Trait mindfulness and cannabis use-related factors in adolescents and young adults with frequent use.

Background: Mindfulness-based interventions (MBIs) are effective in adult substance-use treatment and may be helpful for adolescents and young adults (AYAs). One target of MBIs is to improve trait mindfulness, which has been associated with better lifestyle and health outcomes. To inform MBIs for reducing cannabis use in AYAs, we sought to identify how trait mindfulness was associated with cannabis-related problems and quit attempts, as well as with motivation to change use in youth who report frequent use. Methods: Participants aged 15-24 years using cannabis ≥ 3x/week were recruited from AYA clinics in a northeastern US city to participate in a cannabis-use intervention pilot, randomized trial. At baseline, we assessed cannabis-use history, problems associated with use, attempts to quit, and trait mindfulness. All participants were offered two sessions of motivational enhancement therapy, during which they rated motivation to quit cannabis. Regression analyses were conducted to assess associations between trait mindfulness and cannabis use-related problems, attempts to quit, and motivation to change. Results: Seventy participants, mean age 20.7 ± 1.9 years, enrolled. Sixty percent identified as female, 47% as Black non-Hispanic, and 31% as Hispanic. Participants started using cannabis at mean age 15.0 ± 2.8 years and were using ≥ 3x/week by 17.0 ± 2.3 years. Higher mindfulness scores were associated with fewer cannabis-related problems (p = 0.004) and fewer quit attempts (p = 0.035). The number of cannabis-related problems did not significantly mediate the relationship between mindfulness and quit attempts. Trait mindfulness did not predict motivation to change cannabis use. Conclusions: Among AYAs using cannabis frequently, higher trait mindfulness was associated with both fewer cannabis use--related problems and fewer quit attempts. Future research should assess whether trait mindfulness is an appropriate target for decreasing cannabis use and the utility of MBIs for reducing cannabis-use behaviors.

The future of screening, brief intervention and referral to treatment in adolescent primary care: research directions and dissemination challenges.

PURPOSE OF REVIEW: Screening, brief intervention and referral to treatment (SBIRT) offers a practical, integrated model for addressing substance use in primary care settings. This review provides an update of the research on SBIRT for adolescents in primary care, examines current dissemination challenges and suggests future research directions. RECENT FINDINGS: A number of brief screening tools for adolescents have been developed and tested relative to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) substance use disorders. Computerized previsit screening promotes standardization and is a more time-efficient alternative to provider interview. The adolescent brief intervention literature is growing, particularly with respect to technology-based tools, but is still limited, with evidence greatest for alcohol, and for motivational enhancement therapy interventions. Increasing SBIRT implementation in pediatric primary care remains a challenge. Using nonphysician behavioral health providers to deliver SBIRT, and embedding a screener and decision support tool in electronic medical record systems are strategies being investigated to promote SBIRT implementation. SUMMARY: Substance use begins in adolescence, and pediatric SBIRT could help to achieve a population-level reduction of substance use-related harms. With a growing number of available tools, adolescent SBIRT effectiveness and feasibility are increasing, but more studies are needed to grow its evidence base, and elucidate strategies to increase implementation.

Development and psychometric characteristics of the pediatric inpatient experience survey (PIES).

