The Internalization of Stigma and the Shaping of the Grief Experience for Peers Bereaved by a Drug-Related Death.

People who use drugs form a significant part of the community who are impacted by drug-related deaths, but their stigmatized positioning in society yields implications for their access to support and the social recognition of their grief. This project explores how the internalization of drug-related stigmas shapes the grief experience for peers bereaved by a DRD. Six individuals who experienced the drug death of a peer during their own time in active addiction participated in semi-structured interviews, analyzed by interpretative phenomenological analysis. Three superordinate themes are reported in this paper: (i) Forged Connections; (ii) The Condemnation Script; and (iii) Nowhere Left to Turn. Participants reported grief responses such as survivor's guilt, shame, and increased drug use against the wider social invalidation of their close peer bonds. This paper appeals for a more health-based approach to supporting people in active addiction that recognizes and validates their grief experiences.

'There's no waiting list, just press play': listeners' experiences of mental-health-related podcasts.

INTRODUCTION: The activity of podcasting has increased exponentially but little is known about the qualitative listener experiences of podcasts related to mental health. The aim of this study was to understand what listeners of mental health podcasts obtain from this medium. Participants were asked questions relating to mental health literacy, stigma and help-seeking behaviour. METHODS: The study gathered data, via an online survey (n=722). This article reports on the responses to open-ended questions: 'What do you take away from listening to mental health-related podcasts? What do you learn about yourself (or a loved one)? What do you find most useful about listening to mental health-related podcasts?' Inductive thematic analysis was utilised. RESULTS: Thematic analysis produced five core themes: accessibility, mental health literacy, potential pitfalls, reassurance and lived experiences. Accessibility of material and discussions featuring professionals and people with lived experience were reported key highlights. CONCLUSION: Results indicate that podcasts influence the development of mental health literacy, reduce stigma and increase help-seeking. Given the challenges with service access in underserved populations, there is a potential role for the use of podcasts in rural regions.

The experience of drug-related client loss for healthcare professionals who support people in addiction.

INTRODUCTION: Addiction support and recovery is a multi-faceted support context in which practitioners work with clients who present with increased mortality risks. Drug-related deaths are understood to be a risk factor for complicated grief-reactions but, to date, research has neglected to explore the intricacies of drug-related client loss for practitioners who work with clients experiencing addiction. Due to wider expectations of professional endurance and the demanding nature of health care, grief-related reactions associated with the loss of a client may go unprocessed and, therefore, result in long-term health implications. METHOD: Fifteen health care professionals took part in individual semi-structured interviews, which were analyzed using reflexive thematic analysis. Participants represented various disciplines in addiction support and recovery, including homelessness, inclusion health, addiction, and emergency medicine. RESULTS: Three core themes emerged encapsulating the experience of drug-related bereavement for HCPs who support people experiencing addiction, as follows: (i) Grief Beneath the Surface, (ii) The Cost of Caring, and (iii) Finding Closure. The findings identified acute grief-related reactions in HCPs such as self-blame and shame, alongside fears of litigation and questions of clinical competency. Participants' accounts of drug-related client loss emphasized a deep professional connection with those that they work with, with grief-responses akin to the loss of peers, family members, and other close connections. The bereavement experience was complicated by unique compounding variables associated with drug-related deaths, but also by incongruity between their emotional responses to death and their professional responsibilities. CONCLUSIONS: This article highlights the complex nature of drug-related client loss, and despite their social positioning as experts in their field, HCPs' reactions to client deaths were predominantly human responses to loss. The article identified a need for targeted postvention protocols that address complicated grief while also allowing staff to resume occupational functioning in a measured manner.

Ethnic-Racial Socialization, Teacher Discrimination, and Black Youth's School Engagement and Achievement.

Ethnic-racial socialization is one strategy Black parents use to support their children's school engagement and academic achievement given the occurrence and toxic effects of discrimination. Egalitarianism and preparation for bias socialization messages have yielded mixed evidence of promotive and protective effects for Black youth's school outcomes, and effects may vary according to ethnicity. Thus, this research examined associations between ethnic-racial socialization messages and school engagement and achievement, and whether these messages protected against teacher discrimination effects on academic achievement transmitted through school engagement, among a nationally representative sample of Black adolescents who participated in the National Survey of American Life Adolescent supplement study. Ethnic-racial socialization message content and the frequency of communication about race demonstrated different associations with engagement (i.e., school bonding, aspiration-expectation discrepancy, and disciplinary actions) and achievement (i.e., grades) for African American and Caribbean Black youth. However, the benefits were not sufficient to combat the adverse effects of teacher discrimination on school engagement and, in turn, achievement. These findings highlight the utility of integrating ethnic-racial socialization into prevention programs to support Black youth's school experiences; demonstrate the importance of attention to heterogeneity within Black youth; and underscore the critical need for prevention programs to address teacher discrimination.

