0.30; 95% CI = 0.06, 1.48) and suicidal behavior (Hazard ratio = 0.36; 95% CI = 0.10, 1.37) three months after discharge. Moreover, augmentation with booster calls did not have an overall meaningful impact on suicide attempts (Hazard ratio = 0.65; 95% CI = 0.17, 3.05) or suicidal behavior (Hazard ratio = 0.78; 95% CI = 0.23, 2.67); however, boosters benefited most those initially assigned to MI-SP + Texts. Conclusions The current SMART was feasible and acceptable for the purpose of informing an AI for suicidal adolescents, warranting additional study. Findings also indicate that postdischarge text-based support offers a promising augmentation to safety planning delivered during hospitalization.

Just-in-time adaptive interventions (JITAIs) are time-varying adaptive interventions that use frequent opportunities for the intervention to be adapted--weekly, daily, or even many times a day. The micro-randomized trial (MRT) has emerged for use in informing the construction of JITAIs. MRTs can be used to address research questions about whether and under what circumstances JITAI components are effective, with the ultimate objective of developing effective and efficient JITAI. The purpose of this article is to clarify why, when, and how to use MRTs; to highlight elements that must be considered when designing and implementing an MRT; and to review primary and secondary analyses methods for MRTs. We briefly review key elements of JITAIs and discuss a variety of considerations that go into planning and designing an MRT. We provide a definition of causal excursion effects suitable for use in primary and secondary analyses of MRT data to inform JITAI development. We review the weighted and centered least-squares (WCLS) estimator which provides consistent causal excursion effect estimators from MRT data. We describe how the WCLS estimator along with associated test statistics can be obtained using standard statistical software such as R (R Core Team, 2019). Throughout we illustrate the MRT design and analyses using the HeartSteps MRT, for developing a JITAI to increase physical activity among sedentary individuals. We supplement the HeartSteps MRT with two other MRTs, SARA and BariFit, each of which highlights different research questions that can be addressed using the MRT and experimental design considerations that might arise., Comment: arXiv admin note: substantial text overlap with arXiv:2005.05880, arXiv:2004.10241

Understanding factors influencing risky drinking among emerging adults could enhance interventions to reduce adverse outcomes. As a motivational construct, the dualistic model of passion (i.e., obsessive passion: drinking is compelling and conflicts with other life activities/values; harmonious passion: drinking is an important, but not overwhelming, part of life) offers a novel explanation for persistent alcohol use. Yet, the dualistic model of passion has not yet been evaluated in this at-risk population. Therefore, we examined whether the variables proposed by the dualistic model of passion were associated with sex, binge-drinking, and alcohol-related consequences among young risky drinkers. We analyzed cross-sectional baseline data collected as part of an ongoing randomized controlled trial of emerging adults (n=327; M(age)=22.6, SD=1.1, range 21–24; 61% female; 76% White non-Hispanic) engaged in risky drinking (AUDIT-C score ≥ 4 females, ≥ 5 males) recruited nationally via social media advertisements. A path analysis revealed significant positive direct effects between obsessive passion and binge drinking and alcohol-related consequences, and significant negative direct effects between male sex and harmonious passion and binge drinking. There was also a positive direct effect between binge drinking and alcohol-related consequences. Male sex and obsessive passion were both indirectly related to alcohol-related consequences via binge drinking. Type of passion and male sex differentiates risky drinkers who binge drink and who experienced alcohol-related consequences. Future research should examine whether targeting obsessive passion reduces binge drinking and negative outcomes.