OBJECTIVE: To study the psychometric properties of the Pediatric Inpatient Experience Survey (PIES), a mail and phone survey for parent reporting of family-centered aspects of inpatient care experiences. DESIGN: Two waves of cross-sectional survey data were collected by mail and phone in 2009 to design a measurement instrument with good psychometric characteristics. Additional cross-sectional data from a mail administration in 2011 confirmed the measurement domains. SETTING: Free-standing pediatric hospital in the northeastern USA. PARTICIPANTS: A convenience sample of English-speaking parents of hospitalized children, stratified by patient type (medical versus surgical) and previous stays at this hospital (yes versus no), constituted the instrument design phase. Four hundred and seventy-nine (63%) of those approached agreed to participate and were randomly assigned to mail or phone survey administration. Four hundred and one of these respondents completed the first wave of the survey and 354 respondents completed the second wave. A shortened instrument was mailed to parents randomly selected from patient discharge records. Data from 929 parents (response rate: 36.2%) were used for confirmatory analysis of the created measurement domains. MAIN OUTCOME MEASURES: The main outcome measures of this psychometric validation study were individual item performance, test-retest reliability, internal consistency, and construct validity. RESULTS: The resulting survey includes 61 items with 35 rating items with satisfactory test-retest reliability loading on eight domains. The factor structure was supported by Cronbach's alpha and confirmatory factor analysis. The survey supported construct validity in distinguishing between medical versus surgical and first time versus previous hospital stay groups known to differ with regard to satisfaction. Comparing mail and phone administrations, differences in scores were exacerbated in domain scores and showed the need for mode adjustment. CONCLUSION: PIES shows satisfactory test-retest reliability, internal consistency, and construct validity. A new domain measuring emotional connectedness to staff and the hospital is highly correlated with overall satisfaction.

Adolescent substance use screening in primary care: Validity of computer self-administered versus clinician-administered screening.

BACKGROUND: Computer self-administration may help busy pediatricians' offices increase adolescent substance use screening rates efficiently and effectively, if proven to yield valid responses. The CRAFFT screening protocol for adolescents has demonstrated validity as an interview, but a computer self-entry approach needs validity testing. The aim of this study was to evaluate the criterion validity and time efficiency of a computerized adolescent substance use screening protocol implemented by self-administration or clinician-administration. METHODS: Twelve- to 17-year-old patients coming for routine care at 3 primary care clinics completed the computerized screen by both self-administration and clinician-administration during their visit. To account for order effects, we randomly assigned participants to self-administer the screen either before or after seeing their clinician. Both were conducted using a tablet computer and included identical items (any past-12-month use of tobacco, alcohol, drugs; past-3-month frequency of each; and 6 CRAFFT items). The criterion measure for substance use was the Timeline Follow-Back, and for alcohol/drug use disorder, the Adolescent Diagnostic Interview, both conducted by confidential research assistant interview after the visit. Tobacco dependence risk was assessed with the self-administered Hooked on Nicotine Checklist (HONC). Analyses accounted for the multisite cluster sampling design. RESULTS: Among 136 participants, mean age was 15.0 ± 1.5 years, 54% were girls, 53% were black or Hispanic, and 67% had ≥3 prior visits with their clinician. Twenty-seven percent reported any substance use (including tobacco) in the past 12 months, 7% met criteria for an alcohol or cannabis use disorder, and 4% were HONC positive. Sensitivity/specificity of the screener were high for detecting past-12-month use or disorder and did not differ between computer and clinician. Mean completion time was 49 seconds (95% confidence interval [CI]: 44-54) for computer and 74 seconds (95% CI: 68-87) for clinician (paired comparison, P < .001). CONCLUSIONS: Substance use screening by computer self-entry is a valid and time-efficient alternative to clinician-administered screening.

Predicting Time to Return to Cannabis Use After a Cessation Attempt: Impact of Cumulated Exposure to Nicotine-Containing Products.

