Report of the 2023-2024 Strategic Engagement Standing Committee.

The American Association of Colleges of Pharmacy has long emphasized the value of strategic engagement, recognizing that it is critical to the success of pharmacy education, contributing to the expansion of pharmacy and public health practice, the fulfillment of institutional missions, and the meeting of programmatic needs. The 2023-2024 Strategic Engagement Committee was charged with operationalizing advocacy champions, creating an advocacy resource guide to support advocacy champions in their engagement with diverse public and private stakeholders, offering formal training to advocacy champions in the form of a new connect community and webinar series, and conducting focus groups at the 2024 Annual Meeting to determine strengths of the advocacy guide and opportunities to support advocacy champions further.

The Bridging Pharmacy Education and Practice Summit: A Unique Convening With Purpose.

It is not often that a group of health executives, educators, and professionals gather with the goal of identifying a preferred future for their profession and the patients they serve. It is even more rare when such an assembly results in a clear and actionable plan to follow to achieve that desired future. Nevertheless, the Bridging Pharmacy Education and Practice (BPEP) Summit, an unprecedented collaborative event in June 2022 that involved six sites across the country and more than 300 participants, was just such a convening. In this Commentary we provide a brief overview of this extraordinary summit and the events that led up to it.

The Rx-HEART Framework to Address Health Equity and Racism Within Pharmacy Education.

Objective. To identify gaps in health equity and anti-racism education across the pharmacy curriculum, define the key health equity and anti-racism concepts that are suggested to be included across the pharmacy curriculum, and recommend a framework with steps to integrate health equity and anti-racism education across the pharmacy curriculum.Findings. Other professions, such as social work, nursing, and medicine, have taken steps to address social injustice by integrating anti-racism into their curriculum. The National Association of Social Workers (NASW) advocates for "social justice and social change with and on behalf of clients" and included racism and health equity in its mission to eradicate "discrimination, oppression, poverty, and other forms of social injustice." The American Association of Colleges of Nursing (AACN) curricular standards for baccalaureate nursing education provided four key changes for immediate implementation to overcome structural, individual, and ideological racism (SIIR). In October 2020, the Association of American Medical Colleges (AAMC) released a four-pillar framework to address racism.Summary. The Academy must also actively engage in efforts to eradicate social injustices by incorporating into its curriculum topics that would result in the graduation of culturally and linguistically sensitive and structurally competent pharmacists. The five-phase framework, Pharmacy Health Equity Anti-Racism Training (Rx-HEART) provides guidance on how to accomplish the objectives described in this paper and the theme issue on social injustice.

Characterizing Sexual Violence in Intimate Relationships: An Examination of Blame Attributions and Rape Acknowledgment.

Rape by an intimate partner frequently involves a precedence of sexual consent between victim and perpetrator, often does not include the use of physical force, and may not fit societal definitions of rape. Given these unique characteristics, women who are assaulted by an intimate partner may be less likely to acknowledge the experience as a rape. In turn, they might make fewer blame attributions toward themselves and their perpetrators than victims of rape by a nonpartner. Consistent with these expectations, results from 208 community women reporting rape in adulthood revealed the presence of indirect effects of perpetrator type (nonpartner vs. intimate partner) on both behavioral self-blame and perpetrator blame through rape acknowledgment, even when controlling for both victim substance use at the time of the assault and coercion severity. Compared with women who experienced a rape by a nonpartner, women who experienced rape in the context of a marital or dating relationship were less likely to blame themselves or the perpetrator for the assault, in part because they were less likely to label their experience as a rape. Overall, these findings highlight the unique nature of intimate partner rape and provide further information about the relatively underresearched area of sexual violence in intimate relationships.

Healthy People 2030: Roadmap for Public Health for the Next Decade.

Pharmacists play key roles in public health activities. The Healthy People initiative is a future-oriented approach to promote health and prevent disease, and serves as a framework for priority areas of intervention. The latest iteration, Healthy People 2030, was released in August 2020. Healthy People 2030 contains 355 specific objectives and raises awareness about gaps between actual and optimal health status. Pharmacists and student pharmacists can directly impact the majority of the objectives to improve the nation's health. Pharmacy educators should utilize resources including the Clinical Prevention and Population Health Curriculum Framework to ensure they are adequately preparing their students to affect clinical prevention and population health.

