User Experience of a Just-in-Time Smartphone Resonance Breathing Application for Substance Use Disorder: Acceptability, Appropriateness, and Feasibility.

BACKGROUND: Addressing the negative impact of substance use disorders (SUDs) on individuals, families, and communities is a public health priority. Most treatments and interventions require engagement with a healthcare provider or someone who can offer recovery support. The need for interventions that facilitate self-management of relapse triggers at the moment they occur is also critical. Our study aimed to explore the user experience of individuals using a just-in-time smartphone episodic resonance breathing (eRPB) intervention to address stress, anxiety, and drug cravings. METHODS: We conducted an 8-week pilot study of the eRPB with 30 individuals in recovery from SUD. Data on 3 indicators of user experience-acceptability, appropriateness, and feasibility-were collected using survey questions (n = 30) and semi-structured interviews (n = 11). We performed univariate analysis on the survey data and deductive thematic analysis on the qualitative data. RESULTS: A majority of the survey respondents agreed that the application (app) was acceptable (> 77%), appropriate (> 82%), and feasible (> 89%). Several interview participants stated that the app helped them relax and manage stress and cravings and expressed appreciation for the simplicity of its design. Participants also reported barriers to feasibility (such as forgetting to use the app) and recommendations for improvement (such as the addition of motivational messages). CONCLUSIONS: Our findings show that individuals in recovery from SUD had highly positive experiences with the eRPB app. A positive user experience may improve adherence to the intervention and, ultimately, the self-management of stress, anxiety, and craving relapse triggers.

It's not just Black and White: Identifying the combined influence of multi-level determinants of tobacco use among Black adolescents.

OBJECTIVE: Black individuals are disproportionately affected by tobacco-related illnesses. Although tobacco use is often initiated in adolescence and risk factors thereof originate from multiple domains of influence, investigations of tobacco use among Black adolescents seldom consider these multiple domains simultaneously. These examinations are needed to identify the influence of co-occurring risk factors on tobacco use and inform comprehensive tobacco prevention and treatment programs. Our study sought to identify the combined influence of factors across multiple domains on tobacco use among Black adolescents. METHOD: Participants were Non-Hispanic Black (N = 1,801) adolescent (age 12-17 years) respondents from Wave 1 of the Population Assessment of Tobacco and Health study. Latent class analysis identified unique response patterns to items assessing risk of tobacco use across sociocultural, environmental, psychological, and behavioral (e.g., alcohol use) domains. Subsequent logistic regressions compared the odds of ever and current tobacco use between the classes. RESULTS: Four latent classes were identified. According to item response probabilities they were named: Low Risk (LR: 36.5%), Low Psychological (LP: 19.0 %), High Psychological (HP: 30.4%) and High Social, Psychological, and Behavioral (HSPB: 14.1%) risk. The odds of ever and current tobacco use were highest among adolescents in the HSPB latent class compared to the other latent classes (odds ratio: 6.5 to 42.1). CONCLUSIONS: Adolescents with the highest odds of tobacco use endorse multiple risks including feeling distress, perceiving tobacco as beneficial for handling stress, and using substances, and may prioritize the management of negative emotions over perceived health consequences from tobacco use. Multi-level interventions that incorporate the development of coping strategies for effectively handling negative affect may prove highly effective in preventing tobacco use among Black adolescents.

Acceptability and Perceived Utility of Virtual Reality Among People Who Are Incarcerated Who Use Drugs.

People who are incarcerated are at heightened risk of overdose upon community reentry. Virtual reality (VR) may provide an innovative tool for overdose prevention intervention in corrections facilities. This mixed methods study sought to understand incarcerated individuals' perspectives on VR for overdose prevention and explore physiological arousal associated with use of VR equipment. Study participants were 20 individuals, stratified by gender, with an opioid use disorder at a county jail. Qualitative interviews assessed acceptability and perceived utility of VR in the jail setting. Thematic analysis indicated high levels of acceptability and potential utility in the following areas: (a) mental health and substance use interventions, (b) community reentry skills training, and (c) communication and conflict resolution skills. Heart rate variability (HRV) data were collected continuously during the interview and during VR exposure to explore whether exposure to the VR environment provoked arousal. Physiological data analyses showed a significant decrease in heart rate (HR) [b = -3.14, t(18) = -3.85, p < .01] and no arousal as measured by root mean square of successive RR interval differences (RMSSD) [b = -0.06, t(18) = -1.06, p = .30] and high frequency-HRV (HF-HRV) [b = -0.21, t(18) = -1.71, p = .10]. This study demonstrated high acceptability and decreased HR response of VR among incarcerated people who use drugs.