Perceived Neighborhood Safety and Depressive Symptoms: The Role of Perceived Neighborhood Cohesion and Perceived Control.

Few have examined mechanisms explaining the link between perceived neighborhood unsafety, neighborhood social processes, and depressive symptoms for Black adolescents. The goal of this study was to examine the role of perceived control as a mechanism linking perceptions of neighborhood unsafety and depressive symptoms, and neighborhood cohesion as a protective factor. Participants were 412 Black adolescents living in a major Mid-Atlantic urban center in the United States (49% female, Mage = 15.80, SD = 0.36). Participants reported perceptions of neighborhood unsafety at grade 10, neighborhood cohesion at grade 10, perceived control at grades 10 and 11 and depressive symptoms in grades 10 and 12. High neighborhood unsafety was associated with low perceived control and in turn high depressive symptoms only when neighborhood cohesion was high. The results highlight the role of neighborhood unsafety and perceived control in the development of depressive symptom and the possible downsides of neighborhood social factors.

Intersectional discrimination from black women, white women, black men, or white men impacts young adult black women's affective states and risky health cognitions.

OBJECTIVE: Black women experience pronounced inequalities in alcohol use and sexual risk outcomes. Racial discrimination is a known contributor to health inequalities. However, Black women face unique and intersectional forms of discrimination beyond racial discrimination. The current study investigates how exclusion from four distinct social groups effects Black women's negative affect and risky health cognitions. DESIGN: Black women (N = 124; ages 18-29) were randomly assigned to be excluded in Cyberball by Black women, Black men, White women, or White men. MAIN OUTCOME MEASURES: Participants responded to measures of internalising (depressive, anxious) and externalising (anger) affect, heavy alcohol use willingness, and risky sex expectations. RESULTS: Participants primarily attributed exclusion from White women to racial discrimination, exclusion from Black men to gender discrimination, and exclusion from White men to both gender and racial discrimination. When excluded by White women, participants reported the highest levels of anger, depressive affect, and anxiety. Exclusion by White men predicted the greatest heavy drinking willingness, though exclusion by Black men predicted the greatest risky sex expectations. CONCLUSION: This study is the first to demonstrate that exclusion from different social groups leads to differing patterns of negative affect and risky health cognitions in young adult Black women.

Posttraumatic growth following a drug-related death: A family perspective.

This paper explores the experience of posttraumatic growth in families who have lost a family member to a drug-related death. Seven family units (17 participants) were interviewed, and interviews were analyzed using reflexive thematic analysis. Analyses revealed themes that reflected positive adaptation and growth, including (a) reframing the loss, (b) open dialogue and social support, and (c) reclamation of purpose. Themes are presented in this paper for their pertinence in understanding how best to negotiate adaptation through complicated grief. The paper concludes that posttraumatic growth can occur once families begin a process of acceptance and receive support through the journey.

Strategic Directions in Preventive Intervention Research to Advance Health Equity.

As commissioned by the Society for Prevention Research, this paper describes and illustrates strategic approaches for reducing health inequities and advancing health equity when adopting an equity-focused approach for applying prevention science evidence-based theory, methodologies, and practices. We introduce an ecosystemic framework as a guide for analyzing, designing, and planning innovative equity-focused evidence-based preventive interventions designed to attain intended health equity outcomes. To advance this process, we introduce a health equity statement for conducting integrative analyses of ecosystemic framework pathways, by describing the role of social determinants, mechanisms, and interventions as factors directly linked to specific health equity outcomes. As background, we present health equity constructs, theories, and research evidence which can inform the design and development of equity-focused intervention approaches. We also describe multi-level interventions that when coordinated can produce synergistic intervention effects across macro, meso, and micro ecological levels. Under this approach, we encourage prevention and implementation scientists to apply and extend these strategic directions in future research to increase our evidence-based knowledge and theory building. A general goal is to apply prevention science knowledge to design, widely disseminate, and implement culturally grounded interventions that incrementally attain specific HE outcomes and an intended HE goal. We conclude with recommendations for conducting equity-focused prevention science research, interventions, and training.

