Long-Term RCT outcomes for adolescent alcohol and cannabis use within a predominantly Hispanic sample.

Because adolescents are unlikely to seek, receive, or complete treatment for alcohol and/or cannabis misuse, it is important to enhance the lasting impact of clinical contacts when they do occur. Adolescents (N = 506; 72.5% Hispanic) were randomized to motivational interviewing (MI) versus alcohol and cannabis education (ACE). Latent growth models estimated change over time. Significant reductions in alcohol use were observed, with slightly greater reductions by 12-month follow-up for MI. Both interventions significantly reduced cannabis use, with no treatment group differences. When outcomes were examined comparing Hispanic to non-Hispanic participants, there were no significant differences in intervention efficacy by group. MI's inherently client-centered and culturally adaptive approach may contribute to its equitable degree of behavior change for youth across race/ethnic backgrounds.

Feel good now or regret it later? The respective roles of affective attitudes and anticipated affective reactions for explaining health-promoting and health risk behavioral intentions.

Evidence supporting the incorporation of affective constructs, such as affective attitudes and anticipated regret, into theoretical models of health behavior has been mounting in recent years; however, the role of positive anticipated affective reactions (e.g., pride) has been largely unexplored. The purpose of the present investigation was to assess how affective attitudes and anticipated affective reactions (both pride and regret for performing a behavior or not) may provide distinct utility for understanding intentions to perform health-promoting and health risk behaviors over and above cognitive attitudes and other established theoretical constructs from the theory of planned behavior (TPB). Participants (N = 210) were recruited via Amazon's Mechanical Turk to complete a one-time online battery assessing TPB and affective constructs. Self-reported intentions served as the main outcome measure, and hierarchical linear modeling was used to examine the effects of TPB and affective constructs across behaviors. Controlling for TPB constructs, more positive affective attitudes and greater anticipated regret, but not anticipated pride, predicted intentions to engage in future health behaviors. Anticipated affective reactions contributed explanatory variance for intentions to perform health risk behaviors, but anticipated pride and regret were not associated with intentions to perform health risk behaviors. Contributions made via the inclusion of both positively and negatively valence anticipated affective reactions for both action and inaction (performing a behavior or not) across a range of health promoting and health risk behaviors are discussed, as well as implications for future intervention work.

Dismantling the theory of planned behavior: evaluating the relative effectiveness of attempts to uniquely change attitudes, norms, and perceived behavioral control.

The current study compares the effectiveness of interventions that attempted to uniquely influence hypothesized determinants of behavior in the Theory of Planned Behavior versus some optimal combination of constructs (three constructs vs. four) to increase condom use among intentions and behavior college students. 317 participants (Mage = 19.31; SDage = 1.31; 53.3% female; 74.1% Caucasian) were randomly assigned to one of seven computer-based interventions. Interventions were designed using the Theory of Planned Behavior as the guiding theoretical framework. 196 (61.8%) completed behavioral follow-up assessments 3-month later. We found that the four construct intervention was marginally better at changing intentions (estimate = - .06, SE = .03, p = .06), but the single construct interventions were more strongly related to risky sexual behavior at follow-up (estimate = .04, SE = .02, p = .05). This study suggests that these constructs may work together synergistically to produce change (ClinicalTrials.gov Number NCT# 02855489).

Using Videogame Apps to Assess Gains in Adolescents' Substance Use Knowledge: New Opportunities for Evaluating Intervention Exposure and Content Mastery.