Mobile resonance frequency breathing smartphone application to support recovery among people with opioid use disorder: Study protocol for feasibility study.

BACKGROUND: Experiencing drug cravings is an aspect of substance use disorders that frequently compromises the recovery efforts of people who use drugs. Most treatment approaches that address drug cravings either involve cognitive strategies or medication. Few interventions directly address the physiological aspects of craving, such as increased heart rate. Previous research has demonstrated that slow-paced breathing may be effective in managing drug cravings by manipulating an individual's heart rate. The purpose of this paper is to describe a study protocol for an intervention that offers resonance frequency breathing training for managing cravings via a smartphone application (app). METHODS: This trial is registered in ClinicalTrials.gov (Identifier: NCT05830773). The intervention focuses on persons in recovery from opioid use disorder who receive services from the Texas Health and Human Service Commission Recovery Support Services division. Participants will be trained to use Camera Heart Rate Variability (CHRV), a resonance frequency breathing app. The CHRV app measures heart rate and the volumetric variations of blood circulation. When experiencing stress, anxiety, or cravings, participants will use the app to practice breathing exercises. Participants (N = 60) will also complete surveys at baseline, 4 weeks, and 8 weeks; the survey questions, covers demographic characteristics, personal trauma history, substance use experience, and utilization of substance use treatment services. The surveys will also include psychosocial measures of craving, stress, and anxiety to allow the study team to assess changes between baseline and study completion. Participants who complete the full 8-week intervention will be invited to participate in a 30-minute interview about their experience with the app. Interviews will provide details on implementation outcomes, including acceptability, appropriateness, and feasibility. CONCLUSION: Many evidence-based interventions for opioid use require interpersonal communication with individuals in one's recovery network. However, individuals may be unable to engage others in their recovery network in the moments when they are experiencing cravings or stress- and anxiety-related triggers. Therefore, recovery support interventions that emphasize individual self-management of cravings, stress, and anxiety when they occur can empower individuals in recovery and enhance existing interventions.

Applications of Immersive Virtual Reality for Illicit Substance Use: A Systematic Review.

OBJECTIVE: This study aims to review applications of immersive, head-mounted display (HMD)-delivered virtual reality (VR) technology for the assessment and modification of clinically relevant factors (e.g., craving, electrophysiological reactions, brain activation) present in illicit substance use. METHOD: A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-guided systematic review was conducted and retrieved articles from four databases. Articles included were peer-reviewed, empirical studies and were screened on criteria pertaining to sample using (or with a history of using) substances and measurement of substance-related factors. RESULTS: Eighteen articles met inclusion criteria. Applications of immersive, HMD-delivered VR in assessment and modification were most prevalent among individuals using (or with a history of using) methamphetamine and targeted subjective craving, electrophysiological biomarkers (e.g., heart rate variability, skin conductance), and brain activity. Environments presented through VR involved substance-relevant cues (e.g., paraphernalia) and neuropsychological assessments. The majority of assessment studies elicited clinically relevant factor(s) present in illicit substance use through VR and all reviewed modification studies effectively reduced clinically relevant factors in methamphetamine and opioid use (e.g., craving, subjective pain). CONCLUSIONS: There is evidence to support the use of immersive, HMD-delivered VR in the assessment and modification of clinically relevant factors in methamphetamine use, as well as preliminary evidence to support its effectiveness for clinically relevant factors in opioid use. Future research should further examine the effectiveness of HMD-delivered VR in modifying illicit substance use and triangulate biomarkers measured in individuals using illicit substances.

The relative contribution of ethnic identity and ethnic discrimination on alcohol, tobacco, and other drug use disorders among Hispanic/Latin American individuals.