Objective: Cannabis is frequently co-used with tobacco/nicotine products, especially among young adults. Little is known about the effects of this co-use on cannabis cessation outcomes. Within a sample of young adults using cannabis frequently (current use of ≥5 days/week in the past 3 months), this study aimed to (a) document sources of exposure to tobacco/nicotine products, whether used simultaneously with cannabis or on different occasions, (b) examine if the level of cumulated exposure to tobacco/nicotine (self-reported or from biochemical testing) could predict time to cannabis lapse during a cannabis abstinence period, and (c) explore the relationship between nicotine/tobacco exposure and time to cannabis lapse according to tobacco cigarette smoking status. Method: Urine cotinine measures and self-reported data on use of different tobacco/nicotine products, collected from 32 participants (aged 19 to 23), were analyzed to predict time to lapse during a 2-week period of attempted abstinence from cannabis, controlling for cannabis dependence and sex. Results: Half of participants (56.3%) used at least one tobacco/nicotine product. Higher urine cotinine, representing higher cumulated tobacco/nicotine exposure, was related to a higher risk of lapsing (Hazard Ratio [HR] = 1.64; 95%CI [1.04, 2.58]). The risk of lapsing was even higher ([HR] = 3.46; 95%CI [1.17, 10.25]) among heavily tobacco/nicotine exposed (>600 ng/mL, urine cotinine) participants than among unexposed (<50 ng/mL) or lightly/moderately exposed (50-600 ng/mL) participants. Among those smoking cigarettes (solely or in combination with other products), there was no relation between cotinine level and time to lapse, likely due to a reduced variability in abstinence probability and a high likelihood of lapse observed for higher cotinine levels, mainly achieved by cigarette use. Conclusions: With a rapidly changing landscape of tobacco/nicotine use, our results underscore the need to consider all sources of tobacco/nicotine exposure to fully understand the specific and cumulative contributions of tobacco/nicotine to cannabis cessation outcomes.

Correction: Longitudinal effects of gender minority stressors on substance use and related risk and protective factors among gender minority adolescents.

[This corrects the article DOI: 10.1371/journal.pone.0250500.].

Computer-Facilitated Screening and Brief Intervention for Alcohol Use Risk in Adolescent Patients of Pediatric Primary Care Offices: Protocol for a Cluster Randomized Controlled Trial.

BACKGROUND: Alcohol and other substance use disorders usually begin with substance use in adolescence. Pediatric primary care offices, where most adolescents receive health care, are a promising venue for early identification of substance use and for brief intervention to prevent associated problems and the development of substance use disorder. OBJECTIVE: This study tests the effects of a computer-facilitated screening and brief intervention (cSBI) system (the CRAFFT [Car, Relax, Alone, Forget, Family/Friends, Trouble] Interactive System [CRAFFT-IS]) on heavy episodic drinking, riding with a driver who is substance impaired, or driving while substance impaired among adolescents aged 14 to 17 years presenting for a well visit at pediatric primary care practices. METHODS: We are conducting a cluster randomized controlled trial of the CRAFFT-IS versus usual care and recruiting up to 40 primary care clinicians at up to 20 pediatric primary care practices within the American Academy of Pediatrics (AAP) Pediatric Research in Office Settings network. Clinicians are randomized 1:1 within each practice to implement the CRAFFT-IS or usual care with a target sample size of 1300 adolescent patients aged 14 to 17 years. At study start, intervention clinicians complete web-based modules, trainer-led live sessions, and mock sessions to establish baseline competency with intervention counseling. Adolescents receive mailed recruitment materials that invite adolescents to complete an eligibility survey. Eligible and interested adolescents provide informed assent (parental permission requirement has been waived). Before their visit, enrolled adolescents seeing intervention clinicians complete a self-administered web-based CRAFFT screening questionnaire and view brief psychoeducational content illustrating substance use-associated health risks. During the visit, intervention clinicians access a computerized summary of the patient's screening results and a tailored counseling script to deliver a motivational interviewing-based brief intervention. All participants complete previsit, postvisit, and 12-month follow-up study assessments. Primary outcomes include past 90-day heavy episodic drinking and riding with a driver who is substance impaired at 3-, 6-, 9-, and 12-month follow-ups. Multiple logistic regression modeling with generalized estimating equations and mixed effects modeling will be used in outcomes analyses. Exploratory aims include examining other substance use outcomes (eg, cannabis and nicotine vaping), potential mediators of intervention effect (eg, self-efficacy not to drink), and effect moderation by baseline risk level and sociodemographic characteristics. RESULTS: The AAP Institutional Review Board approved this study. The first practice and clinicians were enrolled in August 2022; as of July 2023, a total of 6 practices (23 clinicians) had enrolled. Recruitment is expected to continue until late 2024 or early 2025. Data collection will be completed in 2025 or 2026. CONCLUSIONS: Findings from this study will inform the promotion of high-quality screening and brief intervention efforts in pediatric primary care with the aim of reducing alcohol-related morbidity and mortality during adolescence and beyond. TRIAL REGISTRATION: ClinicalTrials.gov NCT04450966; https://www.clinicaltrials.gov/study/NCT04450966. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55039.