BACKGROUND: Videogame interventions are becoming increasingly popular as a means to engage people in behavioral interventions; however, strategies for examining data from such interventions have not been developed. OBJECTIVE: The objective of this study was to describe how a technology-based intervention can yield meaningful, objective evidence of intervention exposure within a behavioral intervention. This study demonstrates the analysis of automatic log files, created by software from a videogame intervention, that catalog game play and, as proof of concept, the association of these data with changes in substance use knowledge as documented with standardized assessments. METHODS: We analyzed 3- and 6-month follow-up data from 166 participants enrolled in a randomized controlled trial evaluating a videogame intervention, PlayForward: Elm City Stories (PlayForward). PlayForward is a videogame developed as a risk reduction and prevention program targeting HIV risk behaviors (substance use and sex) in young minority adolescents. Log files were analyzed to extract the total amount of time spent playing the videogame intervention and the total number of game levels completed and beaten by each player. RESULTS: Completing and beating more of the game levels, and not total game play time, was related to higher substance use knowledge scores at the 3- (P=.001) and 6-month (P=.001) follow-ups. CONCLUSIONS: Our findings highlight the potential contributions a videogame intervention can make to the study of health behavior change. Specifically, the use of objective data collected during game play can address challenges in traditional human-delivered behavioral interventions. TRIAL REGISTRATION: Clinicaltrials.gov NCT01666496; https://clinicaltrials.gov/ct2/show/NCT01666496 (Archived by WebCite at http://www.webcitation.org/6cV9fxsOg).

What Works? An Empirical Perspective on How to Retain Youth in Longitudinal Human Immunodeficiency Virus (HIV) and Substance Risk Reduction Studies.

BACKGROUND: Low retention rates are a problem for longitudinal studies involving adolescents, and this is particularly true for justice-involved youth. METHODS: This study evaluates (1) strategies used to retain high-risk adolescents participating in a longitudinal research project; (2) the extent to which retention efforts were different in a justice-involved versus a non-justice-involved (school-based) sample; and (3) differential characteristics of justice-involved versus school-based adolescents that might explain differences in retention difficulty. RESULTS: Compared with the school-based youth, justice-involved youth required significantly more phone calls to be successfully reached. Additionally, baseline substance use (alcohol and marijuana use frequency) was higher in the justice-involved sample and significantly related to retention difficulty. CONCLUSIONS: High retention rates for justice-involved and substance-using youth are possible with focused efforts on frequent communication and effortful contact.

Predictors of sexual coercion and alcohol use among female juvenile offenders.

Female juvenile offenders report high rates of sexual coercion and substance use, yet the temporal relationship between the two remains unclear. The focus of this study was to conduct a prospective examination of predictors of sexual coercion and substance use for a group of high-risk young women. Two hundred and forty five adolescent females (34 % of a sample including males and females), between the ages of 14-17, and from a larger study of juvenile offenders, were recruited from juvenile probation offices to participate in a longitudinal study on substance use and sexual risk. At baseline, participants completed measures associated with increased risk for sexual coercion, including substance use, perceived relationship control, and externalizing behavior. At 6- and 24-month follow-up, participants also completed a measure assessing sexually coercive experiences. Path analysis revealed that less relationship control at baseline predicted sexual coercion at 6-months. Additionally, 6-month sexual coercion predicted alcohol use and sexual coercion at 24-month follow-up. Logistic regression analysis revealed also that alcohol use at 6-months predicted sexual revictimization at 24-months. Sexual coercion appears to be associated with subsequent increases in alcohol use, suggesting that female juvenile offenders may be using alcohol to cope with the psychological and emotional consequences of victimization. Alcohol use is linked to increased risk for repeat sexual coercion, suggesting that exposure to risky environments also may be important in understanding these girls' risk. Difficulties responding assertively in sexual relationships (i.e., low relationship control) also seem to increase female juvenile offenders' risk for sexual coercion. Finally, previous sexual coercion appears to increase risk for future victimization, highlighting the importance of early intervention for this at-risk group.

Queering the Conflict in Adolescent Dating Relationships Inventory: An Examination of the Conflict in Adolescent Relationships Inventory Perpetration Scale's Measurement Invariance Across Heterosexual and Sexual Minority Youth.

