Bidirectional Associations Between Pain and Perceived Stress Among Veterans: Depressive Disorder as a Predisposing Factor.

OBJECTIVE: Military veterans who were injured in combat very often report pain along with co-occurring perceived stress and preexisting depressive disorder. The systems model of pain is a theoretical model suggesting that pain and perceived stress are bidirectionally associated at the within-person level, and associations are heightened among those with depressive disorder. However, the systems model of pain has not been adequately tested. Testing the systems model of pain could illuminate salient treatment targets for combat-injured veterans with pain and co-occurring psychological problems. METHODS: The present study empirically tests the systems model of pain among a sample of combat-injured veterans ( N = 902) surveyed five times during an 18-month period. We used a multigroup, autoregressive latent trajectory with structured residual statistical model to test the within-person associations between pain and perceived stress and determine whether associations differ between veterans with and without a positive screen for depressive disorder. RESULTS: In line with the systems model of pain, pain and perceived stress were bidirectionally associated only among combat-injured veterans with depressive disorder. Among such veterans, perceived stress was positively associated with subsequent pain ( b = 0.12; 95% confidence interval = 0.06-0.17), and pain was positively associated with subsequent perceived stress ( b = 0.44; 95% CI = 0.11-0.77). CONCLUSIONS: Our work highlights the interplay between pain and its psychological correlates among a particularly at-risk population. Clinicians addressing pain and perceived stress among combat-injured veterans should be prepared to identify and address depressive disorder.

Longitudinal associations between insomnia, cannabis use and stress among US veterans.

Insomnia is highly prevalent among military veterans, with rates nearly double that of civilian populations. Insomnia typically co-occurs with other psychological problems, including substance use (e.g. cannabis) and perceived stress. Much of the research focused on insomnia, stress and cannabis use explores cannabis as a sleep aid and a mechanism for stress relief. However, recent theoretical and empirical evidence suggests a dynamic interplay between insomnia, cannabis use and perceived stress, yet few longitudinal studies exist. Using a sample of 1105 post-9/11 veterans assessed over four time points across 12 months, we used latent difference score modelling to examine proportional change between insomnia, perceived stress and cannabis use. Results revealed a complex interplay between all three constructs. In particular, we show that higher prior levels of insomnia are associated with greater increases in perceived stress, and greater prior levels of stress are associated with greater increases in cannabis use. Perhaps more importantly, our results also point to cannabis use as a catalyst for greater increases in both stress and insomnia severity. Our results suggest there may be both benefits and costs of cannabis use among veterans. Specifically, for veterans who experience chronic sleep problems, perceived stress may become overwhelming, and the benefit of stress reduction from increased cannabis use may come at the cost of increasing insomnia symptomology.

An Examination of Pregaming Behavior and Motives among Sexual and Gender Minority College Students.

Introduction: Pregaming is a popular but high-risk drinking behavior common among college students. Although sexual and gender minority (SGM) college students are a vulnerable population with regards to hazardous alcohol use and alcohol consequences, there is currently limited research investigating the pregaming behavior of this group. The present study aimed to (1) examine mean level differences in pregaming behaviors and motives between SGM and non-SGM college students and (2) explore how SGM status was associated with pregaming behaviors and if SGM status moderated the association between motives and pregaming behaviors. Methods: The sample consisted of 485 college student drinkers in the US, with 19% (n = 93) identifying as SGM. All participants completed measures of past 30-day pregaming frequency and quantity (yielding a total pregaming drinks outcome) and drinking consequences experienced on pregaming days. Results: SGM participants consumed significantly fewer pregaming drinks than non-SGM participants, but did not significantly differ on alcohol-related consequences or drinking motives. The pregaming motive of intimate pursuit moderated the association between SGM status and total pregaming drinks, such that non-SGM participants with high intimate pursuit motives drank the heaviest. Conclusions: Our findings suggest that SGM students consume significantly fewer pregaming drinks than their non-SGM counterparts. However, they may be at a similar risk of experiencing pregaming consequences as non-SGM students. SGM students were less susceptible to the effect of intimate pursuit motives on pregaming drink consumption. This study offers support for past research regarding the effects of certain pregaming motives on pregaming drink consumption and consequences.