Correction: Computer-Facilitated Screening and Brief Intervention for Alcohol Use Risk in Adolescent Patients of Pediatric Primary Care Offices: Protocol for a Cluster Randomized Controlled Trial.

[This corrects the article DOI: 10.2196/55039.].

Standard Versus Family-Based Screening, Brief Intervention, and Referral to Treatment for Adolescent Substance Use in Primary Care: Protocol for a Multisite Randomized Effectiveness Trial.

BACKGROUND: Screening, brief intervention, and referral to treatment for adolescents (SBIRT-A) is widely recommended to promote detection and early intervention for alcohol and other drug (AOD) use in pediatric primary care. Existing SBIRT-A procedures rely almost exclusively on adolescents alone, despite the recognition of caregivers as critical protective factors in adolescent development and AOD use. Moreover, controlled SBIRT-A studies conducted in primary care have yielded inconsistent findings about implementation feasibility and effects on AOD outcomes and overall developmental functioning. There is urgent need to investigate the value of systematically incorporating caregivers in SBIRT-A procedures. OBJECTIVE: This randomized effectiveness trial will advance research and scope on SBIRT-A in primary care by conducting a head-to-head test of 2 conceptually grounded, evidence-informed approaches: a standard adolescent-only approach (SBIRT-A-Standard) versus a more expansive family-based approach (SBIRT-A-Family). The SBIRT-A-Family approach enhances the procedures of the SBIRT-A-Standard approach by screening for AOD risk with both adolescents and caregivers; leveraging multidomain, multireporter AOD risk and protection data to inform case identification and risk categorization; and directly involving caregivers in brief intervention and referral to treatment activities. METHODS: The study will include 2300 adolescents (aged 12-17 y) and their caregivers attending 1 of 3 hospital-affiliated pediatric settings serving diverse patient populations in major urban areas. Study recruitment, screening, randomization, and all SBIRT-A activities will occur during a single pediatric visit. SBIRT-A procedures will be delivered digitally on handheld tablets using patient-facing and provider-facing programming. Primary outcomes (AOD use, co-occurring behavior problems, and parent-adolescent communication about AOD use) and secondary outcomes (adolescent quality of life, adolescent risk factors, and therapy attendance) will be assessed at screening and initial assessment and 3-, 6-, 9-, and 12-month follow-ups. The study is well powered to conduct all planned main and moderator (age, sex, race, ethnicity, and youth AOD risk status) analyses. RESULTS: This study will be conducted over a 5-year period. Provider training was initiated in year 1 (December 2023). Participant recruitment and follow-up data collection began in year 2 (March 2024). We expect the results from this study to be published in early 2027. CONCLUSIONS: SBIRT-A is widely endorsed but currently underused in pediatric primary care settings, and questions remain about optimal approaches and overall effectiveness. In particular, referral to treatment procedures in primary care remains virtually untested among youth. In addition, whereas research strongly supports involving families in interventions for adolescent AOD, SBIRT-A effectiveness trial testing approaches that actively engage family members in primary care are absent. This trial is designed to help fill these research gaps to inform the critical health decision of whether and how to include caregivers in SBIRT-A activities conducted in pediatric primary care. TRIAL REGISTRATION: ClinicalTrials.gov NCT05964010; https://www.clinicaltrials.gov/study/NCT05964010. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/54486.

