ADVANCE integrated group intervention to address both substance use and intimate partner abuse perpetration by men in substance use treatment: a feasibility randomised controlled trial.

BACKGROUND: Substance use is a risk factor for intimate partner abuse (IPA) perpetration. Delivering perpetrator interventions concurrently with substance use treatment shows promise. METHODS: The feasibility of conducting an efficacy and cost-effectiveness trial of the ADVANCE 16-week intervention to reduce IPA by men in substance use treatment was explored. A multicentre, parallel group individually randomised controlled feasibility trial and formative evaluation was conducted. Over three temporal cycles, 104 men who had perpetrated IPA towards a female (ex) partner in the past year were randomly allocated to receive the ADVANCE intervention + substance use treatment as usual (TAU) (n = 54) or TAU only (n = 50) and assessed 16-weeks post-randomisation. Participants' (ex) partners were offered support and 27 provided outcome data. Thirty-one staff and 12 men who attended the intervention participated in focus groups or interviews that were analysed using the framework approach. Pre-specified criteria assessed the feasibility of progression to a definitive trial: 1) ≥ 60% of eligible male participants recruited; 2) intervention acceptable to staff and male participants; 3) ≥ 70% of participants followed-up and 4) levels of substance use and 5) IPA perpetrated by men in the intervention arm did not increase from average baseline level at 16-weeks post-randomisation. RESULTS: 70.7% (104/147) of eligible men were recruited. The formative evaluation confirmed the intervention's acceptability. Therapeutic alliance and session satisfaction were rated highly. The overall median rate of intervention session attendance (of 14 compulsory sessions) was 28.6% (range 14.3-64.3% by the third cycle). 49.0% (51/104) of men and 63.0% (17/27) of their (ex) partners were followed-up 16-weeks post-randomisation. This increased to 100% of men and women by cycle three. At follow-up, neither substance use nor IPA perpetration had worsened for men in the intervention arm. CONCLUSIONS: It was feasible to deliver the ADVANCE intervention in substance use treatment services, although it proved difficult to collect data from female (ex)partners. While some progression criteria were met, others were not, although improvements were demonstrated by the third cycle. Lessons learned will be implemented into the study design for a definitive trial of the ADVANCE intervention. TRIAL REGISTRATION: ISRCTN79435190 prospectively registered 22nd May 2018.

Problematic alcohol use as a risk factor for cyber aggression within romantic relationships.

BACKGROUND AND OBJECTIVES: Cyber aggression has emerged as a modern form of intimate partner violence which has yet to undergo sufficient research necessary to identify risk factors that may increase the likelihood or severity of cyber aggressive behavior toward a relationship partner. Prior research offers contradictory findings pertaining to the relationship between problematic alcohol use and cyber aggression. METHODS: We recruited 100 (40 female) adult participants through online crowdsourcing to complete a series of questionnaires assessing traditional partner violence, cyber aggression, and problematic alcohol use. RESULTS: Forty-two percent of the sample reported perpetrating cyber relational aggression and 35% reported perpetrating cyber privacy invasion during the year prior to study participation. Traditional partner violence was associated with both forms of cyber aggression. Problematic alcohol use was only associated with privacy invasion after accounting for demographic factors and traditional partner violence. DISCUSSION AND CONCLUSIONS: Cyber aggression was prevalent among the current adult sample. Results suggest that problematic alcohol use is a risk factor for cyber privacy invasion but not cyber relational aggression. SCIENTIFIC SIGNIFICANCE: Findings add to and clarify the nascent, conflicting results that have emerged from prior research on alcohol-related cyber aggression. (Am J Addict 2018;XX:1-7).

Adapting the ADVANCE group program for digitally-supported delivery to reduce intimate partner violence by men in substance use treatment: a feasibility study.