INTRODUCTION: Racial/ethnic discrimination and ethnic identity, the affiliation and connection to one's ethnic group, are important for understanding alcohol, tobacco, and drug use disorders (AUD, TUD, DUD, respectively) among Hispanic/Latin American individuals. Although discrimination is a well-recognized risk factor, the role of ethnic identity is less understood. Moreover, no study has examined which of these factors is more important for informing AUD, TUD, and DUD. This information is necessary for creating effective prevention and treatment programs tailored for Hispanic/Latin American people. Herein we examined the role and relative importance of racial/ethnic discrimination and Hispanic ethnic identity on past year AUD, TUD, and DUD. METHODS: Hispanic/Latin American participants of the National Epidemiologic Survey on Alcohol and Related Conditions-III constituted the sample for this cross-sectional secondary data analysis. Participants (N = 7037) were 39.93 years old on average (SD = 15.32). More than half were female (56.1 %) and had family incomes below the median household income in the United States (58.7 %). Most had national origins in North America (79.3 %), including US dependent territories and Mexico. Confirmatory factor analysis (CFA) verified the psychometric properties of the discrimination and Hispanic ethnic identity measures. Logistic regressions, supplemented with dominance analysis, estimated the role and relative contribution of discrimination and Hispanic ethnic identity on the probability of past year AUD, TUD, and DUD. RESULTS: The CFAs yielded adequate convergent validity and reliability for each construct. More racial/ethnic discrimination and a higher Hispanic ethnic identity related to a higher and lower probability of AUD, TUD, and DUD, respectively. The magnitude of the association between Hispanic ethnic identity and the probability of TUD exceeded that of racial/ethnic discrimination, but the converse was the case for AUD and DUD. CONCLUSIONS: Prevention and treatment programs for TUD that highlight the value of having a strong sense of self as a member of a Hispanic ethnic group, and that encourage the individual to explore their Hispanic ancestry may prove effective among Hispanic/Latin American individuals, particularly those who have experienced racial/ethnic discrimination. Programs for AUD and DUD tailored for Hispanic Latin/American adults should also incorporate coping strategies to address experiences with racial/ethnic discrimination.

"We do it ourselves": strengths and opportunities for improving the practice of harm reduction.

BACKGROUND: Unprecedented increases in substance-related overdose fatalities have been observed in Texas and the U.S. since the onset of the COVID-19 pandemic and have made clear there is considerable need to reduce harms associated with drug use. At the federal level, initiatives have called for widespread dissemination and implementation of evidence-based harm reduction practices to reduce overdose deaths. Implementation of harm reduction strategies is challenging in Texas. There is a paucity of literature on understanding current harm reduction practices in Texas. As such, this qualitative study aims to understand harm reduction practices among people who use drugs (PWUD), harm reductionists, and emergency responders across four counties in Texas. This work would inform future efforts to scale and spread harm reduction in Texas. METHODS: Semi-structured qualitative interviews were conducted with N = 69 key stakeholders (25 harm reductionists; 24 PWUD; 20 emergency responders). Interviews were transcribed verbatim, coded for emergent themes, and analyzed using Applied Thematic Analysis with Nvivo 12. A community advisory board defined the research questions, reviewed the emergent themes, and assisted with interpretation of the data. RESULTS: Emergent themes highlighted barriers to harm reduction at micro and macro levels, from the individual experience of PWUD and harm reductionists to systemic issues in healthcare and the emergency medical response system. Specifically, (1) Texas has existing strengths in overdose prevention and response efforts on which to build, (2) PWUD are fearful of interacting with healthcare and 911 systems, (3) harm reductionists are in increasing need of support for reaching all PWUD communities, and (4) state-level policies may hinder widespread implementation and adoption of evidence-based harm reduction practices. CONCLUSIONS: Perspectives from harm reduction stakeholders highlighted existing strengths, avenues for improvement, and specific barriers that currently exist to harm reduction practices in Texas.

Differences among factors associated with tobacco product use among Black and White adolescents: A cross-sectional analysis of wave one of the PATH study 2013-2014.

