Development and Usability Testing of an mHealth Tool for Trauma-Informed Prevention of Substance Use, HIV Acquisition, and Risky Sexual Behaviors Among Adolescents: Mixed Methods Study.

BACKGROUND: Youth who experience traumatic events are at a substantially higher risk of engaging in substance use and sexual risk behaviors and problems (eg, HIV acquisition) than their non-trauma-exposed counterparts. Evidence-based substance use and risky sexual behavior prevention may reduce the risk of these outcomes. Trauma-focused mental health treatment provides a window of opportunity for the implementation of such preventive work with these youth. However, overburdened clinicians face challenges in adding prevention content while implementing evidence-based treatments. Mobile health (mHealth) tools can help reduce this burden in delivering prevention curricula. Trauma-Informed Prevention for Substance Use and Risky Sexual Behavior (TIPS) is an mHealth app that was developed to aid trauma-focused cognitive behavioral therapy (TF-CBT) clinicians in the implementation of an evidence-based risk behavior prevention curriculum. OBJECTIVE: The goal of this paper is to describe the rationale for and development of the TIPS app and present the results of a mixed methods approach for the initial evaluation of its usability. METHODS: Participants included clinicians (n=11), adolescents (n=11), and caregivers (n=10) who completed qualitative interviews and an adapted version of the Website Analysis and Measurement Inventory. RESULTS: In total, 4 overarching themes emerged from the participants' answers to the qualitative interview questions, demonstrating a generally positive response to the app. The themes were (1) strength of app content, (2) suggestions about app content, (3) esthetics and usability, and (4) benefits to the patient and session implementation. Clinicians, adolescents, and caregivers all agreed that the content was very relevant to adolescents and used examples and language that adolescents could relate to. All 3 groups also discussed that the content was comprehensive and addressed issues often faced by adolescents. All 3 groups of users made suggestions about the esthetics, which mostly comprised suggestions to change the font, color, or pictures within the app. Of all the groups, adolescents were most positive about the esthetics and usability of the app. Results from the Website Analysis and Measurement Inventory further illustrated the users' favorable reaction to the TIPS app, with 100% (11/11) of clinicians, 100% (10/10) of caregivers, and most adolescents (7/11, 64%) selecting strongly agree or somewhat agree to the following statement: "This app has much that is of interest to me." Adolescents generally found the app easier to use than did caregivers and clinicians. CONCLUSIONS: The TIPS app shows promise as an mHealth tool for TF-CBT clinicians to integrate evidence-based substance use, risky sexual behavior, and HIV prevention during treatment. Future research, including a randomized controlled trial comparing TF-CBT implementation with and without the inclusion of the app, is necessary to evaluate the feasibility and efficacy of the app in reducing the risk of substance use and risky sexual behavior among trauma-exposed adolescents. TRIAL REGISTRATION: ClinicalTrials.gov NCT03710720; https://clinicaltrials.gov/study/NCT03710720.

A qualitative analysis of black mother preparation for bias messages following incidents of racism-related violence.

Preparation for bias messages (PFB), represent a specific form of racial socialization, used to inform youth about racism and how to cope with racism-related adversity. Although research commonly examines how frequently PFB are delivered to children, few studies have qualitatively explored the heterogeneity in the content of such messages, making it difficult to ascertain how caregivers prepare and coach their children to negotiate incidents of racism-related violence. To address this gap in the literature, the present study qualitatively examined the content of PFB given to Black children from their mothers following high-profile incidents of anti-Black violence. Semistructured interviews were conducted with 12 mothers (Mage = 41.91) of Black children to explore how parental concerns regarding their children's safety inform the content of their PFB. Using thematic analysis, two primary themes emerged. The first theme related to psychosocial factors among caregivers that precipitated PFB (i.e., awareness of anti-Black violence, worry about the child being a victim). The second theme pertained to the different types of PFB that caregivers provided to their children (i.e., awareness of racial biases, strategies to navigate discriminatory encounters). Overall findings support and extend extant racial socialization research and have important implications for how Black youth come to understand the significance of race and racism in the aftermath of racism-related violence. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

An eHealth Prevention Program for Substance Use, Sexual Assault, and Sexual Risk Behaviors for Adolescents in Primary Care: Pilot Feasibility Randomized Controlled Trial of Teen Well Check.

