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Background: There is growing optimism regarding the use of screening and brief intervention (SBI) to identify and reduce risk behaviors during adolescence. However, understanding successful SBI implementation remains unclear. We previously reported the effects of CONNECT, a school-based SBI, on reducing the primary outcome, the rate of monthly alcohol use among primarily American Indian (AI) and White high school students in the Cherokee Nation. In this paper, we describe the design and implementation process for CONNECT. Method: CONNECT was designed to reduce alcohol use with 2 key strategies: (1) SBI with motivational interviewing (MI), implemented by a school-based CONNECT coach, and (2) a media campaign. Results: Implementation results indicate that during each semester of the 2-1/2 years, between 73% and 100% of eligible students had at least one 15-minute meeting with a CONNECT coach. Postcards and posters with positive communication tips for parents were displayed in CONNECT communities. No statistically significant differences occurred between the CONNECT and control groups on the hypothesized intermediate outcomes. Conclusions: We describe implementation of a universal, school-based, culturally adapted SBI that was effective in reducing alcohol use among youth living in the Cherokee Nation. Schools provide an important context for universal delivery of SBI interventions, such as CONNECT, for diverse adolescent populations, including AI youth.

Tobacco use and related mortality remain disproportionately high among individuals with substance use disorders (SUDs). Though engagement in tobacco cessation interventions is associated with improved long-term recovery, many individuals in SUD treatment do not participate. The goal of the present study was to better understand patient views regarding tobacco use/cessation during residential SUD treatment, in order to decrease barriers for this vulnerable population. This study utilized a cross-sectional design and mixed methods analysis. Following discharge from residential SUD treatment, individuals who reported any use of tobacco were invited to participate in a brief phone interview. Forty-one of the 60 who were reached (68%) agreed to participate. Responses were quantified for analysis when appropriate, and descriptive statistics were calculated for quantitative data. Thematic analysis was used to analyze qualitative responses. Most respondents (83%) reported that tobacco cessation was an important goal and were open to tobacco cessation treatment. The vast majority (85%) did not think tobacco use interfered with their recovery from other SUDs. Respondents noted the socially-reinforcing nature of tobacco use in treatment, and indicated a desire for increased access to cessation services. Results suggest increased patient education and changes to treatment center tobacco policies may assist individuals recovering from SUD with tobacco cessation. [ABSTRACT FROM AUTHOR]

Objective: Hookah smoking is a popular form of tobacco use on university campuses. This study documented use, attitudes, and knowledge of hookah smoking among college students. Participants: The sample included 943 university students recruited between February 2009 and January 2010. Respondents ("M" age = 20.02) included 376 males, 533 females, and 34 who did not report sex. Methods: An anonymous online questionnaire was completed by respondents. Results: In this sample, 42.9% of college students had tried hookah, and 40% of those individuals had used it in the past 30 days. Students perceived fewer negative consequences of hookah smoking compared with cigarette smoking. Age, sex, racial background, marijuana/cigarette use, and perceptions of side effects were significantly associated with hookah use. Conclusions: University students are misinformed regarding the health consequences of hookah smoking. Programs aimed at education, prevention, and intervention for hookah use are needed to address this growing public health concern.

Background and Objectives: Adverse events during childhood increase the risk for the development of substance use disorders (SUDs). This study examined the association between adverse childhood experiences (ACEs) and SUD treatment response. Methods: This cohort analysis included data from longitudinal clinical assessments extracted from the records of 438 consenting individuals undergoing SUD treatment (63% male; 88.8% White). Mixed effects models evaluated the relationship between scores on the ACE questionnaire and indicators of treatment response (i.e., alcohol and drug abstinence self‐efficacy; symptoms of depression, anxiety, and posttraumatic stress disorder) for individuals with alcohol‐related (n = 332) and other drug‐related (n = 275) diagnoses, with some participants included in both groups. Results: Treatment response varied as a function of ACEs, with the magnitude of differences varying across time in treatment. Relative to those with no ACE history, those who experienced ≥2 ACEs reported worse depression, anxiety, PTSD symptoms, and alcohol/drug abstinence self‐efficacy at baseline, with many differences remaining at the 30‐day assessment. All differences abated by discharge, with the exception of PTSD symptoms among those in the drug use group with a history of ≥4 ACEs. Male gender and older age were generally associated with lower symptomology and higher abstinence self‐efficacy. Discussion and Conclusions: Assessing ACE history early in SUD treatment may improve treatment planning and prognosis. Future studies should evaluate the role of trauma‐informed programming and individual interventions to improve treatment response. Scientific Significance: This study demonstrates the association between adverse childhood experiences and symptom severity among patients across participation in SUD treatment. [ABSTRACT FROM AUTHOR]

