A step forward in conceptualizing psychological closeness/distance to suicide methods: A qualitative approach.

INTRODUCTION: Suicide is a leading cause of death, making suicide prevention a major public health priority. Increasing understanding of factors influencing suicidal behavior is paramount. Previous research has implicated psychological closeness, characterized by perceptions of how close/distant or attached/detached one feels to a particular object, as a cognitive factor that influences suicidal behavior. However, a better understanding of how psychological closeness to suicide methods is conceptualized by relevant populations is needed to improve its assessment and understand how it may confer risk for suicide. METHODS: The goal was to refine the conceptualization of psychological closeness to suicide methods by incorporating feedback from relevant populations. We conducted 30 interviews with those primarily identifying as having lived experience of suicide (n = 10), clinicians who work with suicidal patients (n = 11), and suicide researchers (n = 9). A rigorous thematic approach using NVivo software was used to uncover common themes. RESULTS: Primary themes included familiarity, comfort, and attachment, with one emerging theme of symbolism. We define these themes, provide context to their meaning, and share exemplary quotes across diverse participants. CONCLUSION: We consider clinical, research, and policy implications from an interdisciplinary lens and discuss the strengths and limitations of this study.

The COVID-19 Lived Experience Through the Eyes of Nursing and Social Work Students.

Purpose: The purpose of this study was to explore the lived experiences of nursing and social work students who were taking courses during the COVID-19 pandemic. Focus group discussions gave students a chance to express the pandemic's effects on their education and life. Methods: A hermeneutic phenomenological approach using Van Manen's Four Lifeworld Existentials guided this study. Using an open-ended format, interviews were conducted in 6 small groups ranging from 2 to 9 individuals, in person or via Zoom. The study was conducted from May to August 2022 in a university setting with 23 participants. Results: Ten existential themes emerged: Being Behind, Groundhog Day, Trying to Keep Up, Loss of Community, Fear of COVID, Being Alone, What is Self-Care?, Is This Career Right for Me?, What is Healthy?, and Access to Counseling. Conclusions: Participants indicated that the COVID-19 pandemic negatively impacted educational delivery, limiting learning opportunities and increasing feelings of isolation, stress, and anxiety. Implications for Education and the Future Workforce: Projected health-care workforce shortages may be exacerbated by students departing from the health-care professions as a result of increased burnout. Resilience training while in school is necessary to help promote coping, self-care strategies, and retention in the health-care professions.

'My safety depends on everyone else feeling safe and good': emotion work among transgender and gender diverse Texans.

Emotion work is a regulatory method used to change the degree or quality of one's own or another's emotions. Among sexual minority people, emotion work is a regulatory method utilised to maximise identity expression while maintaining harmony in interpersonal connections. However, little is known about the utilisation of emotion work among transgender and gender diverse (TGD) people. We sought to address this gap by qualitatively exploring emotion work among members of this population. We conducted semi-structured focus groups and interviews with 11 TGD adults. Eligibility criteria included (1) English speaking, (2) at least 18 years old, (3) currently living in Texas, and (4) identifying as TGD. Interviews explored identity-related experiences of discrimination and affirmation in different social environments, and emotional, physiological and behavioural responses. Interview transcripts were analysed by four researchers using thematic analysis. Four superordinate themes were developed: 1) feeling rules, 2) intrapersonal processes, 3) identity management strategies, and 4) psychophysiological strain. We found transgender and gender diverse participants feel responsible for emotion work to maintain comfort in social interactions often at the expense of authentic identity expression and psychosocial wellbeing. Findings are interpreted using the existing literature on identity management and emotion regulation. Implications for clinical practice are also provided.

Characteristics of Cannabis and Opioid Users Among Older U.S. Veterans and Their Health Outcomes: A Longitudinal Perspective.

Medical cannabis use among U.S. Veterans has continued to rise. However, data on cannabis use by older Veterans is generally less available. This study aims to understand the characteristics of older Veterans who enrolled in the Medical Cannabis Patient Program in Illinois and analyze their health outcomes and co-use of cannabis and opioids using longitudinal survey data. Overall, participants reported positive outcomes for pain, sleep, and emotional problems because of cannabis use in two survey periods. Approximately, 62% and 85% respondents reported no change in memory and falls, respectively, with only 3% and 1% reporting a negative outcome for the conditions in both surveys. About 20.4% of those who indicated cannabis use only in the initial survey started to co-use opioids in the follow-up survey, while 44.1% of those who indicated the use of both substances in the initial survey reported no longer using opioids in the follow-up survey. However, these changes were not statistically significant (α=0.05). The logistic regression showed that both clinical and contextual factors affected co-use. In conclusion, older U.S. Veterans may be using cannabis to alleviate their pain and other chronic conditions. More research is needed to understand the effect of cannabis use on reducing or substituting opioids.

