Considering the importance of 'Communities of Practice' and Health Promotion Constructs for Upstream Suicide Prevention.

Background: Suicide is a serious and growing health inequity for Alaska Native (AN) youth (ages 15-24), who experience suicide rates significantly higher than the general U.S. youth population. In low-resourced, remote communities, building on the local and cultural resources found in remote AN communities to increase uptake of prevention behaviors like lethal means reduction, interpersonal support, and postvention can be more effective at preventing suicide than a risk-referral process. This study expands the variables we hypothesize as important for reducing suicide risk and supporting wellbeing. These variables are: 1) perceived suicide prevention self-efficacy, 2) perceived wellness self-efficacy, and 3) developing a 'community of practice' (CoP) for prevention/wellness work. Method: With a convenience sample (N = 398) of participants (ages 15+) in five remote Alaska Native communities, this study characterizes respondents' social roles: institutional role if they have a job that includes suicide prevention (e.g. teachers, community health workers) and community role if their primary role is based on family or community positioning (e.g. Elder, parent). The cross-sectional analysis then explores the relationship between respondents' wellness and prevention self-efficacy and CoP as predictors of their self-reported suicide prevention and wellness promotion behaviors: (1) working together with others (e.g. community initiatives), (2) offering interpersonal support to someone, (3) reducing access to lethal means, and (4) reducing suicide risk for others after a suicide death in the community. Results: Community and institutional roles are vital, and analyses detected distinct patterns linking our dependent variables to different preventative behaviors. Findings associated wellness self-efficacy and CoP (but not prevention self-efficacy) with 'working together' behaviors, wellness and prevention self-efficacy (but not CoP) with interpersonal supportive behaviors; both prevention self-efficacy and CoP with higher postvention behaviors. Only prevention self-efficacy was associated with lethal means reduction. Conclusions: The study widens the scope of suicide prevention. Promising approaches to suicide prevention in rural low-resourced communities include: (1) engaging people in community and institutional roles, (2) developing communities of practice for suicide prevention among different sectors of a community, and (3) broadening the scope of suicide prevention to include wellness promotion as well as suicide prevention.

Loneliness and risk for cardiovascular disease in the United States and Japan: The effects of nationality, collectivism, and gender.

RATIONALE: Loneliness is a global concern associated with adverse effects on cardiovascular disease (CVD) that may differ by nationality, collectivism, and gender. OBJECTIVE: This study examined whether associations between loneliness and CVD indicators (e.g., metabolic dysregulation [MetD], inflammation, sleep dysfunction) would vary by nationality, collectivism, and gender. We predicted that loneliness would be associated with poorer CVD values in (1) Japan than the United States (U.S.), (2) in individuals higher rather than lower in collectivism, and (3) our exploratory hypotheses about gender were that loneliness would interact with gender to be associated with differential CVD indicators in the U.S. versus Japan. METHODS: Participants (aged 36 to 78) from the MIDUS Refresher Biomarker (n = 644) and the MIDJA 2 Biomarker studies (n = 293) completed questionnaires, bloodwork, and a physical exam. U.S. participants were from multiple cities, and Japanese participants were from Tokyo. Loneliness was measured via responses to the question, "How often in the past week did you feel lonely?" Logistic regression and path analyses using structural equation modeling determined individual differences in loneliness, whether loneliness predicted CVD indicators, and whether nationality, collectivism, and gender moderated these associations. RESULTS: Loneliness was prevalent in the U.S. (25.39%) and Japan (20.82%). Unexpectedly, Japanese adults reported less collectivism than U.S. adults. We found significant interactions of (1) nationality and gender on MetD and inflammation, (2) gender and loneliness on sleep dysfunction, and (3) nationality and loneliness on MetD. Loneliness was associated with greater MetD in the U.S. but not in Japan. CONCLUSIONS: Cultural influences on loneliness contradicted expectations and suggested caution when equating nationality with cultural values. Our Japanese sample was from Tokyo, which may have lower collectivism than rural Japanese regions. We recommend future studies consider geographic location when examining associations between loneliness, collectivism, and CVD.

Individual-Community Misalignment in Partisan Identity Predicts Distancing From Norms During the COVID-19 Pandemic.