Background: Relapse prevention for those with substance use disorder (SUD) is an evolving practice. Initiatives focused on relapse prevention from other populations may provide the foundation for future considerations and recommendations for recovering anesthesia providers in the workplace. The purpose of this scoping review was to examine what is known about return-to-use prediction and prevention strategies in various populations struggling with SUDs to inform future considerations and implications for recovering anesthesia providers with a history of SUD. Methods: The Arksey and O'Malley framework was used to conduct a scoping review of the literature. A systematic search was conducted across three databases (PubMed, CINAHL, and PsycInfo) for relevant literature. Search terms used were “measures predicting relapse in substance use disorder” and “relapse prevention in substance use disorder AND anesthesia.” Data from articles that met the eligibility criteria were extracted and summarized by the primary author. Results: The search identified 46 articles highlighting various relapse prediction and prevention strategies related to craving and stress, underlying biological factors, neuroimaging, and mindfulness. Relapse prediction and prevention strategies ranged from cell phone applications, monitoring biological markers, and functional neuroimaging of the brain. Conclusions: Relapse is a concern for individuals with a history of SUD. For anesthesia providers, immediate access to powerful anesthesia medications requires returnto-use prediction and prevention strategies when anesthesia providers return to work after SUD treatment. Although some identified strategies are practical, more research is needed to predict and prevent return to use for recovering anesthesia providers. [ABSTRACT FROM AUTHOR]

This report describes the development and psychometric properties of the Children's Florida Obsessive Compulsive Inventory (C-FOCI). Designed specifically as a brief measure for assessing obsessive-compulsive symptoms, the C-FOCI was created for use in both clinical and community settings. Study 1 included 82 children and adolescents diagnosed with primary Obsessive-Compulsive Disorder, and their parents. The Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) was administered to assess symptom severity. Thereafter, parents completed the Child Obsessive-Compulsive Impact Scale--Parent Version and Child Behavior Checklist, and youth completed the C-FOCI, Child Obsessive-Compulsive Impact Scale--Child Version, Multidimensional Anxiety Scale for Children, and Children's Depression Inventory--Short Form. A subgroup of 21 individuals was retested with the C-FOCI after completing 14 sessions of intensive cognitive-behavioral therapy. Construct validity of the C-FOCI was supported vis-a-vis evidence of treatment sensitivity, and moderate relations with clinician-rated symptom severity, the CY-BOCS Symptom Checklist, child- and parent-rated functional impairment, child-rated anxiety, and parent-rated internalizing symptoms. Discriminant validity was evidenced by weak relationships with parent-reports of externalizing symptoms. For Study 2, 191 non-clinical adolescents completed the C-FOCI to assess the feasibility of internet administration. Overall, internal consistency was acceptable for the C-FOCI Symptom Checklist and Severity Scale, and respondents were able to complete the measure with little difficulty. Taken together, the findings of Studies 1 and 2 provide initial support for the reliability and validity of the C-FOCI for the assessment of pediatric obsessive-compulsive symptoms.