Prevention, Practice, and Policy: Older US Veterans' Perspectives on Cannabis Use.

BACKGROUND AND OBJECTIVE: Veterans often struggle with disabling physical and mental health conditions that tend to worsen as they age. Current medications used to treat these conditions include opioids and benzodiazepines though they can have negative side effects. Looking for alternatives to these medications, many older Veterans use cannabis for medical purposes. We aimed to develop a deeper understanding of older Veterans' cannabis use. METHODS: We used maximum variation sampling to select 32 Veterans who had completed baseline and follow-up surveys to participate in semi-structured interviews. RESULTS: After applying a thematic analysis, results show older Veterans are using medical cannabis as a means of harm reduction as an adjunct or substitute for other medications and substances with limited guidance from their healthcare providers. Veterans also reported that there exists an inconsistency across the Veterans Health Administration system regarding the interpretation and application of cannabis policies. CONCLUSIONS: Drawing from these findings, we explore medical cannabis as a harm reduction technique and discuss how a lack of physician engagement and current Veterans Health Administration policies discourage older Veterans from discussing and potentially benefiting from the use of medical cannabis.

"It's the Environment, Not Me": Experiences shared by transgender and gender diverse adults living in Texas.

Transgender and gender diverse people (TGD) experience elevated rates of behavioral health problems, including depression, anxiety, substance misuse, and suicidality. Minority stressors (e.g., discrimination and victimization) contribute to these poor health outcomes. A salient form of discrimination is the use of gender nonaffirming language, such as using incorrect pronouns or names, yet less is known about other environmental stimuli that may be reined as affirming or nonaffirming. A recent study uncovered the impact symbols (e.g., flags, stickers) may have on invoking positive or negative feelings among TGD youth in the Midwest. Our study further investigates this phenomenon with TGD adults in Texas. During Summer 2021, 3 researchers conducted audio-recorded semistructured focus groups and interviews with 11 participants who identified as transgender, gender nonconforming, or nonbinary. Interview topics included gender-affirming and nonaffirming language, positive and negative experiences, nonsupportive and supportive symbolism, and coping mechanisms. In this manuscript, we present findings regarding symbolism. Within our two primary themes, supportive and nonsupportive symbolism, subthemes emerged. Supportive symbolism includes flags and signage, written and oral language and communication, and representation of diversity. Nonsupportive symbolism includes extreme patriotism and religious symbols and highly gendered settings. Further, Texas-specific culture and a meter of safety were identified as being related to interacting with and observing an array of symbols. Symbolism can have a profound impact on someone's identity development, expression, emotions, coping mechanisms, and access to and engagement with social environments, exemplifying the importance of understanding geographic and cultural-specific mechanisms within environments TGD people occupy.

Weeding Out the Stigma: Older Veterans in Illinois Share Their Experiences Using Medical Cannabis.

Many U.S. Veterans are using cannabis for medical purposes. Modern research findings continue to point to medical cannabis as a potentially effective alternative to prescription medications for treating a range of medical conditions. While research exists on the use levels of cannabis, limited research can be found on the perceived stigma of using cannabis, especially among older Veterans. We surveyed 121 older U.S. Veterans who were enrolled in the Illinois Medical Cannabis Patient Program during Fall 2020. We then used maximum variation sampling to select a subset of 32 Veterans to partake in a phone interview. Two researchers conducted and qualitatively coded 30-minute audiotaped semi-structured interviews. Interview topics included (1) the use of cannabis, opioids, and benzodiazepines; (2) interactions with medical providers; (3) stigma regarding cannabis use; and (4) educational materials. We share findings from stigma. We identified three themes: (1) stereotypes regarding people who use cannabis, (2) media portrayal of cannabis users, and (3) hesitation in disclosing cannabis use. Stigma creates situations in which older Veterans may be hesitant to disclose their use of cannabis with physicians and friends/family, which can be dangerous and socially isolating. Additional research is needed to expand upon our findings with more generalizable methods.