Report of the 2020 Special Committee on Substance Use and Pharmacy Education.

EXECUTIVE SUMMARYThe 2020 Special Committee on Substance Use and Pharmacy Education was charged to update the work of the 2010 Special Committee on Substance Abuse and Pharmacy Education Report (SAPER) specifically with recommendations on core curricular content and delivery processes on substance misuse and substance use disorder (SUD). This report provides information on the committee's process to address the charges, background information and resources pertaining to the charges, and rationale for SUD being a critical topic for curriculum at colleges and schools of pharmacy. This committee offers several recommendations to the Association of Colleges of Pharmacy (AACP) pertaining to the committee charges.

Beyond the Force-Substance Dichotomy: Examining the Experience of Combined and Incapacitated Type Rapes and Their Relation to PTSD Symptoms.

Prior research has examined how posttraumatic stress disorder (PTSD) symptoms are influenced by the experience of different types of rape, defined according to the method of coercion used. This work, which classifies rape experiences as either forcible or substance-involved, has yielded mixed findings regarding differences in PTSD symptoms as a function of rape type. Based on recent evidence indicating significant heterogeneity within substance-involved rapes, the present study utilized a novel four-group conceptualization of rape type to examine differences in PTSD symptom severity and associated factors across rape type. Using a sample of 161 community women with experiences of adult rape, we examined four rape types based on method of coercion: forcible-only rape (i.e., involving only force/threat of force; n = 48), impaired rape (i.e., substance-related impairment was present, but the participant remained conscious; n = 56), combined rape (i.e., both force/threat of force and substance-related impairment were present; n = 29), and incapacitated rape (i.e., the participant was intoxicated to the point of unconsciousness; n = 28). We compared these groups on PTSD symptom severity within each symptom cluster, as well as on assault characteristics and consequences, including peritraumatic fear and injury, acknowledgment, and self-blame. Combined type rapes were associated with significantly more severe PTSD symptoms than forcible-only and impaired type rapes. Differences among the groups were also found for peritraumatic fear and injury, and rape acknowledgment. Utilizing a dichotomous approach to rape type overlooks the complexity of women's experiences. Differences in PTSD symptom severity as a function of the proposed four-group conceptualization of rape type highlight the importance of assessing method of coercion when treating rape-related PTSD. Likewise, differences across rape types in peritraumatic fear and rape acknowledgment highlight the potential utility of type-specific targets of intervention.

Effects of childhood emotional maltreatment on depressive symptoms through emotion dysregulation in treatment-seeking patients with heroin-dependence.

BACKGROUND: Although individuals who experience childhood emotional maltreatment (CEM) are more likely to use maladaptive emotion regulation strategies, resulting in vulnerability to depression, no research has examined whether emotion dysregulation may explain the association between CEM and current depressive symptoms in a clinical sample of heroin-dependent individuals. OBJECTIVES: The current study aimed to assess the direct effect of CEM on current depressive symptoms and its indirect effect via emotion dysregulation in a treatment-seeking sample of males with heroin dependence. In a cross-sectional design, participants (N = 350) completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Difficulties in Emotion Regulation Scale (DERS), the Obsessive-Compulsive Drug Use Scale (OCDUS), and the Beck Depression Inventory-II (BDI-II). RESULTS: Emotional abuse and neglect severity had significant direct effects on current depressive symptoms and significant indirect effects through emotion dysregulation after controlling for clinical factors related to heroin use. LIMITATIONS: Study limitations include the cross-sectional design and use of self-report scales. CONCLUSIONS: Findings suggest emotion dysregulation may increase depressive symptoms in heroin users who experienced CEM. Training in emotion regulation strategies may decrease depressive symptoms in heroin-dependent individuals with CEM. Additional research with a longitudinal design to confirm these results is warranted.

