Evaluating Declines in Compliance With Ecological Momentary Assessment in Longitudinal Health Behavior Research: Analyses From a Clinical Trial.

BACKGROUND: Ecological momentary assessment (EMA) is increasingly used to evaluate behavioral health processes over extended time periods. The validity of EMA for providing representative, real-world data with high temporal precision is threatened to the extent that EMA compliance drops over time. OBJECTIVE: This research builds on prior short-term studies by evaluating the time course of EMA compliance over 9 weeks and examines predictors of weekly compliance rates among cigarette-using adults. METHODS: A total of 257 daily cigarette-using adults participating in a randomized controlled trial for smoking cessation completed daily smartphone EMA assessments, including 1 scheduled morning assessment and 4 random assessments per day. Weekly EMA compliance was calculated and multilevel modeling assessed the rate of change in compliance over the 9-week assessment period. Participant and study characteristics were examined as predictors of overall compliance and changes in compliance rates over time. RESULTS: Compliance was higher for scheduled morning assessments (86%) than for random assessments (58%) at the beginning of the EMA period (P<.001). EMA compliance declined linearly across weeks, and the rate of decline was greater for morning assessments (2% per week) than for random assessments (1% per week; P<.001). Declines in compliance were stronger for younger participants (P<.001), participants who were employed full-time (P=.03), and participants who subsequently dropped out of the study (P<.001). Overall compliance was higher among White participants compared to Black or African American participants (P=.001). CONCLUSIONS: This study suggests that EMA compliance declines linearly but modestly across lengthy EMA protocols. In general, these data support the validity of EMA for tracking health behavior and hypothesized treatment mechanisms over the course of several months. Future work should target improving compliance among subgroups of participants and investigate the extent to which rapid declines in EMA compliance might prove useful for triggering interventions to prevent study dropout. TRIAL REGISTRATION: ClinicalTrials.gov NCT03262662; https://clinicaltrials.gov/ct2/show/NCT03262662.

A Psychometric Evaluation of the Stanford Expectations of Treatment Scale (SETS) in the Context of a Smoking Cessation Trial.

INTRODUCTION: Although treatment outcome expectancies (TOEs) may influence clinical outcomes, TOEs are rarely reported in the smoking cessation literature, in part because of the lack of validated measures. Therefore, we conducted a psychometric evaluation of TOEs scores with the Stanford Expectations of Treatment Scale (SETS) in the context of a smoking cessation clinical trial. METHODS: Participants were 320 adults enrolled in a randomized controlled trial of extended versus standard pre-quit varenicline treatment for smoking cessation (clinicaltrials.gov ID: NCT03262662). Across an 8-week treatment period, we examined the nature and stability of the factor structure using confirmatory factor analysis (CFA), evaluated discriminant validity by examining correlations with abstinence self-efficacy and positive/negative affect (PA/NA), and assessed internal consistency and test-retest reliability of SETS scores. RESULTS: CFAs supported a 2-factor structure that was stable (ie, invariant) across weeks. Positive and negative TOEs were each reflected in three-item subscales that exhibited acceptable to excellent internal consistency (Cronbach's alphas ≥ .77). Positive and negative TOEs were modestly correlated with PA and NA (all |rs| <.27, p < .05). Positive TOEs, but not negative TOEs, were moderately correlated with abstinence self-efficacy (rs = .45 to .61, p < .01). Both positive and negative TOEs scores demonstrated moderate test-retest reliability between assessments (rs = .54 to .72). CONCLUSIONS: SETS scores generally reflect a valid and reliable assessment of positive and negative TOEs in a sample of adults enrolled in a smoking cessation trial. The SETS appears to be a reasonable option for assessing TOEs in future smoking treatment studies. IMPLICATIONS: Assessments of treatment outcome expectancies are rarely reported in the smoking cessation literature. The present results support the validity and reliability of the SETS scores among adults seeking treatment for their smoking behavior.

At risk and in love: A mixed methodexamination of the link between childhood maltreatment and youth relationships.

