How providing a low-cost water filter pitcher led Latino parents to reduce sugar-sweetened beverages and increase their water intake: explanatory qualitative results from the Water Up!@Home intervention trial.

OBJECTIVE: This study sought to explain results of the Water Up!@Home randomised controlled trial where low-income parents were randomised to receive an educational intervention +a low-cost water filter pitcher or only the filter. Parents in both groups had reported statistically significant reductions in sugar-sweetened beverages (SSB) and increases in water intake post-intervention. DESIGN: Qualitative explanatory in-depth interviews analysed thematically and deductively. SETTING: Washington, DC metropolitan area, USA. PARTICIPANTS: Low-income Latino parents of infants/toddlers who had participated in the Water Up! @Home randomised controlled trial. RESULTS: The filter-stimulated water consumption in both groups by (1) increasing parents' perception of water safety; (2) acting as a cue to action to drink water; (3) improving the flavour of water (which was linked to perceptions of safety) and (4) increasing the perception that this option was more economical than purchasing bottled water. Safe and palatable drinking water was more accessible and freely available in their homes; participants felt they did not need to ration their water consumption as before. Only intervention participants were able to describe a reduction in SSB intake and described strategies, skills and knowledge gained to reduce SSB intake. Among the comparison group, there was no thematic consensus about changes in SSB or any strategies or skills to reduce SSB intake. CONCLUSIONS: A low-cost water filter facilitated water consumption, which actively (or passively for comparison group) displaced SSB consumption. The findings have implications for understanding and addressing the role of water security on SSB consumption.

The Adelante project: Realities, challenges and successes in addressing health disparities among central American immigrant youth.

OBJECTIVE: The Adelante intervention, implemented between 2013 and 2018, addressed an important syndemic health disparity for Central American immigrant youth approaching or in high school-the co-occurrence of substance abuse, sex risk (pregnancy, sexually transmitted infections, HIV), and interpersonal violence. Adelante was implemented and evaluated by the Avance Center for the Advancement of Immigrant/Refugee Health, which built on a university-community partnership that has been in place since 2005. Using a tailored, ecological positive youth development (PYD) approach, Adelante employed intervention strategies across ecological levels, including individual, family, peer, and community levels, with the use of social marketing and digital media strategies to link activities under one aspirational identity and support community engagement. METHOD: Using a Community Based Participatory Research approach with multiple community partners involved in the effort, the research assessed changes in co-occurring behavioral outcomes and tested hypotheses concerning relationships between PYD mediators and these outcomes. Multiple methods were used in collaboration with partners to assess intervention inputs and outcomes-detailed implementation process records; prepost surveys to assess changes in PYD assets, risk behavior knowledge, and prevention skills; a community survey in the intervention and comparison communities (total N = 3,600) at baseline and two follow-up waves; surveys of a high risk cohort (n = 238) at baseline and follow-up; and social marketing campaign surveys (n = 1,549) at baseline with 2 follow-up waves. RESULTS: Analysis showed multiple improvements in PYD mediators and risk behavior outcomes, including an overall 70% increase in knowledge and a 15% increase in prevention skills. Preliminary analysis of risk behavior outcomes demonstrated, for example, a significant, inverse effect on reported sexual activity (past 3 months) for both Adelante intervention community and cohort samples. In addition, self-reported exposure to the social marketing campaign was associated with positive effects on multiple outcomes, including drug use risk and violence attitudes, and improvement in violence/sexual risk behavior outcomes in the intervention versus comparison community. CONCLUSION: There are few models in the literature that provide a roadmap for how to address multiple, related health conditions in marginalized, immigrant communities, even as most health disparities are associated with complex social ecologies. The Adelante intervention adds a useful model of this nature to the evidence base, and provides support for the ecological approach to PYD with respect to such communities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

E-cigarettes and smoking cessation: a prospective study of a national sample of pregnant smokers.