Peer Discrimination, Deviant Peer Affiliation, and Latino/a Adolescent Internalizing and Externalizing Symptoms: A Prospective Study.

OBJECTIVE: U.S. Latino/a adolescents experience high levels of ethnic discrimination, particularly in new immigrant destinations. Due to the salience of peers during adolescence, this study examined how peer discrimination related directly and indirectly, through deviant peer affiliation, to changes in Latino/a adolescents' internalizing and externalizing symptoms. Culture-specific moderators hypothesized to buffer discrimination impacts on adolescent symptomology included Spanish language enculturation and adolescents' social ties to relatives in the family's country-of-origin. METHOD: The sample of 547 Latino/a adolescent participants from the Caminos al Bienestar study (55.4% female; age M = 12.8, range = 11-16) was selected at random from middle schools in a large, suburban school district in Atlanta, Georgia. Three time points of survey data spaced roughly 6 months apart were collected during 2018 and 2019. RESULTS: Results from longitudinal structural equation models revealed that peer discrimination was associated indirectly with increased externalizing symptoms, through increases in affiliation with deviant peers (ß = 0.05; SE = 0.02; B = 0.02; 95% CI = 0.01, 0.09). We did not observe direct or indirect effects of peer discrimination on changes in internalizing symptoms, and we found no significant protective effects of either Spanish language enculturation or social ties with the country-of-origin. CONCLUSIONS: Ethnic discrimination by peers may lead to deviant peer affiliation and, in turn, increased externalizing behaviors. Future research identifying protective factors that buffer discrimination impacts on deviant peer affiliation is needed to inform the development of interventions that can prevent Latino/a adolescents' externalizing symptoms.

COVID-19 Stressors and Latinx Adolescents' Mental Health Symptomology and School Performance: A Prospective Study.

This study addressed the need for research examining impacts of the Coronavirus-19 (COVID) pandemic on Latinx adolescents' adjustment. Survey data for a probability sample of 547 Latinx adolescents (Mage = 13.71, SD = 0.86; 55.2% female) were collected from 2018 to 2021, including two times both prior to, and during, COVID. Independent variables assessed COVID-related household hospitalization, job/income loss, and adolescents' increased childcare responsibility. Structural Equation Model results indicated that COVID-related increases in adolescent childcare responsibility were associated with increased internalizing and externalizing symptoms and declines in school performance. COVID hospitalization and job/income loss were associated indirectly, through childcare responsibilities, to worse adolescent outcomes. Family adversities may harm adolescents' adjustment by burdening adolescents with responsibilities such caring for children.

Residential mobility, neighborhood cohesion, and depressive symptoms among urban-dwelling African American adolescents.

Mechanisms linking residential mobility and depressive symptoms among urban-dwelling African American adolescents have received little attention. This study examined neighborhood cohesion as a possible mechanism. Participants were 358 urban-dwelling African American adolescents (Mage = 14.78; SD = 0.34) who reported their neighborhood cohesion in Grade 10 and depressive symptoms in Grades 9 and 11, and for whom residential address information was available. There was a significant indirect effect of past moves in middle school on depressive symptoms 1 year later through reduced neighborhood cohesion. However, the indirect effect was not significant in a propensity score-matched sample. Results from the full sample of adolescents suggest that neighborhood cohesion may play a role in the experience of depressive symptoms following past moves in middle school. Different findings for the propensity score-matched sample highlight the need for future studies of residential mobility to employ strategies to correct for possible selection bias.

Protective factors for suicidal ideation among Black adolescents indirectly exposed to community violence.

OBJECTIVE: Community violence exposure has been identified as a risk factor for Black youth suicide ideation. However, little is known about factors that protect community violence exposed youth against suicide ideation. The current study examined associations between knowledge of family member and peers' community violence exposure and Black youth's subsequent suicidal ideation, and investigated self-worth and social support as protective factors. METHOD: Participants were a community sample of Black youth (N = 447, 47.4% female; Mage = 11.77, SD = 0.35) who reported about community violence exposure, self-worth, social support, and suicide ideation in grades 6 and 7. RESULTS: Regression analyses revealed that grade 6 knowledge of family member and peers' community violence exposure was associated with increases in suicide ideation assessed in grade 7. Self-worth attenuated the association between knowledge of others' community violence exposure and suicide ideation for male adolescents. For female adolescents, social support attenuated the association between knowledge of others' community violence and suicide ideation. CONCLUSIONS: Findings highlight the consequential impact of knowledge about community violence for Black youth's suicidal ideation. Enhancing protective factors for Black youth is an important target for intervening with exposure to violence and reducing suicide ideation.