Teen dating violence (TDV) is a public health concern impacting more than half of U.S. adolescents aged 12 to 18. Sexual minority youth (i.e., adolescents who are not exclusively heterosexual) experience disproportionately high rates of TDV. Yet, measures of TDV such as the Conflict in Adolescent Dating Relationships Inventory (CADRI) have been developed without considering sexual identity with items and instructions frequently anchored in heterosexual romantic relationships. Examination of measurement equivalence across heterosexual and sexual minority youth has only begun recently with existing research examining the CADRI's victimization scale measurement invariance providing empirical support for invariance across heterosexual and sexual minority youth. However, no prior research has examined the measurement invariance of the CADRI perpetration scales across heterosexual and sexual minority youth. The current study fills this gap by examining the CADRI perpetration scale measurement invariance across heterosexual and sexual minority youth. Using multigroup confirmatory factor analysis responses from 1,143 adolescents (Mage = 15.88, SD = 2.49) to the CADRI perpetration items were examined across heterosexual (n = 922) and sexual minority youth (n = 218). Results confirmed the five-factor structure of the CADRI perpetration scales, providing empirical support for the appropriateness of the use of the CADRI perpetration scale's scores across heterosexual and sexual minority youth broadly. However, findings of partial scalar measurement invariance on the emotional/verbal abuse perpetration scale raise questions about the appropriateness of mean-score comparisons on this particular subscale. Areas of potential revisions of the emotional/verbal abuse perpetration scale are discussed to facilitate meaningful comparisons among heterosexual and sexual minority youth and to substantiate program evaluation results by groups.

Attitude Is Everything: Examining Acceptance of Violence Items for Differential Item Functioning Across Heterosexual and Sexual Minority Youth.

Acceptance of dating violence (ADV) is a cognitive risk factor for violence perpetration and a common target of prevention programs. However, frequently used items assessing ADV are characterized by heteronormative item wording, and limited research has evaluated the degree to which ADV items function equivalently for both heterosexual and sexual minority youth (SMY). The current study sought to determine if there are differences in the way heterosexual and SMY respond to ADV survey items. Secondary data from a total of 2,014 adolescents (Mage = 16.78) were used to examine differences in ADV. Results of differential item functioning analysis indicated nonuniform differential item functioning for two of eight ADV items, with heterosexual youth being more likely to express strong levels of agreements with (a) female-perpetrated physical violence in response to male-perpetrated violence and (b) female-perpetrated violence against males broadly, relative to SMY. Although these differences were of negligible magnitude and only resulted in minimal differences in overall expected average scores, heterosexual youth were more likely to strongly accept female-perpetrated dating violence compared to SMY. Findings highlight differences in ADV item response patterns across heterosexual and sexual minority identifying youth and provide preliminary evidence for group differences in acceptance of female-perpetrated dating violence. Implications for prevention programming based on current findings include greater focus on measure adaptation and development as well as more consensus on the necessity of preventing female-perpetrated violence.

Cybervictimization in Relation to Self and Other Protection and Response Behaviors: A Cross-Sectional Look at an Age-Diverse National Sample.

This study considered whether experiencing cybervictimization is associated with increased recognition of cybervictimization intervention opportunities (i.e., witnessing others' cybervictimization), as well as greater engagement in self-protective (e.g., changing usernames and privacy settings) and other-protective cybervictimization bystander response behaviors. We collected cross-sectional self-report data from an age-diverse (M = 46.29 years, SD = 19.14, range = 15-93) national sample (n = 3002). We hypothesized that: (1) personal experiences with cybervictimization would be associated with increased reports of witnessing opportunities to intervene when others are cybervictimized, greater self-reported use of active bystander behaviors in witnessed situations, and greater use of self-protective strategies; (2) We also expected that engagement in self-protective behaviors would be positively associated with engagement in other-protective bystander behaviors in response to witnessed cybervictimization. To test our hypotheses, we estimated a structural equation model wherein four latent variables were constructed: cybervictimization experienced, witnessed opportunities to intervene, engagement in self-protective behaviors, and engagement in other-protective cybervictimization bystander behaviors. As hypothesized, cybervictimization was associated with witnessing more opportunities to intervene in other's cybervictimization, greater self-reported use of active cyber bystander behaviors, and greater engagement in self-protective strategies. However, the strength of two associations was moderated by age, with stronger relationships between cybervictimization and witnessing opportunities to intervene as well as engaging in bystander behavior for older as compared to younger participants. Contrary to hypothesis, there were no significant associations between use of self and other protective behaviors. Furthermore, greater witnessing of cybervictimization was associated with less engagement in bystander behavior in the final model. The implications for existing bystander intervention programs are described. Longitudinal studies of these associations in multiple age groups and among different cultural groups remain necessary.