BACKGROUND: Smoking during pregnancy has adverse health consequences for the mother and fetus. E-cigarettes could aid with smoking cessation but there is limited research on the prevalence and patterns of e-cigarette use, and their association with smoking cessation among pregnant smokers. METHODS: We conducted a secondary analysis of a randomized controlled trial of a text-messaging program for smoking cessation among a U.S. national cohort of pregnant smokers (n = 428). Outcomes assessed were trajectories of e-cigarettes use from baseline to one-month follow-up, and longitudinal association between e-cigarette use at baseline and smoking cessation at one-month follow-up. RESULTS: At baseline, 74 (17.29%) pregnant smokers used e-cigarettes in the past 30 days and 36 (8.41%) used e-cigarettes in the past 7 days. The primary reason stated for using e-cigarettes during pregnancy was for quitting. E-cigarette use between baseline and 1-month was inconsistent. Of 36 dual-users at baseline, 20 (55.56%) stopped using e-cigarettes by the 1-month follow-up and 14 initiated e-cigarette use. There was no evidence of an association between e-cigarette use at baseline and the primary smoking cessation outcome, 7-day point prevalence abstinence [adjusted odds ratio = 0.79, 95% confidence intervals = 0.33-1.92]. CONCLUSIONS: A secondary analysis of a national sample of pregnant smokers indicates that use of e-cigarettes is inconsistent and is not associated with improved smoking cessation outcomes. There is an urgent need to further examine the risk and benefits of e-cigarette use, especially during pregnancy.

The Mediating Effect of Adelante brand equity on Latino Immigrant Positive Youth Development Outcomes.

This paper reports on mediation analysis of effects of the Adelante brand, an innovative program for Latino immigrant adolescents and their families, and positive youth development (PYD) outcomes. Specific objectives were to increase adolescent engagement and participation in a community-based program called Adelante, based on PYD theory, which sought to reduce substance use, sexual risk taking, and interpersonal violence among Latino immigrant youth. A total of 238 parent-child dyads were recruited from a predominantly low-income Latino immigrant community and followed for an average of 22 months. Measures included demographics; acculturation; stress and coping; social support; violence, substance use, and sexual risk attitudes; future expectations; the Adelante brand equity scale; and PYD asset measures. Multiple regression modeling shows that the leadership brand equity construct is associated with decreased proviolence and increased antiviolence attitudes. Additionally, having any program exposure (vs. none) is associated with improved substance abuse attitudes in models adjusting for the loyalty brand equity construct. In mediation analysis, we observed a mediating effect of the leadership brand equity construct on improved antiviolence attitudes among those exposed to the Adelante program. As found in previous research, Adelante brand equity operated as a mediator of program effects on Latino youth PYD outcomes.

Applying Ecological Positive Youth Development Theory to Address Co-Occurring Health Disparities Among Immigrant Latino Youth.

This article outlines the theory and resulting approach employed in a multilevel, integrated, collaborative community intervention called Adelante, implemented by a university-community partnership in a Latino immigrant community to address co-occurring health disparities of substance abuse, sex risk, and interpersonal violence among youth. The basis for the intervention is a social-ecological interpretation of positive youth development theory, which focuses on changes in the person environment context and community assets as a preventive mechanism. This approach is viewed as appropriate for a community facing multiple barriers to health equity. The article describes the translation of this positive youth development model to practice, including the design of the intervention, intervention components, and the protocol for evaluation. The Adelante intervention is intended to reduce health disparities and, in addition, to add a broader community model to the evidence base.

Male Pattern Baldness in Relation to Prostate Cancer-Specific Mortality: A Prospective Analysis in the NHANES I Epidemiologic Follow-up Study.

We used male pattern baldness as a proxy for long-term androgen exposure and investigated the association of dermatologist-assessed hair loss with prostate cancer-specific mortality in the first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. From the baseline survey (1971-1974), we included 4,316 men who were 25-74 years of age and had no prior cancer diagnosis. We estimated hazard ratios and used Cox proportional hazards regressions with age as the time metric and baseline hazard stratified by baseline age. A hybrid framework was used to account for stratification and clustering of the sample design, with adjustment for the variables used to calculate sample weights. During follow-up (median, 21 years), 3,284 deaths occurred; prostate cancer was the underlying cause of 107. In multivariable models, compared with no balding, any baldness was associated with a 56% higher risk of fatal prostate cancer (hazard ratio = 1.56; 95% confidence interval: 1.02, 2.37), and moderate balding specifically was associated with an 83% higher risk (hazard ratio = 1.83; 95% confidence interval: 1.15, 2.92). Conversely, patterned hair loss was not statistically significantly associated with all-cause mortality. Our analysis suggests that patterned hair loss is associated with a higher risk of fatal prostate cancer and supports the hypothesis of overlapping pathophysiological mechanisms.