BACKGROUND: Substance use, sexual assault, and sexual risk behaviors are common among adolescents and are interrelated. Nearly 1 in 5 adolescents use substances before sexual encounters, placing these young people at risk for both sexual assault and sexual risk behaviors. Primary care visits present a unique opportunity to address multiple health risk behaviors. OBJECTIVE: Teen Well Check is a web-based integrated prevention program for substance use, sexual assault, and sexual risk behaviors with demonstrated usability and acceptability among patients and providers. The aim of this study was to conduct a pilot randomized controlled trial to assess feasibility. METHODS: Adolescents (n=123) aged 14 to 18 years from diverse backgrounds were recruited from primarily Medicaid-serving pediatric primary care clinics. Participants completed a baseline survey; were randomized to receive Teen Well Check or an assessment-only control; and completed 1-, 3-, and 6-month follow-up surveys. Feasibility was assessed in terms of recruitment and retention rates. Preliminary changes from baseline to follow-up periods were examined separately in the Teen Well Check and control conditions. RESULTS: We recruited 123 participants (Teen Well Check: n=61, 49.6%; control: n=62, 50.4%). Of the 61 participants assigned to the Teen Well Check condition, 55 (90%) completed the full program and viewed all intervention content. Of the 123 participants, 105 (85.4%) were retained across at least 1 follow-up period, and there was no difference in follow-up rates between the conditions (χ21=0.6; P=.43). The completion of Teen Well Check took an average of 6.2 (SD 5.8) minutes. Preliminary analyses revealed that there were significant reductions in perceived peer norms (descriptive norms) for substance use before sex across follow-ups among participants in the Teen Well Check condition (P=.001 from baseline to 6 months), whereas there were significant increases among participants in the control condition (P=.003 from baseline to 6 months). In addition, there were nonsignificant reductions in substance misuse risk from baseline to the 6-month follow-up among participants in the Teen Well Check condition (P=.16). CONCLUSIONS: These findings support the feasibility of Teen Well Check delivery within pediatric primary care clinics. A randomized clinical trial is needed to assess efficacy. TRIAL REGISTRATION: ClinicalTrials.gov NCT3489434; https://www.clinicaltrials.gov/study/NCT03489434.

Prevention and Intervention with Young People as a Critical Public Health Strategy to Curtail the Opioid Epidemic: A Call to Action.

Opioid use continues to represent a significant public health problem in the United States, as well as globally. The opioid epidemic has motivated advances in the effective treatment of opioid use disorder (OUD), with a particular focus on medications for OUD (MOUD), including methadone, buprenorphine, and naltrexone. Although these medications are remarkably effective, MOUD expansion initiatives alone have not been sufficient to combat the opioid epidemic. Further, critical questions remain regarding the effectiveness of these medications for individuals who initiate opioid use under age 16. Key strategies to combat the opioid epidemic, including MOUD and naloxone distribution, target intervention for individuals who have already developed an OUD. Like every other health problem, shifting attention earlier in the etiological process can lend itself to a more cost-effective approach by preventing the onset of behaviors that contribute to subsequent increases in morbidity and mortality. Therefore, we argue that targeted interventions for adolescents with substance use problems, including for non-opioid drugs (i.e., cannabis, alcohol), is critical to prevent the onset of OUD and turn the tide of the opioid overdose epidemic. In line with this call to action to move toward earlier intervention as a public health strategy, we propose several concrete recommendations. These include use of universal screening and prevention strategies for teens, an enhanced focus on addressing mental health (i.e., depression, trauma-related anxiety) and ecological (i.e., low caregiver monitoring, affiliating with substance using peers) precursors of substance use initiation in adolescents, a significant restructuring of resource allocation to more effectively and equitably address youth substance use and mental health problems, and continuous efforts dedicated to the de-stigmatization of the disease of substance use disorders.

Moving toward transdisciplinary approaches to addressing HIV and psychological trauma: Barriers and facilitators to building collaborations.

