Predicting Time to Return to Cannabis Use After a Cessation Attempt: Impact of Cumulated Exposure to Nicotine-Containing Products.

Objective: Cannabis is frequently co-used with tobacco/nicotine products, especially among young adults. Little is known about the effects of this co-use on cannabis cessation outcomes. Within a sample of young adults using cannabis frequently (current use of ≥5 days/week in the past 3 months), this study aimed to (a) document sources of exposure to tobacco/nicotine products, whether used simultaneously with cannabis or on different occasions, (b) examine if the level of cumulated exposure to tobacco/nicotine (self-reported or from biochemical testing) could predict time to cannabis lapse during a cannabis abstinence period, and (c) explore the relationship between nicotine/tobacco exposure and time to cannabis lapse according to tobacco cigarette smoking status. Method: Urine cotinine measures and self-reported data on use of different tobacco/nicotine products, collected from 32 participants (aged 19 to 23), were analyzed to predict time to lapse during a 2-week period of attempted abstinence from cannabis, controlling for cannabis dependence and sex. Results: Half of participants (56.3%) used at least one tobacco/nicotine product. Higher urine cotinine, representing higher cumulated tobacco/nicotine exposure, was related to a higher risk of lapsing (Hazard Ratio [HR] = 1.64; 95%CI [1.04, 2.58]). The risk of lapsing was even higher ([HR] = 3.46; 95%CI [1.17, 10.25]) among heavily tobacco/nicotine exposed (>600 ng/mL, urine cotinine) participants than among unexposed (<50 ng/mL) or lightly/moderately exposed (50-600 ng/mL) participants. Among those smoking cigarettes (solely or in combination with other products), there was no relation between cotinine level and time to lapse, likely due to a reduced variability in abstinence probability and a high likelihood of lapse observed for higher cotinine levels, mainly achieved by cigarette use. Conclusions: With a rapidly changing landscape of tobacco/nicotine use, our results underscore the need to consider all sources of tobacco/nicotine exposure to fully understand the specific and cumulative contributions of tobacco/nicotine to cannabis cessation outcomes.

Standard Versus Family-Based Screening, Brief Intervention, and Referral to Treatment for Adolescent Substance Use in Primary Care: Protocol for a Multisite Randomized Effectiveness Trial.

BACKGROUND: Screening, brief intervention, and referral to treatment for adolescents (SBIRT-A) is widely recommended to promote detection and early intervention for alcohol and other drug (AOD) use in pediatric primary care. Existing SBIRT-A procedures rely almost exclusively on adolescents alone, despite the recognition of caregivers as critical protective factors in adolescent development and AOD use. Moreover, controlled SBIRT-A studies conducted in primary care have yielded inconsistent findings about implementation feasibility and effects on AOD outcomes and overall developmental functioning. There is urgent need to investigate the value of systematically incorporating caregivers in SBIRT-A procedures. OBJECTIVE: This randomized effectiveness trial will advance research and scope on SBIRT-A in primary care by conducting a head-to-head test of 2 conceptually grounded, evidence-informed approaches: a standard adolescent-only approach (SBIRT-A-Standard) versus a more expansive family-based approach (SBIRT-A-Family). The SBIRT-A-Family approach enhances the procedures of the SBIRT-A-Standard approach by screening for AOD risk with both adolescents and caregivers; leveraging multidomain, multireporter AOD risk and protection data to inform case identification and risk categorization; and directly involving caregivers in brief intervention and referral to treatment activities. METHODS: The study will include 2300 adolescents (aged 12-17 y) and their caregivers attending 1 of 3 hospital-affiliated pediatric settings serving diverse patient populations in major urban areas. Study recruitment, screening, randomization, and all SBIRT-A activities will occur during a single pediatric visit. SBIRT-A procedures will be delivered digitally on handheld tablets using patient-facing and provider-facing programming. Primary outcomes (AOD use, co-occurring behavior problems, and parent-adolescent communication about AOD use) and secondary outcomes (adolescent quality of life, adolescent risk factors, and therapy attendance) will be assessed at screening and initial assessment and 3-, 6-, 9-, and 12-month follow-ups. The study is well powered to conduct all planned main and moderator (age, sex, race, ethnicity, and youth AOD risk status) analyses. RESULTS: This study will be conducted over a 5-year period. Provider training was initiated in year 1 (December 2023). Participant recruitment and follow-up data collection began in year 2 (March 2024). We expect the results from this study to be published in early 2027. CONCLUSIONS: SBIRT-A is widely endorsed but currently underused in pediatric primary care settings, and questions remain about optimal approaches and overall effectiveness. In particular, referral to treatment procedures in primary care remains virtually untested among youth. In addition, whereas research strongly supports involving families in interventions for adolescent AOD, SBIRT-A effectiveness trial testing approaches that actively engage family members in primary care are absent. This trial is designed to help fill these research gaps to inform the critical health decision of whether and how to include caregivers in SBIRT-A activities conducted in pediatric primary care. TRIAL REGISTRATION: ClinicalTrials.gov NCT05964010; https://www.clinicaltrials.gov/study/NCT05964010. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/54486.

