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BACKGROUND: More than half a million Americans died of an opioid-related overdose between 1999 and 2020, the majority occurring between 2015 and 2020. The opioid overdose mortality epidemic disproportionately impacts Black, Indigenous, and people of color (BIPOC): since 2015, overdose mortality rates have increased substantially more among Black (114%) and Latinx (97%) populations compared with White populations (32%). This is in part due to disparities in access to naloxone, an opioid antagonist that can effectively reverse opioid overdose to prevent death. Our recent pilot work determined that many barriers to naloxone access can be identified and addressed by syringe service programs (SSPs) using the Systems Analysis and Improvement Approach to Naloxone distribution (SAIA-Naloxone). This randomized controlled trial will test SAIA-Naloxones ability to improve naloxone distribution in general and among BIPOC specifically. METHODS: We will conduct a trial with 32 SSPs across California, randomly assigning 16 to the SAIA-Naloxone arm and 16 to receive implementation as usual. SAIA-Naloxone is a multifaceted, multilevel implementation strategy through which trained facilitators work closely with SSPs to (1) assess organization-level barriers, (2) prioritize barriers for improvement, and (3) test solutions through iterative change cycles until achieving and sustaining improvements. SSPs receiving SAIA-Naloxone will work with a trained facilitator for a period of 12 months. We will test SAIA-Naloxones ability to improve SSPs naloxone distribution using an interrupted time series approach. Data collection will take place during a 3-month lead-in period, the 12-month active period, and for an additional 6 months afterward to determine whether impacts are sustained. We will use a structured approach to specify SAIA-Naloxone to ensure strategy activities are clearly defined and to assess SAIA-Naloxone fidelity to aid in interpreting study results. We will also assess the costs associated with SAIA-Naloxone and its cost-effectiveness. DISCUSSION: This trial takes a novel approach to improving equitable distribution of naloxone amid the ongoing epidemic and associated racial disparities. If successful, SAIA-Naloxone represents an important organizational-level solution to the multifaceted and multilevel barriers to equitable naloxone distribution.

INTRODUCTION: High social-emotional functioning, including emotion regulation and nonviolent conflict resolution, constitute developmental competencies of adolescence that promote health and well-being. We used prospective longitudinal data from a predominantly Latinx population to understand how family context and social environment risk factors for violence related to patterns of social-emotional functioning during the transition between middle school and high school. METHODS: We prospectively interviewed 599 8th graders every 6 months for 2 years. We used trajectory models to explore longitudinal patterns of emotion regulation and nonviolent problem solving and multinomial regression to distinguish how these groups were associated with family context, partner and peer gang involvement, and neighborhood social disorder. RESULTS: Youth reporting lower neighborhood disorder in 8th grade were more likely to be in the high emotion regulation trajectory group. Youth without exposure to gangs through peers and partners in 8th grade were more likely to be in the high nonviolent problem-solving skills trajectory group. Family cohesion was associated with being in the high trajectory groups for both emotional regulation and problem-solving skills. CONCLUSION: Emotion regulation and nonviolent problem-solving skills had different associations with the social environment risk factors for violence examined, indicating that mechanisms of influence and strategies for intervention may vary. The association between problem-solving skills and exposure to gangs through peers and partners shows that social norms may be important targets of change. Additionally, interventions with parents that build family cohesion during adolescence may buffer environmental exposures that shape adolescents ability to practice protective social-emotional behaviors.

The negative consequences for victims and perpetrators of school violence are significant, multifaceted and, if left unchecked, can have personal costs that may last well into their adult lives. Universal violence preventive interventions may not be sufficiently effective in mitigating problems among middle school youth who exhibit risk of violent behavior. School-based mental health (SBMH) approaches show promise for reducing problems among the minority of youth responsible for violence perpetration, although the impact of teacher-delivered SBMH has been somewhat limited. The present study examines the impact of "practitioner"-delivered SBMH in middle school settings, with (a) a three-armed randomized controlled trial (RCT) comparing Expanded SBMH and Enhanced SBMH to Standard SBMH and (b) a separate quasi-experiment comparing the three SBMH arms in the RCT to a separate set of non-randomized, non-SBMH schools. SBMH schools who expanded their services saw decreases in aggressive behavior and victimization, across both study structures, that were either statistically significant, meaningful based on Cohen effect size conventions or both. These results suggest that the expansion of practitioner-delivered mental health services to youth who are at risk of violence perpetration, "but would otherwise be ineligible for, or unable to afford, services" achieves a significant impact on the larger school environment.