Most people living with HIV have experienced potentially traumatic events (e.g., physical assault, sexual assault, intimate partner violence) and, consequently, are at risk of trauma-related mental health difficulties, including posttraumatic stress disorder (PTSD). Yet, research and clinical efforts related to HIV and psychological trauma remain siloed. Guided by the four-phase model of transdisciplinary research, the current study explored barriers and facilitators to transdisciplinary HIV/trauma clinical and research collaborations to address the overlap between HIV and psychological trauma. This exploration represents an initial step in the development and conceptualization of a transdisciplinary team known as Team REACH (Resiliency, Engagement, and Accessibility for Comorbid HIV/PTSD), which seeks to address the overlap between HIV and psychological trauma. Barriers and facilitators were explored through individual qualitative interviews with 21 research and clinical staff members across two clinics within an academic medical center (i.e., an infectious diseases clinic and a trauma-focused specialty mental health clinic). The findings revealed a number of barriers, including a lack of awareness, time and funding concerns, and a lack of clarity regarding services or the division of responsibility. The results also highlight perceived facilitators for collaborations, such as existing infrastructure and relationships, shared goals, leadership support, knowledge of other agency activities, and staff/team buy-in. Recommendations for increased collaboration included ongoing communication, needs assessment and goal development, access to partners, and role establishment. These findings will guide the next steps in further developing transdisciplinary collaboration goals and have implications for increasing collaborative approaches to patient care and targeting processes to enhance team effectiveness for transdisciplinary goals.

Developmental differences in the impact of racial discrimination on depression and anxiety among Black youth: Examining rumination as a mechanism.

Experiences of racial discrimination are pervasive among Black youth, resulting in psychosocial problems such as depression and anxiety. Rumination plays a key role in linking racial discrimination and internalizing concerns. Developmental age has also been shown to influence the extent to which racial discrimination and rumination impact mental health; however, studies have yet to explore the interplay between these factors. This study examined the association between racial discrimination and internalizing concerns among Black youth, whether racial discrimination was indirectly associated with internalizing concerns through rumination, and whether developmental age moderated these direct and indirect effects. Participants included 158 pre- and early-adolescent youth recruited from a community sample (Mage = 11.56 years; 53% female). Data were from baseline questionnaire responses from a larger longitudinal study conducted in the Southeastern United States examining the effects of interpersonal stressors on youth mental health outcomes. Racial discrimination was directly and indirectly associated with internalizing concerns through rumination. Developmental age moderated the indirect link between racial discrimination and depressive symptoms via rumination with the association being stronger as participant age increased. The impact of racial discrimination on mental health among Black youth is informed by maladaptive coping strategies such as rumination and developmental age. Such factors help to identify who is most at risk for the impact of racial discrimination and potential intervening targets. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Teen Well Check: an e-health prevention program for substance use, sexual assault, and sexual risk behaviors for adolescents in primary care.

Objective: Adolescents are at risk for substance use, sexual assault, and sexual risk behaviours; however, to date no integrated prevention programmes address all three risk behaviours. The goal of this study was to evaluate the usability and acceptability of Teen Well Check, an e-health prevention programme targeting substance use, sexual assault, and sexual risk among adolescents in primary care settings.Methods: The current study included content analysis of interviews with adolescents in primary care (aged 14-18; n = 25) in the intervention development process, followed by usability and acceptability testing with qualitative interviews among adolescents in primary care (aged 14-18; n = 10) and pediatric primary care providers (n = 11) in the intervention refinement process. All data were collected in the Southeastern U.S.Results: Feedback on Teen Well Check addressed content, engagement and interaction, language and tone, aesthetics, logistics, inclusivity, parent/guardian-related topics, and the application of personal stories. Overall, providers reported they would be likely to use this intervention (5.1 out of 7.0) and recommend it to adolescents (5.4 out of 7.0).Conclusions: These findings suggest preliminary usability and acceptability of Teen Well Check. A randomized clinical trial is needed to assess efficacy.

Adolescents are at risk for substance use, sexual assault, and sexual risk behaviours.The goal of this study was to evaluate the usability and acceptability of Teen Well Check, an e-health prevention programme targeting substance use, sexual assault, and sexual risk among adolescents in primary care settings.Providers and adolescents rated Teen Well Check as usable and acceptable, and providers indicated that they would recommend it to their adolescent patients.

Neurophysiology of predictable unpleasant event processing in pre-adolescents and early adolescents, part II: Reflex and event-related potential markers of defensive reactivity and peripheral attention modulation.

