Young adults with a history of substance use disorder experienced more negative mental health, social and economic outcomes during the COVID-19 pandemic period.

BACKGROUND AND AIMS: For young adults, the disruptions brought by the COVID-19 pandemic to work, social relationships and health-care probably impacted normative life stage transitions. Disaster research shows that negative effects of these events can persist for years after the acute crisis ends. Pandemic-related disruptions may have been especially consequential for young adults with a history of substance use disorder (SUD). The current work aimed to measure the broad impact of the COVID-19 pandemic on young adults with and without a history of SUD. DESIGN, SETTING AND PARTICIPANTS: Data were from a longitudinal panel of n = 4407 young adults across the United States surveyed repeatedly from 2014 to 2019 (aged 19-26 years, pre-pandemic) and again in 2021 (aged 28 years, mid-pandemic). MEASUREMENTS: We fitted multi-level models to understand the association between SUD history and pandemic outcomes, controlling for potential confounders (socio-demographic and health measures). Outcomes included overall life disruption; mental health, social and economic impacts; substance use; and physical health. FINDINGS: Young adults with a history of SUD reported greater life disruption (standardized ß = 0.13-0.15, Ps < 0.015) and negative mental health impacts (standardized ß = 0.12-0.14, Ps < 0.012), experienced approximately 20% more work-related stressors (relative risks = 1.18-1.22, Ps < 0.002) and 50% more home-related stressors (relative risks = 1.40-1.51, Ps < 0.001), and had two to three times the odds of increased substance use during the pandemic (odds ratios = 2.07-3.23, Ps < 0.001). Findings generally did not differ between those with a recent SUD diagnosis and those in recovery from SUD before the pandemic began. CONCLUSIONS: United States young adults with a history of substance use disorder (SUD) reported more life disruption and greater negative physical and mental health, social and economic impacts during the COVID mid-pandemic period than young adults with no history of SUD.

Estimating substance use disparities across intersectional social positions using machine learning: An application of group-lasso interaction network.

OBJECTIVE: An aim of quantitative intersectional research is to model the joint impact of multiple social positions on health risk behaviors. Although moderated multiple regression is frequently used to pursue intersectional research hypotheses, such parametric approaches may produce unreliable effect estimates due to data sparsity and high dimensionality. Machine learning provides viable alternatives, offering greater flexibility in evaluating many candidate interactions amid sparse data conditions, yet remains rarely employed. This study introduces group-lasso interaction network (glinternet), a novel machine learning approach involving hierarchical regularization, to assess intersectional differences in substance use prevalence. METHOD: Utilizing variable selection and parameter stabilization functionality for main and interaction effects, glinternet was employed to examine two-way interactions between three primary social positions (gender, sexual orientation, and race) predicting heavy episodic drinking, cannabis use, and cigarette use prevalence. Analyses were conducted using the All of Us Research Program (N = 283,403), a national sample with high representation from populations historically underrepresented in biomedical research. Results were replicated using holdout cross-validation and compared against logistic regression estimates. RESULTS: Glinternet prevalence estimates were more stable across discovery and replication samples relative to logistic regression, particularly among sparsely represented groups. Prevalence estimates for cigarette and cannabis use were elevated among sexual minority and White cisgender women compared to heterosexual and non-White women, respectively. CONCLUSIONS: Glinternet may improve upon traditional moderated multiple regression methods for pursuing intersectional hypotheses by improving model parsimony and parameter stability, providing novel means for quantifying health disparities among intersectional social positions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Characterizing the momentary association between loneliness, depression, and social interactions: Insights from an ecological momentary assessment study.

Evidence suggests that loneliness causes people to feel more depressed. It is unknown, however, why this association occurs and whether momentary versus chronic experiences of loneliness are implicated. Theoretical accounts suggest that momentary feelings of loneliness produce two competing motivations: social reaffiliation and social withdrawal. Social affiliation is protective against depression; social withdrawal, in contrast, is a risk factor. Thus, engaging in frequent and high-quality interactions following experiences of loneliness may protect against subsequent depression. We tested this hypothesis using a random-interval experience sampling design (5x/day/day, 14 days; Nobs = 6568) with a racially/ethnically diverse sample of adults with elevated depression symptoms (N = 102). Momentary loneliness was associated with depressed mood at the same time point and âˆ¼2.5h and âˆ¼5h later. Frequency and quality of social interaction did not moderate these associations. Findings suggest that momentary feelings of loneliness may be an important target for clinical intervention.

