Disparities in Use/Misuse of Specific Illicit and Prescription Drugs among Sexual Minority Adults in a National Sample.

Background: Compared to heterosexual adults, lesbian, gay, and bisexual (LGB) adults have higher rates of any illicit drug use and any prescription drug misuse, yet disparities regarding specific drugs remain poorly characterized. Methods: We examined disparities by sexual identity and sex for 8 illicit and prescription drugs using 2015-2019 National Survey on Drug Use and Health data. Outcomes included past-year use/misuse of cocaine/crack, hallucinogens, inhalants, methamphetamine, heroin, prescription opioids, prescription stimulants, prescription tranquilizers/sedatives, and level of polydrug use/misuse (2 substances; 3+ substances). For each outcome, odds ratios relative to heterosexual adults of same sex were estimated using logistic regression controlling for demographics; significant estimates were interpreted as a disparity. Results: Among gay men, significant disparities were present for all drugs except prescription stimulants and heroin; inhalant use was particularly elevated. Bisexual women exhibited significant disparities for every drug examined, as did bisexual men (except heroin). Among lesbian/gay women, disparities were only present for prescription opioids and stimulants. Relative to heterosexual peers, use of 3+ substances was 3 times higher among gay men and bisexual women and 2 times higher among bisexual men. Conclusions: Consistent with minority stress theory, prevalences of illicit and prescription drug use/misuse were 2-3 times higher among LGB adults than heterosexual adults. Illicit drug use should not be perceived as only impacting gay/bisexual men - bisexual women had similar - or higher - prevalences of hallucinogen, cocaine, methamphetamine, and heroin use. Yet, in contrast to bisexual women, lesbian/gay women did not exhibit disparities for any illicit drugs.

Persistent Risk-Related Worry as a Function of Recalled Exposure to the Deepwater Horizon Oil Spill and Prior Trauma.

Large oil spills are disasters associated with psychological effects for exposed communities. The amount of worry that individuals experience after a disaster may be influenced by many factors, such as the type and extent of exposure to disaster impacts, prior trauma, and sociodemographic characteristics. This study examined the nature and predictors of worry about ongoing impacts of the 2010 Deepwater Horizon (DH) oil spill reported by Gulf of Mexico coastal residents. A random sample of 2,520 adult residents of Gulf of Mexico coastal counties were administered a telephone survey in 2016, including items about persistent worry and exposure to DH impacts, prior trauma, residence at the time of the spill, and sociodemographic characteristics. Respondents varied in the amount of worry they reported about ongoing health, social, and economic impacts. Controlling for sociodemographic characteristics, higher exposure to the DH oil spill was related to higher levels of worry about ongoing impacts, with past traumatic events related specifically to worry about health impacts. Unexpectedly, those who moved into the region after the spill showed similar levels of worry to residents exposed to the spill, and higher levels than residents who did not recall being exposed to the DH oil spill. This study highlights the impact of the DH oil spill on coastal residents many years after the DH disaster. The findings underscore the need to examine multiple pathways by which individuals experience disasters and for risk researchers to close knowledge gaps about long-term impacts of oil spills within a multi-dimensional framework.

Detecting Changes in Newspaper Reporting of Suicide after a Statewide Social Marketing Campaign.

A social marketing campaign was introduced in California in 2012, promoting media adherence to consensus-based guidelines on reporting about suicide. We examine adherence to these guidelines by applying quantitative scores to articles in California and a national control group in two six-month intervals prior to and following campaign implementation. Utilizing a difference-in-difference approach, we found no significant effect of the campaign, though the type of article content was a significant indicator of the overall score. Findings also demonstrated a nation-wide downward trend in the quality of reporting. Qualitative results suggest a need for more flexible guidelines in light of a technologically driven news culture.

A systematic review of peer-supported interventions for health promotion and disease prevention.