INTRODUCTION: Tobacco use remains a primary cause of health disparities between Black and White Americans. Current approaches have not improved tobacco-related racial health disparities. This study aimed to identify differences in factors associated with tobacco product use among Black and White adolescents. METHODS: This cross-sectional design used data from Wave One (2013-2014) of the Population Assessment of Tobacco and Health Study. Adolescents aged 12-17 years who identified as non-Hispanic Black or African American (n=1800) or non-Hispanic White (n=6495) were included. Primary outcomes were the ever use and current use of any tobacco products. Sociocultural, household environment, psychological, and behavioral factors were included. Logistic regressions, stratified by race, were used to determine significance. Dominance analysis was used to rank significant factors by their level of importance. RESULTS: Although there were many Black-White commonalities, there were also important differences. Black adolescents in the Northeast were more likely to have ever used tobacco compared to those in the South (OR=0.6; 95% CI: 0.6-0.7, p<0.001) and Midwest (OR=0.6; 95% CI: 0.5-0.7, p<0.001). White adolescents in the Northeast were less likely to use tobacco products than in other regions. Peer influences (OR=1.9; 95% CI: 1.1-3.2, p<0.05) were uniquely associated with ever use among Black adolescents. Access to tobacco in the home (OR=2.0; 95% CI: 1.4-3.0, p<0.001) and thinking that tobacco use would help reduce stress (OR=1.3; 95% CI: 1.1-1.6, p<0.01) were uniquely associated with current use among Black adolescents. CONCLUSIONS: There are significant Black-White differences in the factors associated with tobacco use. Factors uniquely associated with Black adolescent tobacco use should be considered in developing strategies to prevent adolescent tobacco use in Black communities.

"If It Didn't Get Reported, It Didn't Happen": Current Nonfatal Overdose Reporting Practices among Nontraditional Reporters in Texas.

Background: Drug overdose deaths in Texas have been accelerating in recent years with an increase of 33% in the 12 months leading up to December 2020. Accurate counts of nonfatal overdoses - including associated aspects of overdose, such as substances involved, demographic information, and reversal agents administered is critical to increase timely and adequate response to individuals and communities in need. Methods: Twenty semi-structured interviews were conducted with harm reduction workers across four Texas counties to understand existing methods of reporting overdoses, naloxone dissemination/administration, and recommendations for improving overdose surveillance. Interviews were transcribed and emergent themes were identified based on the a priori research goals. Results: Findings highlighted a variety of overdose data collection methods and tools among harm reduction organizations including Excel spreadsheet, web-based TONI application, notes on personal cell phones, and paper notes. Types of overdose data collected varied widely. Participants noted existing methods are suboptimal and that there is a need for a unified, statewide reporting system to improve overdose data capture. Participants also highlighted that overdose surveillance should include "hidden populations" of people who use drugs that are not currently counted in surveillance methods as a result of not interacting with the healthcare system. Conclusions: Texas lacks a unified overdose reporting system to capture critical data to inform overdose response and prevention efforts. Nontraditional reporters may be critical toward improving overdose syndromic efforts and capturing data among hard-to-reach populations. Harm reduction organizations are uniquely positioned to facilitate reporting among community gatekeepers and people who use drugs.

Longitudinal Correlates of Suicide Ideation in People who use Drugs during the COVID-19 Pandemic.

Some individuals may be more vulnerable to increased suicide-related thoughts and behavior in response to the COVID-19 pandemic but few studies have investigated risk factors that may be more predictive/specific to particular populations that are established to have a high risk for suicide, including gender differences in risk factors. We conducted a longitudinal study investigating risk factors for suicide ideation during the COVID-19 pandemic in adults who use alcohol and other drugs. Participants completed up to three surveys over a six-month follow-up period. Trait differences in substance use, COVID exposure/worry, trauma exposure, mood and post-traumatic stress disorder symptoms were investigated between individuals who presented with suicide ideation during course of study, compared to those that did not. Interactions with gender was investigated. State-related changes that relate to fluctuations in suicide ideation were also investigated (within subject design). A total of 214 participants were enrolled (61% women, agemean= 33 years, 45% presenting with suicide ideation during the course of the study). Greater frequency of vaping and using tobacco, opiates, and other substances, greater depression, anxiety, and PTSD symptoms, and greater COVID exposure and COVID-related worry were observed in individuals who presented with suicide ideation, compared to those that did not (p ≤ .0042). Increases in suicide ideation (within subject) was associated with increases in the frequency of alcohol and vaping, COVID-related worry, and PTSD symptoms (p ≤ .05). Gender-related differences in factors that relate to suicide ideation was observed. Within women, increases in frequency of alcohol use and PTSD symptoms and greater perceived early life trauma related to suicide ideation; while in men increases in vaping and COVID-related worry related to suicide ideation. This study further emphasizes the importance of investigating and identifying risk/resiliency factors for suicide-related thoughts and behavior in people who use drugs, including gender differences.