Psychometric evaluation of the family-centered care scale for pediatric acute care nursing.

BACKGROUND: Caring for families is fundamental to pediatric nursing. However, existing measures do not capture parents' experiences with family-centered nursing care. OBJECTIVE: The aim of this study was to describe the development and initial psychometric testing of the Family-Centered Care Scale, a seven-item instrument designed to measure a parent's experience of nursing care that embodies core principles of family-centered care. METHODS: In Phase 1, 18 items describing what nurses do to engage parents of hospitalized children were derived from the literature describing mutuality. After establishing face validity, pretesting, and revision for clarity, the scale was administered to a convenience sample of 91 parents of hospitalized patients. In Phase 2, two items on parents' perceptions of being well-cared-for were added. The 20-item scale was administered to 564 parents of children recruited from all inpatient units in a children's hospital. In Phase 3, the scale was shortened to seven items and retested for validity among 454 additional parents. RESULTS: Internal consistency reliability was high across all versions and testing phases. Confirmatory factor analysis with data from a subsequent sample supported the final factor structure, regardless of patient type and race. There was a linear association between the scale consistency scores and overall quality of care ratings, supporting predictive validity of the scale. DISCUSSION: The Family-Centered Care Scale showed initial evidence of reliability and validity among parents with hospitalized children.

Associations of Momentary Mindfulness With Affect and Cannabis Desire in a Trial of Cannabis Use Interventions With and Without Momentary Assessment.

PURPOSE: Mindfulness, awareness resulting from attending to the present without judgment, has been associated with improved health. When considered as a time-varying momentary state, mindfulness is associated with other momentary states such as affect. We examined whether momentary mindfulness, specifically mindful attention and awareness (MAA), changed after counseling interventions to reduce cannabis use that included ecological momentary assessment (EMA) and explored associations with negative affect, positive affect, and cannabis desire. METHODS: Outpatients 15-24 years using cannabis ≥3x/week were randomized to one of the three interventions, each including two motivational enhancement therapy (MET) sessions. For two interventions, MET was followed by 2 weeks of EMA (with/without messaging). Momentary MAA, negative affect, positive affect, and cannabis desire were assessed over 1 week of EMA at baseline and 3-month follow-up (N = 1,971 reports, 68 participants). We examined changes in momentary MAA from baseline to follow-up overall and by group (MET + EMA, MET-only) using generalized linear mixed effects models. We tested associations of momentary MAA with momentary affect and cannabis desire using generalized estimating equations. RESULTS: Momentary MAA increased from baseline to follow-up after MET counseling plus EMA (ß = 0.237), but did not change with MET counseling alone. Higher momentary MAA was associated with lower negative affect (ß = -0.526) and cannabis desire (ß = -0.521), but not with positive affect. DISCUSSION: Among youth using cannabis frequently, momentary MAA was increased 3 months after interventions with EMA after counseling and was inversely associated with momentary negative affect and momentary cannabis desire. Mindfulness may be a useful target for momentary intervention.

Evaluation of raising adolescent families together program: a medical home for adolescent mothers and their children.

OBJECTIVES: This study described a medical home model for adolescent mothers and their children, and their 1- and 2-year preventive care, repeat pregnancy, and psychosocial outcomes. METHODS: In this prospective, single cohort demonstration project, adolescent mothers (14-18 years old) and their children received care in a medical home. Demographic, medical and social processes, and outcomes data were collected at enrollment through 24 months. Change over time and predictors of repeat pregnancy were analyzed. RESULTS: A total of 181 adolescents enrolled, with 79.6% participating for 2 years. At 2 years, 90.2% of children were completely immunized. Children and adolescent mothers met standards for health care visits, and adolescent condom use improved. Rates of cumulative repeat pregnancy were 14.7% and 24.6%, school attendance 77.6% and 68.7%, and employment 21.2% and 32.3% at 1 and 2 years, respectively. CONCLUSIONS: A medical home model with comprehensive and integrated medical care and social services can effectively address the complex needs of adolescent parents and their children.