Bystander intervention for problematic alcohol use among graduate and international students: opportunities and challenges.

OBJECTIVES: Bystander intervention (BI) is a prevention approach commonly used for interpersonal violence, but is less studied for problematic alcohol use (PAU). Domestic graduate and international students' life experiences bring a unique context for the potential application of BI to PAU. METHODS AND MEASURES: We conducted a mixed methods study that consisted of a needs assessment and focus groups at a southeastern university in the U.S. The aims of this study were to understand (1) differences in PAU BI opportunities for domestic graduate versus international students, (2) reasons for differences in PAU BI use, and (3) barriers/facilitators in use of PAU BI. RESULTS: Overall, participants had few opportunities to use BI. Domestic graduate students had slightly more opportunities compared to international students. Most prominent reasons for lack of opportunities included not wanting to drive, the cost of drinking, and holding a graduate student identity (e.g. not interested in heavy drinking). Trusting others to be responsible for themselves was a common barrier noted for not using BI for PAU. CONCLUSION: PAU BI programs should contextualize experiences of domestic graduate and international students to provide appropriate skill development that considers unique barriers and facilitators to intervention use.

Gender, sexual orientation, and mental health in the kink community: an application of coping self-efficacy theory.

OBJECTIVE: This paper advances understanding of the kink community by examining mental health and coping-self efficacy (CSE) variation by gender and sexual orientation. DESIGN: Adult members of the National Coalition for Sexual Freedom (N = 332) completed an online cross-sectional health assessment. MAIN OUTCOME MEASURES: The assessment included the Coping Self-Efficacy (CSE) Scale; Depression and Anxiety Stress Scale-21; and Alcohol Use Disorders Identification Test. RESULTS: Transgender and non-binary persons reported consistently low coping beliefs and poor mental health. Queer sexual minority persons reported low CSE thought stopping and high anxiety. Several CSE thought stopping moderation effects on mental health were observed. CONCLUSIONS: Findings may inform clinical implications, as bolstering coping-related beliefs and skills via cognitive-behavioral therapy may offer mental health benefit to kink practitioners.

The bystander intervention for problematic alcohol use model (BIPAUM).

Objective: The study aimed to identify phases of bystander intervention (BI) for problematic alcohol use (PAU) among college students. Participants: Twenty focus groups and nine interviews were conducted. Methods: Transcripts were thematically analyzed. Results: The phases of the Bystander Intervention for Problematic Alcohol Use Model (BIPAUM) include: (1) plan in advance, (2) notice and interpret a sign, (3) decide (i.e., assume responsibility, assess support/feasibility to intervene, and identify intervention strategy), (4) intervene, and (5) assess outcomes. Assessing outcomes loops to influence future behavior and each phase is influenced by barriers and facilitators. Conclusions: These unique phases should be considered when designing and evaluating intervention programs for PAU to meet students' needs and better reduce PAU. Future research should empirically test the BIPAUM. The results of the current study demonstrate a promising opportunity for applying BI to PAU, with the goal of reducing risky drinking among college students.

A Systematic Review of Validated Measures of U.S.-Based Bystander Intervention-Related Constructs.