Correction: Longitudinal effects of gender minority stressors on substance use and related risk and protective factors among gender minority adolescents.

[This corrects the article DOI: 10.1371/journal.pone.0250500.].

Correction: Computer-Facilitated Screening and Brief Intervention for Alcohol Use Risk in Adolescent Patients of Pediatric Primary Care Offices: Protocol for a Cluster Randomized Controlled Trial.

[This corrects the article DOI: 10.2196/55039.].

Computer-Facilitated Screening and Brief Intervention for Alcohol Use Risk in Adolescent Patients of Pediatric Primary Care Offices: Protocol for a Cluster Randomized Controlled Trial.

BACKGROUND: Alcohol and other substance use disorders usually begin with substance use in adolescence. Pediatric primary care offices, where most adolescents receive health care, are a promising venue for early identification of substance use and for brief intervention to prevent associated problems and the development of substance use disorder. OBJECTIVE: This study tests the effects of a computer-facilitated screening and brief intervention (cSBI) system (the CRAFFT [Car, Relax, Alone, Forget, Family/Friends, Trouble] Interactive System [CRAFFT-IS]) on heavy episodic drinking, riding with a driver who is substance impaired, or driving while substance impaired among adolescents aged 14 to 17 years presenting for a well visit at pediatric primary care practices. METHODS: We are conducting a cluster randomized controlled trial of the CRAFFT-IS versus usual care and recruiting up to 40 primary care clinicians at up to 20 pediatric primary care practices within the American Academy of Pediatrics (AAP) Pediatric Research in Office Settings network. Clinicians are randomized 1:1 within each practice to implement the CRAFFT-IS or usual care with a target sample size of 1300 adolescent patients aged 14 to 17 years. At study start, intervention clinicians complete web-based modules, trainer-led live sessions, and mock sessions to establish baseline competency with intervention counseling. Adolescents receive mailed recruitment materials that invite adolescents to complete an eligibility survey. Eligible and interested adolescents provide informed assent (parental permission requirement has been waived). Before their visit, enrolled adolescents seeing intervention clinicians complete a self-administered web-based CRAFFT screening questionnaire and view brief psychoeducational content illustrating substance use-associated health risks. During the visit, intervention clinicians access a computerized summary of the patient's screening results and a tailored counseling script to deliver a motivational interviewing-based brief intervention. All participants complete previsit, postvisit, and 12-month follow-up study assessments. Primary outcomes include past 90-day heavy episodic drinking and riding with a driver who is substance impaired at 3-, 6-, 9-, and 12-month follow-ups. Multiple logistic regression modeling with generalized estimating equations and mixed effects modeling will be used in outcomes analyses. Exploratory aims include examining other substance use outcomes (eg, cannabis and nicotine vaping), potential mediators of intervention effect (eg, self-efficacy not to drink), and effect moderation by baseline risk level and sociodemographic characteristics. RESULTS: The AAP Institutional Review Board approved this study. The first practice and clinicians were enrolled in August 2022; as of July 2023, a total of 6 practices (23 clinicians) had enrolled. Recruitment is expected to continue until late 2024 or early 2025. Data collection will be completed in 2025 or 2026. CONCLUSIONS: Findings from this study will inform the promotion of high-quality screening and brief intervention efforts in pediatric primary care with the aim of reducing alcohol-related morbidity and mortality during adolescence and beyond. TRIAL REGISTRATION: ClinicalTrials.gov NCT04450966; https://www.clinicaltrials.gov/study/NCT04450966. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55039.

