Multidimensional Evaluation of Screening Brief Intervention and Referral to Treatment Training for Medical Students.

OBJECTIVE: Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based approach to identifying and addressing alcohol use in non-specialty settings. Many medical schools teach SBIRT, but most published evaluations of these efforts exclude rigorous skill assessments and teaching methods. METHODS: During the 2017-2018 academic year, 146 third-year medical students received classroom-based learning on SBIRT and motivational interviewing (MI) and at least two SBIRT practices with feedback as part of a 4-week psychiatry clerkship. The objective of this curriculum was to improve SBIRT knowledge, attitudes, and confidence and enable learners to skillfully deliver SBIRT. Outcomes evaluated included satisfaction, knowledge, attitudes and confidence, and clinical skill in delivering SBIRT to a standardized patient (rated by the actor, as well as an expert). RESULTS: Results indicated acceptable satisfaction at post-curriculum and significant improvements in attitudes and knowledge from pre- to post-curriculum. On the clinical skills exam, all students were rated as having mastered at least 80% of SBIRT elements by standardized patients and 91.8% were rated at this level by a faculty expert. Student attitudes and knowledge were unrelated to expert ratings, and standardized patient ratings had limited associations with expert ratings. CONCLUSIONS: These results suggest curriculum objectives were achieved and provide unique contributions to the SBIRT curricular outcome research for healthcare trainees. Other findings included that trainee knowledge and confidence may not relate to skill, and standardized patient feedback provides different information on SBIRT and MI skill than expert ratings.

Ethnic/Racial Differences in Alcohol Use: Does Drinking Refusal Self-Efficacy Matter?

Introduction: College students-including those of Hispanic backgrounds-are at risk for hazardous drinking. Research has shown robust group differences between Hispanic and White individuals in alcohol use outcomes. The ability to resist alcohol consumption can be leveraged to reduce hazardous drinking; however, little research has examined Hispanic-White differences and whether drinking refusal self-efficacy accounts for group differences in hazardous drinking. Considering Hispanic individuals make up the largest ethnic/racial minority group in the United States, it is important to identify malleable psychological factors that prevent and reduce drinking problems. Method: Hispanic and White college students at two predominantly White institutions (N = 389; 58.6% women, Mage= 20.22) completed measures assessing drinking refusal self-efficacy, hazardous drinking, and negative drinking consequences. Results: Hispanic students reported lower levels of hazardous drinking, alcohol-related problems, and drinking refusal self-efficacy than White students. Drinking refusal self-efficacy was found to partially explain Hispanic-White differences in the levels of hazardous drinking and drinking-related problems. Specifically, drinking refusal self-efficacy was associated with alcohol use outcomes only among White students and not Hispanic students. Conclusion: The correspondence between drinking refusal self-efficacy and actual behaviors to turn down drinks, ethnic/racial distinctiveness in ratings of self-efficacy and cultural orientations, and situational contexts that surround drinking should be examined in future research.

Mississippi INBRE Outreach Scholars program: adapting a summer scholars program to the virtual world amidst the COVID-19 pandemic.

The Mississippi IDeA Networks of Biomedical Research Excellence (INBRE) supported by the National Institute of General Medical Sciences (Grant P20GM103476) launched the new Mississippi INBRE Outreach Scholars (MIOS) summer research program in 2019. The program was designed to offer students community outreach and research experiences related to the study of behavioral and health disparities life sciences. The program was adapted in early 2020 to offer the program in a fully online format in the summer of 2020. This article details the program adaptations and discusses program evaluation data related to scholars' perceptions of program benefits and expectations and their confidence in research-related skills. The program evaluation was a mixed-method approach that included a qualitative postprogram survey and a pre-post quantitative survey. Scholars identified technical and communication skill building and resilience as areas of personal growth. Overall, the program met scholars' expectations for the program and significantly improved their confidence on 8 of the 19 (with confidence interval estimated differences from 0.3 to 2.56, where a difference of 1 is an improvement across 1 anchor on a Likert-type scale) various research-related tasks/skills after completion of the program. The analyses presented demonstrated that a combined qualitative and quantitative analysis approach is useful for examining the extent to which programs such as Mississippi INBRE are meeting goals of providing a rich research experience in health disparities for a diverse student body. Future longitudinal data may be examined to explore the long-term impact of MIOS on career preparation and choices and graduate education.NEW & NOTEWORTHY The Mississippi INBRE Outreach Scholars program is a summer research program for Mississippi college students that was successfully adapted to a fully online environment amidst the coronavirus-19 pandemic.