Clinician Perspectives on Delivering Medication Treatment for Opioid Use Disorder during the COVID-19 Pandemic: A Qualitative Evaluation.

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic necessitated changes in opioid use disorder care. Little is known about COVID-19's impact on general healthcare clinicians' experiences providing medication treatment for opioid use disorder (MOUD). This qualitative evaluation assessed clinicians' beliefs about and experiences delivering MOUD in general healthcare clinics during COVID-19. METHODS: Individual semistructured interviews were conducted May through December 2020 with clinicians participating in a Department of Veterans Affairs initiative to implement MOUD in general healthcare clinics. Participants included 30 clinicians from 21 clinics (9 primary care, 10 pain, and 2 mental health). Interviews were analyzed using thematic analysis. RESULTS: The following 4 themes were identified: overall impact of the pandemic on MOUD care and patient well-being, features of MOUD care impacted, MOUD care delivery, and continuance of telehealth for MOUD care. Clinicians reported a rapid shift to telehealth care, resulting in few changes to patient assessments, MOUD initiations, and access to and quality of care. Although technological challenges were noted, clinicians highlighted positive experiences, including treatment destigmatization, more timely visits, and insight into patients' environments. Such changes resulted in more relaxed clinical interactions and improved clinic efficiency. Clinicians reported a preference for in-person and telehealth hybrid care models. CONCLUSIONS: After the quick shift to telehealth-based MOUD delivery, general healthcare clinicians reported few impacts on quality of care and highlighted several benefits that may address common barriers to MOUD care. Evaluations of in-person and telehealth hybrid care models, clinical outcomes, equity, and patient perspectives are needed to inform MOUD services moving forward.

The daily association between affect and alcohol use: A meta-analysis of individual participant data.

Influential psychological theories hypothesize that people consume alcohol in response to the experience of both negative and positive emotions. Despite two decades of daily diary and ecological momentary assessment research, it remains unclear whether people consume more alcohol on days they experience higher negative and positive affect in everyday life. In this preregistered meta-analysis, we synthesized the evidence for these daily associations between affect and alcohol use. We included individual participant data from 69 studies (N = 12,394), which used daily and momentary surveys to assess affect and the number of alcoholic drinks consumed. Results indicate that people are not more likely to drink on days they experience high negative affect, but are more likely to drink and drink heavily on days high in positive affect. People self-reporting a motivational tendency to drink-to-cope and drink-to-enhance consumed more alcohol, but not on days they experienced higher negative and positive affect. Results were robust across different operationalizations of affect, study designs, study populations, and individual characteristics. These findings challenge the long-held belief that people drink more alcohol following increases in negative affect. Integrating these findings under different theoretical models and limitations of this field of research, we collectively propose an agenda for future research to explore open questions surrounding affect and alcohol use.

Sexual identity and race/ethnicity as predictors of treatment outcome and retention in dialectical behavior therapy.

OBJECTIVE: There is inconclusive evidence regarding sexual identity and race/ethnicity differences in outcomes in evidence-based psychological treatments. Although dialectical behavior therapy (DBT) is well-studied, little is known about the extent to which its efficacy generalizes to sexual minority and racial/ethnic minority people. This study examined sexual identity, race/ethnicity, and their interaction as predictors of treatment outcome and retention in DBT. METHOD: Data were from five clinical trials conducted in research and community settings with a variety of adult populations (N = 269) engaged in standard DBT, augmented DBT, or DBT components. Longitudinal mixed-effects models evaluated sexual identity and racial/ethnic differences in clinical outcomes (suicide attempts, nonsuicidal self-injury [NSSI], global functioning, psychiatric hospitalizations) and retention. RESULTS: Sexual identity, race/ethnicity, and their interaction did not predict the average severity or the rate of change in any clinical outcome over time. Sexual minority identity was associated with decreased risk of treatment dropout (OR = .44, p < .001). However, this effect was moderated by race/ethnicity, such that non-Hispanic White sexual minority participants had the lowest rates of dropout. Exploratory analyses suggested potential differences related to NSSI for certain sexual and racial/ethnic minority subgroups. CONCLUSIONS: Findings suggest no significant differences in DBT treatment outcomes when comparing between sexual minority and heterosexual individuals and between non-Hispanic White and racial/ethnic minority individuals. Sexual minority identity interacted with race/ethnicity to predict dropout, such that non-Hispanic sexual minority people were more likely to complete DBT compared to sexual minority people of color and heterosexual individuals. Further research is needed to clarify potential subgroup and intersectional differences. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A daily diary study of the romantic partner relationship dynamics associated with anger and other posttraumatic stress disorder symptoms.