Associations of Momentary Mindfulness With Affect and Cannabis Desire in a Trial of Cannabis Use Interventions With and Without Momentary Assessment.

PURPOSE: Mindfulness, awareness resulting from attending to the present without judgment, has been associated with improved health. When considered as a time-varying momentary state, mindfulness is associated with other momentary states such as affect. We examined whether momentary mindfulness, specifically mindful attention and awareness (MAA), changed after counseling interventions to reduce cannabis use that included ecological momentary assessment (EMA) and explored associations with negative affect, positive affect, and cannabis desire. METHODS: Outpatients 15-24 years using cannabis ≥3x/week were randomized to one of the three interventions, each including two motivational enhancement therapy (MET) sessions. For two interventions, MET was followed by 2 weeks of EMA (with/without messaging). Momentary MAA, negative affect, positive affect, and cannabis desire were assessed over 1 week of EMA at baseline and 3-month follow-up (N = 1,971 reports, 68 participants). We examined changes in momentary MAA from baseline to follow-up overall and by group (MET + EMA, MET-only) using generalized linear mixed effects models. We tested associations of momentary MAA with momentary affect and cannabis desire using generalized estimating equations. RESULTS: Momentary MAA increased from baseline to follow-up after MET counseling plus EMA (ß = 0.237), but did not change with MET counseling alone. Higher momentary MAA was associated with lower negative affect (ß = -0.526) and cannabis desire (ß = -0.521), but not with positive affect. DISCUSSION: Among youth using cannabis frequently, momentary MAA was increased 3 months after interventions with EMA after counseling and was inversely associated with momentary negative affect and momentary cannabis desire. Mindfulness may be a useful target for momentary intervention.

Young and invisible: a qualitative study of service engagement by people who inject drugs in India.

OBJECTIVES: The HIV epidemic in India is concentrated in key populations such as people who inject drugs (PWID). New HIV infections are high among young PWID (≤30 years of age), who are hard to engage in services. We assessed perspectives of young PWID to guide development of youth-specific services. SETTING: We conducted focus group discussions (FGDs) with PWID and staff at venues offering services to PWID in three Indian cities representing historical and emerging drug use epidemics. PARTICIPANTS: PWID were eligible to participate if they were between 18 and 35 years, had initiated injection as adolescents or young adults and knew adolescent PWID in their networks. 43 PWID (81% male, 19% female) and 10 staff members participated in FGDs. A semistructured interview guide was used to elicit participants' narratives on injection initiation experiences, barriers to seeking harm reduction services, service delivery gaps and recommendations to promote engagement. Thematic analysis was used to develop an explanatory model for service engagement in each temporal stage across the injection continuum. RESULTS: Injection initiation followed non-injection opioid dependence. Lack of services for non-injection opioid dependence was a key gap in the preinjection initiation phase. Lack of knowledge and reliance on informal sources for injecting equipment were key reasons for non-engagement in the peri-injection phase. Additionally, low-risk perception resulted in low motivation to seek services. Psychosocial and structural factors shaped engagement after established injection. Housing and food insecurity, and stigma disproportionately affected female PWID while lack of confidential adolescent friendly services impeded engagement by adolescent PWID. CONCLUSIONS: Development of youth-specific services for young PWID in India will need to address unique vulnerabilities and service gaps along each stage of the injection continuum. Scaling-up of tailored services is needed for young female PWID and adolescents, including interventions that prevent injection initiation and provision of confidential harm reduction services.

Longitudinal effects of gender minority stressors on substance use and related risk and protective factors among gender minority adolescents.