Making sense of design thinking: A primer for medical teachers.

An increasing number of medical teachers have taken an interest in design thinking, which has been used for years in business, law, and technology sectors. Yet, what does design thinking mean, and how has it been applied in medical education? This commentary discusses design thinking from multiple perspectives. First, it overviews, briefly, the historical development of design thinking, which medical education literature has seldom addressed in detail. Second, it synthesizes three current understandings of design thinking across disciplines: design thinking as a cognitive style, as a process of creativity and innovation, and as an organizational attribute. Third, it presents a 'roundup' of design thinking initiatives that have been applied at preclinical and clinical levels, including programs, courses, workshops, and hackathons. To conclude, the commentary suggests future directions for medical teachers interested in design thinking. Although design thinking is showing promise in medical education, there is substantial work to be done theoretically and practically.

Protective Behavioral Strategies Mediate the Relationship between Overparenting and Alcohol-Related Consequences among College Students.

BACKGROUND: The negative consequences associated with alcohol misuse remain a concern on college campuses nationwide. Alcohol protective behavioral strategies are important factors in mitigating college students' experiences of alcohol-related negative consequences. Overparenting, or "helicopter parenting," is a form of over-involved parenting which has been associated with a range of substance use concerns in college students. The mechanism by which overparenting is associated with alcohol use and/or consequences is unclear; however, it may be partially explained by failure to engage in the use of protective behavioral strategies. Purpose/objectives: The current study explored the degree to which alcohol protective behavioral strategies mediated the relationship between overparenting and alcohol-related negative consequences when accounting for alcohol consumption and if these associations were invariant across race and gender. Methods: Participants were 625 traditional age college students who consumed alcohol within the 30 days prior to completing measures of alcohol consumption, overparenting, alcohol-related negative consequences, and alcohol protective behavioral strategies. Results: Alcohol protective behavioral strategies, specifically manner of drinking, partially mediated the relationship between overparenting and alcohol-related negative consequences when accounting for alcohol misuse. There were no differences noted across gender, but the models were found to be invariant across White and African American participants in relation to the protective value of alcohol protective behavioral strategies. Conclusion/Importance: Overparenting may relate to negative alcohol outcomes in part through less use of harm reduction strategies. More investigation into the value of alcohol protective behavioral strategies across race is needed.

Screening for alcohol use disorders in college student drinkers with the AUDIT and the USAUDIT: a receiver operating characteristic curve analysis.

Background: The Alcohol Use Disorders Identification Test (AUDIT) and its consumption subscale (AUDIT-C) are international gold standard screeners for identifying at-risk drinkers. Items have been modified to reflect United States low-risk drinking guidelines in the USAUDIT and USAUDIT-C, which also perform well in identifying at-risk drinkers. The USAUDIT may also be used to screen for potential AUD, an important first step to identify individuals needing diagnostic testing and treatment referrals. Objectives: The present study sought to evaluate the sensitivity and specificity of each measure in predicting potential AUDs via diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition in a college sample. Methods: Participants were 382 college student drinkers (Mage = 20.2, SD = 1.5; 68.7% female) who completed online surveys assessing alcohol use, at-risk drinking, and AUD symptom endorsement. Receiver operating curves provide optimal cutoff scores for each measure in overall, male, and female samples. Results: Results indicated the AUDIT and USAUDIT are equally superior in detecting potential AUD in the current sample. Recommended cutoff scores for detecting likely AUD with the USAUDIT are 12 for males (sensitivity = 62.0%, specificity = 86.6%) and 8 for females (sensitivity = 65.3%, specificity = 87.7%). Conclusions: Whereas prior work supports the USAUDIT-C in detecting at-risk drinking, the current study supports the AUDIT and USAUDIT in detecting potential AUD. Based on prior work, and in an effort to be consistent with standard US drinking guidelines, we recommend using the USAUDIT in screening and brief interventions across college campuses.