Posttraumatic stress disorder (PTSD) is linked to negative relationship outcomes, but the relational processes that link specific PTSD symptoms to these outcomes over granular periods are not well understood. The current study used a daily diary methodology to investigate the associations between specific PTSD symptoms (i.e., anger, avoidance, reexperiencing, hyperarousal, and numbing) and proximal indices of relationship functioning (i.e., accommodation behaviors, disclosure, intimacy). Participants were members of 64 couples, each comprising a male service member (SM) and female romantic partner (RP), who completed daily assessments of PTSD symptoms and indices of relationship functioning for 2 weeks. The results suggest a somewhat unique role of anger on relationship dynamics: Although mean levels of PTSD symptom clusters were associated with negative relationship outcomes at the bivariate level, daily fluctuations in anger were uniquely related to accommodation behaviors and SM- and RP-reported intimacy in multilevel models, Bs = -0.08-0.50). These findings highlight the importance of considering the differential role of specific PTSD symptoms, like anger, in dyadic interventions for PTSD; several strategies for doing so in the context of contemporary evidence-based treatments are discussed.

Pathways of personality and learning risk for addictive behaviors: A systematic review of mediational research on the acquired preparedness model.

OBJECTIVE: The Acquired Preparedness (AP) model proposes that impulsive personality traits predispose some individuals to learn certain behavior-outcome associations (expectancies), and that these expectancies in turn influence the escalation of risky behaviors. This theory has been applied to the development of behaviors such as drinking, drug use, gambling, and disordered eating. In the current study, we aimed to summarize empirical tests of this model over the 20 years since it was proposed. METHOD: We used a descriptive approach to summarize tests of mediation across 50 studies involving n = 21,715 total participants. RESULTS: We observed a consistent effect of personality on expectancies (median effect size = .22), of expectancies on behavior (.24), and a small mediated effect (.05) of personality on behavior via expectancies. Impulsive traits that involve positive or negative affect showed the most consistent support for AP, as did positive expectancies. Most studies testing AP focused on alcohol, but research on other behaviors also showed support for AP. CONCLUSIONS: The literature appears to support a small mediated effect consistent with the AP model. Future research should continue to clarify which AP pathways are most influential in explaining risky behaviors, and supplement correlational research with experimental and quasi-experimental designs.

Examining interactions between negative emotionality and effortful control in predicting preadolescent adjustment problems.

Negative emotionality and effortful control consistently predict child adjustment, yet few studies explore their interactive effects on adjustment. In concurrent and longitudinal (one-year follow-up) analyses, we examined negative emotionality-by-effortful control interactions in predicting anxiety, depression, and conduct problems in 214 children aged 8-12. Temperament was assessed using behavioral tasks measuring fear, frustration, executive control, and delay ability. An interaction between frustration and executive control predicting conduct problems was observed; higher executive control was related to fewer concurrent conduct problems for those moderate to high in frustration, but did not predict conduct problems for those low in frustration. This interaction did not predict conduct problems one year later. No support was found for negative emotionality-by-effortful control interactions predicting anxiety or depression. Our findings highlight the importance of executive control during preadolescence and provide mixed evidence regarding whether facets of negative emotionality and executive control interact with one another to influence adjustment.

Cross-Study, Cross-Method Associations Between Negative Urgency and Internalizing Symptoms.