Protective Behavioral Strategies and Alcohol Use While Pregaming: The Moderating Role of Depression and Anxiety Symptoms.

BACKGROUND: The study evaluated the moderating role of anxiety and depression symptoms on the association between subscales on the Protective Behavioral Strategies for Pregaming (PBSP) scale (safety and familiarity, setting drink limits, pacing drinking, and minimizing intoxication) and alcohol consumption during pregaming. Methods: Participants were 359 traditional age undergraduate college students (M = 20, SD = 1.37; 61.7% female; 61.2% White) who reported pregaming in the past year. All participants completed measures through an online survey which evaluated PBSP, depression and anxiety symptoms, and alcohol use during pregame events in the past month. Results: Among students with high depression symptoms, the more frequent use of PBSP to minimize intoxication was not associated with alcohol consumption levels, whereas among those with low depression symptoms, higher use of PBSP to minimize intoxication was associated with higher alcohol consumption. Among those with high anxiety symptoms, the more frequent use of PBSP to minimize intoxication was associated with lower alcohol consumption at pregaming events, whereas among those with low anxiety symptoms, the use of this PBSP was associated with higher alcohol consumption. The more frequent use of PBSP related to safety and familiarity among those with high anxiety symptoms was unrelated to alcohol consumption during pregaming, whereas among those low in anxiety symptoms, the more frequent use of this PBSP was associated with lower alcohol consumption. Conclusion: The findings begin to inform clinical care and intervention techniques aimed at reducing harm associated with risky drinking practices among a vulnerable subset of college students.

Development of a Measure to Assess Protective Behavioral Strategies for Pregaming among Young Adults.

Background: Although most young adults drink alcohol, there are specific drinking contexts that are associated with increased risk for alcohol-related consequences. One such drinking context is pregaming, which typically involves heavy drinking in brief periods of time and has consistently been linked to consequences within the pregaming event itself, on a night after pregaming, and in the long-term. Intervention efforts that specifically target this risky behavior are needed, but these efforts need to be informed by empirical work to better understand what behaviors young people engage in that can protect them from pregaming-related harms. Purpose: We designed this study to create a measure of protective behavioral strategies that young people use before, during, and after pregaming to inform future intervention work. Methods: We tested an item pool with 363 young adult college students who engaged in pregaming in the past year and conducted exploratory factor analysis to develop a 19-item Protective Behavioral Strategies for Pregaming (PBSP) scale, which featured four subscales of safety and familiarity, setting drink limits, pacing strategies, and minimizing intoxication. Results: Each subscale negatively and significantly correlated with measures of alcohol use and consequences, though subscales differed in their associations with specific pregaming outcomes and by sex. Conclusion: This initial exploratory examination of the PBSP scale's psychometric properties suggests that use of protective behavioral strategies used specifically during pregaming events may protect young people from heavy drinking and harms. More research with the PBSP scale is encouraged to determine its practical utility as a clinical and assessment tool with young people.

Examining the Role of Source Credibility and Reference Group Proximity on Personalized Normative Feedback Interventions for College Student Alcohol Use: A Randomized Laboratory Experiment.

BACKGROUND: Personalized normative feedback (PNF) interventions are designed to reduce misperceived drinking norms by delivering feedback regarding the actual drinking behavior of college students, thereby leading to subsequent reductions in one's own drinking. OBJECTIVE: We examined the roles of data source credibility and reference group proximity in the effectiveness of a laboratory-based PNF intervention to reduce perceived drinking norms and thereby decrease intentions to drink. METHOD: Following completion of an online preintervention survey and using a 2 (highly credible data source/low credible data source) × 2 (proximal reference group/distal reference group) between-subjects factorial design, 104 college student drinkers were randomly assigned to condition. Participants then completed a postintervention questionnaire to assess for changes in various aspects of drinking. RESULTS: Highly credible feedback was associated with greater reductions in perceived weekly drinking by American college students compared to feedback with low credibility. Similarly, more proximal than distal reference group feedback led to greater reductions in perceived weekly drinking by a same-gender/same-class year students at one's university. No condition effects emerged for intended drinks per week. CONCLUSIONS: PNF interventions may benefit from considering data source credibility and reference group proximity to reduce misperceptions of college student drinking, depending on the goals and resources of practitioners implementing such programs. Even the use of such a distal reference group as American college students can indeed lead to a reduction of normative perceptions provided there is an emphasis on the credibility of the data source.

