A Tutorial for Propensity Score Weighting for Moderation Analysis With Categorical Variables: An Application Examining Smoking Disparities Among Sexual Minority Adults.

OBJECTIVE: To provide step-by-step guidance and STATA and R code for using propensity score (PS) weighting to estimate moderation effects with categorical variables. RESEARCH DESIGN: Tutorial illustrating the key steps for estimating and testing moderation using observational data. Steps include: (1) examining covariate overlap across treatment groups within levels of the moderator; (2) estimating the PS weights; (3) evaluating whether PS weights improved covariate balance; (4) estimating moderated treatment effects; and (5) assessing the sensitivity of findings to unobserved confounding. Our illustrative case study uses data from 41,832 adults from the 2019 National Survey on Drug Use and Health to examine if gender moderates the association between sexual minority status (eg, lesbian, gay, or bisexual [LGB] identity) and adult smoking prevalence. RESULTS: For our case study, there were no noted concerns about covariate overlap, and we were able to successfully estimate the PS weights within each level of the moderator. Moreover, balance criteria indicated that PS weights successfully achieved covariate balance for both moderator groups. PS-weighted results indicated there was significant evidence of moderation for the case study, and sensitivity analyses demonstrated that results were highly robust for one level of the moderator but not the other. CONCLUSIONS: When conducting moderation analyses, covariate imbalances across levels of the moderator can cause biased estimates. As demonstrated in this tutorial, PS weighting within each level of the moderator can improve the estimated moderation effects by minimizing bias from imbalance within the moderator subgroups.

Clinical Pathway for Suicide Risk Screening in Adult Primary Care Settings: Special Recommendations.

Suicide is a serious public health concern. On average, 80% of suicide decedents had contact with primary care within 1 year of their suicide. This and other research underscore the importance of screening for suicide risk within primary care settings, and implementation of suicide risk screening is already underway in many practices. However, while primary care practices may be familiar with screening for other mental health concerns (e.g., depression), many feel uncomfortable or unprepared for suicide risk screening. To meet the increasing demand for evidence-based suicide-risk-screening guidance, we provide a clinical pathway for adult primary care practices (to include family medicine, internal medicine, women's health). The pathway was developed by experts with research, clinical expertise, and experience in suicide risk screening and primary care. We also provide detailed guidance to aid primary care practices in their decisions about how to implement the clinical pathway.

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).

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.

Behavioral Health of Gulf Coast Residents 6 Years After the Deepwater Horizon Oil Spill: The Role of Trauma History.

OBJECTIVE: The purpose of this study was to examine the associations between oil spill exposure, trauma history, and behavioral health 6 years after the Deepwater Horizon oil spill (DHOS). We hypothesized that prior trauma would exacerbate the relationship between oil spill exposure and behavioral health problems. METHODS: The sample included 2,520 randomly selected adults in coastal areas along the Gulf of Mexico. Participants reported their level of oil spill exposure, trauma history, depression, anxiety/worry, illness anxiety, and alcohol use. RESULTS: Individuals with more traumatic experiences had a significantly higher risk for all measured behavioral health problems after controlling for demographic factors and DHOS exposure. Those with higher levels of DHOS exposure were not at greater risk for behavioral health problems after controlling for prior trauma, with the exception of illness anxiety. There was no evidence that trauma history moderated the association between DHOS exposure and behavioral health. CONCLUSIONS: Findings suggest that trauma exposure may be a better indicator of long-term behavioral health risk than DHOS exposure among disaster-prone Gulf Coast residents. DHOS exposure may be a risk factor for illness anxiety but not more general behavioral health concerns. Trauma history did not appear to exacerbate risk for behavioral health problems among Gulf residents exposed to the DHOS. (Disaster Med Public Health Preparedness. 2019;13:497-503).