Ethnic-racial socialization as a moderator of associations between discrimination and psychosocial well-being among African American and Caribbean Black adolescents.

OBJECTIVE: Discrimination can have debilitating effects on Black adolescents' psychosocial well-being. Ethnic-racial socialization (ERS) is crucial in helping youth manage racial discrimination and its adverse effects. However, little is known about how ERS can be beneficial against discrimination for subgroups of Black youth, despite evidence that culture and nationality may influence how adults prepare youth for discrimination. The present study examined if associations between discrimination and psychosocial well-being outcomes, and the moderating effects of ERS, varied by ethnicity for African American (AA) and Caribbean Black (CB) adolescents. METHOD: Participants were 1,170 Black adolescents, 810 (AA); 360 (CB), who participated in the National Survey of American Life Adolescent supplement study. Multigroup analysis was applied to examine the moderating effects of ERS for AA and CB adolescents. RESULTS: For CB adolescents who reported high preparation for bias, discrimination was associated with fewer mastery beliefs, and the positive association between discrimination and perceived stress was stronger at higher levels of preparation for bias. Additionally, the negative association between discrimination and John Henryism active coping was stronger for youth who reported high egalitarian messages. CONCLUSIONS: Findings indicate that preparation for bias messages differentially influences the effects of discrimination on stress and mastery for AA and CB adolescents. The results highlight the importance of exploring ethnic heterogeneity of ERS. Implications for psychosocial well-being are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The impact of COVID-19 on health care professionals who are exposed to drug-related deaths while supporting clients experiencing addiction.

INTRODUCTION: This paper explores the impact of the COVID-19 pandemic on health care professionals who support clients experiencing addiction. During the pandemic, addiction support became more challenging, as existing health care models had changed or been completely abolished. Clients continued to engage with social, justice, and health services in limited capacities, connecting with general practitioners, key workers, homelessness support workers, and other service providers. This marginalized population was among the most high-risk groups for adverse health outcomes during the pandemic and understanding the associated implications for practitioner well-being is crucial. METHODS: Fifteen health care professionals who work with active addiction in homelessness, public health, addiction, emergency medicine, and other areas participated in individual semi-structured interviews. Data analyses utilized reflexive thematic analysis. RESULTS: Four core themes emerged from the analysis: (i) Shift in Priority, (ii) Being Left Behind, (iii) Managing a Death, and (iv) Anxious Environment. Within each core theme, associated subthemes provide further context. The COVID-19 pandemic had a significant impact on the well-being of clinicians who work with people who use drugs, fostering a more anxious environment and compounding what can already be a high-stress occupation. Participants exhibited high levels of concern for the well-being of clients, and uncertainty permeated throughout conversations. Furthermore, staff expressed concern for their own well-being in the long term due to the inability to process adverse events, such as a service user's death, due to the chaotic nature of the pandemic. CONCLUSIONS: This paper highlights some areas of concern to address for future service delivery and presents opportunities to future-proof services as the world moves toward hybrid models of working. The inflexibility of service provision during the pandemic and the digital divide due to public health measures pushed marginalized groups further into the margins, with significant implications for practitioner occupational well-being due to feelings of anxiety, powerlessness, and concern for mortality of clients. This study collects a broad scope of experiences across disciplines in health care and demonstrates how professionals navigated unprecedented circumstances.

'Special death': Living with bereavement by drug-related death in Ireland.

This paper explores the impact of complicated grief on the family system following the drug-related death of a family member. Drug-related deaths are rife with moral stigmas, and those left behind often carry an emotional burden laden with shame and guilt. 17 bereaved family members were interviewed using semi-structured interviews and transcripts were analyzed using reflexive thematic analysis. Three core themes were generated: Renegotiation of Relationships; Experiencing Complex Emotions; and Adjusting to a New Reality. The findings demonstrate that this population experience great difficulty in processing their grief as they struggle with family breakdown, navigating supports and stigma.

A longitudinal test of acculturative family distancing theory explaining latino/a/x adolescents' adjustment.