PURPOSE: Gender minority (GM) adolescents, who have a different gender identity than their sex assigned at birth, may use substances as a coping strategy in response to GM-related stressors. This study examined longitudinal effects of gender minority stressors on substance use in GM adolescents, and related risk factors (internalized transphobia, depressive symptoms, anxious symptoms) and protective factors (resilience, gender-related pride, family functioning, social support, gender-related community connectedness). METHODS: Participants were 30 GM adolescents, ages 13-17 years, from the U.S. community-based longitudinal Trans Teen and Family Narratives Project. Participants completed an online survey every 6 months across 2 years (5 waves; data collected 2015-2019). RESULTS: Exposure to gender minority stressors was associated with higher odds of alcohol use. Across models, internalized transphobia (risk factor), resilience (protective factor), and gender-related pride (protective factor) were the most significant mediators of associations between gender minority stressors and substance use. Family functioning and social support (protective factors) significantly moderated the association between gender minority stressors and alcohol use, such that family functioning and social support were protective for alcohol use at lower levels of gender minority stress, but not at higher levels. CONCLUSION: Results suggest that GM adolescents engage in substance use as a coping strategy in response to gender minority stressors. A number of hypothesized risk and protective factors mediated or moderated these associations. Future interventions with GM adolescents should focus efforts on addressing internalized transphobia as a risk factor and strengthening resilience, gender-related pride, and family functioning as protective factors for substance use.

Trait mindfulness and cannabis use-related factors in adolescents and young adults with frequent use.

Background: Mindfulness-based interventions (MBIs) are effective in adult substance-use treatment and may be helpful for adolescents and young adults (AYAs). One target of MBIs is to improve trait mindfulness, which has been associated with better lifestyle and health outcomes. To inform MBIs for reducing cannabis use in AYAs, we sought to identify how trait mindfulness was associated with cannabis-related problems and quit attempts, as well as with motivation to change use in youth who report frequent use. Methods: Participants aged 15-24 years using cannabis ≥ 3x/week were recruited from AYA clinics in a northeastern US city to participate in a cannabis-use intervention pilot, randomized trial. At baseline, we assessed cannabis-use history, problems associated with use, attempts to quit, and trait mindfulness. All participants were offered two sessions of motivational enhancement therapy, during which they rated motivation to quit cannabis. Regression analyses were conducted to assess associations between trait mindfulness and cannabis use-related problems, attempts to quit, and motivation to change. Results: Seventy participants, mean age 20.7 ± 1.9 years, enrolled. Sixty percent identified as female, 47% as Black non-Hispanic, and 31% as Hispanic. Participants started using cannabis at mean age 15.0 ± 2.8 years and were using ≥ 3x/week by 17.0 ± 2.3 years. Higher mindfulness scores were associated with fewer cannabis-related problems (p = 0.004) and fewer quit attempts (p = 0.035). The number of cannabis-related problems did not significantly mediate the relationship between mindfulness and quit attempts. Trait mindfulness did not predict motivation to change cannabis use. Conclusions: Among AYAs using cannabis frequently, higher trait mindfulness was associated with both fewer cannabis use--related problems and fewer quit attempts. Future research should assess whether trait mindfulness is an appropriate target for decreasing cannabis use and the utility of MBIs for reducing cannabis-use behaviors.

Does Tobacco Screening in Youth Primary Care Identify Youth Vaping?

PURPOSE: The purpose of this study was to evaluate the sensitivity of a tobacco use screening question, modified to include the word "e-cigarette," in detecting past 12-month nicotine vaping and past 12-month tobacco product use inclusive of nicotine vaping, among adolescent primary care patients. METHODS: We conducted secondary analysis of data from a pilot trial of adolescent substance use screening and brief intervention in pediatric primary care. Participants were patients aged 12-18 years (N = 278) presenting for annual well-visits at five practices in Massachusetts in 2015-2017. Study measures consisted of a clinical brief screener item and tobacco/electronic cigarette items on a confidential, self-administered research questionnaire (criterion measure). RESULTS: The clinical brief screener item identified 24 of 30 adolescents with past 12-month tobacco use (sensitivity 80%); 15 of 30 with past 12-month electronic cigarette use (sensitivity 50.0%), and 25 of 42 with tobacco and/or electronic cigarette use (sensitivity 59.5%). CONCLUSIONS: These findings support the need to develop and test a screening measure that is sensitive for capturing electronic cigarette use.