INTRODUCTION: Research indicates that sexual and romantic relationships play an important role in youth well-being and development. This strengths-based perspective sits in tension with the documented risks that youth with histories of maltreatment face in sexual/romantic relationships. We conducted a U.S.-based mixed-method study to examine the connection between childhood maltreatment and youth relationships. METHOD: We collected retrospective ratings of relationship quality and open-ended comments about those relationships using an online sexual life history calendar. Quantitative analyses drew on data from 98 participants (51 cisgender women, 47 cisgender men) between the ages of 18-25 (Mage = 22.51). Qualitative analyses compared demographically matched subsamples of 19 participants who reported multiple forms of child maltreatment and 20 who reported none. RESULTS: Quantitative analyses indicated that ratings of relationship stability, intimacy, and pleasure were unrelated to prior abuse or neglect. Qualitative analyses showed the relationships of those with multiple maltreatment histories, compared to those without any maltreatment, to be more often intertwined with and complicated by other hardships (e.g., homelessness). CONCLUSIONS: Quantitatively, childhood maltreatment appeared unrelated to youth sexual/romantic relationship quality, though we regard those findings with due caution. Complementing this was qualitative evidence of differences between participants based on trauma histories, with those who had experienced childhood maltreatment referring more often to surrounding circumstances and hardships in descriptions of their youth sexual/romantic relationships. These mixed method findings reinforce the importance of youth sexuality research, policy, and practice that takes the broader conditions of young people's lives into consideration.

Contraceptive use in Appalachian women who use drugs and were recruited from rural jails.

This study describes a secondary data analysis of contraceptive use across the lifetime and within the six months prior to incarceration in a sample of 400 currently incarcerated women recruited from rural, Appalachian jails, who were using drugs prior to incarceration. Phase 1 (baseline) data from an NIH funded study were used to examine rates of contraceptive use, reasons for nonuse of condoms, and correlates of condom use. Results indicate that the majority (96.5%) of respondents reported lifetime use of contraceptives, and most (70.5%) had a history of using multiple methods, with male condoms, oral contraceptive pills, and contraceptive injections being the most commonly used methods. Almost 69% of respondents reported nonuse of contraceptives within the last six months, despite high rates of involvement in risky, intimate male partnerships prior to incarceration. Contraceptive use was found to be historically acceptable in this sample, in stark contrast to rates of use within the last six months prior to incarceration, suggesting that reproductive justice-informed, social work interventions to help improve current contraceptive use are warranted as a harm-reduction approach.

Retraumatization Mediates the Effect of Adverse Childhood Experiences on Clinical Training-Related Secondary Traumatic Stress Symptoms.

Previous research (Butler, Carello, & Maguin, 2016) has found that exposure to trauma-related material in graduate clinical coursework and field training can put students at risk for reactivations of feelings/memories from negative past experiences (retraumatization) and for secondary traumatic stress (STS) symptoms. The present report sought to examine the role, if any, of adverse childhood experiences (ACEs) in these outcomes. Using the Butler et al. (2016) sample, we examined: (1) rates of ACEs in 195 graduate social work students, (2) whether the total number of ACEs was associated with training-related retraumatization (TRT) and/or STS symptoms, and (3) if TRT mediated the relationship between ACEs and STS symptoms. The results indicate that more than three quarters of the sample had experienced one or more ACEs before age 18 and almost one third endorsed 4 or more. The most commonly reported ACEs were household mental illness, parental separation/divorce, household alcohol/substance abuse, and emotional abuse or neglect by a parent or household member. Higher ACE scores were associated with increased likelihood of TRT experiences and STS symptoms during training. A mediation analysis confirmed that TRT mediated the effect of ACE scores on STS symptoms; this finding also provides support for the role of proximal emotional reactions in mediating the effects of distal adverse experiences on the development of trauma symptoms. In summary, despite the evident resilience of this graduate student sample, those with ACE histories were at heightened risk for training-related distress. These results underscore the need for a trauma-informed approach to clinical training.

A trauma-informed examination of the hardships experienced by abortion fund patients in the United States.

Researchers describe hardships experienced by abortion patients, examining administrative health cases from 2010 to 2015 in the United States. All patients received financial assistance from an abortion fund to help pay for abortion. Case data were analyzed to assess types and numbers of hardships experienced by age, race, and geographic origin. Hardships ranged from homelessness to parenting multiple children. Patients from the geographic South experienced the most hardships, followed by those from the Midwest. Hardships experienced by abortion fund patients are like those reported in other samples of abortion patients; hardships potentially cause or exacerbate trauma. Results are discussed in the context of a trauma-informed perspective.