Coping Styles Mediate the Association between Posttraumatic Stress Disorder Symptoms and Alcohol Outcomes in College Students.

BACKGROUND: College students report high rates of alcohol consumption and Criterion A traumatic events, which puts them at higher risk for dangerous alcohol-related negative consequences when compared to the general population. The self-medication theory suggests coping as the potential link between substance use and psychological distress, and it has been found that ineffective coping styles are related to increased PTSD symptom severity and harmful drinking behaviors. Purpose: This study evaluated the mediating role of coping styles (i.e. problem-solving and avoidance coping) on the relationship between posttraumatic stress disorder (PTSD) symptoms and alcohol outcomes (i.e. hazardous drinking and alcohol-related negative consequences [ARNC]). Methods: A national sample of 672 traditional age (i.e. 18-25 years old; M = 22.35, SD = 1.97) college students who reported alcohol consumption in the past month were recruited via Amazon's Mechanical Turk website. Participants were 55.1% male and 60.9% White and completed measures of PTSD symptoms, coping styles, hazardous drinking, and ARNC. Results: Problem-solving coping mediated the positive relationship between PTSD symptoms and hazardous drinking such that PTSD symptoms were negatively associated with problem-solving coping, which was negatively associated with hazardous drinking. Avoidance coping mediated the positive relationship between PTSD symptoms and ARNC through a positive association between PTSD symptoms and avoidance coping. Conclusions: These novel findings highlight the importance of adaptive coping styles as a protective factor for college students experiencing co-occurring PTSD symptoms and harmful alcohol use.

College Alcohol Beliefs and Alcohol Outcomes: The Mediating Effects of Alcohol Protective Behavioral Strategies.

BACKGROUND: The present study examined the mediating role of alcohol protective behavioral strategies (i.e. serious harm reduction [PBS-SHR], manner of drinking [PBS-MOD], stopping/limiting drinking [PBS-SLD]) on the relationships between college alcohol beliefs and alcohol outcomes (i.e. hazardous drinking and alcohol-related negative consequences) in an attempt to replicate recent findings in the early stages of college alcohol belief and PBS research. Methods: Participants were 625 traditional age undergraduate college students (M = 19.00, SD = 1.72; 63.7% White; 80.7% female) recruited from a southeastern United States university who reported past 30-day alcohol consumption. All participants completed measures of college alcohol beliefs, alcohol PBS use, hazardous drinking, and alcohol-related negative consequences through an online survey. Results: Higher college alcohol beliefs were associated with greater hazardous drinking and alcohol-related negative consequences. Further, PBS-MOD mediated the positive relationship college alcohol beliefs had with hazardous drinking, such that higher college alcohol beliefs predicted less PBS-MOD use which was associated with greater hazardous drinking. Discussion: These findings provide further evidence to support previous findings highlighting the additional protective value of certain alcohol PBS especially for college students with high college alcohol beliefs.

Post-traumatic stress and marijuana outcomes: The mediating role of marijuana protective behavioral strategies.

Background: The present study investigated the mediating role of protective behavioral strategies for marijuana (PBSM) on the relationship between posttraumatic stress disorder (PTSD) and marijuana outcomes (i.e. marijuana use frequency, marijuana use quantity, cannabis use disorder (CUD) symptoms, and marijuana-related problems). Methods: Participants were 1,107 traditional age college students (Mage = 20.26, SD = 3.32; 66.5% White, non-Hispanic; 68.8% female), who reported consuming marijuana at least once in the last 30 days and completed measures of PTSD symptoms, PBSM, and marijuana-related outcomes. Results: PBSM significantly mediated the positive relationships between PTSD symptoms and both CUD symptoms and marijuana-related problems. More specifically, PTSD symptoms were negatively associated with PBSM, which in turn was negatively associated with marijuana use frequency and marijuana use quantity, which were in turn positively associated with CUD symptoms and marijuana-related problems. Conclusion: Taken together, the associations between higher PTSD symptoms and greater experience of CUD symptoms and marijuana-related problems may occur because students use fewer PBSM and thus engage in larger quantity and frequency of marijuana use. These findings lend support to the utility of targeting PBSM as a harm reduction effort for students with PTSD symptoms who use marijuana.