Is Prepartying a Cause of Heavy Drinking and Consequences Rather Than Just a Correlate? A Longitudinal Look at the Relationship Between Prepartying, Alcohol Approval, and Subsequent Drinking and Consequences.

BACKGROUND: Prepartying, or drinking before an event where more alcohol may or may not be consumed, has been positioned in the literature as a behavior engaged in by heavy drinkers. However, recent findings suggest that prepartying may confer distinct risks, potentially causing students to become heavier drinkers over time. OBJECTIVES: The goals of this study were to disentangle the longitudinal relationships between prepartying, general and episodic alcohol consumption, and alcohol-related consequences by investigating (1) whether prepartying is associated with future consequences above and beyond current alcohol consumption habits and (2) whether augmentations in approval for alcohol and related increases in drinking mediate this relationship. METHODS: One-hundred and ninety-five undergraduates completed online questionnaires at baseline, 6 months, and 12 months later. RESULTS: Prepartying frequency was more strongly related to alcohol-related consequences one year later than was overall or episodic drinking. In addition, a path mediation model confirmed our hypothesis that this relationship is due to gradual increases in drinking which occur as a result of more approving attitudes toward alcohol brought on by exposure to prepartying. Conclusion/Importance: Findings suggest a new model for conceptualizing the relationship between prepartying, drinking, and consequences whereby students who get involved in prepartying may witness slow increases in their approval for alcohol use and, as a result, consumption. Importantly, results suggest that the increases in drinking displayed by prepartiers over the course of a year may account for the strong relationship between prepartying and later consequences. Prevention and intervention initiatives may benefit from directly targeting prepartying as a means of tempering risky alcohol use trajectories during one's college tenure.

Perceived parent and peer marijuana norms: the moderating effect of parental monitoring during college.

This study examined descriptive and injunctive normative influences exerted by parents and peers on college student marijuana approval and use. It further evaluated the extent to which parental monitoring moderated the relationship between marijuana norms and student marijuana outcomes. A sample of 414 parent-child dyads from a midsize American university completed online surveys. A series of paired and one-sample t tests revealed that students' actual marijuana use was significantly greater than parents' perception of their child's use, while students' perception of their parents' approval were fairly accurate. The results of a hierarchical multiple regression indicated that perceived injunctive parent and student norms, and parental monitoring all uniquely contributed to the prediction of student marijuana approval. Furthermore, parental monitoring moderated the effects of perceived norms. For example, at low but not high levels of parental monitoring, perceptions of other students' marijuana use were associated with students' own marijuana approval. Results from a zero-inflated negative binomial regression showed that students who reported higher descriptive peer norms, higher injunctive parental norms, and reported lower parental monitoring were likely to report more frequent marijuana use. A significant Parental Monitoring × Injunctive Parental norms interaction effect indicated that parental approval only influenced marijuana use for students who reported that their parents monitored their behavior closely. These findings have intervention implications for future work aimed at reducing marijuana approval and use among American college students.

Barriers and Facilitators to Behavioral Healthcare for Women Veterans: a Mixed-Methods Analysis of the Current Landscape.

Women veterans have historically faced barriers to behavioral health treatment, particularly through the VA. In conjunction, there have been changes in behavioral healthcare delivery resulting from efforts to improve care for women veterans and the COVID-19 pandemic (e.g., widespread telehealth implementation). The current study draws on a quantitative and qualitative study centering current perspectives of women veterans in their choices to seek or not seek behavioral healthcare in VA and non-VA settings through interviewing 18 women recruited from a larger survey study on veteran behavioral health (n = 83 women, n = 882 men) on their experiences with behavioral health care access and satisfaction, including barriers and facilitators to seeking care. Quantitative findings are descriptively reported from the larger study, which outlined screening for behavioral health problems, behavioral health utilization, treatment modality preferences, and barriers/facilitators to care. While women in the survey sample screened for various behavioral health disorders, rates of treatment seeking remained relatively low. Women reported positive and negative experiences with telehealth and endorsed many barriers to treatment seeking in interviews not captured by survey findings, including lack of women-specific care (e.g., care for military sexual trauma, women-only groups), reports of stranger harassment at the VA, and lack of female providers. Women veterans continue to face barriers to behavioral healthcare; however, ongoing efforts to improve care access and quality, including the implementation of telehealth, show promise in reducing these obstacles. Continued efforts are needed to ensure diverse treatment modalities continue to reach women veterans as this population grows.