Pediatric obsessive-compulsive disorder (OCD) is a chronic, disabling condition that affects both patients and their families. Despite the identification of efficacious treatments (e.g., cognitive-behavioral therapy and selective serotonin reuptake inhibitor medications), not all patients respond fully. The purpose of the present study was to examine whether the amount of family accommodation provided to pediatric patients with OCD is associated with treatment outcome, and whether decreases in accommodation are associated with improved outcome. The sample consisted of 49 youths (6-18 years of age), who participated in 14 sessions of family-based cognitive-behavioral therapy for OCD, and their parents. Participants completed measures at pretreatment and posttreatment. Results indicate that family accommodation was prevalent among families of pediatric patients with OCD and that such accommodation was associated with symptom severity at pretreatment. In addition, decreases in family accommodation during treatment predicted treatment outcome, even when controlling for pretreatment OCD severity-impairment. Results suggest that the level of accommodation provided by the family may indicate an important obstacle to, or predictor of, treatment outcome in pediatric OCD. Directions for future research are discussed. (Contains 3 footnotes and 5 tables.)

A chronic psychiatric condition among children and adolescents of concern is obsessive-compulsive disorder, which involves comorbid conditions. The impact of a range of comorbid illnesses on cognitive-behavioral therapy response and remission rates was conducted, with results revealing a negative impact on treatment response.

The Tourette's Disorder Scales (Shytle et al., 2003) are parent- (Tourette's Disorder Scales-Parent Rated; TODS-PR) and clinician-rated (Tourette's Disorder Scales-Clinician Rated; TODS-CR) measures that assess tics, obsessions, compulsions, inattention, hyperactivity, aggression, and emotional disturbances among children with tics. Although the TODS-PR/CR are being increasingly used in clinical trials, relatively little psychometric data have been reported. Subjects were 44 children and adolescents recruited in a university tic specialty clinic. Families were administered the TODS-CR and Yale Global Tic Severity Scale. Completion of the TODS-PR and Child Behavior Checklist were counterbalanced. Results indicated adequate to excellent internal consistency for the TODS-PR/CR scores. Excellent inter-rater agreement and convergent and divergent validity was found. These results provide further psychometric support for the TODS-PR and TODS-CR.

Objective: To examine the relative efficacy of intensive versus weekly cognitive-behavioral therapy (CBT) for children and adolescents with obsessive-compulsive disorder (OCD). Method: Forty children and adolescents with OCD (range 7-17 years) were randomized to receive 14 sessions of weekly or intensive (daily psychotherapy sessions) family-based CBT. Assessments were conducted at three time points: pretreatment, posttreatment, and 3-month follow-up. Raters were initially blind to randomization. Primary outcomes included scores on the Children's Yale-Brown Obsessive-Compulsive Scale, remission status, and ratings on the Clinical Global Impression-Severity and Clinical Global Improvement scales. Secondary outcomes included the Child Obsessive Compulsive Impact Scale-Parent Rated, Children's Depression Inventory, Multidimensional Anxiety Scale for Children, and Family Accommodation Scale. Adjunctive pharmacotherapy was not an exclusion criterion. Results: Intensive CBT was as effective as weekly treatment with some advantages present immediately after treatment. No group differences were found at follow-up, with gains being largely maintained over time. Although no group x time interaction was found for the Children's Yale-Brown Obsessive-Compulsive Scale ([F[subscript 1,38]] = 2.2, p = 0.15), the intensive group was rated on the Clinical Global Impression-Severity as less ill relative to the weekly group ([F[subscript 1,38]] = 9.4, p less than 0.005). At posttreatment, 75% (15/20) of youths in the intensive group and 50% (10/20) in the weekly group met remission status criteria. Ninety percent (18/20) of youths in the intensive group and 65% (13/20) in the weekly group were considered treatment responders on the Clinical Global Improvement ([[chi square][subscript 1]] = 3.6, p = 0.06). Conclusions: Both intensive and weekly CBT are efficacious treatments for pediatric OCD. Intensive treatment may have slight immediate advantages over weekly CBT, although both modalities have similar outcomes at 3-month follow-up. (Contains 3 tables and 1 figure.)