Impact of COVID-19 among people who use drugs: A qualitative study with harm reduction workers and people who use drugs.

BACKGROUND: Fatal drug overdoses in the USA hit historical records during the COVID-19 pandemic. Throughout the pandemic, people who used drugs had greater odds of contracting COVID-19, increased drug use due to COVID-related stress, and heightened levels of anxiety and depression. This qualitative study examined the specific ways the pandemic negatively impacted people who use drugs. METHODS: Qualitative interviews with 24 people who use drugs and 20 substance use harm reduction workers were conducted. Data from the qualitative interviews were analyzed using applied thematic analysis to identify emergent themes based on the a priori research goals. RESULTS: Thematic analysis identified several common experiences during the pandemic among people who use drugs. These included mental distress due to financial strain and social isolation; increased drug use; increased risky drug-seeking and use behaviors due to changes in the drug markets; and reduced access to harm reduction, treatment, and recovery support services. CONCLUSIONS: Our study highlighted critical systemic failures that contributed to the rise in overdose deaths during the COVID-19 pandemic. Addressing these challenges through policy reform and improved funding models will ensure the sustainability of harm reduction services and increase access to substance use treatment among highly vulnerable people who use drugs.

Development of a digital platform to improve community response to overdose and prevention among harm reduction organizations.

The overdose crisis in the USA remains a growing and urgent public health concern. Over 108,000 people died due to overdose during 2021. Fatal and non-fatal overdoses are under-reported in the USA due to current surveillance methods. Systemic gaps in overdose data limit the opportunity for data-driven prevention efforts and resource allocation. This study aims to improve overdose surveillance and community response through developing a digital platform for overdose reporting and response among harm reduction organizations. We used a community-engaged, user-center design research approach. We conducted qualitative interviews with N = 44 overdose stakeholders including people who use drugs and harm reductionists. Results highlighted the need for a unified, multilingual reporting system uniquely tailored for harm reduction organizations. Anonymity, data transparency, protection from legal repercussions, data accuracy, and community-branded marketing emerged as key themes for the overdose platform. Emergent themes included the need for real-time data in a dashboard designed for community response and tailored to first responders and harm reduction organizations. This formative study provides the groundwork for improving overdose surveillance and data-driven response through the development of an innovative overdose digital platform.

Comparison of Concurrent and Same-Day Balance Measurement Approaches in a Large Sample of Uninjured Collegiate Athletes.

BACKGROUND: Measures of postural stability are useful in assisting the diagnosing and managing of athlete concussion. Error counting using the Balance Error Scoring System (BESS) is the clinical standard, but has notable limitations. New technologies offer the potential to increase precision and optimize testing protocols; however, whether these devices enhance clinical assessment remains unclear. PURPOSE: To examine the relationships between metrics of balance performance using different measurement systems in uninjured, healthy collegiate athletes. STUDY DESIGN: Cross-sectional. METHODS: Five hundred and thirty uninjured collegiate athletes were tested using the C3Logix app, which computes ellipsoid volume as a measure of postural stability during the six standard BESS conditions, while concurrently, errors were manually counted during each condition per standard BESS protocols. The association between concurrently measured ellipsoid volumes and error counts were examined with Spearman's correlations. From this sample, 177 participants also performed two double-leg conditions on the Biodex BioSway force plate system on the same day. This system computes Sway Index as a measure of postural stability. The association of ellipsoid volume (C3Logix) and Sway Index (Biodex) was examined with Spearman's correlations. Individual-level data were plotted to visually depict the relationships. RESULTS: C3Logix ellipsoid volume and concurrently recorded error counts were significantly correlated in five of the six BESS conditions (rs:.22-.62; p< 0.0001). C3Logix ellipsoid volume and Biodex Sway Index were significantly correlated in both conditions (rs=.22-.27, p< 0.004). However, substantial variability was shown in postural stability across all three measurement approaches. CONCLUSION: Modest correlation coefficients between simultaneous and same-day balance assessments in uninjured collegiate athletes suggest a need to further optimize clinical protocols for concussion diagnosis. LEVEL OF EVIDENCE: 2b.