The ability to anticipate and process predictable unpleasant events, while also regulating emotional reactivity, is an adaptive skill. The current article and a companion in this issue test for potential changes in predictable event processing across the childhood-to-adolescence transition, a key developmental period for biological systems that support cognitive/ emotional abilities. While the companion article focuses on neurophysiology of predictable event processing itself, the present article examines peripheral emotional response regulation and attention modulation that coincides with event processing. A total of 315 third-, sixth-, or ninth-grade individuals saw 5-s cues predicting "scary," "every day," or uncertain pictures, and here, blink reflexes and brain event-related potentials (ERPs) elicited by peripheral noise probes are analyzed. During the cue, blink reflexes and probe ERP (P200) amplitudes were increased when the cue predicted scary, compared to everyday, content. After picture onset, reflex enhancement by scary content then disappeared for predictable images, whereas ERP modulation was similar regardless of predictability. Patterns are similar to those in adults and suggest (1) sustained defensive response priming and enhancement of peripheral attention during aversive anticipation, and (2) an ability, even in pre-adolescents, to downregulate defensive priming while maintaining attentional modulation once an awaited predictable aversive event occurs.

Neurophysiology of predictable unpleasant event processing in preadolescents and early adolescents, part I: Event-related potential markers of unpleasant image anticipation and processing.

The ability to anticipate and process predictable unpleasant events, while also regulating emotional reactivity, is an adaptive skill. The current article and a companion in this issue test for potential changes in predictable event processing across the childhood-to-adolescence transition, a key developmental period for biological systems that support cognitive/emotional abilities. While the companion article focuses on emotion regulation and peripheral attention modulation in predictable unpleasant contexts, the current paper presents neurophysiological markers of predictable event processing itself. 315 third-, sixth-, or ninth-grade individuals saw 5-s cues predicting "scary," "every day," or uncertain image content; in this paper, cue- and picture-locked event-related potentials (ERPs) are analyzed. During the cue, early ERP positivities were increased and later slow-wave negativities were reduced when predicted content was scary as compared with mundane. After picture onset, a picture processing-related positivity was then increased for scary compared with everyday images regardless of predictability. Cue-interval data suggest enhanced processing of scary cues and reduced anticipatory processing of scary images-opposite to adults. After event onset, meanwhile, emotional ERP enhancement regardless of predictability is similar to adults and suggests that even preadolescent individuals maintain preferential engagement with unpleasant events when they are predictable.

Clinical diversity in a randomized trial that explicitly sought racial/ethnic diversity in its sample: Baseline comparisons in a treatment of youth substance use and posttraumatic stress.

OBJECTIVE: For more than two decades, federal agencies have sought to address a persistent lack of inclusion of Black, Latinx, Asian, and indigenous peoples in randomized controlled trials (RCTs), often with an underlying hypothesis that such efforts will increase diversity across clinically-relevant dimensions. We examined racial/ethnic and clinical diversity, including racial/ethnic differences in prior service access and symptom dimensions, in an RCT focusing on trauma-related mental health and substance use among adolescents. METHOD: Participants were 140 adolescents in an RCT of Reducing Risk through Family Therapy. Recruitment followed several recommendations for enhancing diversity. Structured interviews examined trauma exposure, posttraumatic stress disorder (PTSD) and depression symptoms, substance use, service utilization, and demographics. RESULTS: Non-Latinx (NL) Black youth were more likely to receive mental health services for the first time and have greater trauma exposure, but less likely to report symptoms of depression (ps < .05) relative to NL White youth. Relevant caregiver differences included that NL Black caregivers were more likely to be unemployed and looking for work (p < .05) despite having similar levels of education relative to NL White caregivers (p > .05). CONCLUSION: Results suggest that efforts to expand racial/ethnic diversity in an RCT of combined substance use and trauma-focused mental health may also expand other clinical dimensions. Many of these differences reflect multiple dimensions of racism experienced by NL Black families that clinicians must attend to. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Role of Social Support in Coping with Psychological Trauma: An Integrated Biopsychosocial Model for Posttraumatic Stress Recovery.

This theoretical review proposes an integrated biopsychosocial model for stress recovery, highlighting the interconnectedness of intra- and interpersonal coping processes. The proposed model is conceptually derived from prior research examining interpersonal dynamics in the context of stressor-related disorders, and it highlights interconnections between relational partner dynamics, perceived self-efficacy, self-discovery, and biological stress responsivity during posttraumatic recovery. Intra- and interpersonal processes are discussed in the context of pre-, peri-, and post-trauma stress vulnerability as ongoing transactions occurring within the individual and between the individual and their environment. The importance of adopting an integrated model for future traumatic stress research is discussed. Potential applications of the model to behavioral interventions are also reviewed, noting the need for more detailed assessments of relational dynamics and therapeutic change mechanisms to determine how relational partners can most effectively contribute to stress recovery.