This study investigated whether misalignment between an individual and their community in partisan identity predicted psychological and behavioral distancing from local COVID-19 norms. A nationally representative sample of Republicans and Democrats provided longitudinal data in April (N = 3,492) and June 2020 (N = 2,649). Democrats in Republican communities reported especially heightened better-than-average estimates, perceiving themselves as more adherent to and approving of non-pharmaceutical interventions (NPI; e.g., mask wearing) than their community. Democrats'better-than-average estimates reflected high approval and behavior in Republican communities and substantial norm underestimation. Republicans in Democratic communities did not evidence worse-than-average estimates. In longitudinal models, injunctive norms only predicted NPI behavior when individual and community partisan identity were aligned. The strong personal approval-behavior association did not depend on misalignment; there were no effects of descriptive norms. Normative messages may have limited efficacy for a sizable subpopulation in politically polarized contexts, such as the COVID-19 pandemic.

Getting the message across: flexitarians as messengers for meat reduction.

Despite a consensus among climate scientists on the impact of meat consumption on climate change, this has not yet had a significant impact on dietary attitudes and behavior in the broader public. Recent efforts to address this have focused on reduction of meat consumption (e.g., flexitarianism, reducetarianism) rather than elimination of meat consumption. This reduction-rather-than-elimination approach may have positive effects on how far messages about meat consumption will spread in a social network, reaching more people with therefore a potentially greater impact. To better understand the potential impact of such message, three studies compared reduction versus vegetarian messages that were provided by a person who reduces their meat consumption versus a vegetarian. Overall, reduction focused messages and messengers result in greater acceptance of the message and higher willingness to share the message with others compared to a strictly vegetarian message/messenger.

An evaluation of the feasibility, acceptability, and preliminary efficacy of cognitive-behavioral therapy for opioid use disorder and chronic pain.

AIMS: The primary study aim was to evaluate the feasibility and acceptability of cognitive-behavioral therapy (CBT) for opioid use disorder and chronic pain. The secondary aim was to examine its preliminary efficacy. METHODS: In a 12-week pilot randomized clinical trial, 40 methadone-maintained patients were assigned to receive weekly manualized CBT (n = 21) or Methadone Drug Counseling (MDC) to approximate usual drug counseling (n = 19). RESULTS: Twenty of 21 patients assigned to CBT and 18 of 19 assigned to MDC completed the pilot study. Mean (SD) sessions attended were 8.4 (2.9) for CBT (out of 12 possible) and 3.8 (1.1) for MDC (out of 4 possible); mean (SD) patient satisfaction ratings (scored on 1-7 Likert-type scales) were 6.6 (0.5) for CBT and 6.0 (0.4) for MDC (p < .001). The proportion of patients abstinent during the baseline and each successive 4-week interval was higher for patients assigned to CBT than for those assigned to MDC [Wald χ2 (1) = 5.47, p = .02]; time effects (p = .69) and interaction effects between treatment condition and time (p = .10) were not significant. Rates of clinically significant change from baseline to end of treatment on pain interference (42.9% vs. 42.1%, [χ2 (1, N = 40) = 0.002, p = 0.96]) did not differ significantly for patients assigned to CBT or MDC. CONCLUSIONS: We found support for the feasibility, acceptability, and preliminary efficacy of cognitive-behavioral therapy relative to standard drug counseling in promoting abstinence from nonmedical opioid use among patients with opioid use disorder and chronic pain. Overall, patients exhibited improved pain outcomes, but these improvements did not differ significantly by treatment condition.

Teaching systems thinking to 4th and 5th graders using Environmental Dashboard display technology.

Tackling complex environmental challenges requires the capacity to understand how relationships and interactions between parts result in dynamic behavior of whole systems. There has been convincing research that these "systems thinking" skills can be learned. However, there is little research on methods for teaching these skills to children or assessing their impact. The Environmental Dashboard is a technology that uses "sociotechnical" feedback-information feedback designed to affect thought and behavior. Environmental Dashboard (ED) combines real-time information on community resource use with images and words that reflect pro-environmental actions of community members. Prior research indicates that ED supports the development of systems thinking in adults. To assess its impact on children, the technology was installed in a primary school and children were passively exposed to ED displays. This resulted in no measurable impact on systems thinking skills. The next stage of this research examined the impact of actively integrating ED into lessons on electricity in 4th and 5th grade. This active integration enhanced both content-related systems thinking skills and content retention.