Introduction: COVID-19 restrictions created barriers to "business as usual" in healthcare but also opened the door to innovation driven by necessity. This manuscript (1) describes how ADVANCE, an in-person group perpetrator program to reduce intimate partner violence (IPV) against female (ex)partners by men in substance use treatment, was adapted for digitally-supported delivery (ADVANCE-D), and (2) explores the feasibility and acceptability of delivering ADVANCE-D to men receiving substance use treatment. Methods: Firstly, the person-based approach and mHealth development framework were used to iteratively adapt ADVANCE for digitally-supported delivery including conceptualization, formative research, and pre-testing. Then, a non-randomized feasibility study was conducted to assess male participants' eligibility, recruitment, and attendance rates and uptake of support offered to their (ex)partners. Exploratory analyses on reductions in IPV perpetration (assessed using the Abusive Behavior Inventory; ABI) and victimization (using the revised ABI; ABI-R) at the end of the program were performed. Longitudinal qualitative interviews with participants, their (ex)partners, and staff provided an understanding of the program's implementation, acceptability, and outcomes. Results: The adapted ADVANCE-D program includes one goal-setting session, seven online groups, 12 self-directed website sessions, and 12 coaching calls. ADVANCE-D includes enhanced risk management and support for (ex)partners. Forty-five participants who had perpetrated IPV in the past 12 months were recruited, forty of whom were offered ADVANCE-D, attending 11.4 (SD 9.1) sessions on average. Twenty-one (ex)partners were recruited, 13 of whom accepted specialist support. Reductions in some IPV perpetration and victimization outcome measures were reported by the 25 participants and 11 (ex)partners interviewed pre and post-program, respectively. Twenty-two participants, 11 (ex)partners, 12 facilitators, and 7 integrated support service workers were interviewed at least once about their experiences of participation. Overall, the program content was well-received. Some participants and facilitators believed digital sessions offered increased accessibility. Conclusion: The digitally-supported delivery of ADVANCE-D was feasible and acceptable. Remote delivery has applicability post-pandemic, providing greater flexibility and access. Given the small sample size and study design, we do not know if reductions in IPV were due to ADVANCE-D, time, participant factors, or chance. More research is needed before conclusions can be made about the efficacy of ADVANCE-D.

Online Crowdsourcing as a Quasi-Experimental Method for Collecting Data on the Perpetration of Alcohol-Related Partner Aggression.

Cross-sectional survey, prospective, and experimental data have been evaluated to better understand the role of alcohol as a contributing cause of intimate partner aggression. Laboratory-based alcohol administration studies provide controlled data regarding causality, but the use of this methodology lacks ecological validity and has been hampered by rigorous procedural and financial demands. Online crowdsourcing is an emerging pseudoexperimental methodology with low costs, rapid data collection, access to diverse populations, greater ecological validity, and the potential to facilitate prolific research to supplement the chronic scarcity of experimental data. The current rapid review first summarizes prior methodological approaches to investigating the proximal influence of alcohol on partner aggression, then reviews prior crowdsourcing research in the disparate areas of alcohol and partner aggression, then describes aggression paradigms that may be readily adapted to online administration. We conclude by introducing recommendations for future quasi-experimental research investigating alcohol-related partner aggression research using the online crowdsourcing methodology. Initial evidence suggests that online crowdsourcing may yield appropriate samples and that existing paradigms may be adapted to rapidly, efficiently, and ethically supplement experimental alcohol-related partner aggression research.

The feasibility of delivering the ADVANCE digital intervention to reduce intimate partner abuse by men receiving substance use treatment: protocol for a non-randomised multi-centre feasibility study and embedded process evaluation.