The undue burden of paying for abortion: An exploration of abortion fund cases.

The results of a secondary data analysis of 3,999 administrative cases from a national abortion fund, representing patients who received pledges for financial assistance to pay for an abortion from 2010 to 2015, are presented. Case data from the fund's national call center was analyzed to assess the impact of the fund and examine sample demographics which were compared to the demographics of national abortion patients. Procedure costs, patient resources, funding pledges, additional aid, and changes over time in financial pledges for second-trimester procedures were also examined. Results indicate that the fund sample differed from national abortion patients in that fund patients were primarily single, African American, and seeking funding for second trimester abortions. Patients were also seeking to fund expensive procedures, costing an average of over $2,000; patients were receiving over $1,000 per case in pledges and other aid; and funding pledges for second trimester procedures were increasing over time. Abortion funding assistance is essential for women who are not able to afford abortion costs, and it is particularly beneficial for patients of color and those who are younger and single. Repeal of policy banning public funding of abortion would help to eliminate financial barriers that impede abortion access.

Measuring Attitudes Towards Empirically Supported Treatment in Real World Addiction Services.

Mental health workers with favorable attitudes toward empirically supported treatments (ESTs) are more likely to break through implementation barriers. The Evidence-Based Practice Attitudes Scale has been shown to be reliable for mental health workers, but has not been validated with addiction workers. This study investigates the use of the scale with a convenience sample of addiction workers from four agencies in one city. Results show that compared to mental health providers, addiction workers were more likely to view ESTs favorably if they were mandated and intuitively appealing. They also tended to rely more heavily on practical experience in forming attitudes toward treatment options. These results may help addiction agencies understand which types of workers are more likely to implement ESTs and inform effective engagement approaches specific to addiction workers.

A randomized controlled trial of a team science intervention to enhance collaboration readiness and behavior among early career scholars in the Clinical and Translational Science Award network.

Introduction: Despite the central importance of cross-disciplinary collaboration in the Clinical and Translational Science Award (CTSA) network and the implementation of various programs designed to enhance collaboration, rigorous evidence for the efficacy of these approaches is lacking. We conducted a novel randomized controlled trial (RCT; ClinicalTrials.gov identifier: NCT05395286) of a promising approach to enhance collaboration readiness and behavior among 95 early career scholars from throughout the CTSA network. Methods: Participants were randomly assigned (within two cohorts) to participate in an Innovation Lab, a week-long immersive collaboration experience, or to a treatment-as-usual control group. Primary outcomes were change in metrics of self-reported collaboration readiness (through 12-month follow-up) and objective collaboration network size from bibliometrics (through 21 months); secondary outcomes included self-reported number of grants submitted and, among Innovation Lab participants only, reactions to the Lab experience (through 12 months). Results: Short-term reactions from Innovation Lab participants were quite positive, and controlled evidence for a beneficial impact of Innovation Labs over the control condition was observed in the self-reported number of grant proposals in the intent-to-treat sample. Primary measures of collaboration readiness were near ceiling in both groups, limiting the ability to detect enhancement. Collaboration network size increased over time to a comparable degree in both groups. Conclusions: The findings highlight the need for systematic intervention development research to identify efficacious strategies that can be implemented throughout the CTSA network to better support the goal of enhanced cross-disciplinary collaboration.

A preliminary randomized trial of reinforcement contingencies to improve compliance with ecological momentary assessment.

Ecological Momentary Assessment (EMA) methods are increasingly used by translational scientists to study real-world behavior and experience. The ability to draw meaningful conclusions from EMA research depends upon participant compliance with assessment completion. Most EMA studies provide financial compensation for compliance, but little empirical evidence addresses the impact of reinforcement parameters on the level of compliance. The purpose of this study-within-a-trial was to determine the effects of varying the amount and frequency of reinforcement on EMA compliance in a clinical sample of individuals seeking treatment for cigarette smoking. In the parent clinical trial, participants were asked to complete 9 weeks of EMA (1 daily Morning Assessment and 4 daily Random Assessments). Following a 5-week Standard Payment phase for EMA compliance, 61 individuals seeking treatment for cigarette smoking enrolled in the larger clinical trial were randomized to receive Standard ($1 per assessment, paid biweekly), Frequent ($1 per assessment, paid 3 times per week), or Large ($2 per assessment, paid biweekly) payments for EMA compliance during a 4-week Payment Manipulation Phase. Overall, receiving Frequent or Large payments did not improve EMA compliance compared to Standard payments, Ps > .30. Varying frequency and amount of remuneration for EMA compliance did not generally improve compliance in an ongoing clinical trial, raising further questions about the importance of reinforcement parameters in promoting EMA compliance.