The Moderating Effects of College Stress on the Relationship between Protective Behavioral Strategies and Alcohol Outcomes.

Background: Protective behavioral strategies (PBS) are harm reduction strategies used to lessen the negative effects of alcohol consumption. PBS controlled consumption (e.g., avoiding shots) center on managing alcohol consumption and tend to be negatively correlated with hazardous drinking whereas PBS serious harm reduction (e.g., having a designated driver) have a negative association with alcohol-related negative consequences. These relationships are often attenuated by factors such as mental health. Stress is linked with hazardous drinking and is experienced by most individuals. However, there are unique aspects of alcohol use and stressors associated with being in college (e.g., adjustment, academics) that require further investigation. Objectives: The purpose of this study was to explore how college stress - specific stressors related to the college experience - moderated the relationships PBS types had with hazardous drinking and alcohol-related negative consequences while accounting for gender. Methods: Participants were 550 college students ages 18 to 24 who drank alcohol within 30 days of completing measures of PBS use, college stress, hazardous drinking, and alcohol-related negative consequences. Results: A negative association was found between PBS controlled consumption and hazardous drinking while a positive association was found between PBS serious harm reduction and hazardous drinking, but neither relationships were significantly moderated by college stress. A negative relationship was found between PBS serious harm reduction and alcohol-related negative consequences, which was strengthened for those with high levels of college stress. Conclusion: These findings highlight the importance of further investigating the role of college stress in relation to safe and hazardous drinking and provide evidence for the protective role of PBS for college students experiencing stress and consuming alcohol.

Motivational interviewing training of substance use treatment professionals: A systematic review.

Background: Through evaluations of training programs, systematic reviews, and meta-analyses, advances in identifying best practices for disseminating motivational interviewing (MI) have emerged. To advance this work further, inclusion of thorough descriptions of the following is needed in research publications: study (design, trainee characteristics, setting characteristics), training and coaching methods (if applicable), trainer qualifications, and evaluation of MI skills. Methods: The purpose of this study was to systematically evaluate the research on MI training of substance use treatment professionals for the inclusion of such descriptions. Twenty-five studies were reviewed using a scoring rubric developed by the authors. Results: Just over two thirds of the studies (68%) were randomized controlled trials of MI training. The majority of studies provided information about (a) trainee characteristics (professional background = 76%, education = 60%, experience = 56%); (b) setting characteristics (80%); (c) training methods (format = 96%, length = 92%); (d) coaching (76%); and (e) evaluation of MI skills (92%). Conclusion: Findings suggest advancements in MI training studies since previous reviews, especially in regards to the inclusion of feedback and coaching. However, this review also found that inconsistencies in methods and reporting of training characteristics, as well as limited follow-up assessment of trainees' skill, continue to limit knowledge of effective training methods.

Evaluating the Positive Drinking Consequences Questionnaire: Support for a Four-Factor Structure and Measurement Invariance.

The 14-item Positive Drinking Consequences Questionnaire (PDCQ) was developed to assess experienced positive drinking consequences. The present study sought to advance the psychometric evaluation of the PDCQ via exploratory and confirmatory factor analyses, measurement invariance, criterion-related validity, and internal consistency. Participants were 1,088 traditional-age college students (81% female) who reported drinking in the past month. Exploratory factor analysis supported a four-factor model (i.e. Sociability, Tension Reduction, Liquid Courage, and Sexual Enhancement), and the confirmatory factor analysis indicated the four factors loaded on a higher-order factor ("PDCQ"). Invariance testing supported invariance for the PDCQ across gender. The PDCQ was positively associated with alcohol use and alcohol-related negative consequences, and negatively associated with protective behavioral strategies. Finally, the four factors of the PDCQ were discriminant from positive expectancies. Collectively, positive drinking consequences appear to be more nuanced than originally conceptualized. Evaluation of specific types of positive drinking consequences may assist in more precise prevention and intervention efforts in the future.

Depressive Symptoms and Drinking Outcomes: The Mediating Role of Drinking Motives and Protective Behavioral Strategies Among College Students.