Impact of COVID-19 Among People Who Use Drugs: A Qualitative Study With Harm Reduction Workers and People Who Use Drugs.

Background: Fatal drug overdoses in the United States hit historical records during the COVID-19 pandemic. Throughout the pandemic, people who used drugs had greater odds of contracting COVID-19, increased drug use due to COVID-related stress, and heightened levels of anxiety and depression. This exploratory qualitative study examined the specific ways the pandemic negatively impacted people who use drugs. Methods: Qualitative interviews with 24 people who use drugs and 20 substance use harm reduction workers were conducted. Data from the qualitative interviews were analyzed using applied thematic analysis to identify emergent themes based on the a priori research goals. Results: Thematic analysis identified several common experiences during the pandemic among people who use drugs. These included mental distress due to financial strain and social isolation; increased drug use; increased risky drug-seeking and use behaviors due to changes in the drug markets; and reduced access to harm reduction, treatment, and recovery support services. Conclusions: Our study highlighted critical systemic failures that contributed to the rise in overdose deaths during the COVID-19 pandemic. Addressing these challenges through policy reform and improved funding models will ensure the sustainability of harm reduction services and increase access to substance use treatment among highly vulnerable people who use drugs.

Digital neuropsychological test performance in a large sample of uninjured collegiate athletes.

Digital neuropsychological test batteries are popular in college athletics; however, well-validated digital tests that are short and portable are needed to expand the feasibility of performing cognitive testing quickly, reliably, and outside standard clinical settings. This study assessed performance on digital versions of Trail Making Test (dTMT) and a modified Symbol Digit Modalities Test (dSDMT) in uninjured collegiate athletes (n = 537; 47% female) using the C3Logix baseline assessment module. Time to complete (dTMT) and the number of correct responses (dSDMT) were computed, transformed into z scores, and compared to age-matched normative data from analogous paper-and-pencil tests. Overall sample performance was compared to normative sample performance using Cohen's d. Sample averages on the dTMT, Part A, and dSDMT were similar to published norms; 97 and 92% of z scores fell within 2 standard deviations of normative means, respectively. The sample averaged faster completion times on dTMT, Part B than published norms, although 98% of z scores were within 2 standard deviations of the normative means. Brief, digitized tests may be useful in populations and testing environments when longer cognitive test batteries are impractical. Future studies should assess the ability of these tests to detect clinically relevant changes following a suspected head injury.

Individual Baseline Balance Assessments in a Large Sample of Incoming NCAA Division I Athletes Using a Force Plate System.

BACKGROUND: Individualized baseline testing is resource and time intensive. The use of normative data to approximate changes after a suspected concussion is thus an appealing alternative. Yet, few peer-reviewed, large-sample studies are available from which to develop accurate normative averages of balance using force-plate technology. PURPOSE: This study sought to validate a normative dataset from the force-plate manufacturer and examine the magnitude and nature of sample variability. STUDY DESIGN: Cross-sectional. METHODS: Baseline balance and self-reported sex, sport, and concussion history were assessed in 533 prospective collegiate athletes (45% female) during pre-participation physical examinations. Balance was measured using four stances from the modified Clinical Test of Sensory Interaction and Balance and quantified as Sway Index Scores with the Biodex Biosway Portable Balance System. Group averages are contrasted to data from the force-plate manufacturer. Individual variability around these averages was visualized and analyzed by sex and sport. RESULTS: Male student athletes showed significantly more sway in the eyes open, soft stance condition than female athletes. These differences were maintained when concussion history was included as a covariate. Athletes, particularly male athletes, in the high versus low contact sport group showed significantly more sway in the eyes open, soft surface and the eyes closed, hard and soft surface stances. CONCLUSION: There was substantial individual variability that was partially explained by sex differences and sport differences. The development of normative averages for sway may benefit from consideration of sex and sport. Further studies should characterize other factors that influence baseline balance in collegiate athletes. LEVEL OF EVIDENCE: 2b.

Serving the Co-Morbid Mental Health and Substance Use Needs of People with HIV.