Drug Counselor Responses to Patients' Pain Reports: A Qualitative Investigation of Barriers and Facilitators to Treating Patients with Chronic Pain in Methadone Maintenance Treatment.

OBJECTIVE: To examine how drug counselors with no prior training in pain management respond to their patients' reports of chronic pain. DESIGN, SETTING, SUBJECTS, AND METHODS: We conducted individual interviews with 30 drug counselors in methadone maintenance treatment. Interviews were audiotaped, transcribed, and systematically coded using the constant comparative method. RESULTS: Participants identified counselor, patient, and logistical factors that serve as a barrier or facilitate their treatment of patients with chronic pain. Counselor barriers included lack of expertise in managing co-occurring chronic pain and opioid use disorder, complexity of patients' treatment needs, concerns about medication regimens, reliance on patient self-report, and absence of patient improvement. Counselor barriers facilitators included empathy, attending to small changes, and self-reflection. Counselors' perceptions of patient-related barriers included prior negative interactions with medical providers, diminished social roles, attenuated motivation, and negative attitudes toward opioid use disorder. Logistical barriers included lack of appropriate pain management referrals, limited counselor time, and attenuated treatment adherence; a logistical facilitator was consulting with medical providers. CONCLUSIONS: Perceived barriers to treating patients with chronic noncancer pain are common among drug counselors. Addressing these barriers in drug counselor training and in methadone maintenance treatment programs may benefit both methadone-maintained patients with chronic pain and their providers.

The Availability of Ancillary Counseling in the Practices of Physicians Prescribing Buprenorphine.

OBJECTIVE: We set out to examine physicians' perceptions of the provision of ancillary services for opioid dependent patients receiving buprenorphine. METHODS: An e-mail invitation describing the study was sent out by the American Society of Addiction Medicine to its membership (approximately 3700 physicians) and other entities (for a total of approximately 7000 e-mail addresses). E-mail recipients were invited to participate in a research study funded by the National Institutes on Drug Abuse involving completion of an online survey; 346 physicians completed the survey. RESULTS: The majority of the 346 respondents were internal or family medicine (37%), or addiction medicine providers (30%), who were practicing in urban (57%) or suburban settings (27%). Most respondents reported either offering (66%) or referring patients for ancillary counseling (31%). Interventions that were most frequently offered or referrals provided were individual counseling (51%) and self-help groups (63%), respectively. Counseling availability differed significantly by provider specialization for any, individual, group, family or couples, and self-help groups. CONCLUSIONS: Generally, respondents reported compliance with ancillary counseling requirements for buprenorphine treatment of opioid use disorder. In addition to examining the efficacy of a variety of ancillary counseling services for patients receiving opioid agonist treatment, further research should examine physicians' attitudes toward the role of such counseling in buprenorphine treatment. Although the study sample was relatively large, the generalizability of the findings is unclear, suggesting that further investigation of the availability of ancillary counseling in buprenorphine treatment among a larger nationally representative sample of providers may be warranted.

Physical activity, psychiatric distress, and interest in exercise group participation among individuals seeking methadone maintenance treatment with and without chronic pain.

BACKGROUND AND OBJECTIVES: Physical activity may improve chronic pain, anxiety, and depression, which are prevalent among patients in methadone maintenance treatment (MMT), but relatively little is known about the physical activity levels or interest in exercise of patients in MMT. METHODS: We used a brief self-report instrument to assess physical activity levels, chronic pain, psychiatric distress, and interest in exercise group participation among 303 adults seeking MMT. RESULTS: Most (73%) reported no moderate or vigorous intensity physical activity in the past week; 27% met recommended physical activity levels, and 24% reported interest in exercise group participation. Participants with (compared to those without) chronic pain had higher levels of psychiatric distress and were less likely to meet recommended levels of physical activity (p < .05), but did not differ significantly in their interest in participating in an exercise group. Participants who met recommended levels of physical activity in the past week were more likely to be men and had lower levels of depression than others (p < .05). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Low levels of physical activity and low interest in exercise group participation among patients entering MMT point to the need for and likely challenges of implementing exercise interventions in MMT.