BACKGROUND: College students with depressive symptoms tend to engage in more hazardous drinking and experience more alcohol-related consequences to cope with their symptoms. Given the perceived tension reducing effects of alcohol among these students, it is important to explore how protective factors, such as protective behavioral strategies, account for the relationships among depressive symptoms, drinking motives, and alcohol-related outcomes. OBJECTIVE: To examine the mediating role of drinking motives and protective behavioral strategies on the associations that depressive symptoms have with typical weekly alcohol consumption, hazardous drinking, and alcohol-related negative consequences in a sample of college student drinkers. METHODS: Traditional age college students (n = 566, 73% women; 58% White, non-Hispanic) completed measures of depression, drinking motives, protective behavioral strategies, weekly alcohol use, hazardous drinking, and alcohol-related negative consequences. RESULTS: Coping with depression motives and controlled consumption PBS explained the association between depression and weekly alcohol consumption and hazardous drinking whereas coping with depression motives and serious harm reduction PBS explained the depression-negative consequences relationship. Conformity motives and serious harm reduction PBS explained the association between depression and hazardous drinking and alcohol-related negative consequences. CONCLUSIONS: Findings suggest that students with more depressive symptoms would benefit from clinical interventions tailored to address negative reinforcement drinking motives and, by extension, increase student utilization of PBS related to minimizing harm. Clinical and research implications are provided.

Treatment Seeking among College Students with Comorbid Hazardous Drinking and Elevated Mood/Anxiety Symptoms.

BACKGROUND: Hazardous drinking is prevalent among college students and often comorbid with mood and/or anxiety disorders; however, these disorders frequently go untreated. Prior studies have found that individuals with comorbid hazardous drinking are more likely to seek treatment than those with an hazardous drinking alone. OBJECTIVES: The current study tested possible psychological and structural explanations to understand these treatment seeking behaviors. METHODS: A sample of 222 students identified as hazardous drinkers (AUDIT ≥ 8) participated from September 2010 to April 2011. Behavioral measures designed to mimic actual treatment seeking and self-report measures were used to assess treatment seeking behaviors, and the influence of psychopathology and individual predictors on treatment interest. RESULTS: Students were more interested in treatment for emotional problems than for alcohol problems. Further, treatment seeking interest was significantly higher among individuals with comorbid hazardous drinking. When provided a telephone offer for a free on-campus clinic appointment, no students were interested in receiving treatment for alcohol use problems, but some were interested in an appointment for emotional problems (n = 13). Of those students expressing interest on the phone, seven attended the clinic appointment. Logistic regression analyses revealed that students with anxiety, anxiety sensitivity, and depression were more likely to attend the clinic appointment. Conclusions/Importance: In sum, targeting mood and anxiety disorders may be a viable way to increase treatment seeking rates in hazardous drinking college students.

Harmful alcohol use and alcohol-related sex expectancies as predictors of risky sex among african american female college drinkers.

African American college women are experiencing sex-related negative consequences at alarming rates. Alcohol use and alcohol-related sex expectancies are predictors of risky sexual behavior among college women; however, African American college women are often underrepresented in empirical studies. The purpose of the present study was to examine the link between alcohol-related sex expectancies (i.e., enhancement, sexual risk taking, and disinhibition expectancies), alcohol use, and risky sexual behavior among a sample of 222 sexually active African American female college drinkers. Participants completed measures assessing alcohol-related sex expectancies, typical weekly drinking, harmful alcohol use, and risky sexual behavior. Results indicated that combined sexual risk taking and disinhibition alcohol-related sex expectancies predicted both typical weekly drinking and harmful alcohol use. In addition, enhancement alcohol-related sex expectancies and harmful alcohol use predicted risky sexual behavior; however, typical weekly drinking did not. Clinical and research implications are discussed.

A randomized trial using motivational interviewing for maintenance of blood pressure improvements in a community-engaged lifestyle intervention: HUB city steps.