Risk for Revictimization Following Interpersonal and Noninterpersonal Trauma: Clarifying the Role of Posttraumatic Stress Symptoms and Trauma-Related Cognitions.

One victimization experience can increase the risk for subsequent victimization, which is known as revictimization. The aims of this study were to build on sexual revictimization research by (a) broadening the understanding of revictimization to interpersonal (and potentially noninterpersonal) trauma generally and (b) gaining specificity in the mechanisms that underlie revictimization. Using a prospective multisite design, an ethnically and racially diverse sample of 453 young women from the community (age range: 18-25 years, 60.7% European American) completed an initial survey and at least one follow-up survey within the subsequent year. Participants completed self-report measures of trauma history, posttraumatic stress symptoms, and maladaptive posttraumatic cognitions. Structural equation models revealed that interpersonal revictimization was observed when controlling for past noninterpersonal trauma, odds ratio (OR) = 2.27, 95% CI [1.23, 4.18], and supported the role of posttraumatic stress symptoms as a mechanism underlying such revictimization, 95% CI of indirect effect (IE) [0.08, 0.51]. Additionally, a history of noninterpersonal trauma (controlling for past interpersonal trauma) increased risk of subsequent interpersonal victimization via posttraumatic stress symptoms, 95% CI of IE [0.01, 0.38]. Notably, however, when maladaptive cognitions were included as mediators in addition to posttraumatic stress symptoms, the only unique indirect effect was for the association between interpersonal trauma and risk of revictimization specifically through perceived threat of harm, 95% CI of IE [0.05, 0.20]. These findings suggest that efforts to reduce interpersonal revictimization should target maladaptive posttraumatic cognitions, particularly perceptions of threat in the environment.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Riesgo de revictimización luego de trauma interpersonal y no interpersonal: Aclarando el rol de los Síntomas de Estrés postraumático y las Cogniciones relacionadas con el Trauma REVICTIMIZACIÓN, TEPT Y COGNICIONES Una experiencia de victimización puede aumentar el riesgo de una subsiguiente victimización, conocida como revictimización. Los objetivos de este estudio fueron desarrollar una investigación sobre la revictimización sexual mediante (a) una comprensión más amplia de la revictimización al trauma interpersonal (y potencialmente no interpersonal) en general, y (b) la obtención de especificidad en los mecanismos que subyacen a la revictimización. Utilizando un diseño multisitio prospectivo, una muestra étnica y racialmente diversa de 453 mujeres jóvenes de la comunidad (rango de edad: 18-25 años, 60.7% europeo-estadounidense) completaron una encuesta inicial y al menos una encuesta de seguimiento dentro del año siguiente. Las participantes completaron medidas de auto reporte del historial de traumas, síntomas de estrés postraumático y cogniciones postraumáticas no adaptativas. Los modelos de ecuaciones estructurales revelaron que se observó una revictimización interpersonal al controlar traumas no interpersonales pasados, odds ratio (OR) = 2.27, IC 95% [1.23, 4.18], y apoyaron el rol de los síntomas de estrés postraumático como un mecanismo subyacente a dicha revictimización, IC del 95% de efecto indirecto (IE) [0.08, 0.51]. Además, un historial de trauma no interpersonal (controlando el trauma interpersonal pasado) incrementó el riesgo de subsecuente victimización interpersonal mediante síntomas de estrés postraumático, IC del 95% de IE [0.01, 0.38]. Sin embargo, notablemente, cuando se incluyeron las cogniciones no adaptativas como mediadores además de los síntomas de estrés postraumático, el único efecto indirecto fue la asociación entre el trauma interpersonal y el riesgo de revictimización, específicamente a través de la percepción de la amenaza de daño, IC del 95% de IE [0.05, 0.20]. Estos hallazgos sugieren que los esfuerzos para reducir la revictimización interpersonal deben dirigirse a las cogniciones postraumáticas no adaptativas, en particular las percepciones de amenaza en el medio ambiente.

A Longitudinal Examination of Posttraumatic Stress Disorder Symptoms and Risky Sexual Behavior: Evaluating Emotion Dysregulation Dimensions as Mediators.