Prior research has examined peer programs with respect to specific peer roles (e.g.; peer support) or specific health/wellness domains (e.g.; exercise/diet), or have aggregated effects across roles and domains. We sought to conduct a systematic review that categorizes and assesses the effects of peer interventions to promote health and wellness by peer role, intervention type, and outcomes. We use evidence mapping to visually catalog and synthesize the existing research. We searched PubMed and WorldCat databases (2005 to 2015) and New York Academy of Medicine Grey Literature Report (1999 to 2016) for English-language randomized control trials. We extracted study design, study participants, type of intervention(s), peer role(s), outcomes assessed and measures used, and effects from 116 randomized controlled trials. Maps were created to provide a visual display of the evidence by intervention type, peer role, outcome type, and significant vs null or negative effects. There are more null than positive effects across peer interventions, with notable exceptions: group-based interventions that use peers as educators or group facilitators commonly improve knowledge, attitudes, beliefs, and perceptions; peer educators also commonly improved social health/connectedness and engagement. Dyadic peer support influenced behavior change and peer counseling shows promising effects on physical health outcomes. Programs seeking to use peers in public health campaigns can use evidence maps to identify interventions that have previously demonstrated beneficial effects. Those seeking to produce health outcomes may benefit from identifying the mechanisms by which they expect their program to produce these effects and associated proximal outcomes for future evaluations. PROSPERO REGISTRATION NUMBER: Although we attempted to register our protocol with PROSPERO, we did not meet eligibility criteria because we were past the data collection phase. The full PROSPERO-aligned protocol is available from the authors.

Opportunities to intervene? "Warning signs" for suicide in the days before dying.

To validate warning signs for suicide, researchers interviewed 20 respondents, representing 17 suicides in Orleans Parish, Louisiana, about characteristics of the decedent in the year, month, and days preceding the death. Decedents did exhibit behaviors consistent with existing warning signs, but these were rarely new behaviors present 7 days prior to the suicide but not previously. Research is needed to continue to test warning signs for suicide, and education campaigns that teach warning signs may not be relevant for preventing suicide among those in mental health treatment or involved in the criminal justice system.

The Influence of Training, Reluctance, Efficacy, and Stigma on Suicide Intervention Behavior Among NCOs in the Army and Marine Corps.

The Army and Marine Corps have consistently experienced the highest rates of suicide relative to the other services. In both the Army and Marine Corps, the service members responsible for identifying and referring individuals at risk for suicide are called "gatekeepers" and are typically noncommissioned officers (NCOs). We used structural equation modeling on survey responses from 1184 Army soldiers and 796 marines to estimate the relationships between training, intervention efficacy, reluctance, and mental health stigma on NCO intervention behaviors. Efficacy and reluctance were independently associated with intervention behaviors, and stigma was only associated with intervention behaviors among Army NCOs. Study results suggest that while quantity of training may help NCOs feel more confident about their ability to intervene, other efforts such as changing training content and delivery mode (e.g., interactive vs. didactic training) may be necessary in order to reduce reluctance and stigma to intervene with service members at risk for suicide.

Prevalence of, risk factors for, and consequences of posttraumatic stress disorder and other mental health problems in military populations deployed to Iraq and Afghanistan.

This review summarizes the epidemiology of posttraumatic stress disorder (PTSD) and related mental health problems among persons who served in the armed forces during the Iraq and Afghanistan conflicts, as reflected in the literature published between 2009 and 2014. One-hundred and sixteen research studies are reviewed, most of which are among non-treatment-seeking US service members or treatment-seeking US veterans. Evidence is provided for demographic, military, and deployment-related risk factors for PTSD, though most derive from cross-sectional studies and few control for combat exposure, which is a primary risk factor for mental health problems in this cohort. Evidence is also provided linking PTSD with outcomes in the following domains: physical health, suicide, housing and homelessness, employment and economic well-being, social well-being, and aggression, violence, and criminality. Also included is evidence about the prevalence of mental health service use in this cohort. In many instances, the current suite of studies replicates findings observed in civilian samples, but new findings emerge of relevance to both military and civilian populations, such as the link between PTSD and suicide. Future research should make effort to control for combat exposure and use longitudinal study designs; promising areas for investigation are in non-treatment-seeking samples of US veterans and the role of social support in preventing or mitigating mental health problems in this group.

Time-varying effect moderation using the structural nested mean model: estimation using inverse-weighted regression with residuals.