Elucidating the Neurobiologic Etiology of Comorbid PTSD and Substance Use Disorders.

Early childhood maltreatment and other traumatic event experiences ("trauma") are common among youth, including those with substance use problems including substance use disorders (SUD). Particularly, interpersonal violence is associated with high rates of comorbidity between posttraumatic stress disorder (PTSD) and SUD, and these comorbid disorders exhibit high levels of overlapping symptomatology. Theoretical models proposed to explain the bidirectional relationship between PTSD and SUD include the self-medication hypothesis and susceptibility hypothesis. In this article, we explore neurobiologic changes associated with trauma, PTSD, and SUD that underly dysregulated stress response. Examining lessons learned from recent translational and clinical research, we propose that further elucidating the neurobiologic etiology of comorbid PTSD and SUD will require a collaborative, interdisciplinary approach, including the integration of preclinical and clinical studies, exploration of biologic markers in clinical studies, and accumulation of larger studies and longitudinal studies with the power to study PTSD and SUD. Such research can transform the field and ultimately reduce high rates and costly impairment of co-occurring PTSD and SUD across the lifespan.

Neighborhood Disadvantage Associated With Blunted Amygdala Reactivity to Predictable and Unpredictable Threat in a Community Sample of Youth.

BACKGROUND: Childhood socioeconomic disadvantage is a form of adversity associated with alterations in critical frontolimbic circuits involved in the pathophysiology of psychiatric disorders. Most work has focused on individual-level socioeconomic position, yet individuals living in deprived communities typically encounter additional environmental stressors that have unique effects on the brain and health outcomes. Notably, chronic and unpredictable stressors experienced in the everyday lives of youth living in disadvantaged neighborhoods may impact neural responsivity to uncertain threat. METHODS: A community sample of children (N = 254) ages 8 to 15 years (mean = 12.15) completed a picture anticipation task during a functional magnetic resonance imaging scan, during which neutral and negatively valenced photos were presented in a temporally predictable or unpredictable manner. Area Deprivation Index (ADI) scores were derived from participants' home addresses as an index of relative neighborhood disadvantage. Voxelwise analyses examined interactions of ADI, valence, and predictability on neural response to picture presentation. RESULTS: There was a significant ADI × valence interaction in the middle temporal gyrus, anterior cingulate cortex, hippocampus, and amygdala. Higher ADI was associated with less amygdala activation to negatively valenced images. ADI also interacted with predictability. Higher ADI was associated with greater activation of lingual and calcarine gyri for unpredictably presented stimuli. There was no three-way interaction of ADI, valence, and predictability. CONCLUSIONS: Neighborhood disadvantage may impact how the brain perceives and responds to potential threats. Future longitudinal work is critical for delineating how such effects may persist across the life span and how health outcomes may be modifiable with community-based interventions and policies.

Sexual Risk Behavior among Adolescents Seeking Treatment for Posttraumatic Stress Disorder: Exploring Psychosocial & Symptom Correlates.

Adolescents exposed to trauma experience disproportionate rates of HIV/STI. However, integrated treatment for trauma and sexual risk behavior is rare. To inform integrated prevention efforts, the current study describes prevalence and correlates of sexual risk behavior among adolescents seeking treatment for symptoms of posttraumatic stress and substance use disorders. Adolescents aged 13-18 years (N = 135; 88% female) with histories of interpersonal violence exposure completed pre-treatment questionnaires in a randomized controlled trial of an integrated psychotherapy for trauma and substance use symptomology. Adolescents reported high rates of sexual risk behaviors relative to national estimates and general mental health treatment samples. Symptoms of reexperiencing, substance use, and peer deviance were related to sexual risk behavior beyond the influence of other trauma symptoms. Individual and contextual psychosocial factors may be stronger predictors of sexual risk behavior than posttraumatic stress disorder symptoms among adolescents with trauma symptomology. Integrated interventions targeting traumatic stress, substance use, and sexual risk behavior concurrently may prevent revictimization and HIV/STI incidence among trauma-exposed youth.