People with HIV (PWH) who have mental health disorders (MHD) and substance use disorders (SUD) have lower HIV medication adherence, higher unsuppressed viral loads, and higher mortality rates than those who do not. Individuals who have triple diagnoses (HIV, MHD and SUD) are at an exponential risk for these adverse outcomes. This study explored the barriers and facilitators to accessing and linking PWH with MHD and SUD services. Qualitative interviews with 90 participants were conducted to explore their experiences seeking treatment for MHD and SUD. Results of a thematic analysis found two important barriers to treatment access and utilization: unstable motivation to change and negative experiences with providers. Conversely, an internal drive to heal and rapport with providers facilitated positive treatment experiences. Findings of the study also indicate a need for an integrated treatment model where MHD, SUD, and HIV treatment are available at the same location.

Patterns of health behaviors affecting mental health in collegiate athletes.

OBJECTIVE: To examine the association of multiple health behaviors to mental health functioning in male and female collegiate athletes. Participants: Prospective National Collegiate Athletic Association (NCAA) Division I athletes (n = 183) completed a health and wellness survey in the summer prior to joining the athletic program. Methods: Health behaviors (eating, sleeping, substance use, sexual, and aggressive behaviors) and mental health functioning (psychological distress and perceived stress) were assessed. Partial least squares (PLS) modeling was used as a multivariate approach to simultaneously examine the association of health behaviors to mental health functioning. Results: Aggressive behaviors, alcohol use, and fatigue were significantly associated with symptoms of psychological distress and stress in both males and females. Attention to nutrition, unhealthy dietary habits, and lower alcohol use was further related to psychological distress in female athletes only. Conclusions: Athletes' eating, sleeping, substance use, and aggressive behaviors may provide insight into their mental health functioning.

Bigger Necks Are Not Enough: An Examination of Neck Circumference in Incoming College Athletes.

Neck circumference is quick and simple to measure and thus an attractive proxy of neck strength, a putative mechanism underlying risk of sport-related concussion (SRC). Research, however, is limited on the relationship of neck circumference to SRC. Our study examined differences in neck circumference based on sex, concussion history, concussions experienced subsequent to college entry, and participation in sports with high versus low risk for contact. Neck circumference was measured in incoming NCAA Division I athletes (N = 324) from a large northeastern university during athlete pre-participation physicals. Sex, sport team, and self-reported concussion history were obtained from retrospective pre-participation questionnaires and medical chart review. Concussion diagnoses during college were collected subsequent to neck measurements from medical chart review. Proportional neck circumference (normalized by body mass index) was computed. Each sport was categorized as involving high or low risk of contact (as a proxy of risk for injury). Sex differences in neck circumference and proportional neck circumference were assessed. Differences in neck circumference and proportional neck circumference were also characterized by contact risk and SRC history (with biological sex included as a covariate). Differences in neck circumference and proportional neck circumference were explored among those who did versus did not experience subsequent SRC diagnosis. Males had significantly larger neck circumference and proportional neck circumference than females. Neck circumference and proportional neck circumference were not related to SRC history or subsequent SRC. Neck circumference is a quick and simple measure; however, even when considered in proportion to body mass, it was unrelated to SRC. Future studies are needed to assess whether this is due to a lack of relationship between the neck and injury or limitations in circumference as a proxy measure of cervical spine characteristics and biomechanics.

Simultaneous Alcohol and Marijuana Use: A Brief Measure of Motives.

OBJECTIVE: Increasing numbers of substance users report simultaneous alcohol and marijuana (SAM) use such that their effects overlap. More research is needed to understand what motivates this behavior, especially to inform interventions that address SAM use. A 26-item measure of SAM motives was designed and tested in previous research. The purpose of the current study was to validate that measure and create a briefer version of it. METHOD: Using two waves of data from a multi-site sample of college students (n = 1,014), exploratory and confirmatory factor analyses were conducted to develop a brief 11-item SAM Motives Measure (B-SMM). Negative binomial regression analyses were conducted to assess the reliability and validity of both the original and brief measures. RESULTS: The brief measure contains four subscales (conformity, positive effects, calm/coping, and social) that match the empirically supported motivational model of substance use. Internal consistency of the subscales ranged from .77 to .87. Most subscales significantly predicted frequency and consequences of SAM use both concurrently and prospectively. CONCLUSIONS: The psychometrically sound measure developed in this study facilitates the examination of SAM motives in clinical settings with time-constrained patient contact and can be valuable for research involving frequent and repeated measures of substance use behaviors.