This article considers the problem of examining time-varying causal effect moderation using observational, longitudinal data in which treatment, candidate moderators, and possible confounders are time varying. The structural nested mean model (SNMM) is used to specify the moderated time-varying causal effects of interest in a conditional mean model for a continuous response given time-varying treatments and moderators. We present an easy-to-use estimator of the SNMM that combines an existing regression-with-residuals (RR) approach with an inverse-probability-of-treatment weighting (IPTW) strategy. The RR approach has been shown to identify the moderated time-varying causal effects if the time-varying moderators are also the sole time-varying confounders. The proposed IPTW+RR approach provides estimators of the moderated time-varying causal effects in the SNMM in the presence of an additional, auxiliary set of known and measured time-varying confounders. We use a small simulation experiment to compare IPTW+RR versus the traditional regression approach and to compare small and large sample properties of asymptotic versus bootstrap estimators of the standard errors for the IPTW+RR approach. This article clarifies the distinction between time-varying moderators and time-varying confounders. We illustrate the methodology in a case study to assess if time-varying substance use moderates treatment effects on future substance use.

Do stigma and efficacy mediate the association between training and suicide prevention behavior among Army noncommissioned officers?

INTRODUCTION: Rates of suicide in the Active Component of the military have significantly increased since 2010, with particularly high rates among Army service members. One element of the Army's approach to suicide prevention relies on noncommissioned officers (NCOs) as gatekeepers who have regular contact with soldiers. NCOs receive suicide prevention training, but there is limited evidence that such training leads to behavior change. METHODS: We surveyed 2468 Army NCOs participating in leadership development courses to determine (a) if training on suicide prevention and soft skills (e.g., active listening) was associated with gatekeeper behavior and use of soft skills; and (b) whether that association was explained by two potential barriers, stigma and perceptions of efficacy. RESULTS: Both the number of suicide prevention training topics and soft skills trained were associated with increased gatekeeper behavior; these relationships were explained in part by lower stigma and higher efficacy for use of soft skills. The use of interactive training methods and receiving coaching after training were not associated with stigma or efficacy, though both methods were associated with more frequent use of soft skills. CONCLUSION: Results suggest that the content and format of training is important to preparing NCOs to fulfill a gatekeeper role.

A tutorial on propensity score estimation for multiple treatments using generalized boosted models.

The use of propensity scores to control for pretreatment imbalances on observed variables in non-randomized or observational studies examining the causal effects of treatments or interventions has become widespread over the past decade. For settings with two conditions of interest such as a treatment and a control, inverse probability of treatment weighted estimation with propensity scores estimated via boosted models has been shown in simulation studies to yield causal effect estimates with desirable properties. There are tools (e.g., the twang package in R) and guidance for implementing this method with two treatments. However, there is not such guidance for analyses of three or more treatments. The goals of this paper are twofold: (1) to provide step-by-step guidance for researchers who want to implement propensity score weighting for multiple treatments and (2) to propose the use of generalized boosted models (GBM) for estimation of the necessary propensity score weights. We define the causal quantities that may be of interest to studies of multiple treatments and derive weighted estimators of those quantities. We present a detailed plan for using GBM to estimate propensity scores and using those scores to estimate weights and causal effects. We also provide tools for assessing balance and overlap of pretreatment variables among treatment groups in the context of multiple treatments. A case study examining the effects of three treatment programs for adolescent substance abuse demonstrates the methods.

Drug use among gay and bisexual men at weekend dance parties: the role of intentions and perceptions of peers' behaviors.

Substance use is high among gay and bisexual men attending weekend dance events, yet little research has investigated motivations for drug use and contextual factors influencing use in these settings. We hypothesized that beliefs about peer drug use interact with individuals' own drug use intentions to predict use. 489 men attending weekend dance events completed an anonymous assessment asking about their own and their beliefs about other attendants' drug use intentions--47 % completed a follow-up assessment after the event. Forty-four percent reported intending to use ecstasy at the event; intentions to use GHB, marijuana, cocaine, unprescribed erectile dysfunction drugs, and poppers were also high. Perceptions about other attendant's drug use predicted use among those intending and those not intending to use drugs. Normative beliefs are important predictors of drug use at weekend dance events; event-specific prevention strategies should encompass messages that correct misperceptions of drug use among party attendants.

Subgroups analysis when treatment and moderators are time-varying.