A latent profile analysis of social anxiety, depression, and pregaming motives among heavy-drinking college students.

BACKGROUND: Pregaming is a high-risk drinking behavior that is associated with heavy drinking and negative alcohol-related consequences. College students may engage in pregaming for several reasons, including to enhance social experiences or cope with negative affect. Research shows that associations between drinking, social anxiety, and depression are multifaceted. However, our understanding of the complex associations of mental health symptoms with pregaming motives and behaviors remains limited. METHODS: This study examined heterogeneity in how pregaming motives, social anxiety, and depression associate with past 30-day pregaming variables (quantity, frequency, and negative consequences). We used latent profile analysis (LPA) in a sample of heavy-drinking university students (N = 479). RESULTS: LPA results indicated four profiles: mild/moderate social anxiety and depression symptoms, moderate motives (n = 285), minimal social anxiety and depression symptoms, low motives (n = 61), subclinical/elevated social anxiety and depression symptoms, high motives (n = 75), and clinically elevated social anxiety and depression symptoms, moderate motives (n = 58). The subclinical/elevated symptoms, high motives profile reported the highest pregaming frequency and consequences, including blackouts. Individuals in the clinically elevated symptoms, moderate motives profile reported more consequences than those in the minimal symptoms, low motives and mild/moderate symptoms, moderate motives profiles. Individuals in the minimal symptoms, low motives profile reported the fewest consequences. CONCLUSIONS: Among these students, social anxiety and pregaming motives were associated with more frequent pregaming and social anxiety and depression were associated with greater negative consequences. Interventions that target pregaming-specific motives among students with mental health symptoms may be warranted to reduce this risky behavior and associated drinking-related harm.

Study design to evaluate a web-intervention to prevent alcohol and cannabis-impaired driving and use among adolescents in driver education.

BACKGROUND: Alcohol and cannabis are the most commonly used substances among adolescents in the U.S. The consequences related to using both substances together are significantly higher relative to use of either substance alone. Teens' propensity to engage in risky driving behaviors (e.g., speeding, rapid lane changes, and texting) and their relative inexperience with the timing and duration of cannabis' effects puts them at heightened risk for experiencing harms related to driving under the influence. Use of alcohol and cannabis peak at age 16, the legal age teens may apply for a provisional driver's license in some states. Targeting novice teen drivers prior to licensure is thus an ideal time for prevention efforts focused on reducing alcohol and/or cannabis initiation, use, and impaired driving. METHODS: The current study proposes to evaluate the efficacy of webCHAT among 15.5 to 17-year-old adolescents (n = 150) recruited at driver education programs. WebCHAT is a single session online intervention that aims to prevent alcohol and cannabis use and risky driving behaviors. We will recruit adolescents enrolled in driver education programs, and stratify based on whether they used cannabis and/or alcohol in the past 3 months (60% screening negative and 40% screening positive). All participants will receive usual driver education and half will also receive webCHAT. We will test whether webCHAT in addition to usual driver education reduces alcohol and/or cannabis initiation or use and reduces risky driving attitudes and behaviors (intent to drive after drinking/using, riding as a passenger with someone who drank/used) compared to teens in usual driver education over a 6-month period. We will also explore whether variables such as beliefs and perceived norms serve as explanatory mechanisms for our outcomes. DISCUSSION: The study has the potential to promote public welfare by decreasing adolescent initiation and use of cannabis and alcohol and reducing risky driving behaviors that can have substantial monetary, personal, and social costs. The study recruits adolescents who are at risk for substance use as well as those who are not and it is delivered remotely during a teachable moment when adolescents receive driver education. Trial registration This study was registered with ClinicalTrials.gov on July 13, 2021 (NCT04959461). https://clinicaltrials.gov/ct2/show/NCT04959461.

Considerations Around the Use of Intensive Outpatient Programs for Service Members Who Experienced Sexual Trauma in the U.S. Military.