Web-based professional development has the potential to increase the early childhood workforce's knowledge of young dual language learners (DLLs). Yet there is a gap in the literature on web-based professional development specific to DLLs and its role in changes in actual and perceived knowledge among early childhood professionals. To begin addressing this gap, the current study examines the associations between early childhood professionals' participation in a web-based learning platform with targeted content on supporting young DLLs and changes in actual and perceived knowledge about DLLs. This study also examines how background characteristics and experiences may be associated with increases in knowledge after module participation. Results show increases in participants' actual and perceived knowledge after completing the module. Relevant background characteristics included having a college-degree, working in home-based child care, and participating in DLL-specific professional development within the prior year. Having prior DLL-specific professional development moderated the links between pre-module knowledge and post-module knowledge. These results highlight the relevance of web-based professional development as an approach to building the knowledge of early childhood professionals to work with young DLLs.

The purpose of this study was to explore the influence of maternal depressive symptoms on adolescent alcohol use among a sample of Latino/Latina youth aged 10 to 16 years from a high-risk community. Direct and mediating effects of youth depressive symptoms, controlling for levels of concurrent emotion dysregulation, on alcohol use were examined. Participants consisted of 525 children and their mothers randomly sampled from low-income schools with high rates of substance use. The panel design included four waves, and we used structural equation modeling with a longitudinal mediational framework. Results indicated that the relationship between maternal depressive symptoms and adolescent alcohol use was mediated by adolescents' symptoms of depression for girls only. Findings are discussed in the context of the development of skills to cope with negative affect and the influence parental depressive symptoms may have on this process.

It is unknown whether perceived pubertal timing changes as puberty progresses or whether it is an important component of adolescent identity formation that is fixed early in pubertal development. The purpose of this study is to examine the stability of perceived pubertal timing among a school-based sample of rural adolescents aged 11-17 (N = 6,425; 50% female; 53% White). Two measures of pubertal timing were used, "stage-normative," based on the Pubertal Development Scale, a self-report scale of secondary sexual characteristics, and "peer-normative," a one-item measure of perceived pubertal timing. Two longitudinal methods were used: one-way random effects ANOVA models and latent class analysis. When calculating intraclass correlation coefficients using the one-way random effects ANOVA models, which is based on the average reliability from one time point to the next, both measures had similar, but poor, stability. In contrast, latent class analysis, which looks at the longitudinal response pattern of each individual and treats deviation from that pattern as measurement error, showed three stable and distinct response patterns for both measures: always early, always on-time, and always late. Study results suggest instability in perceived pubertal timing from one age to the next, but this instability is likely due to measurement error. Thus, it may be necessary to take into account the longitudinal pattern of perceived pubertal timing across adolescence rather than measuring perceived pubertal timing at one point in time.

Objective: This study uses data from the largest effectiveness trial to date on treatment of co-occurring posttraumatic stress and substance use disorders, using advances in statistical methodology for modeling treatment attendance and membership turnover in rolling groups. Method: Women receiving outpatient substance abuse treatment (N = 353) were randomized to 12 sessions of Seeking Safety or a health education control condition. Assessments were completed at baseline and at 1 week, 3, 6, and 12 months posttreatment. Outcome measures were alcohol and cocaine use in the prior 30 days captured using the Addiction Severity Index. Latent class pattern mixture modeling (LCPMM) was used to estimate attendance patterns and to test for treatment effects within and across latent attendance patterns and group membership turnover. Results: Across LCPMM analyses for alcohol and cocaine use, similar treatment attendance patterns emerged: Completers never decreased below an 80% probability of attendance, droppers never exceeded a 41% probability of attendance, and titrators demonstrated a 50% to 80% probability of attendance. Among completers, there were significant decreases in alcohol use from baseline to 1-week posttreatment, followed by nonsignificant increases in alcohol during follow-up. No differences between treatment conditions were detected. Titrators in Seeking Safety had lower rates of alcohol use from 1-week through 12-month follow-up compared with control participants. Droppers had nonsignificant increases in alcohol during both study phases. Cocaine use findings were similar but did not reach significance levels. Conclusions: The impact of client self-modulation of treatment dosage and group membership composition may influence behavioral treatment outcomes among this population. (Contains 1 footnote, 3 tables, and 4 figures.)