BACKGROUND: Compared to men in the general population, men in substance use treatment are more likely to perpetrate intimate partner abuse (IPA). The ADVANCE group intervention for men in substance use treatment is tailored to address substance use and IPA in an integrated way. In a feasibility trial pre-COVID, men who received the ADVANCE intervention via face-to-face group delivery showed reductions in IPA perpetration. Due to COVID-19, ADVANCE was adapted for remote digital delivery. METHODS/DESIGN: This mixed-methods non-randomised feasibility study, with a nested process evaluation, will explore the feasibility and acceptability of delivering the ADVANCE digital intervention to men in substance use treatment who have perpetrated IPA towards a female partner in the past year. Sixty men will be recruited from seven substance use treatment services in Great Britain. The ADVANCE digital intervention comprises a preparatory one-to-one session with a facilitator to set goals, develop a personal safety plan, and increase motivation and a preparatory online group to prepare men for taking part in the intervention. The core intervention comprises six fortnightly online group sessions and 12 weekly self-directed website sessions to recap and practise skills learned in the online group sessions. Each website session is followed by a one-to-one video/phone coaching session with a facilitator. Men will also receive their usual substance use treatment. Men's female (ex) partners will be invited to provide outcome data and offered support from integrated safety services (ISS). Outcome measures for men and women will be sought post intervention (approximately 4 months post male baseline interview). Feasibility parameters to be estimated include eligibility, suitability, consent, recruitment, attendance, retention and follow-up rates. In-depth interviews or focus groups will explore the intervention's acceptability to participants, facilitators and ISS workers. A secondary focus of the study will estimate pre-post-differences in outcome measures covering substance use, IPA, mental health, self-management, health and social care service use, criminal justice contacts and quality of life. DISCUSSION: Findings will inform the design of a multicentre randomised controlled trial evaluating the efficacy and cost-effectiveness of the ADVANCE digital intervention for reducing IPA. TRIAL REGISTRATION: The feasibility study was prospectively registered: ISRCTN66619273 .

The impact of adverse childhood experiences on adolescent health risk indicators in a community sample.

OBJECTIVE: Despite growing awareness of the high prevalence of adverse childhood experiences (ACEs) in community samples of adolescents, little work has examined the impact of ACEs on adolescence and well-being during this critical period of development. Much research has focused on retrospective reports of ACEs by adults and adult physical and mental health, finding that ACEs contribute to a range of diseases and mental health disorders in adulthood. This study examined differences in self-reported mental health, nonsuicidal self-injury, suicidality, violence, and substance use between adolescents without self-reported history of ACEs, youth with one self-reported ACE, and youth with self-reported multiple (2 or more) ACEs. METHOD: The sample included 1,532 adolescents who completed the Youth Risk Behavior Surveillance Survey in their local high schools. By local consensus, this national survey was augmented with questions exploring prevalence of 11 commonly identified ACEs. RESULTS: After controlling for age, gender, and race, youth with multiple ACEs reported 3 to 15 times the odds of a range of negative health experiences. CONCLUSIONS: Findings indicate a serious burden of ACEs on adolescent social emotional well-being. This study did not include youth in out of school placements or who were not present the day the survey was given, and thus represent youth who may benefit from universal prevention and intervention programs. Universal screening of ACEs and health-related outcomes suggests that reporting multiple ACEs is strongly related to a wide range of mental health, violence, and substance use histories. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A meta-analytic review of the relationship between cyber aggression and substance use.

BACKGROUND: Prior research has demonstrated that various substances of abuse play a contributing role to acts of physical and verbal aggression. It is less clear if and to what extent substance use is associated with an increased risk in perpetrating cyber aggression, an emerging form of aggressive behavior that occurs through digital communication. METHODS: A comprehensive review of the literature resulted in 15 studies and 18 unique samples from which effect size estimates were calculated. RESULTS: Analyses resulted in a moderate, significant mean observed correlation indicating that individuals who engaged in substance use were more likely than those who did not to perpetrate cyber aggression (r = 0.24, k = 18, 95% CI = 0.20, 0.28). Comparing data across types of substances revealed that alcohol use represents a stronger risk factor for cyber aggression than nicotine, cannabis, or other illicit drugs. Results also suggest a stronger relationship between substance use and cyber aggression among older than younger samples and in the context of intimate partner rather than peer aggression. Comparable estimates of substance-related cyber aggression emerged across types of cyber aggression and perpetrator gender. CONCLUSIONS: Further research is required to increase confidence in estimates used in moderation analyses. As with traditional aggression, alcohol use appears to represent a risk factor for cyber aggression, though it is unclear if the disinhibitory properties of alcohol are the mechanism of action for substance-related cyber aggression.