This study sought to examine quality of life (QoL) in clinic-referred children and adolescents (n = 59, M age = 11.4[plus or minus]2.6 years) with a chronic tic disorder. The QoL scores for tic patients were lower than for healthy controls but higher than for the psychiatric sample on the majority of domains. Children's self-reported QoL scores and a measure of tic severity were moderately and inversely correlated. Parent reports of their child's QoL were weakly related to tic severity. Correlations between parent and child ratings of QoL for children ages 8 to 11 years were generally higher than those for youth ages 12 to 17 years. Finally, externalizing behavior moderated the relations between tic severity and parent-rated QoL, such that tic severity was significantly associated with parent-rated QoL for children with below average externalizing symptoms but not for children with above average externalizing symptoms.

Attachment insecurity and maladaptive coping are associated with depression in adolescence; however, it is unclear whether these links primarily reflect stable individual differences among teens (trait influences), experiential differences in their interactions with relationship partners (social influences) or both. In this study, teens (ages 14-18; N = 150) completed questionnaires to assess their attachment security, depressive symptoms, and coping strategies with different attachment figures. Measures were completed three times, based on experiences with a maternal figure, paternal figure, and closest peer. Generalizability analyses were used to separate each construct into trait and social influence components. Next, multivariate g correlations were computed to examine the correlations among the constructs for the trait component as well as the social component. Correlation magnitudes differed depending on whether the trait or social influence components were examined.

Despite the importance of the family in the treatment of pediatric obsessive-compulsive disorder (OCD), relatively little empirical attention has been directed to family accommodation of symptoms. This study examined the relations among family accommodation, OCD symptom severity, functional impairment, and internalizing and externalizing behavior problems in a sample of 57 clinic-referred youth 7 to 17 years old (M = 12.99 plus or minus 2.54) with OCD. Family accommodation was a frequent event across families. Family accommodation was positively related to symptom severity, parent-rated functional impairment (but not child-rated impairment), and externalizing and internalizing behavior problems. Family accommodation mediated the relation between symptom severity and parent-rated functional impairment.

Research Findings: Children require cognitive skills (e.g., phoneme awareness, verbal intelligence) and environmental resources (e.g., stimulation, print exposure) to acquire reading. This investigation examined the additional contribution of parental nurturance to literacy development during the transition from preschool to elementary school. Participants were 77 children attending Head Start, their primary caregivers, and their teachers. A variety of methods were used to measure nurturance (e.g., self-report, laboratory observation, home observation) and reading achievement (e.g., standardized testing and teacher report). Approximately 3 1/2 years later, 52 families and 39 teachers were available for repeat assessments of children's reading achievement. After controlling for the variance accounted for by prior reading ability, phonological awareness, verbal reasoning ability, and home academic stimulation, parental nurturance made a significant unique contribution to children's growth in reading achievement. Results supported the hypothesis that caregiver nurturance can be an important ingredient in the recipe for literacy.

Background: After‐hours documentation burden among US clinicians is often uncompensated work and has been associated with burnout, leading health systems to identify root causes and seek interventions to reduce this. A few studies have suggested quality programme participation (e.g., Merit‐Based Incentive Payment System [MIPS]) was associated with a higher administrative burden. However, the association between MIPS participation and after‐hours documentation has not been fully explored. Thus, this study aims to assess whether participation in the MIPS programme was independently associated with after‐hours documentation burden. Methods: We used 2021 data from the National Electronic Health Records Survey. We used a multivariable ordinal logistic regression model to assess whether MIPS participation was associated with the amount of after‐hours documentation burden when controlling for other factors. We controlled for physician age, specialty, sex, number of practice locations, number of physicians, practice ownership, whether team support (e.g., scribes) is used for documentation tasks, and whether the practice accepts Medicaid patients. Results: We included 1801 office‐based US physician respondents with complete data for variables of interest. After controlling for other factors, MIPS participation was associated with greater odds of spending a greater number of hours on after‐hours documentation (odds ratio = 1.44, 95% confidence interval 1.06–1.95). Conclusions: MIPS participation may increase after‐hours documentation burden among US office‐based physicians, suggesting that physicians may require additional resources to more efficiently report data. [ABSTRACT FROM AUTHOR]