Section 702 of the fiscal year 2019 National Defense Authorization Act directed the U.S. Department of Defense (DoD) to conduct a pilot study to assess the feasibility and advisability of using intensive outpatient treatment programs to address posttraumatic stress disorder (PTSD) and associated mental health problems among service members who have experienced sexual harassment or sexual assault while in the military. RAND researchers conducted a programmatic review of four intensive outpatient programs (IOPs)-two in the private sector and two in DoD-to understand different program components available to active-duty service members who have suffered sexual trauma and other trauma. A review of policies to understand TRICARE authorization procedures and other regulations governing IOPs and an analysis of data from the 2014 RAND Military Workplace Study survey on the prevalence of sexual trauma among personnel with mental health conditions helped obtain contextual information to inform the Psychological Health Center of Excellence's response to Congress. The review identified evidence-based approaches that IOPs have successfully used in programs designed for military service members and barriers to using this type of care to treat members of the military community. While examining the IOP model of care, the research team identified knowledge gaps surrounding the experiences, treatment needs, and effectiveness of different treatment components and models of care for active-duty service members affected by the mental health consequences of sexual harassment and sexual assault in the military.

High Spirits? Exploring "Halloweekend" Alcohol and Cannabis Use Among Heavy-Drinking College Students.

OBJECTIVE: Specific events are associated with heavier and riskier substance use behaviors among college students, including holidays like Halloween, which may include several days of themed parties/events ("Halloweekend"). The current study compared drinking, pregaming (i.e., fast-paced drinking before going out for the night), cannabis use, same-day alcohol and cannabis co-use, and negative alcohol-related consequences over Halloweekend compared with two adjacent non-Halloween weekends among a sample of heavy-drinking university students. METHOD: Participants (N = 228; 65% female) provided 28 days of daily diary data. We used a three-level generalized linear mixed model (GLMM) approach estimating zero-inflated Conway-Maxwell Poisson regressions to assess the effect of weekend and specific weekend day on number of overall drinks, number of pregaming drinks, and negative alcohol-related consequences. Proportions tests assessed for differences in any cannabis use and daily co-use between Halloweekend and non-Halloween weekends. RESULTS: Zero-inflated portions of the GLMMs indicated that general drinking, pregaming, and negative consequences were most prevalent on Halloweekend and Fridays and Saturdays. Count portions of the models indicated that general drinking quantity was highest during these periods, and participants experienced a greater number of negative consequences on Halloweekend compared with the weekend before; no differences were observed in the quantity of pregaming drinks consumed across weekends or days. No significant differences in cannabis use or co-use were observed between weekends. CONCLUSIONS: Given risk associated with Halloweekend compared with weekends immediately before and after, interventions targeting alcohol use and pregaming on Halloweekend may be beneficial to reduce related harm for heavy-drinking students.

A mobile-based pregaming drinking prevention intervention for college students: A pilot randomized controlled trial.

OBJECTIVE: Pregaming is among the riskiest drinking behaviors in which college students engage, often leading to elevated blood alcohol levels and negative alcohol-related consequences. Yet, tailored interventions to reduce risk associated with pregaming are lacking. The present study was designed to develop and evaluate the efficacy of a brief, mobile-based intervention targeting heavy drinking during pregaming among college students, called Pregaming Awareness in College Environments (PACE). METHOD: PACE was developed using two innovations to facilitate behavior change: (a) a mobile-based application to increase intervention accessibility and (b) personalized pregaming-specific intervention content delivered using a harm reduction approach with cognitive behavioral skills training. After development and ß-testing, we employed a randomized clinical trial with 485 college students who reported pregaming at least once per week in the past month (Mage = 19.98; 52.2% from minoritized racial and/or ethnic groups; 65.6% female). Participants were randomly assigned to PACE (n = 242) or a control condition website (n = 243), which consisted of general information about the effects of alcohol. Analysis assessed intervention effects on pregaming drinking, global drinking, and alcohol-related consequences at 6 and 14 weeks postintervention. RESULTS: Although participants in both conditions reduced drinking, small and significant intervention effects favoring PACE were found at 6-week follow-up for overall drinking days, pregaming days, and alcohol-related consequences. CONCLUSIONS: Findings suggest the brief mobile PACE intervention has potential to address risky drinking, but more intensive pregaming-focused efforts may be necessary to achieve stronger and lasting effects among college students. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Study protocol for a sequential multiple assignment randomized trial to reduce risky drinking among service members and their partners.