There is a small body of research that has connected individual differences in negative urgency, the tendency to report rash actions in response to negative emotions, with self-report depressive and anxiety symptoms. Despite the conceptual overlap of negative urgency with negative emotionality, the tendency to experience frequent and intense negative emotions, even fewer studies have examined whether the association of negative urgency with internalizing symptoms hold when controlling for negative emotionality. In the current study, we estimated the bivariate association between negative urgency and internalizing symptoms, tested whether they remained significant after partialling out negative emotionality, and tested whether these effects generalized to real-time experiences of negative emotions. We used data from five independent samples of high school and college students, assessed with global self-report (n = 1,297) and ecological momentary assessment (n = 195). Results indicated that in global self-report data, negative urgency was moderately and positively associated with depressive and anxiety symptoms, and the partial association with depressive symptoms (but not anxiety symptoms) controlling for negative emotionality remained significant and moderate in magnitude. This pattern was replicated in ecological momentary assessment data. Negative urgency may convey risk for depressive symptoms, independent of the effects of negative emotionality.

Interpreting Interaction Effects in Generalized Linear Models of Nonlinear Probabilities and Counts.

Psychology research frequently involves the study of probabilities and counts. These are typically analyzed using generalized linear models (GLMs), which can produce these quantities via nonlinear transformation of model parameters. Interactions are central within many research applications of these models. To date, typical practice in evaluating interactions for probabilities or counts extends directly from linear approaches, in which evidence of an interaction effect is supported by using the product term coefficient between variables of interest. However, unlike linear models, interaction effects in GLMs describing probabilities and counts are not equal to product terms between predictor variables. Instead, interactions may be functions of the predictors of a model, requiring nontraditional approaches for interpreting these effects accurately. Here, we define interactions as change in a marginal effect of one variable as a function of change in another variable, and describe the use of partial derivatives and discrete differences for quantifying these effects. Using guidelines and simulated examples, we then use these approaches to describe how interaction effects should be estimated and interpreted for GLMs on probability and count scales. We conclude with an example using the Adolescent Brain Cognitive Development Study demonstrating how to correctly evaluate interaction effects in a logistic model.

Making sense of some odd ratios: A tutorial and improvements to present practices in reporting and visualizing quantities of interest for binary and count outcome models.

OBJECTIVE: Generalized linear models (GLMs) such as logistic and Poisson regression are among the most common statistical methods for modeling binary and count outcomes. Though single-coefficient tests (odds ratios, incidence rate ratios) are the most common way to test predictor-outcome relations in these models, they provide limited information on the magnitude and nature of relations with outcomes. We assert that this is largely because they do not describe direct relations with quantities of interest (QoIs) such as probabilities and counts. Shifting focus to QoIs makes several critical nuances of GLMs more apparent. METHOD: To bolster interpretability of these models, we provide a tutorial on logistic and Poisson regression and suggestions for enhancements to current reporting practices for predictor-outcome relations in GLMs. RESULTS: We first highlight differences in interpretation between traditional linear models and GLMs, and describe common misconceptions about GLMs. In particular, we highlight that link functions (a) introduce nonconstant relations between predictors and outcomes and (b) make predictor-QoI relations dependent on levels of other covariates. Each of these properties causes interpretation of GLM coefficients to diverge from interpretations of linear models. Next, we argue for a more central focus on QoIs (probabilities and counts). Finally, we propose and provide graphics and tables, with sample R code, for enhancing presentation and interpretation of QoIs. CONCLUSIONS: By improving present practices in the reporting of predictor-outcome relations in GLMs, we hope to maximize the amount of actionable information generated by statistical analyses and provide a tool for building a cumulative science of substance use disorders. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A mindfulness-based promotive coping program improves well-being in college undergraduates.

BACKGROUND AND OBJECTIVES: An increasing number of college students in the U.S. report elevations in stress and anxiety. One approach to addressing this need is to offer skills training programs. DESIGN: This study used a stepped-wedge design to test the effects of a mindfulness-based coping-enhancement program on college students' stress-management, emotion regulation, coping, and well-being. The 6-week program includes didactics and practices for mindfulness, coping with challenging situations, regulating emotions, and compassion for oneself and others. METHODS: Participants (N = 208) were predominantly first-year college students living in residence halls on campus, where the program was delivered. RESULTS: Students who received the program were compared to those who had not yet received the program and reported improved mindfulness, executive control, active coping, self-compassion, social connectedness, resilience, and flourishing. The majority of these changes were maintained at a three-month follow-up. CONCLUSIONS: The results of this study suggest that the program shows promise for supporting well-being in college students.