Qualitatively Exploring Mental Health Attitude Changes among Emerging Adult Motivational Interviewing after One Motivational Enhanced Interview.

Emerging adult military members and veterans (MMV) are experiencing many transitions (e.g., adulthood, military). The sum of these changes can cause stress, anxiety, and mental health challenges. Stigma of mental health and treatment exists, and military populations are often not seeking or engaging in appropriate care. Recent research emphasizes the need to uncover mental health attitudes and self-stigma barriers regarding help seeking. We evaluated the impact of a single motivational-interviewing enhanced interview with 26 MMV, all who reported high risk substance use. In 75-minute interviews with the primary focus of discussing their experiences regarding mental health, substance use, and identity development, the interviewer incorporated motivational interviewing strategies (e.g., affirmations, complex reflections). Participants shared their developmental experiences, stressors transitioning, and barriers and stigma around mental health treatment. Participants completed a survey which included a variety of standardized measures and open-ended questions two weeks before and after the interview. Qualitative follow-up data via open ended questions shows the session was well received by participants as they could share their stories, think critically about their military experiences, and brainstorm solutions for mental health care. We conclude that using individual, confidential interviews to discuss sensitive topics for data collection with MMV is an area to continue developing. Conducting qualitative research with motivational interviewing strategies has the potential to be twofold: advance scholarship and inform practitioners, but also serve as a therapeutic platform for some participants. Supplementary Information: The online version contains supplementary material available at 10.1007/s10615-022-00837-z.

Sensitivity and specificity of the CRAFFT to identify heavy cannabis use: Evidence from a large statewide adolescent sample.

BACKGROUND AND AIM: Screening adolescents at risk for cannabis use disorders is critical. The CRAFFT is a screening tool designed to address both alcohol and drug use among youth. Current study tests the psychometric properties of the CRAFFT and attempts to modify one of the screening items to compare the efficiency. DESIGN: We examined the ideal cut-off point of the CRAFFT for identifying persons with heavy cannabis use and compared the utility of the original and revised CRAFFT. PARTICIPANTS: Sample (N = 132,555) averaged 16.19 (±1.21) years of age; 51.0% were female, 59.7% were White, 15.2% were Latino/Latina, and 6.7% were African-American. Majority resided in non-rural area and 34.5% were receiving free or reduced lunch at school. MEASUREMENTS: Heavy cannabis use was defined as using cannabis 10 or more times in the past 30 days. Sensitivity, specificity, the area under the receiver operating characteristic curve, and Youden value were analyzed to determine the ideal cut-off point. FINDINGS: Maximum overall predictive accuracy was at a cutoff score of 2 or higher when using the original CRAFFT questions. At a cutoff score of 2, sensitivity was 82.0%, specificity was 83.7%, with an AUC of 0.880. On the contrary, when an alternative CAR question was used, maximum predictive accuracy was at a cutoff score of 1 or higher when predicting heavy cannabis use. At a cutoff score of 1, sensitivity was 92.7%, specificity was 75.5%, with an AUC of 0.900. CONCLUSIONS: The results provide evidence that the CRAFFT is a promising brief diagnostic instrument for heavy cannabis use among youth. Modification to Car item may have potential in reducing disparities in sensitivity among different racial ethnic groups, as well as those who with low socioeconomic status.

Improving Recruitment Procedures for School-Based Surveys: Through the Lens of the Illinois Youth Survey.

BACKGROUND: Epidemiological surveys are designed to collect representative trend data. School-based surveys are important to utilize so systems can effectively create prevention and intervention programs to alter youths' perceptions and behaviors related to substance use. However, there are many barriers when implementing a school-based survey. METHODS: This mixed methods study sought to uncover 30 school personnel's challenges when making the decision to implement the Illinois Youth Survey (IYS). Through a descriptive and interpretive approach, participants' thoughts to improve future recruitment procedures and reduce barriers for implementation were analyzed. RESULTS: Results found challenges included: (1) time; (2) parent-opt out consent letter; (3) wording of the survey responses; (4) honesty of the students' responses; (5) importance and use of the data. Moreover, the most common suggestions to improve recruitment included: (1) sharing knowledge about trend data; (2) year-round communication with school personnel; (3) targeting school personnel groups; and (4) providing examples of data use. CONCLUSIONS: Findings can be used to improve recruitment procedures for others who have similar challenges. If schools, counties, and states have representative data they can more precisely tailor their programming to meet the needs of their population.