BACKGROUND: Military spouses and partners in relationships with a heavy drinking service member report high levels of mental health concerns and consequences, which are compounded when both partners drink heavily. Military spouses and partners -termed "concerned partners" (CPs)-may be an important gateway for motivating service members (SMs) to seek care. However, CPs may first need to reduce their own drinking and improve their communication to effectively support and encourage changes for their service member partner. Partners Connect is a web-based intervention aimed at improving communication and relationship quality and increasing SM help-seeking. METHODS: The current study design is a two-stage Sequential Multiple Assignment Randomized Trial (SMART) to develop an adaptive CP intervention to decrease CP drinking and increase SM help-seeking. CPs aged 18 and older (n = 408) will be recruited via social media and followed for six months. In stage one, we will randomize CPs to either a 4-session web-based intervention (Partners Connect) or to receive communication resources from the Gottman Institute website. The goal is to have CPs invite their SM to complete an online personalized normative feedback (PNF) session. If their SM completes the PNF at stage one, CPs will be considered "responders," if the SM does not complete, CPs who are "non-responders" will be re-randomized during stage two to receive either (1) a CRAFT workbook or (2) phone-based CRAFT if in Partners Connect; or (1) Partners Connect or (2) a CRAFT workbook if in Gottman. DISCUSSION: By first intervening with the service member's CP, we aim to better equip them to engage their service member partner in treatment services. In doing so, we develop a model that increases treatment accessibility and appeal among a group that may not otherwise seek care. CLINICALTRIALS: gov Identifier: NCT05619185.

Injunctive and descriptive normative feedback for college drinking prevention: Is the whole greater than the sum of its parts?

OBJECTIVE: Single-component personalized normative feedback (PNF) interventions and multicomponent personalized feedback interventions (PFI) have been shown to reduce alcohol consumption among college students. The present study compared the efficacy of PNF interventions targeting descriptive norms alone (descriptive PNF), injunctive norms alone (injunctive PNF), or their combination (combined PNF), against a multicomponent PFI and an attention control condition. METHOD: Undergraduates (N = 1,137) across two universities who reported a minimum of one past-month episode of heavy episodic drinking (i.e., 4 +/5 + drinks on a single occasion for females/males) completed assessments at baseline and 3, 6, and 12 months postintervention. RESULTS: Relative to the attention control, participants in each of the four intervention conditions showed greater reductions in perceived descriptive/injunctive norms, total drinks per week, and alcohol-related consequences. Peak estimated blood alcohol concentration was also reduced in the injunctive PNF, combined PNF, and multicomponent PFI conditions, with the latter two conditions showing an advantage for duration of effects. The multicomponent PFI condition also evidenced greater reductions than the injunctive PNF in descriptive norms at 3-month and injunctive norms at 6- and 12-month follow-ups. No other group comparisons on any outcome were significant. CONCLUSIONS: Each intervention has merit for use in college student harm reduction efforts. Single-component or combined PNF could be considered a potential starting point, as PNF is less burdensome than a multicomponent PFI when considering ease and length of delivery. Results can inform optimization of norms-based interventions and guide recommendations on efficacious components for reducing alcohol use and harms on college campuses. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

I can play all night: examining the relationship between perceived tolerance and drinking game alcohol consumption.

The present study examined the impact of perceived tolerance to alcohol on maximum alcohol consumption while playing drinking games. Participants were student drinkers (N=3,546) from two west coast universities. Among these students, 69.2% (n=2,290) reported playing a drinking game in the past month. Analyses demonstrated game players had higher perceived tolerances, and consumed more alcohol than non-game players. A regression model revealed that higher levels of perceived tolerance were related to increased maximal alcohol consumption while playing drinking games. Study limitations and implications for future research are discussed.

Military Behavioral Health Staff Perspectives on Telehealth Following the Onset of the COVID-19 Pandemic.