Measurement-Based Care in the Treatment of Adolescents with Substance Use Disorders.

Measurement-based care in adolescent substance use is an important element of the evidence-based framework of Screening, Brief Intervention, and Referral to Treatment (SBIRT). Use of a validated measure for detecting substance use, misuse, and substance use disorders is significantly more effective than the use of unvalidated tools or clinician intuition. There are now a variety of established and new validated screening tools that are available for use with adolescents and that capture the range of adolescent substance use behaviors. This area, however, continues to evolve rapidly.

Development and pilot testing of a counseling-plus-mHealth intervention to reduce risk for pregnancy and sexually transmitted infection in young women with depression.

BACKGROUND: Depressed young women have elevated rates of unintended pregnancy and sexually transmitted infections (STIs). The objective of this study was to develop and pilot-test a counseling-plus-mHealth intervention to reduce sexual and reproductive health (SRH) risk in young women with depressive symptoms. METHODS: Using the Behavior-Determinants-Intervention logic model, we developed the Momentary Affect Regulation-Safer Sex Intervention (MARSSI) to address the challenges that depression imposes on SRH risk reduction efforts of high-risk young women: (I) in-person counseling using motivational interviewing (MI) to elicit motivation for safer sex and develop a behavior change plan, and teaching cognitive-behavioral skills to manage negative thoughts and affective states; (II) 4-week Ecological Momentary Intervention (EMI) on a smartphone to report momentary phenomena related to depression and SRH risk, and receive personalized, tailored messages prompting healthy behaviors and encouraging cognitive-behavioral skill use when risk-related cognitions and negative affect are reported; and (III) booster counseling to review behavior change goals and plans and teach a new cognitive-behavioral skill. We developed the counseling through iterative interviews with 11 participants and developed the EMI through a 2-week trial with three participants, then revised MARSSI to reflect participant feedback. We next conducted a pilot-test among depressed, high-risk female adolescent clinic patients age 15-24. Pilot participants completed mental health, motivation to change behavior, and SRH behavior assessments and provided feedback at baseline, post-EMI, and at 3-month follow-up. We analyzed participant retention, counseling duration, app engagement, intervention quality ratings, and participant feedback, and compared mental health and SRH risk behavior across the study. RESULTS: Seventeen participants completed the initial counseling session, 15 participated in the EMI, 14 returned for the booster session, and 14 completed the 3-month follow-up. App engagement was high for all 4 EMI weeks (≥1 report/day for median ≥6 days/week). Post-intervention, most or all participants agreed with each positive statement about the messages, reported "Excellent" MARSSI usefulness, and attributed improvements to MARSSI. Compared to baseline, post-EMI depressive symptoms, confidence to change self-selected risk behavior, and confidence to use the cognitive restructuring skill improved. At 3 months, depressive symptom scores remained lower and confidence to use cognitive restructuring remained higher, compared to baseline. Participants also reported lower frequency of sex, lower proportion of condom-unprotected sex events, and, among those using effective contraception, more consistent condom use at 3-month follow-up vs. baseline. CONCLUSIONS: MARSSI was feasible, acceptable, and engaging to young women with depression and SRH risk behavior, and was associated with increased confidence to reduce SRH risk, decreased SRH risk behaviors, increased confidence to use cognitive restructuring, and decreased depressive symptoms over 3 months. Future research is warranted to evaluate MARSSI's efficacy to improve motivation, skills, affect, and behaviors, as well as reproductive health outcomes in high-risk depressed young women.

Religiously or Spiritually-Motivated Forgiveness and Subsequent Health and Well-Being among Young Adults: An Outcome-Wide Analysis.