The Green Sheep: Exploring the Perceived Risks and Benefits of Cannabis Among Young Military Members and Veterans.

Medical and recreational cannabis are becoming more accessible and socially accepted across the United States. Emerging adults (EAs; 18 to 29) are the largest group of cannabis users. Studies have found that veterans are more likely to report cannabis use compared to nonveterans. While research exists on the use levels of cannabis, limited knowledge is available on the perceived risks and benefits of using cannabis among EA military and veteran populations. Helping professionals encounter veterans who use cannabis and must consider military cultural factors and attitudes towards cannabis that may influence or exacerbate cannabis use. We conducted a qualitative study with 23 EA veteran and military members with high-risk substance use and asked about their thoughts on the acceptability, risks, and perceived benefits associated with cannabis. Two qualitative coders used NVivo to find themes following the six steps of thematic analysis. Results provide in-depth understanding of EA military members and veterans' perceptions of cannabis. Overall, we found participants were receptive to using cannabis for pain ailments, mental health issues, and as an alternative to benzodiazepines, opioids, and alcohol. However, they acknowledged restrictions are needed to moderate cannabis use and mitigate negative outcomes. Lastly, participants recognized the incongruence of cannabis use with military job responsibilities and expectations. These findings shed light on potential risk and protective factors related to using cannabis for recreational or medical reasons and should be considered when consulting EA military members and veterans.

Usability and Acceptability of a Mobile App to Help Emerging Adults Address their Friends' Substance Use (Harbor): Quantitative Study.

BACKGROUND: Technology-assisted intervention and prevention strategies present opportunities for substance use-related research with emerging adults (EAs) and their peers. Emerging adulthood is a developmentally distinct period in which individuals between the ages of 18 and 29 years undergo unique emotional, cultural, developmental, and biological changes as they transition into adulthood. Crowdsourcing, or gathering feedback from a large group within web-based communities, offers researchers a unique and cost-effective way to obtain large amounts of information in a short period. OBJECTIVE: This paper presents market feedback obtained via Amazon's Mechanical Turk from EAs (N=458) on the acceptability and utility of brief intervention scripts for a smartphone app currently under development. The mobile app, Harbor, teaches friends of EAs with substance use problems effective and supportive strategies for helping their friend make changes in their substance use behavior. METHODS: We examined feedback on the wording of the intervention scripts and estimated the market size of EAs who may use this app. Furthermore, we calculated correlations between script ratings and measures of personal risky drinking (ie, Alcohol Use Disorder Identification Test) and the participants' use of confrontational, enabling, or supportive behaviors with an existing friend. RESULTS: Approximately half of our sample (208/458, 45.4%) indicated that they had a close friend for whom they had concerns about their substance use, suggesting a potentially high demand for an app such as Harbor. Initial findings suggest that peers who engage in less enabling behaviors with friends who have a substance use problem exhibited lower risky drinking behaviors overall (r206=-0.501; P<.001). Concerning acceptability, 98.0% (449/458) of the sample rated the scripts' dialogue as either somewhat, moderately, or extremely realistic (mean 3.92, SD 0.48) on 5-point Likert scale items. Finally, 95.4% (437/454) of respondents indicated that the scripts would be at least slightly helpful for training peers to help their friends with substance use issues. Finally, individuals who were better able to identify enabling language in enabling scripts self-reported fewer enabling behaviors toward their friend's substance use (r206=-0.236; P=.001). CONCLUSIONS: There exists a demonstrated level of desirability and acceptability among EAs for a mobile app such as Harbor. EAs who wish to engage in more supportive behaviors with their friends who engage in substance use and who are amenable to assisting their friends with sobriety likely would use and benefit from this app.

Peer Victimization, Internalizing Problems, and Substance Use in Urban African American Adolescents in Chicago: The Relevance of the Self-Medication Hypothesis.

The aim of the study was to explore the link between peer victimization and substance use and tested the mediating role of internalizing problems in urban African American adolescents in Chicago. Six hundred and thirty-eight adolescents in Chicago's Southside participated in the study. Results from the hierarchical linear regression analysis showed that youth who reported peer victimization were at risk of internalizing problems. Those who were bullied by their peers were more likely to display internalizing problems, which was also significantly associated with substance use. Consistent with the self-medication hypothesis, findings from the study suggest that bullied youth are likely to display internalizing problems and turn to substance use. Implications for mental health practice in school settings are also discussed.