The COVID-19 pandemic prompted sweeping changes to behavioral health care delivery in the Military Health System (MHS), which turned to telehealth to minimize disruptions and ensure continuity of care for service members. Four to seven months into the pandemic, MHS behavioral health staff at ten military treatment facilities shared their experiences using telehealth and their perspectives on its utility, barriers to its wider integration in the MHS, and concerns about its use in the post-pandemic future. Telehealth use was previously low across the MHS, but it increased dramatically with the onset of the pandemic. At the time they were interviewed, nearly all providers who treated service members with posttraumatic stress disorder, depression, or substance use disorders were using audio-only telehealth in some capacity. Although most were not using video telehealth, three-quarters expressed an openness to using it in the future. However, the widespread integration of telehealth in the MHS will need to include efforts to overcome technical and administrative barriers and to address provider concerns about telehealth modalities for behavioral health care delivery-for example, the need for clinical guidance on using telehealth with specific types of patients, and provider and patient orientation on using telehealth technology.

A Longitudinal Study of Alcohol and Cannabis Use in Young Adulthood: Exploring Racial and Ethnic Differences in the Effects of Peer and Parental Influences From Middle Adolescence.

OBJECTIVE: This study assessed how changes from middle adolescence to young adulthood in peer and parental influences relate to frequency of alcohol and cannabis use in young adulthood and evaluated the differences between three racial/ethnic groups. METHOD: The analytic sample (n = 2,808; 52.9% female; 54% Hispanic, 22.9% White, 23.1% Asian/Pacific Islander) was derived from a longitudinal cohort initially recruited from 16 middle schools in Southern California who completed annual surveys. Data were collected across six waves beginning in Spring 2013 (mean age = 16.2) through Spring 2019 (mean age = 21.6). RESULTS: Multigroup latent growth models revealed consistent increases during adolescence and young adulthood in perceived peer and parental approval of alcohol and cannabis and in the amount of time spent around peers who used these substances. After we controlled for prior use, these increases related to alcohol and cannabis use at age 21, with few exceptions. The time spent around peers most strongly influenced later cannabis use for Hispanic young adults, whereas the influence of peer approval on later alcohol and cannabis use, and parental approval on later alcohol use, was strongest among White young adults. CONCLUSIONS: The frequency of alcohol and cannabis use in young adulthood was shaped, in part, from increases in direct and indirect peer influence and perceived parental approval of substance use across two important developmental periods. The findings highlight the importance of early and sustained intervention efforts targeting these social influences, especially among White adolescents, which may potentially decrease alcohol and cannabis use as youth enter young adulthood.

A mobile-based pregaming drinking prevention intervention for college students: study protocol for a randomized controlled trial.

BACKGROUND: Pregaming is a high-drink context popular among college students that often leads to elevated blood alcohol levels and negative consequences. Over 15 years of research studies have demonstrated that pregaming represents one of the riskiest known behaviors among college students, yet no pregaming-specific interventions have been developed to help prevent this behavior. General brief interventions for students do not reduce pregaming behavior and may not be appropriate, as they do not help students develop skills unique to the pregaming context that could help them drink less. We developed a brief, mobile-based intervention that is proposed to prevent heavy drinking during pregaming for college students, with the ultimate goal that behavioral reductions in this risky practice will ultimately affect global drinking and prevent consequences. METHODS/DESIGN: The intervention, Pregaming Awareness in College Environments (PACE), was developed by combining two innovations to facilitate behavior change: (1) a mobile-based application that increases accessibility, is easy and engaging to use, and broadens the reach of the intervention content and (2) personalized pregaming-specific intervention content with harm reduction and cognitive behavioral skills proven to be mechanisms preventing and reducing heavy drinking among college students. After a develop and beta-test phase, we propose to test the efficacy of PACE in a preliminary randomized controlled trial with 500 college students who pregame at least once per week. Pregaming, general drinking, and alcohol-related consequences outcomes will be examined in the immediate (2 weeks post-intervention) and short-terms (six and 14-week post-intervention). We will also evaluate moderator effects for age, sex, and heaviness of drinking to allow for more refined information for a planned larger test of the intervention to follow this initial trial of PACE. DISCUSSION: This pregaming intervention clinical trial, if found to be efficacious, will culminate with an easily-disseminated mobile-based intervention for college student drinkers. It has the potential to reach millions of college students, perhaps as a clinical tool used by college counseling centers as an adjunct to formal care or as a preventive tool for first-year students or other high-risk groups on campus. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT04016766.