Motivational Interviewing Training Outcomes Among Providers in a Children's Hospital.

Motivational interviewing (MI) has proven a well-established psychotherapeutic intervention designed to enhance motivation for behavior change. While the benefits of MI have been established, little research has systematically evaluated dissemination of MI efforts to healthcare providers, especially among pediatric providers. The present pilot study evaluated whether healthcare providers gained valuable knowledge, confidence and desire to utilize MI, and skills in MI techniques and if these outcomes varied based on provider characteristics or duration and intensity of MI training. Twenty pediatric healthcare professionals in a large academic pediatric hospital completed an advanced 20-h MI training and 103 pediatric healthcare professionals completed a basic 4-h MI workshop. The study demonstrated no significant differences in post-workshop MI knowledge, confidence, or desire based on trainee demographics. We also found no significant change from post-basic workshop to post-advanced workshop for advanced MI trainees. However, the advanced training workshop participants evidenced significant growth in utilizing MI skills (via MITI coding) and self-reported confidence in using MI skills. We therefore conclude that while the basic workshop allows participants to gain valuable MI knowledge and confidence and desire to utilize MI, it is through the advanced training that providers have the opportunity to practice these skills, receive feedback, and ultimately gain the expertise necessary to be effective MI providers. Overall, results from this pilot study suggest MI training in pediatric hospitals represents an important area of opportunity for multidisciplinary training, dissemination, and practice.

How Substance Users With ADHD Perceive the Relationship Between Substance Use and Emotional Functioning.

OBJECTIVE: Although substance use (SU) is elevated in ADHD and both are associated with disrupted emotional functioning, little is known about how emotions and SU interact in ADHD. We used a mixed qualitative-quantitative approach to explore this relationship. METHOD: Narrative comments were coded for 67 persistent (50 ADHD, 17 local normative comparison group [LNCG]) and 25 desistent (20 ADHD, 5 LNCG) substance users from the Multimodal Treatment Study of Children with ADHD (MTA) adult follow-up (21.7-26.7 years-old). RESULTS: SU persisters perceived SU positively affects emotional states and positive emotional effects outweigh negative effects. No ADHD group effects emerged. Qualitative analysis identified perceptions that cannabis enhanced positive mood for ADHD and LNCG SU persisters, and improved negative mood and ADHD for ADHD SU persisters. CONCLUSION: Perceptions about SU broadly and mood do not differentiate ADHD and non-ADHD SU persisters. However, perceptions that cannabis is therapeutic may inform ADHD-related risk for cannabis use.

A neuroscience perspective on sexual risk behavior in adolescence and emerging adulthood.

Late adolescence and emerging adulthood (specifically ages 15-24) represent a period of heightened sexual risk taking resulting in the greatest annual rates of sexually transmitted infections and unplanned pregnancies in the US population. Ongoing efforts to prevent such negative consequences are likely to benefit from a deepening of our understanding of biological mechanisms through which sexual risk taking emerges and biases decision making during this critical window. Here we present a neuroscience framework from which a mechanistic examination of sexual risk taking can be advanced. Specifically, we adapt the neurodevelopmental triadic model, which outlines how motivated behavior is governed by three systems: approach, avoidance, and regulation, to sexual decision making and subsequent risk behavior. We further propose a testable hypothesis of the triadic model, wherein relatively decreased threat-related amygdala reactivity and increased reward-related ventral striatum reactivity leads to sexual risk taking, which is particularly exaggerated during adolescence and young adulthood when there is an overexpression of dopaminergic neurons coupled with immature top-down prefrontal cortex regulation. We conclude by discussing how future research based on our adapted triadic model can inform ongoing efforts to improve intervention and prevention efforts.

Differential patterns of amygdala and ventral striatum activation predict gender-specific changes in sexual risk behavior.

Although the initiation of sexual behavior is common among adolescents and young adults, some individuals express this behavior in a manner that significantly increases their risk for negative outcomes including sexually transmitted infections. Based on accumulating evidence, we have hypothesized that increased sexual risk behavior reflects, in part, an imbalance between neural circuits mediating approach and avoidance in particular as manifest by relatively increased ventral striatum (VS) activity and relatively decreased amygdala activity. Here, we test our hypothesis using data from seventy 18- to 22-year-old university students participating in the Duke Neurogenetics Study. We found a significant three-way interaction between amygdala activation, VS activation, and gender predicting changes in the number of sexual partners over time. Although relatively increased VS activation predicted greater increases in sexual partners for both men and women, the effect in men was contingent on the presence of relatively decreased amygdala activation and the effect in women was contingent on the presence of relatively increased amygdala activation. These findings suggest unique gender differences in how complex interactions between neural circuit function contributing to approach and avoidance may be expressed as sexual risk behavior in young adults. As such, our findings have the potential to inform the development of novel, gender-specific strategies that may be more effective at curtailing sexual risk behavior.

Development of a measure of college students' adherence to religious doctrine concerning sexual behavior.

OBJECTIVE: The authors developed a 14-item measure of adherence to religious doctrine concerning sexual behavior (ARDSB). The ARDSB psychometric properties were investigated to better understand religious motivations associated with changes in sexual behavior that may provide support for sexual health promotion and prevention programs. PARTICIPANTS: Four hundred eighty-three undergraduates aged 18 to 26. METHODS: Data were collected from an online survey during the 2012-2013 academic school year. RESULTS: Principle components factor analysis identified 2 factors: reasons to break religious doctrine and reasons to adhere to religious doctrine concerning sexual behavior. The subscales had good internal consistency. Correlations, t tests, and analyses of variance of the subscales with measures of intrinsic and extrinsic religiosity and self-reported sexual behavior and risk provide support for concurrent validity. CONCLUSIONS: The ARDSB could be employed as a measure to better understand sexual behavior; it is inexpensive and relatively easy to employ in both research and campus ministry settings.

Identifying Adolescent Patients at Risk for Sexually Transmitted Infections: Development of a Brief Sexual Health Screening Survey.

This study examined the association between survey responses to health behaviors, personality/psychosocial factors, and self-reported sexually transmitted infections (STIs) to create a brief survey to identify youth at risk for contracting STIs. Participants included 200 racially diverse 14- to 18-year-old patients from a pediatric primary care clinic. Two sexual behavior variables and one peer norm variable were used to differentiate subgroups of individuals at risk of contracting a STI based on reported history of STIs using probability (decision tree) analyses. These items, as well as sexual orientation and having ever had oral sex, were used to create a brief sexual health screening (BSHS) survey. Each point increase in total BSHS score was associated with exponential growth in the percentage of sexually active adolescents reporting STIs. Findings suggest that the BSHS could serve as a useful tool for clinicians to quickly and accurately detect sexual risk among adolescent patients.