Male pattern baldness in relation to prostate cancer risks: an analysis in the VITamins and lifestyle (VITAL) cohort study.

BACKGROUND: Male pattern baldness and prostate cancer may share common pathophysiological mechanisms in terms of advancing age, heritability, and endogenous hormones. Results from previous epidemiologic studies are inconsistent. Therefore, we investigated the association of prostate cancer risks with male pattern baldness at age 30 years, age 45 years, and baseline (median age = 60.5 years) in the VITamins And Lifestyle (VITAL) cohort study. METHODS: We included 32,583 men who were aged 50-76 years and without prior cancer diagnosis (excluding non-melanoma skin cancer) at the start of follow-up. First primary incident prostate cancers were ascertained via linkage to the western Washington Surveillance, Epidemiology, and End Results (SEER) program. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were estimated using Cox proportional hazards regressions with adjustment for potential confounders. RESULTS: During follow-up (median = 9 years), 2,306 incident prostate cancers were diagnosed. Male pattern baldness at age 30 years, age 45 years, and baseline were not statistically significantly associated with overall or subtypes of prostate cancer. CONCLUSION: This study did not provide support for the hypothesis that male pattern baldness may be a marker for subsequent prostate cancer. Previous evidence indicates that a distinct class of frontal with vertex balding may be associated with increased risk of aggressive prostate cancer, but all such balding classes were captured as a single exposure category by the VITAL cohort questionnaire. Prostate 75:415-423, 2015. © 2014 Wiley Periodicals, Inc.

Victor and Erika Webnovela: An Innovative Generation @ Audience Engagement Strategy for Prevention.

Entertainment-education (E-E) approaches for young audiences continue to evolve in order to keep stride with younger generations' affinity for technology. E-E and novelas have been used with a wide variety of audiences in the United States, in particular hard-to-reach Latino populations, and have demonstrated effectiveness in disseminating culturally relevant prevention information for a wide variety of health-related risk factors and behaviors. This study discusses the formative research and active engagement of Latino youth living in Langley Park, Maryland, for the development and filming of an innovative 6-episode webnovela titled Victor and Erika (V&E). V&E is part of a larger branding strategy of the Adelante Positive Youth Development intervention that seeks to prevent substance abuse, sexual risk, and interpersonal violence among Latino youth; V&E is also an intervention component. The V&E webnovela is a dramatic portrayal of the lives of 2 immigrant Latino teenagers that also disseminates risk prevention messages. The storyline represents the turning the corner (to a better life) theme that underlies the Adelante intervention brand. Formative research was conducted for character development (n = 20) and creative development of the episodes (n = 14). Results of the formative research showed that youth recommended inclusion of the following topics in V&E episodes: sex, unintended pregnancy, fidelity, trust, family dynamics, immigration status, violence, school dropout, respect, home life, and poverty. Detailed character and episode descriptions are provided, and the implications of using the V&E series as a tool for in-person and online engagement of youth and the dissemination of prevention messages are also discussed.

Pathway to terrorist behaviors: The role of childhood experiences, personality traits, and ideological motivations in a sample of Iraqi prisoners.

Radicalization to terrorism is a multifaceted process with no single theory or approach to explain it. Although research has focused on understanding the process, there is still a dearth of studies that examine an empirically driven pathway to terrorism behavior. This study examines a cross-sectional sample of incarcerated men convicted of terrorism in Iraq (N = 160). A questionnaire-guided interview included adverse childhood experiences (ACEs), conduct disorder (CD), antisocial personality disorder (ASPD), religious and political ideology, views about causes of terrorism, and the severity of terrorist acts. Path analysis was employed to examine the relationships between these factors and to identify the model with the best fit. After adjusting for age, employment, and location, results indicated that ACEs positively impacted CD, ASPD, religious guidance, and terrorism attitudes. ASPD positively affected political commitment and terrorism attitudes, but inversely affected current religious commitment. Political commitment inversely influenced terrorism attitudes. Religious commitment positively influenced the prioritization of religion in life, which subsequently impacted terrorism attitudes and behavior severity. Additionally, attitudes toward terrorism directly affected the severity of terrorism behavior. All paths in the final model were statistically significant at p < 0.05. Although these findings may be limited in generalizability due to the unique sample, results support the complex and interdependent nature of childhood and adult experiences on the development of both terrorism attitudes and the severity of terrorism behavior.