Previous studies have addressed the idea that monetary compensation for participation in research is an effective way to encourage individuals to complete the studies. However, there has been limited exploration as whether the amount and frequency of compensation has an influence on participant adherence. We recruited adults who were seeking cigarette smoking treatment and asked them to complete multiple assessments each day on a smartphone app for 9 weeks. Following completion of the assessments, participants were given monetary compensation. A change after 5 weeks led to some persons receiving $1 per assessment paid three times a week (Frequent Payment Group), while others received $2 per assessment paid biweekly (Large Payment Group), and some continued to receive $1 per assessment paid biweekly (Standard Payment Group) for the next 4 weeks. We found that the experimental payment variations did not significantly change compliance with the assessments. These preliminary findings serve as a benchmark for further research.

Individual Worker-Level Attitudes Toward Empirically Supported Treatments.

OBJECTIVES: There is a growing literature indicating that organizational and individual worker-level factors affect decisions about whether or not empirically supported treatments (ESTs) are adopted within health care agencies. The purpose of this pilot study is to further investigate and measure worker's attitudes within a community organization. METHOD: A small organization participated in the study due to their diversity in services offered. Of the 92 workers eligible for participation in the study, 66 (72%) completed the Evidence-Based Practice Attitude scale survey. RESULTS: Multivariate analyses revealed that female workers scored higher on both Openness and total score; workers with nursing, education, or psychology majors scored lower than workers with other (excluding social work) majors on both Divergence and total score; and that older workers scored higher on Divergence. CONCLUSION: Although small, this study identifies individual characteristics that are most likely to fit the profile of an EST adopter.

Empirically Supported Treatment's Impact on Organizational Culture and Climate.

OBJECTIVES: With the continued push to implement empirically supported treatments (ESTs) into community-based organizations, it is important to investigate whether working condition disruptions occur during this process. While there are many studies investigating best practices and how to adopt them, the literature lacks studies investigating the working conditions in programs that currently use ESTs. METHOD: This study compared the culture and climate scores of a large organization's programs that use ESTs and those programs indicating no EST usage. RESULTS: Of the total 55 different programs (1,273 frontline workers), 27 programs used ESTs. Results indicate that the programs offering an EST had significantly more rigid and resistant cultures, compared to those without any ESTs. In regard to climate, programs offering an EST were significantly less engaged, less functional, and more stressed. CONCLUSION: Outcomes indicate a significant disruption in organizational culture and climate for programs offering ESTs.

Alcohol and cannabis co-use and social context as risk pathways to sexual assault.

Objective: Simultaneous use of alcohol in combination with cannabis ("co-use") is common among young adults, and associated with myriad consequences. Yet no studies have examined how co-use may confer vulnerability for sexual assault (SA). Further, though both co-use and SA commonly occur in social settings, there have been no examinations of the role that co-use may play in the broader social context that leads to assault risk. This was the objective of the present study. Method: In a community sample of young adult women, (N = 174; Mage = 22.6), we examined risk pathways to SA, guided by Routine Activities Theory (Mustaine & Tewksbury, Criminal Justice Review, 2002, 27, 89). Using a longitudinal burst design with 27 daily assessments across 1 year, women reported on their own and others' alcohol, cannabis, and co-use, and on social context and assault experiences. Results: Multilevel path model results showed alcohol and cannabis co-use to confer unique risk for SA, above and beyond the influence of use of either substance alone. Intoxication and components of the co-use social context (proximity to offenders) mediated this risk. Importantly, we observed a key role for co-use by others within the social context in assault risk. Conclusions: This study adds to the literature by providing a nuanced and contextual account of how cannabis-alcohol co-use may lead to assault vulnerability in young adult women. Findings underscore the need for intervention efforts that expand their focus to include the broader social context, and the role that the use and co-use behaviors of others may play within this context. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Who Wears the Pants: The Implications of Gender and Power for Youth Heterosexual Relationships.