Impulsive States and Impulsive Traits: A Study of the Multilevel Structure and Validity of a Multifaceted Measure of Impulsive States.

Emerging evidence suggests impulsive states may be reliably measured in the moment using ecological momentary assessment (EMA); however, research has not investigated whether the multi-factor structure of impulsive traits also characterizes impulsive states. In two independent samples spanning adolescence through young adulthood (n = 211, n = 222), we adapted global self-report measures of impulsive traits to EMA and conducted multilevel confirmatory factor analyses to characterize the within- and between-person factor structure of five impulsive traits (negative urgency, planning, persistence, sensation seeking, and positive urgency). Across both studies, factor models with one factor for each UPPS-P facet fit the data well at both levels, though some latent factors were highly correlated. Aggregated impulsive states, especially negative urgency, predicted oppositional defiant disorder symptoms, emotional problems, alcohol problems, and attention deficit hyperactivity disorder symptoms. Our results suggest that EMA measures can capture a range of impulsive states that mirrors the heterogeneity seen in the trait literature.

A trait-like propensity to experience internalizing symptoms is associated with problem alcohol involvement across adulthood, but not adolescence.

There are stable between-person differences in an internalizing "trait," or the propensity to experience symptoms of internalizing disorders, such as social anxiety, generalized anxiety disorder, and depression. Trait internalizing may serve as a marker of heightened risk for problem alcohol outcomes (such as heavier drinking, binge drinking, or alcohol dependence). However, prior research on the association between internalizing symptoms and alcohol outcomes has been largely mixed in adolescence, with more consistent support for an association during adulthood. It may be that trait internalizing is only associated with problem alcohol outcomes in adulthood, after individuals have gained experience with alcohol. Some evidence suggested that these effects may be stronger for women than men. We used data from a community sample (n = 790) interviewed during adolescence (ages 14-16) and again at ages 21, 24, 27, 30, 33, and 39. Using generalized estimating equations, we tested the association between trait internalizing and alcohol outcomes during both adolescence and adulthood, and tested whether adult trait internalizing mediated the association between adolescent trait internalizing and adult alcohol outcomes. Trait internalizing in adulthood (but not adolescence) was associated with more frequent alcohol use, binge drinking and symptoms of alcohol use disorders, and mediated the effects of adolescent trait internalizing on alcohol outcomes. We observed no moderation by gender or change in these associations over time. Understanding the developmental pathways of trait internalizing may provide further insights into preventing the emergence of problem alcohol use behavior during adulthood. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

State-Level Impulsivity, Affect, and Alcohol: A Psychometric Evaluation of the Momentary Impulsivity Scale Across Two Intensive Longitudinal Samples.

We reexamined the psychometric properties of the Momentary Impulsivity Scale (MIS) in two young adult samples using daily diary (N=77) and ecological momentary assessment (N=147). A one-factor between- and within-person structure was supported, though "I felt impatient" loaded poorly within-person. MIS scores consistently related to emotion-driven trait impulsivity; however, MSSDs of MIS scores were unrelated to outcomes after accounting for aggregate MIS scores. We observed positive, within-person correlations with negative, but not positive, affect. Between-person MIS scores correlated with alcohol problems, though within-person MIS-alcohol relations were inconsistent. MIS scores were unrelated to laboratory-based impulsivity tasks. Findings inform the assessment of state-level impulsivity in young adults. Future research should prioritize expanding the MIS to capture the potential multidimensionality of state-level impulsivity.

A State Model of Negative Urgency: Do Momentary Reports of Emotional Impulsivity Reflect Global Self-Report?

Negative urgency is a trait that is a risk factor for a range of psychopathology. Yet, little research has tested whether global self-report measures of negative urgency truly reflect a heightened association between real-world negative emotions and impulsive behaviors. In a sample of young adults (N = 222) assessed 3 times per day for 10 days, we tested whether negative emotions were associated with multiple facets of impulsivity at the state-level, and whether those associations were moderated by global self-report of negative urgency. Our findings suggest a robust within-person association between negative affect and acting on impulse. However, global self-report of negative urgency did not moderate any emotion-impulsivity association we tested.

Associations between mindfulness and mental health outcomes: A systematic review of ecological momentary assessment research.