This study performs an outcome-wide analysis to prospectively examine the associations of forgiveness (including forgiveness of others, self-forgiveness and divine forgiveness) with a range of psychosocial, mental, behavioral and physical health outcomes. Data from the Nurses' Health Study II and the Growing Up Today Study (Ns ranged from 5,246 to 6,994, depending on forgiveness type and outcome) with 3 or 6 years of follow-up were analyzed using generalized estimating equations. Bonferroni correction was used to correct for multiple testing. All models controlled for sociodemographic characteristics, prior religious service attendance, prior maternal attachment and prior values of the outcome variables. All forgiveness measures were positively associated with all psychosocial well-being outcomes, and inversely associated with depressive or anxiety symptoms. There was little association between forgiveness and behavioral or physical health outcomes. Forgiveness may be understood as a good itself, and may also lead to better subsequent mental health and psychosocial well-being.

Effect of Computer-Based Substance Use Screening and Brief Behavioral Counseling vs Usual Care for Youths in Pediatric Primary Care: A Pilot Randomized Clinical Trial.

Importance: Annual preventive health visits provide an opportunity to screen youths for unhealthy substance use and intervene before serious harm results. Objectives: To assess the feasibility and acceptability and estimate the efficacy of a primary care computer-facilitated screening and practitioner-delivered brief intervention (CSBI) system compared with usual care (UC) for youth substance use and associated risk of riding with an impaired driver. Design, Setting, and Participants: An intent-to-treat pilot randomized clinical trial compared CSBI with UC among 965 youths aged 12 to 18 years at 5 pediatric primary care offices and 54 practitioners. Patients were randomized to CSBI (n = 628) or usual care (n = 243) groups within practitioner with 12 months of follow-up. Data were collected from February 1, 2015, to December 31, 2017. Data analysis was performed January 1, 2018, to March 30, 2019. Interventions: Patients self-administered a computer-facilitated substance use screening questionnaire before their annual preventive health visits. Immediately after completing the screening, they received their score and level of risk and viewed 10 pages of scientific information and true-life vignettes illustrating health risks associated with substance use. Trained practitioners received the screening results, patients' risk levels, talking points designed to prompt brief counseling, and recommended follow-up plans. Main Outcomes and Measures: Feasibility and acceptability were assessed using adolescents' postvisit ratings. Days of alcohol use, cannabis use, and heavy episodic drinking were assessed at baseline and 3-, 6-, 9-, and 12-month follow-ups using Timeline Followback, and riding in the past 3 months with a driver who was impaired by use of alcohol or other drugs was assessed using 2 self-report items. The primary outcome was the intervention effect among at-risk youths who reported using alcohol or other drugs in the past 12 months or riding with an impaired driver in the past 3 months at baseline. The secondary outcome was the prevention effect among those with no prior use or risk. Results: Among 871 youths screened, 869 completed the baseline assessment; 211 of the 869 reported alcohol or cannabis use in the past 12 months at baseline (mean [SD] age, 16.4 [1.3] years; 114 [54.1%] female; 105 [49.8%] non-Hispanic white). Of the 211 youths, 148 (70.1%) were assigned to the CSBI group and 63 (29.9%) were assigned to the UC group. Among youths in the CSBI group, 105 (70.9%) reported receiving counseling about alcohol, 122 (82.4%) reported receiving counseling about cannabis, and 129 (87.2%) reported receiving counseling about not riding with an impaired driver. Adjusted hazard ratios for time to first postvisit use of alcohol or other drugs for CSBI vs UC were as follows: alcohol use, 0.69 (95% CI, 0.47-1.02); heavy episodic drinking, 0.66 (95% CI, 0.40-1.10); and cannabis use, 0.62 (95% CI, 0.41-0.94). At 12-month follow-ups among 99 youths who reported having ridden in the past 3 months at baseline with an impaired driver (64 in the CSBI group; 35 in the UC group), adjusted relative risk ratio of riding in the past 3 months with an impaired driver for CSBI vs UC groups was 0.58 (95% CI, 0.37-0.91). No intervention effect was observed among youths who reported no prior use of alcohol or other drugs (n = 658) or not having ridden with an impaired driver (n = 769) at baseline. Conclusions and Relevance: The CSBI system is a feasible and acceptable option for screening youths in primary care practice for use of alcohol and other drugs and for risk of riding with an impaired driver, and the estimated efficacy in this sample warrants further testing in larger samples. Trial Registration: ClinicalTrials.gov identifier: NCT00227877.