Posttraumatic stress disorder (PTSD) has been linked to a wide array of risky and health-compromising behaviors, including risky sexual behavior (RSB). Cross-sectional studies reveal positive associations between emotion dysregulation and both PTSD and RSB. This study extended that work by exploring whether intermediate levels of emotion dysregulation across multiple dimensions account for the relation between baseline PTSD symptoms and RSB (i.e., number of vaginal sex partners, number of instances of condomless sex, and number of instances of risky/impulsive sex) 16 months later. Participants were 447 trauma-exposed young adult women from the community (60.0% White; M age = 21.80 years) who completed five assessments (separated by 4-month increments) over a 16-month period. Baseline PTSD symptoms were significantly positively associated with all emotion dysregulation dimensions at 8 months and the number of instances of risky/impulsive sex at 16 months. Further, results revealed significant indirect effects of baseline PTSD symptoms on (1) 16-month vaginal sex partners through both the nonacceptance of negative emotions and difficulties controlling impulsive behaviors when distressed at 8-month and (2) 16-month risky/impulsive sex through difficulties engaging in goal-directed behaviors when distressed at 8 months. Results provide support for the mediating roles of nonacceptance of negative emotions and difficulties controlling behaviors when distressed in the relation between PTSD symptoms and later RSB.

Linking childhood emotional abuse and depressive symptoms: The role of emotion dysregulation and interpersonal problems.

Childhood abuse is a major public health problem that has been linked to depression in adulthood. Although different types of childhood abuse often co-occur, few studies have examined their unique impact on negative mental health outcomes. Most studies have focused solely on the consequences of childhood physical or sexual abuse; however, it has been suggested that childhood emotional abuse is more strongly related to depression. It remains unclear which underlying psychological processes mediate the effect of childhood emotional abuse on depressive symptoms. In a cross-sectional study in 276 female college students, multiple linear regression analyses were used to determine whether childhood emotional abuse, physical abuse, and sexual abuse were independently associated with depressive symptoms, emotion dysregulation, and interpersonal problems. Subsequently, OLS regression analyses were used to determine whether emotion dysregulation and interpersonal problems mediate the relationship between childhood emotional abuse and depressive symptoms. Of all types of abuse, only emotional abuse was independently associated with depressive symptoms, emotion dysregulation, and interpersonal problems. The effect of childhood emotional abuse on depressive symptoms was mediated by emotion dysregulation and the following domains of interpersonal problems: cold/distant and domineering/controlling. The results of the current study indicate that detection and prevention of childhood emotional abuse deserves attention from Child Protective Services. Finally, interventions that target emotion regulation skills and interpersonal skills may be beneficial in prevention of depression.

Rape Disclosure and Depression Among Community Women: The Mediating Roles of Shame and Experiential Avoidance.

Many women who disclose a rape encounter victim-blaming responses, which are associated with negative outcomes. The present study examined rape-related shame and experiential avoidance as mediators of the relation between victim-blaming responses to rape disclosure and depression among 103 rape survivors drawn from a community sample. Results revealed that victim-blaming responses were positively associated with depressive symptoms through rape-related shame and experiential avoidance, and shame was indirectly related to depression via avoidance. Findings suggest clinical interventions should focus on rape-related shame and experiential avoidance in targeting depression among rape survivors, and future research should continue to examine how victim-blaming responses to rape disclosure may be related to these factors.

Latent Classes of Lifetime Sexual Victimization Characteristics in Women in Emerging Adulthood: Differential Relations with Emotion Dysregulation.