Background: The present study's aim was to examine the long-term effects (8 to 13 years post-treatment; M = 9.83 years; SD = 1.71) of the most widely used treatment approaches of exposure-based cognitive behavioral treatment for phobic and anxiety disorders in children and adolescents (i.e., group treatment and two variants of individual treatment). An additional aim was to compare the relative long-term efficacy of the treatment approaches. Method: At long-term follow-up, participants (N = 67) were between 16 and 26 years of age (M = 19.43 years, SD = 3.02). Primary outcome was the targeted anxiety disorder and targeted symptoms. Secondary outcomes were other disorders and symptoms not directly targeted in the treatments including (1) other anxiety disorders and symptoms, (2) depressive disorders and symptoms, and (3) substance use disorders and symptoms. Results: Long-term remission for anxiety disorders and symptoms targeted in the treatments was evident 8 to 13 years post-treatment. Long-term remission also was found for the secondary outcomes. There were more similarities than differences in the long-term gains when comparing the treatment approaches. Conclusions: Consistent with past research, the study's findings provide further evidence that the short-term benefits of exposure-based CBT for childhood phobic and anxiety disorders using both group and individual treatment may extend into the critical transition years of young adulthood.

This study compared the impact of the Aban Aya Youth Project (AAYP; Archives of Pediatric and Adolescent Medicine 158: 377-384, 2004) social development classroom curriculum (SDC), school/family/community (SC) intervention curriculum, and a health enhancement curriculum (HEC) attention placebo control on changes over time in violent behaviors among participating youth. Grade 5 pretest and grades 5-8 posttest data were used to investigate the possibility of differential intervention effects, especially the extent to which the SDC and SC interventions were differentially efficacious across age. Unlike most previous investigations of AAYP intervention effects, this study included youth who joined the study after baseline data collection in the outcome analyses. Findings indicated that, regardless of age level, the SDC limited the growth of violence of participating students when compared to students in the control condition. In the SC, however, reduction in the growth of violence emerged only among older participants. Importantly, this included joiners who received less exposure to the intervention. Findings for the SDC are consistent with recent meta-analyses of school based programs, whereas SC findings suggest that violence prevention curricula alone are not sufficient for highly mobile students and that interventions for such populations need to engage multiple social ecological systems. Editors' Strategic Implications: The authors present promising violence prevention findings, and they also provide important answers to dosage and developmental timing questions with their analyses of these longitudinal data.

Interventions for a variety of emotional and behavioral problems are commonly delivered in the context of treatment groups, with many using rolling admission to sustain membership (i.e., admission, dropout, and discharge from group are perpetual and ongoing). The authors present an overview of the analytic challenges inherent in rolling group data and outline commonly used (but flawed) analytic and design approaches to addressing (or sidestepping) these issues. Moreover, the authors propose use of latent class pattern mixture models (LCPMMs) as a statistically and conceptually defensible approach for modeling treatment data from rolling groups. The LCPMM approach is illustrated with rolling group data from a group-based alcoholism pilot treatment trial (N = 128). Different inferences were made with regard to treatment efficacy under LCPMM vs. the commonly used standard group-clustered latent growth model (LGM); coupled with other preliminary findings in this area, inferences from LGMs may be overly liberal when applied to data from rolling groups. Continued work on data analytic difficulties in groups with membership turnover is critical for furthering the ecological validity of research on behavioral treatments.

In a midwestern community sample, we tested for evidence of "hardening" of adolescent cigarette smoking between 1980 and 2001 by comparing adolescent smokers and nonsmokers at these two times on measures indicative of "deviance proneness" in Jessor and Jessor's [Jessor, R., & Jessor, S. L. (1977). "Problem behavior and psychosocial development: A longitudinal study of youth." NY: Academic Press] problem behavior theory. Results produced support for some "hardening" of adolescent smoking, but this was largely confined to younger cohorts. Changing social norms that are reflected in a lowered prevalence of adolescent smoking may have restricted smoking behavior to a somewhat more "deviance prone" segment of the adolescent population. Results illustrate the potential utility of considering changes in the larger social and historical context when studying the development of adolescent risk behavior.