Longitudinal study of depressive symptoms and social support in adolescent mothers.

Previous studies have suggested that adolescent mothers with higher social support have lower depressive symptoms. This is a longitudinal study of adolescent mothers to examine the association of social support and depressive symptoms over one year postpartum. This was a prospective study of adolescent mothers (N at baseline = 120, N at 1 year = 89; age < 19 years) enrolled in a teen tot program. Participants completed the Center for Epidemiological Studies Depression Scale for children (CES-DC) and the Duke-UNC Functional Social Support Questionnaire at baseline, 12 weeks, and 1 year. A score of ≥ 16 on the CES-DC was suggestive of major depression. The mean CES-DC scores of the adolescent mothers were ≥ 16 points at all three time points (baseline: mean = 18.7 ± 10.3; 53% ≥ 16; 12 weeks: mean = 18.4 ± 11.4, 57% ≥ 16; one year: mean = 20.0 ± 11.4; 57% ≥ 16). Social support had a significant, inverse association with depressive symptoms for all participants from baseline to 12 weeks with a stronger association for those with more depressive symptoms (score ≥ 16) at baseline (beta = -0.030 ± 0.007; P < 0.001) than for those with fewer depressive symptoms (score < 16) at baseline (beta = -0.013 ± 0.006; P = 0.021). From 12 weeks to one year, increased social support was only significantly associated with decreased depressive symptoms for those with a higher baseline level of depressive symptoms (beta = - 0.039 ± 0.009; P < 0.001). Depressive symptoms were prevalent among adolescent mothers. For more depressed adolescent mothers, higher levels of social support were associated with less depressive symptoms over the 1 year follow-up. Effective long-term interventions are needed to lessen depression and enhance social support.

Results of a statewide survey of adolescent substance use screening rates and practices in primary care.

Professional guidelines recommend annual screening, brief intervention, and referral to treatment (SBIRT) as part of health maintenance for all adolescents, but reported screening rates have been low and no report has documented the techniques being used. The objective of this study was to describe the results of a statewide questionnaire regarding adolescent substance use screening rates and techniques used by primary care physicians practicing in Massachusetts. A questionnaire was mailed to every licensed physician registered as practicing pediatrics (N = 2176), family medicine (N = 1335), or both (N = 8) in the Massachusetts Board of Medicine database. After eliminating physicians who did not provide care for adolescents, the survey response rate was 28% and the final analyzable sample consisted of 743 surveys. Less than half of respondents reported using a validated adolescent screening tool. The majority of respondents used ineffective screening practices for adolescent substance use. Further physician training is recommended to encourage the use of developmentally appropriate screening tools and interventions for adolescents.

Does Tobacco Screening in Youth Primary Care Identify Youth Vaping?

PURPOSE: The purpose of this study was to evaluate the sensitivity of a tobacco use screening question, modified to include the word "e-cigarette," in detecting past 12-month nicotine vaping and past 12-month tobacco product use inclusive of nicotine vaping, among adolescent primary care patients. METHODS: We conducted secondary analysis of data from a pilot trial of adolescent substance use screening and brief intervention in pediatric primary care. Participants were patients aged 12-18 years (N = 278) presenting for annual well-visits at five practices in Massachusetts in 2015-2017. Study measures consisted of a clinical brief screener item and tobacco/electronic cigarette items on a confidential, self-administered research questionnaire (criterion measure). RESULTS: The clinical brief screener item identified 24 of 30 adolescents with past 12-month tobacco use (sensitivity 80%); 15 of 30 with past 12-month electronic cigarette use (sensitivity 50.0%), and 25 of 42 with tobacco and/or electronic cigarette use (sensitivity 59.5%). CONCLUSIONS: These findings support the need to develop and test a screening measure that is sensitive for capturing electronic cigarette use.