Assessing Racial Effects on Adjudicative Competence.

As racial influences on forensic outcomes are identified in every aspect of practice, scholars are exploring methods to disentangle race from its historical, economic, and attitudinal antecedents. Because jurisdictions vary in these influences, definitions and data may differ among them, creating inconsistencies in analysis and policy. This retrospective database review compared differences in racial outcomes among 200 pretrial defendants, 160 Black and 40 White, exploring a wide range of socioeconomic, clinical, and forensic influences before, during, and after hospitalization. Because of the tight relationship of socioeconomic factors and race, investigators hypothesized that it would be difficult to distinguish racial influences alone. Using a confirmatory approach to data collection and a statistical analysis based in logistic regression, only differences in referral for psychological testing were identified. Application of this method based on local demographics and culture may prove useful for institutions interested in evaluating racial influences on forensic outcomes.

Distinguishing lone from group actor terrorists: A comparison of attitudes, ideologies, motivations, and risks.

The increasing recognition of the risks posed by lone-actor terrorists provides the impetus for understanding the psychosocial and ideological characteristics that distinguish lone from group actors. This study examines differences between lone and group actor terrorists in two domains: (i) attitudes toward terrorism, ideology, and motivation for terrorist acts; and (ii) empirically derived risk factors for terrorism. Using a cross-sectional research design and primary source data from 160 men convicted of terrorism in Iraq, this study applied bivariate and logistic regression analyses to assess group differences. It tested the hypothesis that there are no statistically significant differences between the groups. Bivariate analyses revealed that lone actors were less likely than group actors, to be unemployed, to cite personal or group benefit as the main motives for terrorist activity, and to believe that acts of terrorism achieved their goals. Regression analysis indicated that having an authoritarian father was the only factor that significantly predicted group membership, with group actors three times more likely to report this trait. Lone actors and group actors are almost indistinguishable except for certain differences in attitudes, motives, employment, and having an authoritarian father.

Use of a Water Filter at Home Reduces Sugary Drink Consumption among Parents and Infants/Toddlers in a Predominantly Hispanic Community: Results from the Water Up!@ Home Intervention Trial.

BACKGROUND: Water is recommended as an alternative for sugar-sweetened beverages (SSBs). Low-income, minority groups in the United States continue to exhibit high SSB and low water consumption, and are more likely to exceed 100% fruit juice recommendations. OBJECTIVE: To test the effects of a home-based intervention designed to replace SSBs with tap water and reduce excess juice consumption among parents and their infants/toddlers. DESIGN: Randomized controlled trial. PARTICIPANTS: Parents (n = 92) of infants/toddlers who participated in three Early Head Start home-visiting programs that serve predominantly Hispanic, low-income communities during 2019-2021. INTERVENTION: The 12-week intervention (Water Up!@Home) simultaneously addressed physical barriers to tap water consumption (via a water filter) and sociocultural barriers to replacing SSBs and juice with water (via a curriculum). Comparison group received a water filter only. We hypothesized that the intervention would lead to a reduction of 6 fl oz/d in SSB and juice consumption. MAIN OUTCOMES: Parent-reported self and infant/toddler SSBs, water (filtered, tap, or bottled), and 100% fruit juice consumption. STATISTICAL ANALYSES: Analysis of covariance to compare changes in consumption between experimental groups was performed. We also conducted t tests to assess changes within groups. RESULTS: Participants in both groups reported significant reductions in SSBs from baseline (parents: intervention [-11.2 fl oz/d; P < 0.01]; comparison [-8.0 fl oz/d; P < 0.01]; children: intervention [-1.50 fl oz/d; P = 0.03]; comparison [-1.56 fl oz/d; P = 0.02]), increased water consumption (parents in both groups [+5.6 fl oz/d]; children: intervention [+3.61 fl oz/d; P = 0.01], comparison [+2.24 fl oz/d; P = 0.05]), mostly from filtered tap water. Differences between groups were not statistically significant. Intervention participants reported significant reductions in 100% fruit juice vs comparison (parents: -3.6 fl oz/d vs -1.0 fl oz/d; P < 0.01; children: -0.73 fl oz/d vs +0.48 fl oz/d; P = .03). CONCLUSIONS: The intervention effectively reduced 100% fruit juice consumption. Water security should be examined as a contributor to SSB consumption in this population.