According to acculturative family distancing theory, adolescents' perceptions of cultural incongruencies with parents can diminish the quality of parent-adolescent relationships and, as a result, harm adolescent adjustment. Using four time points of data for a sample of 547 diverse Latino/a/x adolescents, this study examined how parent-adolescent relationship quality and acculturative family distancing were associated with changes in adolescent school performance and internalizing symptoms. At baseline, the school-based sample ranged from 11- to 14-years-old (M = 12.78) and included slightly more females (55%) than males (45%). Cross-lagged structural equation model results indicated that adolescent reports of greater acculturative family distancing were associated with adolescent perceived increases in parent-adolescent conflict and decreases in parental support. Conflict mediated associations between acculturative family distancing and decreased school performance. Associations between parent-child relationship qualities and Latino/a/x adolescent adjustment were bidirectional.

Ethnic-racial Socialization, Perceived Neighborhood Quality, and Psychosocial Adjustment among African American and Caribbean Black Adolescents.

Ethnic-racial socialization is employed by ethnic minority parents to support their children's psychosocial adjustment. These socialization messages may be associated differently with psychosocial adjustment for Black youth according to ethnicity and qualities of the neighborhood context. This research examined whether associations between ethnic-racial socialization messages and psychosocial adjustment vary by ethnicity and perceived neighborhood quality in a nationally representative sample of Black adolescents who participated in the National Survey of American Life Adolescent supplement study. The effects of promotion of mistrust messages varied by ethnicity, and the effects of egalitarianism messages varied depending on perceived neighborhood quality. These findings help clarify prior research which has yielded equivocal results for the effects of these messages for Black youth's psychosocial adjustment.

Individual Differences in Patterns of Community Violence Exposure and Internalizing and Externalizing Behaviors.

Youth community violence has been linked with depressive and anxious symptoms, and aggressive behavior; however, little research has examined different combinations of emotional and behavioral adjustment among community-violence-exposed youth, or individual characteristics that may account for different patterns of emotional and behavioral adjustment in community-violence-exposed youth. This research used person-centered methods to examine how gender, temperament characteristics, and prior exposure to community violence were linked with classes of community violence exposure and internalizing and externalizing adjustment among a sample of urban African American youth. Participants were 464 African American adolescents (46.7% female; mean age = 14.83, SD = .43) who reported their community violence exposure in Grade 9 and for whom reports of depressive and anxious symptoms, and aggressive behavior were available. Latent class analysis identified four classes of adolescents distinguished by their exposure to community violence exposure and internalizing and externalizing behavior. The two classes with high community violence exposure were characterized by internalizing symptoms or aggressive behavior; the two classes with low community violence exposure had low internalizing symptoms with moderate aggression or had all moderate symptoms. These community violence adjustment classes were distinguished by gender, history of community violence exposure, behavioral inhibition, and fight-flight-freeze systems. Findings highlight heterogeneity in internalizing and externalizing responses of community-violence-exposed youth and suggest factors that explain community violence exposure, repeat exposure, and responses to community violence exposure.

Multilevel mobile health approach to improve cardiovascular health in resource-limited communities with Step It Up: a randomised controlled trial protocol targeting physical activity.

INTRODUCTION: Although physical activity (PA) reduces cardiovascular disease (CVD) risk, physical inactivity remains a pressing public health concern, especially among African American (AA) women in the USA. PA interventions focused on AA women living in resource-limited communities with scarce PA infrastructure are needed. Mobile health (mHealth) technology can increase access to PA interventions. We describe the development of a clinical protocol for a multilevel, community-based, mHealth PA intervention for AA women. METHODS AND ANALYSIS: An mHealth intervention targeting AA women living in resource-limited Washington, DC communities was developed based on the socioecological framework for PA. Over 6 months, we will use a Sequential Multi-Assignment, Randomized Trial approach to compare the effects on PA of location-based remote messaging (named 'tailored-to-place') to standard remote messaging in an mHealth intervention. Participants will be randomised to a remote messaging intervention for 3 months, at which point the intervention strategy will adapt based on individuals' PA levels. Those who do not meet the PA goal will be rerandomised to more intensive treatment. Participants will be followed for another 3 months to determine the contribution of each mHealth intervention to PA level. This protocol will use novel statistical approaches to account for the adaptive strategy. Finally, effects of PA changes on CVD risk biomarkers will be characterised. ETHICS AND DISSEMINATION: This protocol has been developed in partnership with a Washington, DC-area community advisory board to ensure feasibility and acceptability to community members. The National Institutes of Health Intramural IRB approved this research and the National Heart, Lung, and Blood Institute provided funding. Once published, results of this work will be disseminated to community members through presentations at community advisory board meetings and our quarterly newsletter. TRIAL REGISTRATION NUMBER: NCT03288207.