Prevention scientists are often interested in understanding characteristics of participants that are predictive of treatment effects because these characteristics can be used to inform the types of individuals who benefit more or less from treatment or prevention programs. Often, effect moderation questions are examined using subgroups analysis or, equivalently, using covariate × treatment interactions in the context of regression analysis. This article focuses on conceptualizing and examining causal effect moderation in longitudinal settings in which both treatment and the putative moderators are time-varying. Studying effect moderation in the time-varying setting helps identify which individuals will benefit more or less from additional treatment services on the basis of both individual characteristics and their evolving outcomes, symptoms, severity, and need. Examining effect moderation in these longitudinal settings, however, is difficult because moderators of future treatment may themselves be affected by prior treatment (for example, future moderators may be mediators of prior treatment). This article introduces moderated intermediate causal effects in the time-varying setting, describes how they are part of Robins' Structural Nested Mean Model, discusses two problems with using a traditional regression approach to estimate these effects, and describes a new approach (a two-stage regression estimator) to estimate these effects. The methodology is illustrated using longitudinal data to examine the time-varying effects of receiving community-based substance abuse treatment as a function of time-varying severity (or need).

Examining Inhalant Use Among Sexual Minority Adults in a National Sample: Drug-Specific Risks or Generalized Risk?

Purpose: The study objective was to compare use of 12 specific inhalants among lesbian, gay, and bisexual (LGB) adults relative to heterosexual adults among a national sample. Methods: Data on 210,392 adults, including 15,007 LGB adults, were from the 2015 to 2019 National Survey on Drug Use and Health. For each inhalant type, logistic regression was used to characterize differences by sexual identity and gender. Unadjusted and demographic adjusted odds ratios are reported. Results: All LGB groups exhibited elevated use of multiple inhalant types (ranging from 5 for gay males to 12 for bisexual females). The largest disparities were for poppers among gay and bisexual males. Gay and bisexual males initiated use at older ages. Conclusion: Observed disparities among LGB adults included inhalants used in a sexual or club context (e.g., poppers) as well as types with particularly elevated fatality risk (e.g., butane, propane, aerosol sprays, and nitrous oxide).

Mental Health Service Use Among Lesbian, Gay, and Bisexual Adults Who Report Having Attempted Suicide.

OBJECTIVE: This study estimated mental health service use among lesbian, gay, and bisexual (LGB) adults in the United States who reported having made a suicide attempt. METHODS: Data came from the pooled 2015-2019 National Surveys on Drug Use and Health. Of the 191,954 adult respondents, 1,946 reported a past-year suicide attempt. Survey-weighted descriptive and regression analyses were conducted to compare mental health service use among LGB and heterosexual adults. RESULTS: Three percent of LGB adults (N=598) reported having attempted suicide in the past year, compared with 0.5% of heterosexual adults (N=1,348). Mental health treatment use was significantly higher among LGB adults than among heterosexual adults (64% versus 56%) before analyses were adjusted for sociodemographic characteristics. CONCLUSIONS: Because suicide attempts and mental health use are elevated among LGB adults, clinicians must provide evidence-based approaches for identifying and managing suicide risk to LGB adults in an affirming manner.

Upstream suicide prevention in the U.S. Army: Noncommissioned officers' perspectives.

The goal of this study was to examine the factors associated with Army noncommissioned officer (NCO) experiences, attitudes, and behaviors in their role of identifying potential suicide risk factors in their fellow soldiers. To better understand the perspectives of NCOs, an anonymous survey was administered to 2,468 Army NCOs. Descriptive statistics and linear regressions were conducted to compare subgroups of NCOs. Most (71%) Army NCOs have received many (11 or more) hours of suicide prevention training, but training in soft skills that may be important for the gatekeeper role was less consistently reported. Active Component soldiers reported greater confidence in their intervention skills (Cohen's d = 0.25) and fewer logistical barriers (e.g., time and space to talk) to intervening with at-risk soldiers (Cohen's d = 0.80) compared to Reserve and National Guard soldiers. Formal coursework in mental health areas like psychology or chaplaincy was associated with a greater level of confidence in intervention skills (Cohen's d = 0.23) and in more frequent intervention behavior (Cohen's d = 0.13). Army NCO trainings should be modified to better equip soldiers with the soft skills (e.g., active listening skills and verbally and nonverbally conveying nonjudgment/acceptance and empathy) needed to have effective conversations with soldiers about suicide risk factors and other sensitive topics. Strategies used within mental health education, which appears to be a strength for NCO gatekeepers, could be used to achieve this goal. Reserve and Guard NCOs may need additional supports and tailored trainings to better fit their operational context. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Syndromic Surveillance 2.0: Emerging Global Surveillance Strategies for Infectious Disease Epidemics.