The association between major depressive disorder and obesity in US adolescents: results from the 2001-2004 National Health and Nutrition Examination Survey.

The association between major depressive disorder (MDD) and obesity was assessed in 4,150 US adolescents aged 12-19 years from the 2001-2004 National Health and Nutrition Examination Survey. Weight and height were measured by health professionals and MDD was based on a structured diagnostic interview. The prevalence of MDD in the past year among US adolescents was 3.2% and 16.8% of US adolescents were obese. After adjustment for sex, age, race/ethnicity and poverty, MDD was not significantly associated with obesity among adolescents overall (adjusted odds ratio (adjOR) = 1.6, 95% confidence interval (CI) = 0.9-2.9), but an increased odds of obesity was observed among males (adjOR = 2.7, 95% CI = 1.1-7.1) and non-Hispanic blacks (adjOR = 3.1, 95% CI = 1.1-8.3) with MDD. Future research on strategies that might reduce the risk of obesity in males and non-Hispanic black adolescents with MDD may be warranted.

Second primary breast, endometrial, and ovarian cancers in Black and White breast cancer survivors over a 35-year time span: effect of age.

Breast cancer incidence increases with age and exhibits a Black-to-White crossover around age 45. Breast cancer survivors are at a significantly elevated risk of developing a second primary breast or gynecological cancer compared with the general population. The purpose of this study was to determine whether a similar crossover occurs in hormonally related second primary breast, endometrial, or ovarian cancers in Black and White women. The Surveillance, Epidemiology, and End Results' Registry 9 was used to follow 415,664 White and 39,887 Black female breast cancer survivors, diagnosed at age 19 or older, for a second primary breast, endometrial, or ovarian cancer between 1973 and 2007. Cumulative incidence curves were generated; Pepe and Mori's test was used to test for significance. Second primary breast cancer followed the incidence pattern of the first primary breast cancer in Black and White women diagnosed before age 45. It was opposite of the pattern of first primary breast cancer in Black and White women diagnosed at age 45 or later. Second primary endometrial and ovarian cancers paralleled the incidence pattern of first primaries of the same anatomic site among Black and White women, independent of the age at diagnosis of the first primary breast cancer. Despite the Black-to-White crossover of first primary breast cancer around age 40, the incidence of hormonally related second primaries does not appear affected by the age at diagnosis of the first primary.

Factors influencing adjudicative competence and length of time to restoration.

Few studies on adjudicative competence explore the relationship between diagnosis, treatment, and restorability. Most focus on demographics and major psychiatric diagnosis with very few exploring the diagnoses common to the forensic population (i.e., personality disorders and substance abuse). Our study of 365 defendants who were incompetent to stand trial at a state psychiatric facility indicates that non-restored defendants have a greater likelihood of cognitive disorders, misdemeanor charges, and histories of prior hospitalization, and less likelihood of personality disorders. In addition, the odds of having a substance use disorder and being medication non-adherent was greater among restored defendants. The mean length of time to restoration (LOR) of 56 days was significantly different from the mean length of time to adjudication (LOA) for those not restored (88 days). This study supports prior literature on restorability while distinguishing those treated for psychosis from those treated for substance use and personality disorder. In its novel focus on medication adherence, the study expands the remediable factors available to clinical and forensic professionals and supports interventions that improve treatment and shorten the time to restoration.

Ethics Oversight in Psychiatry: Data from a Model of Organizational Monitoring.

Hallmarks of professions include self-regulation. The American Psychiatric Association fulfills this responsibility by delegating the handling of ethics complaints against members to each of 72 District Branches (DBs). The authors sought to explore the number and typology of ethics complaints received by member DBs, the handling of complaints, the relationship between the DB and state licensing authorities, the challenges and resources needed for conducting complaints, and the overall attitude of DBs regarding ethics review. This analysis presents the results of the survey and outlines how the process may be useful for professional medical organizations adhering to principles of transparency and empirically informed policy.