DEVIANCE PRONENESS THEORY SUGGESTS that alcohol-related problems may best be predicted by the confluence of temperamental factors and environmental factors, such as poor parenting (Sher, 1991). Recently, researchers have demonstrated [...], Objective: Recently, it has been suggested that traits may dynamically change as conditions change. One possible mechanism that may influence impulsiveness is parental monitoring. Parental monitoring reflects a knowledge regarding one's offspring's whereabouts and social connections. The aim of this investigation was to examine potential gender-specific parental influences to impulsiveness (general behavioral control), control over one's own drinking (specific behavioral control), and alcohol-related problems among individuals in a period of emerging adulthood. Method: Direct and mediational links between parenting styles (permissive, authoritarian, and authoritative), parental monitoring, impulsiveness, drinking control, and alcohol-related problems were investigated. A multiple-group, SEM model with (316 women, 265 men) university students was examined. Results: In general, the overall pattern among male and female respondents was distinct. For daughters, perceptions of a permissive father were indirectly linked to more alcohol-related problems through lower levels of monitoring by fathers and more impulsive symptoms. Perceptions of an authoritative father were also indirectly linked to fewer impulsive symptoms through higher levels of monitoring by fathers among daughters. For men, perceptions of a permissive mother were indirectly linked to more alcohol-related problems through lower levels of monitoring by mothers and more impulsive symptoms. For sons, perceptions of mother authoritativeness were indirectly linked to fewer alcohol-related problems through more monitoring by mothers and fewer impulsive symptoms. Conclusions: Monitoring by an opposite-gender parent mediated the link between parenting styles (i.e., permissive, authoritative) on impulsiveness. (J Stud. Alcohol Drugs, 72, 247-258, 2011)

ALCOHOL ETIOLOGY INVESTIGATORS have long suggested there are several distinct pathways that may lead individuals down the road to problematic alcohol use (e.g., Sher et al., 2005). Schuckit and Smith [...], Objective: The self-medication model suggests that some individuals may use alcohol as a means to cope with their negative experiences. Antisocial personality reflects a lack of concern for others and is often linked to alcohol use disorders. The aim of this investigation was to examine potential parental influences to both pathological reasons for drinking and antisocial personality as pathways to alcohol use and problems. Method: Direct and indirect links between parental bond (care, rejection, overprotection, autonomy, and neglect) and antisocial personality, pathological reasons for drinking, alcohol use, and alcohol-related problems were investigated. A two-group SEM path model with college students (164 female, 240 male) was examined. Results: In general, the overall patterns among male and female respondents were distinct. Among women, perceptions of having a caring mother lowered the likelihood of having antisocial tendencies, and perceptions of being rejected by one's father were directly linked to pathological reasons for drinking. Feeling neglected by one's mother was also directly linked to alcohol-related problems among women. Conversely, feeling neglected by one's father was directly linked to alcohol-related problems among males, suggesting a parent-offspring gender match. For men, antisocial personality mediated the impact of mother rejection and father overprotection on alcohol use. Conclusions: These findings suggest that parental influences regarding vulnerabilities for alcohol use are very complex and that the genders of the respondent and the parent must be considered jointly.

The authors used data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development to model patterns of maternal depressive symptoms, from the period of infants' age 1 month to adolescence (age 12 years), and then examined adolescent adjustment at age 15 years as a function of the course and severity of maternal symptoms. The authors identified 5 latent classes of symptoms in 1,357 women, while also taking into account sociodemographic measures: never depressed, stable subclinical, early decreasing, moderately elevated, and chronic. Women with few symptoms were more likely to be married, better educated, and in better physical health than were women with more elevated symptoms. At age 15 years, adolescents whose mothers were in the chronic, elevated, and stable subclinical latent classes reported more internalizing and externalizing problems and acknowledged engaging in more risky behavior than did children of never depressed mothers. Latent class differences in self-reported loneliness and dysphoria were also found. Discussion focuses on adolescent adjustment, especially among offspring whose mothers reported stable symptoms of depression across their childhoods. Keywords: maternal depressive symptoms, latent class analysis, longitudinal study, offspring adjustment, adolescent outcomes