The U.S. Army has a long history of preventing, detecting, and treating infectious diseases. Like other organizations and agencies involved in public health, the Army is increasingly interested in syndromic surveillance strategies-those designed to identify outbreaks before clinical data are available. Researchers use various methods to identify surveillance strategies across the globe, investigate these strategies' benefits and limitations, and recommend actions to aid the Army in their efforts to detect emerging epidemics and pandemics.

Firearm Suicide Prevention in the U.S. Military: Recommendations From a National Summit.

The U.S. DoD has identified firearm suicide prevention as a key operational priority. One vital approach to addressing firearm suicides is through promoting lethal means safety, which involves the voluntary use of secure storage for personally owned firearms and/or temporarily moving firearms out of the home during risk periods. Despite promising approaches to lethal means safety, critical gaps remain in research, programming, and communication among and across scientists, DoD programmatic leaders, front-line commanders, and service members. To address these gaps, the first-ever national "Firearm Suicide Prevention in the Military: Messaging and Interventions Summit" was convened in June 2022, bringing together DoD personnel and researchers with expertise in firearm suicide prevention and lethal means safety. The Summit identified 10 recommendations to enhance firearm suicide prevention messaging and interventions in the U.S. military, including (1) repeal or amend prohibitions on questioning service members about personal firearms; (2) develop, examine, and use common language for firearm injury prevention; (3) implement a universal approach to training on comprehensive firearm injury prevention; (4) encourage leadership across disciplines and levels; (5) aim for broad culture change; (6) support innovative research; (7) consider various outcome measures; (8) promote "cultural competence" for better communication; (9) reduce territorialism; and (10) develop creative partnerships. Ultimately, these recommendations can facilitate productive partnerships with a shared goal: to develop, test, and implement strategies that standardize lethal means safety and reduce firearm suicides and other firearm injuries or harm among service members.

Suicide Among Veterans: Veterans' Issues in Focus.

Suicide is a major public health challenge that disproportionately affects service members and veterans. Researchers have been studying veteran suicide rates and prevention strategies, but there are opportunities to improve risk identification, evaluation, support, and treatments and interventions. These strategies must include community-based efforts to reach veterans outside the U.S. Department of Veterans Affairs system.

Co-occurring alcohol and mental health problems in the military: Prevalence, disparities, and service utilization.

OBJECTIVE: To examine the prevalence of co-occurring alcohol and mental health (MH) problems (COPs), perceived MH service need, and MH service utilization among active duty service members, and to identify differences in gender, race/ethnicity, age, and sexual orientation and gender identity. METHOD: 16,699 active duty service members participated in the Department of Defense's 2015 Health Related Behaviors Survey. Measures included demographics, combat deployment, smoking status, problematic alcohol use (Alcohol Use Disorders Identification Test-C, AUDIT-C), posttraumatic stress disorder (PTSD Checklist, Civilian Version, PCL-C), depression (Patient Health Questionnaire-9, PHQ-9), anxiety (Generalized Anxiety Disorder-7, GAD-7), and perceived need for and use of MH services. We examined groups of service members with probable: COP, alcohol problem only, MH problem only, and neither. RESULTS: Eight percent of service members reported COPs, 26.89% reported alcohol use problem only, and 9.41% reported a MH condition only. COPs were more common among those who were lesbian, gay, bisexual, and transgender (LGBT), those who had three or more combat deployments, and smokers, and less common among those aged 35 years and older, Asian or Black, and in the Air Force and Coast Guard (relative to Navy). Those reporting a probable MH problem only were significantly less likely to report use of past year MH counseling than those with probable COPs; otherwise, patterns of service utilization and perceived need were similar. CONCLUSIONS: COPs are common enough that screening for and attention to their co-occurrence are needed in the military, and some subgroups of service members are at particularly high risk for COPs. Future research and policy should delve deeper into how the needs of service members with COPs can be addressed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).