Using a Community-Based Participatory Mixed Methods Research Approach to Develop, Evaluate, and Refine a Nutrition Intervention to Replace Sugary Drinks with Filtered Tap Water among Predominantly Central-American Immigrant Families with Infants and Toddlers: The Water Up @Home Pilot Evaluation Study.

Descriptions of the implementation of community-based participatory mixed-methods research (CBPMMR) in all phases of the engagement approach are limited. This manuscript describes the explicit integration of mixed-methods in four stages of CBPR: (1) connecting and diagnosing, (2) prescribing-implementing, (3) evaluating, and (4) disseminating and refining an intervention that aimed to motivate Latino parents (predominantly Central American in the US) of infants and toddlers to replace sugary drinks with filtered tap water. CBPMMR allowed for co-learning that led to the identification of preliminary behavioral outcomes, insights into potential mechanisms of behavior change, and revisions to the intervention design, implementation and evaluation.

The SAFER Latinos project: Addressing a community ecology underlying Latino youth violence.

This paper describes the intervention model, early implementation experience, and challenges for the Seguridad, Apoyo, Familia, Educacion, y Recursos (SAFER) Latinos project. The SAFER Latinos project is an attempt to build the evidence for a multilevel participatory youth violence prevention model tailored to the specific circumstances of Central American immigrants. Specific circumstances targeted in this intervention are decreased family cohesion as a result of sequential immigration (i.e., parents arriving first and bringing their children years later or youth arriving without parents); multiple school barriers; community disorganization and low community efficacy; limited access to services; and a social context (including gang presence) that is linked to youth norms supporting violence. In its implementation, the initial intervention model was adapted to address barriers and challenges. These are described, along with lessons learned and the ongoing evaluation.

Toward Understanding Youth Athletes' Fun Priorities: An Investigation of Sex, Age, and Levels of Play.

Colloquial conjecture asserts perceptions of difference in what is more or less important to youth athletes based on binary categorization, such as sex (girls vs. boys), age (younger vs. older), and level of competitive play (recreational vs. travel). The fun integration theory's FUN MAPS, which identify 11 fun-factors comprised of 81 fun-determinants, offers a robust framework from which to test these conceptions related to fun. Therefore, the purposes of this study were to scientifically explore: (a) the extent to which soccer players' prioritization of the 11 fun-factors and 81 fun-determinants were consistent with the gender differences hypothesis or the gender similarities hypothesis, and (b) how their fun priorities evolved as a function of their age and level of play. Players' (n = 141) data were selected from the larger database that originally informed the conceptualization of the fun integration theory's FUN MAPS. Following selection, innovative pattern match displays and go-zone displays were produced to identify discrete points of consensus and discordance between groups. Regardless of sex, age, or level of play, results indicated extraordinarily high consensus among the players' reported importance of the fun-factors (r = .90-.97) and fun-determinants (r = .92-.93), which were consistently grouped within strata of primary, secondary, and tertiary importance. Overall, results were consistent with the gender similarities hypothesis, thereby providing the first data to dispel common conceptions about what is most fun with respect to sex, in addition to age and level of play, in a sample of youth soccer players.

Factor structure of the Cannabis Experiences Questionnaire in a first-episode psychosis sample.

AIM: The Cannabis Experiences Questionnaire (CEQ) was developed to measure the subjective experiences of cannabis use both during and after intoxication. Despite the need to better understand the nature of the complex and significant relationship between cannabis use and early psychosis, this questionnaire has rarely been used in individuals with first-episode psychosis. METHODS: We conducted a set of factor analyses using CEQ data from 194 first-episode psychosis patients who used cannabis in order to uncover the underlying factor structure of the questionnaire and thus the overarching types of psychological experiences during/after using cannabis in young people with psychotic disorders. RESULTS: Our exploratory factor analysis identified 4 subscales, including: Distortions of Reality and Self-Perception (Factor 1), Euphoria Effects (Factor 2), Slowing and Amotivational Effects (Factor 3), and Anxiety and Paranoia Effects (Factor 4). CONCLUSIONS: Elucidating the underlying factor structure of the CEQ in first-episode psychosis samples could help researchers move towards a deeper understanding of the types of experiences associated with cannabis intoxication among young adults with first-episode psychosis and could inform the development of programs designed to reduce use, improve the course of illness, and possibly delay or prevent the onset of psychotic symptoms in those at risk.