OBJECTIVES: The aims of the present study were to investigate latent classes of sexual victimization among young adult women based on characteristics of their victimization experiences (e.g., relationship with the perpetrator, nature of act, frequency), and examine differences in dimensions of emotion dysregulation across these classes and among non-victims. METHOD: Participants were 491 women in the age range of 18-25 years from the United States; of these, 335 participants (M = 22.0, SD = 2.22) reported at least one experience of sexual victimization during their lifetime. Latent class analysis was employed to identify groups of women based on characteristics of their sexual victimization experiences. RESULTS: A three-class solution was found to be most parsimonious. The classes were labeled as High severity developmental revictimization (DRV; 43.3%), Low severity child/adolescent sexual abuse (CASA: 20.3%), and Low severity adult sexual assault (ASA; 36.4%). The DRV class reported higher rates of penetrative abuse and longer duration of abuse than the CASA class, and higher rates of injury during assault than the ASA class. Further, the DRV class reported greater difficulties in three dimensions of emotion regulation than the ASA class and greater deficits in emotional clarity than the CASA class. Finally, the three latent classes reported greater difficulties in at least four dimensions of emotion regulation than the non-victimized group. CONCLUSIONS: Findings of different classes of sexual victimization suggest the multidimensionality of these experiences. Results also highlight the potential utility of interventions aimed at improving emotion regulation among women with severe childhood sexual abuse.

I Said No: The Impact of Voicing Non-Consent on Women's Perceptions of and Responses to Rape.

The current study explored the impact of voicing non-consent in relation to rape. Aims of the study included determining (a) the prevalence of voicing non-consent, (b) the relationship of voicing non-consent to verbal and physical resistance, and (c) whether voicing non-consent predicts distress and rape acknowledgment. Out of 262 college women who experienced rape, 81% voiced non-consent. Voicing non-consent was related to verbal and physical resistance, but was distinct in prevalence and prediction of distress. Voicing non-consent was associated with trauma-related symptoms in multivariate models. Women who voiced non-consent were more likely to acknowledge their experience as rape or sexual assault. Implications are discussed.

Childhood Sexual Abuse and Fear of Abandonment Moderate the Relation of Intimate Partner Violence to Severity of Dissociation.

Betrayal trauma theory proposes a relation between intimate partner violence (IPV) and dissociation, suggesting that dissociation among victims of IPV may function to restrict awareness of abuse in order to preserve attachments perceived as vital. We investigated two factors that may moderate the relation between IPV and dissociation-childhood sexual abuse (CSA) severity and fear of abandonment-among 348 women currently in a relationship. The relation between frequency of IPV (sexual and physical) and dissociation (amnesia and depersonalization) was moderated by CSA severity and fear of abandonment. Specifically, among women with clinically relevant fear of abandonment, the strength of the relation between IPV and dissociation became stronger as CSA severity increased. This study is the first to demonstrate the moderating roles of fear of abandonment and CSA history in the relation between IPV and dissociation among women. Findings suggest that it may be important to target fear of abandonment in interventions with IPV victims who have a CSA history. Results suggest that fear of abandonment warrants greater attention in research on IPV revictimization.

The Role of Experiential Avoidance in the Relation between Anxiety Disorder Diagnoses and Future Physical Health Symptoms in a Community Sample of Young Adult Women.

Individuals diagnosed with an anxiety disorder report more physical health problems than those without an anxiety disorder. Few studies have examined the relation of anxiety disorders to later physical health symptoms, or the processes that may explain this relation. One process of interest is experiential avoidance (EA), which is commonly reported in populations characterized by high anxiety and often leads to health-compromising behaviors. The present study examined the relations between anxiety disorder diagnostic status, EA, and physical health symptoms in a community sample of young adult women. Results revealed a significant association between an anxiety disorder diagnosis and physical health problems four months later. Furthermore, levels of EA accounted for this relation. Findings highlight the potential utility of targeting EA as a method for improving health outcomes among individuals with anxiety disorders.

Victim Alcohol Intoxication During a Sexual Assault: Relations With Subsequent PTSD Symptoms.

This study examines associations between women's alcohol intoxication at the time of sexual assault and posttraumatic stress disorder (PTSD) symptoms. Drawing on the dual representation theory (Brewin, Gregory, Lipton, & Burgess, 2010), we hypothesized that intoxication at the time of assault would be positively associated with both overall symptoms of PTSD and PTSD reexperiencing symptoms in particular. A total of 143 community women (ages 18-26 years; 71.3% European American) reporting sexual victimization completed questionnaires assessing severity of coercion involved in the assault, perceived level of intoxication at the time of assault, and current PTSD symptoms. Overall, results suggested that greater alcohol intoxication (but not alcohol use alone) was associated with more severe PTSD symptoms when controlling for severity of coercion. Furthermore, higher levels of victim intoxication at the time of the assault were most predictive of reexperiencing symptoms relative to the other symptom clusters.