Little is known about the effective dose of motivational interviewing for maintaining intervention-induced health outcome improvements. The purpose of this study was to compare effects of two doses of motivational interviewing for maintaining blood pressure improvements in a community-engaged lifestyle intervention conducted with African-Americans. Participants were tracked through a 12-month maintenance phase following a 6-month intervention targeting physical activity and diet. For the maintenance phase, participants were randomized to receive a low (4) or high (10) dose of motivational interviewing delivered via telephone by trained research staff. Generalized linear models were used to test for group differences in blood pressure. Blood pressure significantly increased during the maintenance phase. No differences were apparent between randomized groups. Results suggest that 10 or fewer motivational interviewing calls over a 12-month period may be insufficient to maintain post-intervention improvements in blood pressure. Further research is needed to determine optimal strategies for maintaining changes.

Psychosocial constructs and postintervention changes in physical activity and dietary outcomes in a lifestyle intervention, HUB City Steps, 2010.

INTRODUCTION: Although modifications to dietary and physical activity (PA) behavior can reduce blood pressure, racial disparities in prevalence and control of hypertension persist. Psychosocial constructs (PSCs) of self-regulation, processes of change, and social support are associated with initiation and maintenance of PA in African Americans; which PSCs best predict lifestyle behavior changes is unclear. This study's objective was to examine relationships among PSC changes and postintervention changes in PA and dietary outcomes in a community-based, multicomponent lifestyle intervention. METHODS: This study was a noncontrolled, pre/post experimental intervention conducted in a midsized, Southern US city in 2010. Primarily African American adults (n = 269) participated in a 6-month intervention consisting of motivational enhancement, social support, pedometer diary self-monitoring, and 5 education sessions. Outcome measures included pedometer-determined steps per day, fitness, dietary intake, and PSC measures. Generalized linear mixed models were used to test for postintervention changes in behavioral outcomes, identify predictors of PSC changes, and determine if PSC changes predicted changes in PA and diet. RESULTS: Postintervention changes were apparent for 10 of 24 PSCs (P < .05). Processes of change components, including helping relationships, reinforcement management, and consciousness raising, were significant predictors of fitness change (P < .05). CONCLUSION: This article is among the first to address how measures of several theoretical frameworks of behavior change influence changes in PA and dietary outcomes in a multicomponent, community-based, lifestyle intervention conducted with African American adults. Findings reported identify PSC factors on which health behavior interventions can focus.

Drinking Motives and Alcohol Use Behaviors among African American College Students: The Mediating Role of Protective Behavioral Strategies.

Drinking motives are robust predictors of alcohol use behaviors among college students. However, less is known about the link between drinking motives and alcohol use behaviors among African American college students. This study explored the associations between drinking motives and alcohol use behaviors in a sample of 215 African American college students. The study also assessed whether protective behavioral strategies mediated the associations between drinking motives and alcohol use behaviors. A direct relationship emerged between enhancement motives and alcohol consumption, harmful drinking and alcohol-related negative consequences. Protective behavioral strategies mediated each of these relationships. Clinical and research implications are discussed.

Measuring Client Experiences of Motivational Interviewing during a Lifestyle Intervention.

The Client Evaluation of Motivational Interviewing was used to assess MI experiences in a predominantly female, African American sample from the Southeastern U.S. who received MI-based feedback during a multi-component lifestyle intervention. MI was experienced differently than a primarily White, male, Northeastern mental health sample.

Neither a problem nor my problem: Risk factors for underage drinking disengagement among college students.

OBJECTIVE: Underage drinking disengagement (UDD; cognitive restructuring/minimizing agency) measures attitudes about the acceptability and responsibility of drinking. We examined demographic correlates of UDD, as well as the moderating effects of legal drinking status on the association between UDD and drinking. PARTICIPANTS: College student drinkers (n = 893; Mage = 19.48, range = 18-25; White = 74.1%; female = 68.1%) from a multi-site study. METHODS: An online confidential survey included the UDD Scale for College Students and the AUDIT-C. RESULTS: White and multiracial, underage students, or those living with others endorsed greater cognitive restructuring disengagement than Hispanic students, legal-age students, or those living alone or with parents, respectively. Greek membership and greater "party school" perceptions were related to more cognitive restructuring and minimizing agency. The associations between UDD and alcohol use were not moderated by legal drinking age status. CONCLUSION: Identifying and educating students at risk for UDD on the ramifications associated with underage drinking could combat drinking.