Longitudinal effects of gender minority stressors on substance use and related risk and protective factors among gender minority adolescents.

PURPOSE: Gender minority (GM) adolescents, who have a different gender identity than their sex assigned at birth, may use substances as a coping strategy in response to GM-related stressors. This study examined longitudinal effects of gender minority stressors on substance use in GM adolescents, and related risk factors (internalized transphobia, depressive symptoms, anxious symptoms) and protective factors (resilience, gender-related pride, family functioning, social support, gender-related community connectedness). METHODS: Participants were 30 GM adolescents, ages 13-17 years, from the U.S. community-based longitudinal Trans Teen and Family Narratives Project. Participants completed an online survey every 6 months across 2 years (5 waves; data collected 2015-2019). RESULTS: Exposure to gender minority stressors was associated with higher odds of alcohol use. Across models, internalized transphobia (risk factor), resilience (protective factor), and gender-related pride (protective factor) were the most significant mediators of associations between gender minority stressors and substance use. Family functioning and social support (protective factors) significantly moderated the association between gender minority stressors and alcohol use, such that family functioning and social support were protective for alcohol use at lower levels of gender minority stress, but not at higher levels. CONCLUSION: Results suggest that GM adolescents engage in substance use as a coping strategy in response to gender minority stressors. A number of hypothesized risk and protective factors mediated or moderated these associations. Future interventions with GM adolescents should focus efforts on addressing internalized transphobia as a risk factor and strengthening resilience, gender-related pride, and family functioning as protective factors for substance use.

Young and invisible: a qualitative study of service engagement by people who inject drugs in India.

OBJECTIVES: The HIV epidemic in India is concentrated in key populations such as people who inject drugs (PWID). New HIV infections are high among young PWID (≤30 years of age), who are hard to engage in services. We assessed perspectives of young PWID to guide development of youth-specific services. SETTING: We conducted focus group discussions (FGDs) with PWID and staff at venues offering services to PWID in three Indian cities representing historical and emerging drug use epidemics. PARTICIPANTS: PWID were eligible to participate if they were between 18 and 35 years, had initiated injection as adolescents or young adults and knew adolescent PWID in their networks. 43 PWID (81% male, 19% female) and 10 staff members participated in FGDs. A semistructured interview guide was used to elicit participants' narratives on injection initiation experiences, barriers to seeking harm reduction services, service delivery gaps and recommendations to promote engagement. Thematic analysis was used to develop an explanatory model for service engagement in each temporal stage across the injection continuum. RESULTS: Injection initiation followed non-injection opioid dependence. Lack of services for non-injection opioid dependence was a key gap in the preinjection initiation phase. Lack of knowledge and reliance on informal sources for injecting equipment were key reasons for non-engagement in the peri-injection phase. Additionally, low-risk perception resulted in low motivation to seek services. Psychosocial and structural factors shaped engagement after established injection. Housing and food insecurity, and stigma disproportionately affected female PWID while lack of confidential adolescent friendly services impeded engagement by adolescent PWID. CONCLUSIONS: Development of youth-specific services for young PWID in India will need to address unique vulnerabilities and service gaps along each stage of the injection continuum. Scaling-up of tailored services is needed for young female PWID and adolescents, including interventions that prevent injection initiation and provision of confidential harm reduction services.

Measurement-Based Care in the Treatment of Adolescents with Substance Use Disorders.

Measurement-based care in adolescent substance use is an important element of the evidence-based framework of Screening, Brief Intervention, and Referral to Treatment (SBIRT). Use of a validated measure for detecting substance use, misuse, and substance use disorders is significantly more effective than the use of unvalidated tools or clinician intuition. There are now a variety of established and new validated screening tools that are available for use with adolescents and that capture the range of adolescent substance use behaviors. This area, however, continues to evolve rapidly.

Development and pilot testing of a counseling-plus-mHealth intervention to reduce risk for pregnancy and sexually transmitted infection in young women with depression.