A Parenting and Life Skills Intervention for Teen Mothers: A Randomized Controlled Trial.

: media-1vid110.1542/5985300176001PEDS-VA_2018-2303Video Abstract BACKGROUND: Teen mothers often present with depression, social complexity, and inadequate parenting skills. Many have rapid repeat pregnancy, which increases risk for poor outcomes. We conducted a randomized controlled trial of a parenting and life skills intervention for teen mothers aimed at impacting parenting and reproductive outcomes. METHODS: Teen mothers were recruited from a teen-tot clinic with integrated medical care and social services. Participants were randomly assigned 1:1 to receive (1) teen-tot services plus 5 interactive parenting and life skills modules adapted from the Nurturing and Ansell-Casey Life Skills curricula, delivered by a nurse and social worker over the infant's first 15 months or (2) teen-tot services alone. A computerized questionnaire was self-administered at intake, 12, 24, and 36 months. Outcomes included maternal self-esteem, parenting attitudes associated with child maltreatment risk, maternal depression, life skills, and repeat pregnancy over a 36-month follow-up. We used generalized linear mixed modeling and logistic regression to examine intervention effects. RESULTS: Of 152 invited, 140 (92%) participated (intervention = 72; control = 68). At 36 months, maternal self-esteem was higher in the intervention group compared with controls (P = .011), with higher scores on preparedness for mothering role (P = .011), acceptance of infant (P = .008), and expected relationship with infant (P = .029). Repeat pregnancy by 36 months was significantly lower for intervention versus control participants. CONCLUSIONS: A brief parenting and/or life skills intervention paired with medical care for teens and their children has positive effects on maternal self-esteem and repeat pregnancy over 36 months.

Screening and Brief Advice to Reduce Adolescents' Risk of Riding With Substance-Using Drivers.

OBJECTIVE: Alcohol- and drug-related car crashes are a leading cause of death for adolescents in the United States. This analysis tested the effects of a computer-facilitated Screening and Brief Advice (cSBA) system for primary care on adolescents' reports of driving after drinking or drug use (driving) and riding with substance-using drivers (riding). METHOD: Twelve- to 18-year-old patients (N = 2,096) at nine New England pediatric offices completed assessments only during the initial 18-month treatment-as-usual (TAU) phase. Subsequently, the 18-month cSBA intervention phase began with a 1-hour provider training and implementation of the cSBA system at all sites. cSBA included a notebook-computer with self-administered screener, immediate scoring and feedback, and 10 pages of scientific information and true-life stories illustrating substance-related harms. Providers received screening results, "talking points" for 2 to 3 minutes of counseling, and a Contract for Life handout. Logistic regression with generalized estimating equations generated adjusted relative risk ratios (aRRR) for past-90-day driving and riding risk at 3- and 12-month follow-ups, controlling for significant covariates. RESULTS: We found no significant effects on driving outcomes. At 3 months, cSBA youth were less likely than TAU to report riding with a drinking driver (aRRR = 0.70, 95% CI [0.49, 1.00]), and less likely to report riding with a driver who had used cannabis or other drugs (aRRR = 0.46, 95% CI [0.29, 0.74]). The effect was even greater (aRRR = 0.34, 95% CI [0.16, 0.71]) for riding with drinking drivers who were adult family members. All effects dissipated by 12-month follow-up. CONCLUSIONS: Screening and pediatrician brief advice shows promise for reducing adolescents' risk of riding with substance-using drivers.

Pilot randomized trial of MOMENT, a motivational counseling-plus-ecological momentary intervention to reduce marijuana use in youth.