Objectives: Psychological science has taken up investigations of the effectiveness of mindfulness-based programs (MBPs) and mechanisms through which people benefit from mindfulness. Reliable and valid psychometric tools are essential components of psychological science, and efforts have been made to produce tools for the accurate measurement of mindfulness as a construct. However, trait measurement methods, which are commonly used, may not adequately assess mindfulness and mental health outcomes in a way that allows for mechanisms to be adequately tested. Intensive longitudinal assessment methods sample behavior and experience multiple times over a brief period of several days or weeks, and may be more appropriate methods for testing mechanisms of action. We provide a systematic review of published, peer-reviewed studies that used intensive longitudinal methods to investigate the effects of mindfulness on mental health outcomes. Methods: Articles were included in the systematic review if mindfulness measures and/or mindfulness interventions were a part of the study design and if intensive longitudinal methods were used to assess mindfulness or mental health outcomes. Results: Findings consistently demonstrated a positive association between mindfulness and mental health. Only two studies collected both trait and state measurements of either mindfulness or mental health outcomes, and results indicated that EMA produced larger effect sizes between mindfulness and mental health outcomes. Conclusions: Theorized associations between mindfulness and mental health are supported by the current EMA literature. Intensive longitudinal methods may produce more consistent and reliable results through increased sensitivity and ecological validity in that they examine the momentary relationships between mindfulness and mental health outcomes. Thus, intensive longitudinal assessment may be a more appropriate method for investigating hypothesized mechanisms of action in MBPs.

Employment characteristics, work environment, and the course of depression over 23 years: Does employment help foster resilience?

BACKGROUND: Depression is the leading cause of disability and represents a significant challenge to stable employment and professional success. Importantly, employment may also operate as a protective factor against more chronic courses of depression as it can function as a form of behavioral activation and scaffold recovery by facilitating community integration. The current study examined work-related characteristics as protective or risk factors for subsequent long-term depression trajectories. METHODS: Relations between employment characteristics and lifetime course of depression were examined among 424 adults in the community who entered treatment for depression. The sample was followed for 23 years with assessments at 1, 4, 10, and 23 years post baseline. At baseline, participants were asked about employment history and status along with work-related events and aspects of their work environments. Depression was measured at each assessment, and three different life course trajectories of depression were identified. RESULTS: Employment at baseline was associated with lower levels of depression at baseline and less severe life courses of depression. Among employed participants, higher occupational prestige, a more supportive work environment (greater involvement, cohesion, and perceived support), and lower work stress (less pressure and more control, role clarity, and autonomy) may protect against more severe, intractable depression over time and may have bolstered functioning. CONCLUSIONS: Findings have potential to be harnessed for clinical translation to better inform vocational rehabilitation counseling and human resources programs. Specifically, clinician assessment of work setting can guide patient decision making about how to reduce vulnerability to depression and foster resilience via employment.

Institutional Incentives for Mentoring at the U.S. Department of Veterans Affairs and Universities: Associations With Mentors' Perceptions and Time Spent Mentoring.

PURPOSE: Limited empirical attention to date has focused on best practices in advanced research mentoring in the health services research domain. The authors investigated whether institutional incentives for mentoring (e.g., consideration of mentoring in promotion criteria) were associated with mentors' perceptions of mentoring benefits and costs and with time spent mentoring. METHOD: The authors conducted an online survey in 2014 of a national sample of mentors of U.S. Department of Veterans Affairs (VA) Health Services Research and Development Service (HSR&D) mentored career development award recipients who received an award during 2000-2012. Regression analyses were used to examine institutional incentives as predictors of perceptions of benefits and costs of mentoring and time spent mentoring. RESULTS: Of the 145 mentors invited, 119 (82%) responded and 110 (76%) provided complete data for the study items. Overall, mentors who reported more institutional incentives also reported greater perceived benefits of mentoring (P = .03); however, more incentives were not significantly associated with perceived costs of mentoring. Mentors who reported more institutional incentives also reported spending a greater percentage of time mentoring (P = .02). University incentives were associated with perceived benefits of mentoring (P = .02), whereas VA incentives were associated with time spent mentoring (P = .003). CONCLUSIONS: Institutional policies that promote and support mentorship of junior investigators, specifically by recognizing and rewarding the efforts of mentors, are integral to fostering mentorship programs that contribute to the development of early-career health services researchers into independent investigators.