BACKGROUND: Depressed young women have elevated rates of unintended pregnancy and sexually transmitted infections (STIs). The objective of this study was to develop and pilot-test a counseling-plus-mHealth intervention to reduce sexual and reproductive health (SRH) risk in young women with depressive symptoms. METHODS: Using the Behavior-Determinants-Intervention logic model, we developed the Momentary Affect Regulation-Safer Sex Intervention (MARSSI) to address the challenges that depression imposes on SRH risk reduction efforts of high-risk young women: (I) in-person counseling using motivational interviewing (MI) to elicit motivation for safer sex and develop a behavior change plan, and teaching cognitive-behavioral skills to manage negative thoughts and affective states; (II) 4-week Ecological Momentary Intervention (EMI) on a smartphone to report momentary phenomena related to depression and SRH risk, and receive personalized, tailored messages prompting healthy behaviors and encouraging cognitive-behavioral skill use when risk-related cognitions and negative affect are reported; and (III) booster counseling to review behavior change goals and plans and teach a new cognitive-behavioral skill. We developed the counseling through iterative interviews with 11 participants and developed the EMI through a 2-week trial with three participants, then revised MARSSI to reflect participant feedback. We next conducted a pilot-test among depressed, high-risk female adolescent clinic patients age 15-24. Pilot participants completed mental health, motivation to change behavior, and SRH behavior assessments and provided feedback at baseline, post-EMI, and at 3-month follow-up. We analyzed participant retention, counseling duration, app engagement, intervention quality ratings, and participant feedback, and compared mental health and SRH risk behavior across the study. RESULTS: Seventeen participants completed the initial counseling session, 15 participated in the EMI, 14 returned for the booster session, and 14 completed the 3-month follow-up. App engagement was high for all 4 EMI weeks (≥1 report/day for median ≥6 days/week). Post-intervention, most or all participants agreed with each positive statement about the messages, reported "Excellent" MARSSI usefulness, and attributed improvements to MARSSI. Compared to baseline, post-EMI depressive symptoms, confidence to change self-selected risk behavior, and confidence to use the cognitive restructuring skill improved. At 3 months, depressive symptom scores remained lower and confidence to use cognitive restructuring remained higher, compared to baseline. Participants also reported lower frequency of sex, lower proportion of condom-unprotected sex events, and, among those using effective contraception, more consistent condom use at 3-month follow-up vs. baseline. CONCLUSIONS: MARSSI was feasible, acceptable, and engaging to young women with depression and SRH risk behavior, and was associated with increased confidence to reduce SRH risk, decreased SRH risk behaviors, increased confidence to use cognitive restructuring, and decreased depressive symptoms over 3 months. Future research is warranted to evaluate MARSSI's efficacy to improve motivation, skills, affect, and behaviors, as well as reproductive health outcomes in high-risk depressed young women.

Religiously or Spiritually-Motivated Forgiveness and Subsequent Health and Well-Being among Young Adults: An Outcome-Wide Analysis.

This study performs an outcome-wide analysis to prospectively examine the associations of forgiveness (including forgiveness of others, self-forgiveness and divine forgiveness) with a range of psychosocial, mental, behavioral and physical health outcomes. Data from the Nurses' Health Study II and the Growing Up Today Study (Ns ranged from 5,246 to 6,994, depending on forgiveness type and outcome) with 3 or 6 years of follow-up were analyzed using generalized estimating equations. Bonferroni correction was used to correct for multiple testing. All models controlled for sociodemographic characteristics, prior religious service attendance, prior maternal attachment and prior values of the outcome variables. All forgiveness measures were positively associated with all psychosocial well-being outcomes, and inversely associated with depressive or anxiety symptoms. There was little association between forgiveness and behavioral or physical health outcomes. Forgiveness may be understood as a good itself, and may also lead to better subsequent mental health and psychosocial well-being.