This review aimed to identify U.S.-based, construct-validated measures of bystander intervention. Following PRISMA-P guidelines, electronic databases were searched, and emails were solicited identifying 8,559 articles for title screening. Abstracts and full texts were double screened, resulting in 24 scales meeting inclusion criteria: (a) measured a bystander-related construct in a situation where there was a potential for actual or perceived imminent physical or emotional harm, (b) written in English, and (c) statistically validated on U.S. samples. Most scales addressed the domain of interpersonal violence (67%), with fewer relating to bias/bullying (8.2%), mental health crises (12.5%), and substance use (12.5%). Most scales (71%) assessed the "take action" step of the situational model. The modal construct represented was intent/willingness/likelihood to intervene (50%). The average number of items on a scale was 14, and most (79%) provided Likert-style response options. None of the validated scales assessing behavior first accounted for an opportunity. Sample sizes ranged from 163 to 3,397, with the modal setting from colleges. Overall, samples were young (21.8 years old), White (75%), women (64%), and heterosexual (89%). Results indicate the need to validate additional measures that capture the "interpreting the situation as problematic" step of the situational model. Scales also need to be validated using diverse samples, particularly within the mental health crisis domain. Across all domains, validated measures need to be developed that first account for an opportunity when measuring actual bystander behavior. The information gleaned can be used to assist researchers in selecting measures and guide future measure development.

A latent profile analysis using the theory of planned behavior to predict alcohol use.

OBJECTIVE: The current study sought to identify subgroups of adult drinkers who differ in their level of association between alcohol-related Theory of Planned Behavior (TPB) constructs (attitudes, perceived norms, self-efficacy, and intentions), and explore if distinct subgroup profiles relate to alcohol use two weeks later. DESIGN: Participants (N = 121) were recruited to participate in a two-week study about daily experiences with exercise and alcohol (Mage = 30.93; SDage = 9.88; 59.2% female; 71.1% Caucasian). MAIN OUTCOME MEASURES: Alcohol attitudes, subjective norms, alcohol refusal self-efficacy, and intentions were used to create class membership. Behavioral outcomes included (1) drinking frequency, (2) drinking quantity, and (3) drinking to get drunk. RESULTS: Two classes of drinkers were determined - Class 1 was categorized by moderate scores on all constructs, whereas Class 2 was categorized by moderate scores on attitudes and high scores on norms, alcohol refusal self-efficacy, and intentions. Class designation was associated with frequency, but not quantity of use. CONCLUSION: The current study suggests that a minority of individuals who score moderately across all constructs should receive intervention efforts that focus on just those included in the TPB, while the vast majority may require additional constructs to be addressed.

"Everything feels risky now": Perceived "risky" sexual behavior during COVID-19 pandemic.

Social distancing through the COVID-19 pandemic has impacted sexuality and relationships, which may also change risk perceptions beyond traditional definitions (e.g. sexually transmitted infections). This study examines risk perceptions related to sexuality during the pandemic. We present qualitative analyses of a survey of adults in the United States (N = 333) to identify impacts of COVID-19 on individuals' risk perceptions. Risky sexual behavior definitions included: (1) COVID-19-related, (2) STI/pregnancy, (3) relationship-related, (4) physical boundaries, (5) drug or alcohol, and (6) multiple risks. Conventional public health messaging may need to incorporate changing risk definitions to address sexual health during the pandemic.

A psychometric assessment of the Military Suicide Attitudes Questionnaire (MSAQ).

Suicide rates remain high among military populations. Stigmatizing beliefs about suicide contribute to the problem of heightened suicide risk as a deterrent for help-seeking. Measurement of military suicide stigma is therefore an important gap in the literature as a necessity toward the development of military suicide prevention programming. This paper assessed the factor structure, reliability, and validity of the Military Suicide Attitudes Questionnaire (MSAQ). Study 1 featured secondary analysis of a suicide risk dataset from active duty treatment-seeking military personnel (N = 200). Study 2 was a secondary analysis of a statewide assessment of Army National Guard service members' beliefs about mental health and suicide (N =1116). Factor analyses results collectively supported a four-factor Military Suicide Attitudes Questionnaire (MSAQ) structure: discomfort, unacceptability, support, and empathic views. Subscale reliabilities ranged from 0.77 to 0.83 across samples. Unacceptability and support displayed significant negative correlations with psychological distress. Men displayed more negative suicide-related beliefs compared to women counterparts. Discomfort and unacceptability beliefs displayed significant positive associations with perceived barriers to care. The final short version of the MSAQ is an efficient, multi-dimensional measure of military suicide-related beliefs. The instrument can be used for public health assessment and program evaluation in military settings.