The Role of Ethnic-Specific Gender Schemas in Ethnic Disparities in Adolescent Girls' Disruptive Behavior: A Preliminary Examination.

African American adolescent girls have evidenced higher levels of disruptive behavior than girls from other ethnic groups. However, most research focused on understanding disparities in these outcomes has been conducted without consideration of gender or has focused exclusively on boys. Yet, prior research suggests that anger and aggression are less gender-typed in African American youth than they are among youth from other ethnic backgrounds. The purpose of this preliminary investigation was to examine the extent to which ethnic-specific gender schemas about anger mediated the relationship between ethnicity and girls' disruptive behavior. Participants were 66 middle school girls (24.1 % African American, 46.3 % European American; Mage= 12.06). They completed measures of ethnic-specific gender schemas about anger, reactive and instrumental aggression, and classroom disruptive behavior. Results indicated that relative to girls from other ethnic groups, African American girls had higher levels of reactive aggression and classroom disruptive behavior, both of which are rooted in anger. In contrast, no ethnic difference was found for instrumental aggression, which is not connected to anger. Ethnic-specific gender schemas about anger at least partially accounted for ethnic differences in reactive aggression and classroom disruptive behavior. Findings highlight the importance of examining gender schemas specific to ethnicity as factors in ethnic disparities in behavioral outcomes among adolescent girls.

Does Prior Civilian Trauma Moderate the Relationship Between Combat Trauma and Post-deployment Mental Health Symptoms?

In addition to combat trauma, childhood and adult non-military, interpersonal trauma exposures have been linked to a range of psychiatric symptoms (e.g., alcohol use problems, posttraumatic stress disorder [PTSD], depression symptoms) in veterans. However, few studies simultaneously explore the associations between these civilian and combat trauma types and mental health outcomes. Using a sample of combat-exposed veterans who were previously deployed to Iraq and Afghanistan (N = 302), this study sought to (a) understand the independent associations of civilian interpersonal trauma (i.e., childhood trauma and non-military adult trauma) and combat-related trauma with post-deployment alcohol use, PTSD symptoms, and depressive symptoms, respectively and (b) to examine the interactive effects of trauma type to test whether childhood and non-military adult trauma moderate the association of combat trauma with these outcomes. A path analytic framework was used to allow for the simultaneous prediction of these associations. In the final model non-military adult trauma and combat trauma were found to be significantly associated with PTSD symptoms and depression symptoms, but not average amount of drinks consumed per drinking day. Childhood trauma was not associated with any outcomes (i.e., PTSD symptoms, depression symptoms, average amount of drinks consumed per day). Only combat trauma was significantly associated with average amount of drinks consumed per day. Results underscore the importance of assessing multiple trauma types and considering trauma as a non-specific risk factor, as different trauma types may differentially predict various mental health outcomes other than PTSD. Further, results highlight the noteworthiness of considering co-occurring outcomes within the veteran community. Limitations, future directions, and implications of diversity are discussed.

Rumination as a Mediator of the Association Between Racial Discrimination and Depression Among Black Youth.

BACKGROUND: Racial discrimination constitutes a significant risk factor for depressive symptoms among Black youth. Rumination, a maladaptive self-regulatory stress response, is a notable pathway by which racial discrimination contributes to depressive symptoms among racial/ethnic minority adults. Yet, examinations of the mechanistic nature of rumination in the context of racial discrimination among racial/ethnic minority youth remain limited. The present study investigated rumination as a mediator of the association between racial discrimination and depressive symptoms among Black youth. METHODS: Data for the current study were drawn from baseline questionnaire responses of community recruited Black pre-and-early adolescents (N = 158, 53% female, Mage = 11.50) in the southeast USA participating in an ongoing longitudinal study examining the effects of interpersonal stressors on youth mental health outcomes. RESULTS: After adjusting for age and gender, mediation analyses revealed a significant indirect effect of racial discrimination on depressive symptoms through rumination, estimate = 0.29, 95% confidence interval [0.12, 0.47]. Racial discrimination was positively associated with rumination (b = .74, SE = .23, p = .001), and rumination, in turn, was positively associated with depressive symptoms (b = .40, SE = .06, p < .001). CONCLUSION: Consistent with previous research, we found racial discrimination to be directly and indirectly associated with depressive symptoms among Black youth. Findings provide evidence of the cognitive burden of discriminatory experiences and suggest that rumination represents a potential pathway that can be targeted at early developmental stages to reduce the deleterious impact of racism-related stressors.