BACKGROUND: Ecological momentary interventions (EMIs) influence behavior in real time, in real life. We evaluated trial feasibility and preliminary efficacy of MOMENT, a counseling-plus-EMI to reduce frequent marijuana use in youth in primary care. METHODS: Primary care patients age 15-24 years using marijuana at least 3 times/week were randomized to MOMENT [motivational enhancement therapy (MET)/smartphone-based momentary assessment/responsive motivational messaging] vs. No-messages (MET/momentary assessment) vs. MET-only. In MOMENT, two MET sessions were followed by 2 weeks of momentary assessment of marijuana use and factors related to use, with motivational messaging displayed after report of marijuana triggers, desire, use, and effort to avoid use. We evaluated study feasibility (recruitment, retention, and response rates; feedback survey responses) and explored intervention effects on marijuana desire and use at three months with linear mixed effects modeling. RESULTS: Seventy youth [mean (M) =20.7 years, 60% female] were assigned to MOMENT (n=27), No-messages (n=15; assignment suspended to enrich other arms), or MET-only (n=28). Most attrition occurred during baseline, before MET. Of those completing MET session 1, 82% completed their assigned treatment and 79% provided 3-month data. Participants highly rated acceptability; comments reflected changing motivation and behavior. Across arms, participants reported significantly lower marijuana use, desire, and problems at follow-up vs. baseline. Momentary marijuana desire declined more in MOMENT vs. MET-only. Marijuana use following a targeted context or behavior was less likely in MOMENT and No-messages, vs. MET-only. CONCLUSIONS: The MOMENT intervention is feasible to deliver, acceptable, and potentially efficacious in reducing marijuana desire and use among adolescent and young adults in primary care. A larger randomized trial to evaluate efficacy is warranted.

Momentary factors during marijuana use as predictors of lapse during attempted abstinence in young adults.

INTRODUCTION: Young adults using marijuana heavily often try multiple times to quit on their own. We sought to identify momentary experiences during marijuana use that could aid in predicting lapse when young adults subsequently attempt abstinence. METHODS: Young adults (N=34) age 18-25 using marijuana ≥5days/week and planning to quit completed a survey of sociodemographic characteristics, substance use, marijuana expectancies, use motives, perceived social support, and confidence to abstain. They completed ecological momentary assessment (EMA) smartphone reports several times/day for two weeks prior to, then during two weeks of attempted abstinence. Use period EMA reports assessed affect, craving, accessibility, situational permissibility, use, and motivation to abstain. Baseline survey and EMA data were examined in relation to subsequent lapse during attempted abstinence. RESULTS: Nearly 3 in 4 participants (73.5%) reported lapsing during attempted abstinence from marijuana. On bivariate analyses, lower baseline dependence severity score, negative effect expectancies, perceived family support, and confidence to abstain were each associated with lapse. Of the use period EMA variables, greater percent of days with marijuana use, reports of easy accessibility, and reports of situational permissibility were each associated with lapse. Modeled together, negative effect expectancies, perceived family support, confidence to abstain, and situational permissibility during use were highly accurate in predicting lapse during attempted abstinence. CONCLUSIONS: Momentary factors may add to conventionally-surveyed characteristics to enhance prediction of lapse during attempted abstinence among young adults with heavy marijuana use. Momentary assessment prior to a quit attempt may thus enable more effective personalized approaches to preventing lapse.

Computer-Facilitated Screening and Brief Advice to Reduce Adolescents' Heavy Episodic Drinking: A Study in Two Countries.

PURPOSE: A computer-facilitated screening and brief advice (cSBA) intervention was previously shown to reduce drinking among U.S. adolescents but not among Czech youth. The purpose of this study was to assess cSBA effect on heavy episodic drinking (HED). METHODS: Participants were 12- to 18-year-olds at nine U.S. primary care offices (N = 2,096) and 10 Czech pediatrician-generalist offices (N = 589) who completed measurements only during an 18-month treatment-as-usual (TAU) phase. We then initiated the cSBA protocol for all participants and recruited the 18-month cSBA phase. Generalized Estimating Equations logistic regression compared past-90-day HED for cSBA versus TAU at 3- and 12-months, controlling for baseline HED and other covariates. RESULTS: Baseline past-90-day HED rates were 11% for U.S. and 28% for Czech youth. At 3 months, among Czech baseline non-HED, the adjusted relative risk ratio for cSBA versus TAU was .52 (95% confidence interval .29, .92). The effect dissipated by 12 months. CONCLUSIONS: cSBA shows promise for short-term prevention of adolescent HED.