Relationships in which power is equally distributed are consistently associated with greater quality (e.g., deeper intimacy, less turmoil, more pleasure), but it can be difficult to strike such a balance. Furthermore, dominant gender scripts and norms are complexly intertwined with power in heterosexual relationships. We studied the joint implications of power and gender for relationship quality using 114 U.S. emerging adults' quantitative and qualitative assessments of 395 heterosexual relationships. Linear mixed method analyses indicated that participants found relationships in which they shared power or were dominant to be more intimate and stable than those in which they felt subordinate, but we found no link between power and pleasure. Gender acted as a moderator such that women rated relationships in which they felt subordinate as less intimate and more tumultuous than those in which they felt dominant, whereas men's ratings did not vary by whether they felt subordinate or dominant. Qualitative data also showed power imbalances to be more problematic for women: Of the 17 relationships involving an abusive or controlling partner, 15 were reported by women. We conclude that while both young men and young women may feel subordinate in relationships, the consequences thereof are more detrimental for young women.

Impact of individualized education plans on academic success of youth with early onset schizophrenia.

PURPOSE: Youth with early onset schizophrenia (EOS) are eligible for an individualized education plan (IEP) in school settings, yet often have declining academic performance over time. This study examines the impact of IEP and comorbid conditions on educational outcomes for youth with EOS. METHOD: We used mixed models and logistic regression to answer the research questions using data from 129 youth with EOS who participated in a longitudinal study from 1998 to 2006. RESULTS: Not all children had an IEP in all waves. Of those that did, findings demonstrated that having an IEP did not improve absenteeism or academic performance. In addition, regardless of whether they had an IEP, rates of dropping out were equal. CONCLUSIONS: Social workers should consider more individualized approaches to IEPs for youth with EOS to target the specific complexities of the disorder as well as its implications for school success.

The Relative Importance of Mothers' and Youths' Neighborhood Perceptions for Youth Alcohol Use and Delinquency.

Prior studies have examined the influence of neighborhood perceptions on youth outcomes, but few studies have examined whose report of neighborhoods, parents' or youths', are most important in predicting youth outcomes. This study addresses the relative associations of youths' and mothers' neighborhood perceptions with youth alcohol use and delinquency. The sample includes 499 mother-child dyads (youth age: 10 to 16 [mean = 13.3; SD = 2]). Structural equation modeling showed that youths' perceived neighborhood problems were significantly associated with their delinquency but not their alcohol use. However, mothers' perceived neighborhood problems were not related to either youth alcohol use or delinquency, suggesting that youths' perceptions are better indicators of youth behavior. Youth reports may reflect their activities in the neighborhood and their exposure to different forms of deviance, so youths' reports would be better indicators of exposure to neighborhood risk. Challenges for prevention are discussed.

Trauma, stress, and self-care in clinical training: Predictors of burnout, decline in health status, secondary traumatic stress symptoms, and compassion satisfaction.

[Correction Notice: An Erratum for this article was reported in Vol 9(4) of Psychological Trauma: Theory, Research, Practice, and Policy (see record 2016-54155-001). In the article, there was an error in Table 4 of the Results. The Outcomes and Predictors columns were not clearly categorized from one another. The corrected table is present in the erratum.] Objective: Courtois and Gold (2009) have called for the inclusion of trauma in the curriculum for all mental health training programs. The present study investigated the impact of trauma-related content, stress, and self-care (SC) on trainees in such a program. Method: The study examined potential risk factors (trauma exposures in training [being faced with or reacting to trauma-related field work experiences and course content] and perceptions of stress in field and coursework) and protective factors (SC effort and importance) in relation to burnout (BO), health status (HS), secondary traumatic stress symptoms (STSS), and compassion satisfaction (CS) among 195 students in a graduate social work training program. Results: All students reported trauma exposures in their field placements and/or coursework, including retraumatization experiences that were associated with higher STSS and BO. Field stress and SC effort were both consistent predictors across outcomes. Higher field stress levels predicted higher BO and STSS, a greater likelihood of decline in HS, and lower CS. Lower SC effort was also associated with higher BO and STSS, and a greater likelihood of decline in HS, while higher SC effort predicted higher CS. Older students, those with traumatized field clients, and those whose field work addressed trauma, also reported higher CS. Conclusions: These findings suggest that clinical training involving trauma content can be both rewarding and stressful, and may evoke distress in some trainees. Given that learning about and working with trauma are essential to adequate clinical training, the authors suggest adopting a trauma-informed approach within clinical training programs. (PsycINFO Database Record

Examining the validity of the adapted Alabama Parenting Questionnaire-Parent Global Report Version.