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2008.10.017 Byline: Julie A. Patock-Peckham (a), Antonio A. Morgan-Lopez (b) Keywords: Parenting styles; Neuroticism; Alcohol use and problems Abstract: Mediational links between parenting styles, neuroticism, pathological reasons for drinking, alcohol use and alcohol-related problems were tested. A two-group SEM path model with 441 (216 female, 225 male) college students was examined. In general, pathological reasons for drinking mediated the impact of neuroticism on alcohol use and alcohol-related problems. A different pattern of relationships was found for each of the two genders. Perceptions of having an authoritarian father were positively linked to higher levels of neuroticism among males but this pattern was not found among females. For males, neuroticism mediated the impact of having an authoritarian father on pathological reasons for drinking with pathological reasons for drinking mediating the impact of neuroticism on alcohol-related problems. Perceptions of having a permissive father were linked to lower levels of neuroticism in females (but have been found as a consistent risk factor for other pathways to alcohol use elsewhere). Compared with other work in this area, these findings indicate parental influences regarding vulnerabilities for alcohol use may be specific to parent-child gender matches for some pathways and specific to one parent (irrespective of child gender) for other pathways. Author Affiliation: (a) Missouri University of Science and Technology (Formerly University of Missouri-Rolla), United States (b) RTI International, United States Article Note: (footnote) [star] Portions of this paper were presented at the 30th Annual Scientific Meeting of the Research Society on Alcoholism, Chicago, Illinois (July, 2007). This research was partially supported by a Graduate Student Research Award in prevention to Julie A. Patock-Peckham, Center Grant P30MH39346 (Irwin Sandler, principal investigator), National Research Service Award Training Grant 5T32MH18387 (Laurie Chassin, principal investigator) and RTI's Health, Social and Economics Unit. We thank Jeff Starrick and Alexander Serafin for assisting with the data collection and the data entry.

THE QUALITY OF THE RELATIONSHIPS with one's parents is thought to have important implications regarding emotional functioning throughout the life span (Ainsworth, 1989; Lopez, 1995; Simpson et al., 1992) and [...], Objective: Depression is often found to be comorbid with alcohol-related problems. Parental overprotection, which may be of particular importance during emerging adulthood, has been linked to internalizing symptoms in offspring. This article evaluates the impact of parenting styles and parental confidence in their offspring on an internalizing pathway to alcohol-related problems through self-esteem and depression. Method: Mediational links were tested among parenting styles (authoritative, authoritarian, permissive), parental confidence (overprotection, autonomy), self-esteem, depression, and alcohol-related problems. A two-group, multiple indicator multiple-cause structural equation model with 441 (216 female, 225 male) college students was examined. Results: Overall, having a father who was confident in his child's ability to make autonomous decisions was protective against depression for both genders. Perceptions of paternal autonomy mediated the impact of the fathers' parenting styles (authoritative, permissive) on depression for both genders. For men, parental overprotection mediated the impact of an authoritarian father on self-esteem, and self-esteem mediated the impact of parental overprotection on depression. Moreover, among men, perceptions of maternal autonomy mediated the impact of the mothers' parenting styles (authoritative, permissive) on self-esteem, and self-esteem mediated the impact of maternal autonomy on depression. Conclusions: The current pattern of findings is distinct from pathways through behavioral undercontrol with influences from the same-sex parent for both genders. These findings indicate that parenting may have differential influences on internalizing pathways to alcohol-related problems.

Historically, difficulties in analyzing treatment outcome data from open-enrollment groups have led to their avoidance in use in federally funded treatment trials despite the fact that 79% of treatment programs use open-enrollment groups. Recently, latent class pattern mixture models (LCPMM) have shown promise as a defensible approach for making overall (and attendance-class-specific) inferences from open-enrollment groups with membership turnover. We present a statistical simulation study comparing LCPMMs to longitudinal growth models (LGM) to understand when both frameworks are likely to produce conflicting inferences concerning overall treatment efficacy. LCPMMs performed well under all conditions examined; meanwhile, LGMs produced problematic levels of bias and Type I errors under two joint conditions: moderate to high dropout (30%-50%) and treatment by attendance class interactions exceeding Cohen's d [approximately equal to] .2. This study highlights key concerns about using LGM for open-enrollment data: treatment effect overestimation and advocacy for treatments that may be ineffective in reality. Keywords: Treatment groups; Open enrollment; Data analysis

Difficulties in modeling turnover in treatment-group membership have been cited as one of the major impediments to ecological validity of substance abuse and alcoholism treatment research. In this review, our primary foci are on (a) the discussion of approaches that draw on state-of-the-science analytic methods for modeling open-enrollment group data and (b) highlighting emerging issues that are critical to this relatively new area of methodological research (e.g., quantifying membership change, modeling 'holiday' effects, and modeling membership change among group members and leaders). Continuing refinement of new modeling tools to address these analytic complexities may ultimately lead to the development of more federally funded open-enrollment trials. These developments may also Facilitate the building of a 'community-friendly' treatment research portfolio for funding agencies that support substance abuse and alcoholism treatment research. Keywords: Treatment groups; Open enrollment; Data analysis