Efficacy of the Common Elements Treatment Approach (CETA) for Unhealthy Alcohol Use Among Adults with HIV in Zambia: Results from a Pilot Randomized Controlled Trial.

This randomized controlled trial tested the efficacy of a multi-session, evidence-based, lay counselor-delivered transdiagnostic therapy, the Common Elements Treatment Approach (CETA), in reducing unhealthy alcohol use and comorbidities among persons living with HIV (PLWH) in Zambia. Adult PLWH with (a) unhealthy alcohol use plus mental health or substance use comorbidities, or (b) severe unhealthy alcohol use were randomized to receive a single-session alcohol brief intervention (BI) alone or BI plus referral to CETA. Outcomes were measured at baseline and a 6-month follow-up and included Alcohol Use Disorders Identification Test (AUDIT) score (primary), depression and trauma symptoms, and other substance use (secondary). We enrolled 160 participants; 78 were randomized to BI alone and 82 to BI plus CETA. Due to COVID-19, the trial ended early before 36 participants completed. Statistically and clinically significant reductions in mean AUDIT score from baseline to 6-month follow-up were observed in both groups, however, participants assigned to BI plus CETA had significantly greater reductions compared to BI alone (- 3.2, 95% CI - 6.2 to - 0.1; Cohen's d: 0.48). The CETA effect size for AUDIT score increased in line with increasing mental health/substance use comorbidity (0 comorbidities d = 0.25; 1-2 comorbidities d = 0.36; 3+ comorbidities d = 1.6). Significant CETA treatment effects were observed for depression, trauma, and several other substances. BI plus referral to CETA was feasible and superior to BI alone for unhealthy alcohol use among adults with HIV, particularly among those with comorbidities. Findings support future effectiveness testing of CETA for HIV outcomes among PLWH with unhealthy alcohol use.Clinical Trials Number: NCT03966885.

Anxiety-related shifts in smell function in children and adolescents.

Anxious adults show changes in smell function that are consistent with a durable shift in sensitivity toward particular odorants and away from others. Little is known regarding the development of these changes, including whether they exist in youth, are stable during the transition from childhood to adolescence, and whether odorant properties (e.g. trigeminal features, hedonic valence) affect anxiety-related differences in detection. To address this, we measured smell detection thresholds to phenyl ethyl alanine (PEA), a rose-like odorant with little trigeminal properties, and guaiacol (GUA), a smoke-like odorant with high trigeminal properties. These thresholds were measured at baseline and after an acute stress challenge, the Trier Social Stress Tests, in 131 healthy youth (in 4th, 7th, and 10th grades, age 9-16 years) that reported normal to elevated levels of anxiety. At baseline, high anxious youth exhibited heightened sensitivity to GUA coupled with reduced sensitivity to PEA, as well as a further exaggeration of this bias with acute stress. Importantly, sex, age, and hedonic valence moderated the relationship between trait anxiety and sensitivity to both odorants. Smell function and its aberrations are often overlooked in the literature on biomarkers of stress and anxiety. Taken together with the extant literature, these findings suggest that greater attention is warranted to characterize potential novel olfactory therapeutic targets-across the lifespan.

Drinking Patterns of Post-Deployment Veterans: The Role of Personality, Negative Urgency, and Posttraumatic Stress.

Rates of posttraumatic stress disorder (PTSD) and alcohol misuse are known to be high among post-deployment Veterans. Previous research has found that personality factors may be relevant predictors of post-deployment drinking, yet results have been inconsistent and may be influenced by the selection of drinking outcome. This study aimed to examine relations between PTSD, negative urgency, and the five factor models of personality with multiple alcohol consumption patterns, including maximum drinks in a day, number of binge drinking episodes, at-risk drinking, and average weekly drinks in a sample of 397 Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) Veterans. The pattern of results suggested that the association between personality, PTSD, and drinking may depend on which drinking outcome is selected. For example, maximum drinks in a day was significantly associated with younger age, male gender, low agreeableness, and an interaction between negative urgency and PTSD, whereas number of binge drinking days was significantly associated with younger age, extraversion, low agreeableness, and negative urgency. This study highlights the heterogeneity of drinking patterns among Veterans and the need for careful consideration and transparency of outcomes selection in alcohol research.