The purpose of the present study was to comprehensively examine the validity of an adapted version of the parent global report form of the Alabama Parenting Questionnaire (APQ) with respect to its factor structure, relationships with demographic and response style covariates, and differential item functioning (DIF). The APQ was adapted by omitting the corporal punishment and the other discipline items. The sample consisted of 674 Canadian and United States families having a 9- to 12-year-old child and at least 1 parent figure who had received treatment within the past 5 years for alcohol problems or met criteria for alcohol abuse or dependence. The primary parent in each family completed the APQ. The 4-factor CFA model of the 4 published scales used and the 3-factor CFA model of those scales from prior research were rejected. Exploratory structural equation modeling was then used. The final 3-factor model combined the author-defined Involvement and Positive Parenting scales and retained the original Poor Monitoring/Supervision and Inconsistent Discipline scales. However, there were substantial numbers of moderate magnitude cross-loadings and large magnitude residual covariances. Differential item functioning (DIF) was observed for a number of APQ items. Controlling for DIF, response style and demographic variables were related significantly to the factors. (PsycINFO Database Record

Prehospital providers' perceptions of emergency calls near life's end.

The nature of emergency end-of-life calls is changing as people live longer and die from chronic illnesses. This study explored prehospital providers' perceptions of (1) end-of-life 911 calls, (2) the signs and symptoms of dying, and (3) medical orders for life sustaining treatment (MOLST). The exploratory-descriptive pilot study was survey based and cross-sectional. Calls to nursing homes occur most often, (47.8% every shift). The MOLST was seen infrequently (57.9% rarely never). The most frequent signs and symptoms of dying were diagnosis (76%), hospice involvement (82%), apnea (75%), mottling (55%), and shortness of breath (48%). The MOLST identifies wishes about intubation (74%), resuscitation (74%), life-sustaining treatment (72%), and cardiopulmonary resuscitation (70%). Synergy exists between the fields of prehospital, hospice, and palliative medicine which offers potential for improved education and care.

Preparation for frontline end-of-life care: exploring the perspectives of paramedics and emergency medical technicians.

BACKGROUND: Prehospital emergency providers (emergency medical technicians [EMTs] and paramedics) who respond to emergency calls for patients near the end of life (EOL) make critical decisions in the field about initiating care and transport to an emergency department. OBJECTIVE: To identify how a sample of prehospital providers learned about EOL care, their perceived confidence with and perspectives on improved preparation for such calls. DESIGN: This descriptive study used a cross-sectional survey design with mixed methods. SETTING/PARTICIPANTS: One hundred seventy-eight prehospital providers (76 EMT-basics and 102 paramedics) from an emergency medical services agency participated. MEASUREMENTS: Multiple choice and open-ended survey questions addressed how they learned about EOL calls, their confidence with advance directives, and perspectives on improving care in the field. RESULTS: The response rate was 86%. Education about do-not-resuscitate (DNR) orders was formal (92%), experiential (77%), and self-directed (38%). Education about medical orders for life-sustaining treatment (MOLST) was formal (72%), experiential (67%), and self-directed (25%). Ninety-three percent were confident in upholding a DNR order, 87% were confident interpreting MOLST, and 87% were confident sorting out conflict between differing patient and family wishes. Qualitative data analysis yielded six themes on improving preparation of prehospital providers for EOL calls: (1) prehospital provider education; (2) public education; (3) educating health care providers on scope of practice; (4) conflict resolution skills; (5) handling emotional families; and (6) clarification of transfer protocols. CONCLUSION: These study results suggest the need for addressing the potential interrelationship between prehospital and EOL care through improved education and protocols for care in the field.