Coming together in a digital age: Community twitter responses in the wake of a campus shooting.

Campus mass shootings have become a pressing policy and public health matter. Twitter is a platform used for processing events among interested community members. Examining the responses of invested community members to a mass shooting on a college campus provides evidence for how this type of violence affects the immediate community and the larger public. These responses may reflect either content (e.g. context-specific) or emotions (e.g. humor). Aims Using Twitter data, we analyzed the emotional responses as well as the nature of non-affective short-term reactions, in response to the April 2019 shooting at UNC Charlotte. Methods Drawn from a pool of tweets between 4/30/19-5/7/19, we analyzed 16,749 tweets using keywords related to the mass shooting (e.g. "shooting," "gun violence," "UNC Charlotte"). A coding team manually coded the tweets using content and sentiment analyses. Results Overall, 7,148 (42.67%) tweets contained negative emotions (e.g. anger, sadness, disgust, anxiety), 5,088 (30.38%) contained positive emotions (e.g. humor, hope, appreciation), 14,892 (88.91%) were communal responses to the shooting (e.g. prayers, healing, victim remembrance), 8,329 (49.73%) were action-oriented (e.g. action taken, policy advocacy), and 15,498 (92.53%) included information (e.g. death/injury, news). All tweets except positive emotions peaked one day following the incident. Conclusions Our findings point to peaks in most emotions in the 24 hours following the event, with the exception of positive emotions which peaked one day later. Social media responses to a campus shooting suggest college preparedness for immediate deployment of supportive responses in the case of campus violence is needed.

"Making Peace" with Bodies and Sexual Selves: Changes during COVID-19 among Adults in the United States.

The COVID-19 pandemic has negatively impacted the physical and mental health of many and has necessitated widespread societal shifts, including changes to work and family activities. These changes have impacted individuals' identity, including their sexual self-image and body image, yet research on perceptions of these changes is missing. This study reports on quantitative and qualitative data from an electronic survey with adults in the United States (N = 326) to examine these perceptions. Body appreciation did not significantly differ between demographic groups. Themes emerging from the qualitative results included changes in general self-image (becoming more restricted or disempowered), changes in sexual self-image (deepening, becoming more sexy/sexual, or less sexy/sexual), and changes in body image (positive, negative, and neutral). Our findings point to positive, negative, and neutral effects on sexual self-image and body image, implying that nuanced approaches are needed to understand how identity has transformed as a result of the COVID-19 pandemic.

Preferences in Information Processing, Marginalized Identity, and Non-Monogamy: Understanding Factors in Suicide-Related Behavior among Members of the Alternative Sexuality Community.

Suicide-related behavior (SRB) is a mental health disparity experienced by the alternative sexuality community. We assessed mental health, relationship orientation, marginalized identities (i.e., sexual orientation minority, gender minority, racial minority, ethnic minority, and lower education), and preferences in information processing (PIP) as factors differentiating lifetime SRB groups. An online cross-sectional survey study was conducted in 2018. Members of the National Coalition for Sexual Freedom (NCSF; n = 334) took part. Bivariate analyses identified the following SRB risk factors: female and transgender/gender non-binary identity, sexual orientation minority identity, lower education, suicide attempt/death exposure, Need for Affect (NFA) Avoidance, depression, and anxiety. Monogamous relationship orientation was a protective factor. Multi-nomial regression revealed the following: (1) monogamous relationship orientation was a protective factor for suicidal ideation and attempt; (2) lower education was a risk factor for suicide attempt; (3) anxiety was a risk factor for suicide attempt; and (4) depression was a risk factor for suicidal ideation. A two-way interaction showed that elevated NFA Approach buffered the negative impacts of depression. Relationship orientation, several marginalized identities (i.e., based on gender, sexual orientation, and educational level), and PIP all contributed uniquely to SRB. Further study is necessary to understand the role of relationship orientation with suicide. Health education and suicide prevention efforts with NCSF should be tailored to account for marginalized identity, mental health, and NFA factors.