Development and Validation of a State-Based Measure of Emotion Dysregulation.

Existing measures of emotion dysregulation typically assess dispositional tendencies and are therefore not well suited for study designs that require repeated assessments over brief intervals. The aim of this study was to develop and validate a state-based multidimensional measure of emotion dysregulation. Psychometric properties of the State Difficulties in Emotion Regulation Scale (S-DERS) were examined in a large representative community sample of young adult women drawn from four sites ( N = 484). Exploratory factor analysis suggested a four-factor solution, with results supporting the internal consistency, construct validity, and predictive validity of the total scale and the four subscales: Nonacceptance (i.e., nonacceptance of current emotions), Modulate (i.e., difficulties modulating emotional and behavioral responses in the moment), Awareness (i.e., limited awareness of current emotions), and Clarity (i.e., limited clarity about current emotions). S-DERS scores were significantly associated with trait-based measures of emotion dysregulation, affect intensity/reactivity, experiential avoidance, and mindfulness, as well as measures of substance use problems. Moreover, significant associations were found between the S-DERS and state-based laboratory measures of emotional reactivity, even when controlling for the corresponding original DERS scales. Results provide preliminary support for the reliability and validity of the S-DERS as a state-based measure of emotion regulation difficulties.

Emotion Dysregulation Mediates the Relation Between Borderline Personality Disorder Symptoms and Later Physical Health Symptoms.

Despite evidence of a relation between borderline personality disorder (BPD) pathology and physical health problems, the mechanisms underlying this relation remain unclear. Given evidence that emotion dysregulation may affect physical health by altering physiological functioning, one mechanism that warrants examination is emotion dysregulation. This study examined BPD symptoms as a prospective predictor of physical health symptoms 8 months later and the mediating role of emotion dysregulation in this relation. Participants completed three assessments over an 8-month period, including a BPD diagnostic interview. Results of analyses examining baseline predictors of later physical health symptoms revealed a significant unique association between baseline BPD symptom severity and physical health symptoms 8 months later, above and beyond baseline physical health symptoms, depression and anxiety symptoms, and emotion dysregulation. Moreover, structural equation modeling revealed a significant indirect relation of BPD symptoms at Wave 1 to physical health symptoms at Wave 3 through emotion dysregulation at Wave 2.

Emotional lability and affective synchrony in borderline personality disorder.

Extant research on emotional lability in borderline personality disorder (BPD) has focused almost exclusively on lability of individual emotions or emotion types, with limited research considering how different types of emotions shift together over time. Thus, this study examined the temporal dynamics of emotion in BPD at the level of both individual emotions (i.e., self-conscious emotions [SCE], anger, and anxiety) and mixed emotions (i.e., synchrony between emotions). One hundred forty-four women from the community completed a diagnostic interview and laboratory study involving 5 emotion induction tasks (each of which was preceded and followed by a 5-min resting period or neutral task). State ratings of SCE, anger, and anxiety were provided at 14 time points (before and after each laboratory task and resting period). Hierarchical linear modeling results indicate that women with BPD reported greater mean levels of SCE and Anxiety (but not Anger), and greater lability of Anxiety. Women with BPD also exhibited greater variability in lability of all 3 emotions (suggestive of within-group differences in the relevance of lability to BPD). Results also revealed synchrony (i.e., positive relations) between each possible pair of emotions, regardless of BPD status. Follow-up regression analyses suggest the importance of accounting for lability when examining the role of synchrony in BPD, as the relation of SCE-Anger synchrony to BPD symptom severity was moderated by Anger and SCE lability. Specifically, synchronous changes in SCE and Anger were associated with greater BPD symptom severity when large shifts in SCE were paired with minor shifts in Anger. (PsycINFO Database Record