A study protocol to assess the feasibility of conducting an evaluation trial of the ADVANCE integrated intervention to address both substance use and intimate partner abuse perpetration to men in substance use treatment.

BACKGROUND: Strong evidence exists that substance use is a contributory risk factor for intimate partner abuse (IPA) perpetration. Men in substance use treatment are more likely to perpetrate IPA than men from the general population. Despite this, referral pathways are lacking for this group. This trial will assess the feasibility of conducting an evaluation trial of a tailored integrated intervention to address substance use and IPA perpetration to men in substance use treatment. METHODS/DESIGN: ADVANCE is a multicentre, parallel-group individually randomised controlled feasibility trial, with a nested formative evaluation, comparing an integrated intervention to reduce IPA + substance use treatment as usual (TAU) to TAU only. One hundred and eight men who have perpetrated IPA in the past 12 months from community substance use treatment in London, the West Midlands, and the South West will be recruited. ADVANCE is a manualised intervention comprising 2-4 individual sessions (2 compulsory) with a keyworker to set goals, develop a personal safety plan and increase motivation and readiness, followed by a 12-session weekly group intervention delivered in substance use services. Men will be randomly allocated (ratio 1:1) to receive the ADVANCE intervention + TAU or TAU only. Men's female (ex) partners will be invited to provide outcome data and offered support from integrated safety services (ISS). Regular case management meetings between substance use and ISS will manage risk. Outcome measures will be obtained at the end of the intervention (approximately 4 months post-randomisation) for all male and female participants. The main objective of this feasibility trial is to estimate parameters required for planning a definitive trial including rates of consent, recruitment, and follow-up by site and group allocation. Nested formative evaluation including focus groups and in-depth interviews will explore the intervention's acceptability to participants, group facilitators, keyworkers and ISS workers. Secondary outcomes include substance use, IPA, mental health, self-management, health and social care service use, criminal justice contacts, and quality of life. DISCUSSION: Findings from this feasibility trial will inform the design of a multicentre randomised controlled trial evaluating the efficacy and cost-effectiveness of the ADVANCE intervention for reducing IPA and improving the well-being of female (ex)partners. TRIAL REGISTRATION: ISRCTN79435190.

Teachers' Perceptions of Bullying of Lesbian, Gay, Bisexual, Transgender, and Questioning (LGBTQ) Students in a Southwestern Pennsylvania Sample.

This study was designed to ascertain teachers' perceptions of bullying of Lesbian, Gay, Bisexual, Transgender, and Questioning (LGBTQ) youth. In a sample of 200 educators (61.0% female; 96.5% White) from a county in southwestern Pennsylvania, there was a significant positive relationship between the teachers' perceptions of the supportiveness of school staff towards students regardless of sexual orientation and those teachers' reports of the frequency of bullying victimization experienced by LGBTQ students. Teachers' perceptions of a higher level of staff and student support was associated with higher reported frequencies of students' use of derogatory language about LGBTQ individuals and various types of bullying of LGBTQ students. Teachers with a lesbian, gay, or bisexual orientation were found to rate the school staff and students as significantly less supportive of students regardless of their sexual orientation, gender identity, or gender expression in comparison to heterosexual teachers. Finally, teachers who either were unaware of or believed that their school lacked an anti-bullying policy reported significantly higher rates of physical bullying victimization of LGBTQ students when compared to the rates observed by teachers who reported knowledge of their schools' anti-bullying policies.