Mobile resonance frequency breathing smartphone application to support recovery among people with opioid use disorder: Study protocol for feasibility study.

BACKGROUND: Experiencing drug cravings is an aspect of substance use disorders that frequently compromises the recovery efforts of people who use drugs. Most treatment approaches that address drug cravings either involve cognitive strategies or medication. Few interventions directly address the physiological aspects of craving, such as increased heart rate. Previous research has demonstrated that slow-paced breathing may be effective in managing drug cravings by manipulating an individual's heart rate. The purpose of this paper is to describe a study protocol for an intervention that offers resonance frequency breathing training for managing cravings via a smartphone application (app). METHODS: This trial is registered in ClinicalTrials.gov (Identifier: NCT05830773). The intervention focuses on persons in recovery from opioid use disorder who receive services from the Texas Health and Human Service Commission Recovery Support Services division. Participants will be trained to use Camera Heart Rate Variability (CHRV), a resonance frequency breathing app. The CHRV app measures heart rate and the volumetric variations of blood circulation. When experiencing stress, anxiety, or cravings, participants will use the app to practice breathing exercises. Participants (N = 60) will also complete surveys at baseline, 4 weeks, and 8 weeks; the survey questions, covers demographic characteristics, personal trauma history, substance use experience, and utilization of substance use treatment services. The surveys will also include psychosocial measures of craving, stress, and anxiety to allow the study team to assess changes between baseline and study completion. Participants who complete the full 8-week intervention will be invited to participate in a 30-minute interview about their experience with the app. Interviews will provide details on implementation outcomes, including acceptability, appropriateness, and feasibility. CONCLUSION: Many evidence-based interventions for opioid use require interpersonal communication with individuals in one's recovery network. However, individuals may be unable to engage others in their recovery network in the moments when they are experiencing cravings or stress- and anxiety-related triggers. Therefore, recovery support interventions that emphasize individual self-management of cravings, stress, and anxiety when they occur can empower individuals in recovery and enhance existing interventions.

Power analysis for idiographic (within-subject) clinical trials: Implications for treatments of rare conditions and precision medicine.

Power analysis informs a priori planning of behavioral and medical research, including for randomized clinical trials that are nomothetic (i.e., studies designed to infer results to the general population based on interindividual variabilities). Far fewer investigations and resources are available for power analysis of clinical trials that follow an idiographic approach, which emphasizes intraindividual variabilities between baseline (control) phase versus one or more treatment phases. We tested the impact on statistical power to detect treatment outcomes of four idiographic trial design factors that are under researchers' control, assuming a multiple baseline design: sample size, number of observations per participant, proportion of observations in the baseline phase, and competing statistical models (i.e., hierarchical modeling versus piecewise regression). We also tested the impact of four factors that are largely outside of researchers' control: population size, proportion of intraindividual variability due to residual error, treatment effect size, and form of outcomes during the treatment phase (phase jump versus gradual change). Monte Carlo simulations using all combinations of the factors were sampled with replacement from finite populations of 200, 1750, and 3500 participants. Analyses characterized the unique relative impact of each factor individually and all two-factor combinations, holding all others constant. Each factor impacted power, with the greatest impact being from larger treatment effect sizes, followed respectively by more observations per participant, larger samples, less residual variance, and the unexpected improvement in power associated with assigning closer to 50% of observations to the baseline phase. This study's techniques and R package better enable a priori rigorous design of idiographic clinical trials for rare diseases, precision medicine, and other small-sample studies.

Biological and Sociocultural Factors During the School Years Predicting Women's Lifetime Educational Attainment.

BACKGROUND: Lifetime educational attainment is an important predictor of health and well-being for women in the United States. In this study, we examine the roles of sociocultural factors in youth and an understudied biological life event, pubertal timing, in predicting women's lifetime educational attainment. METHODS: Using data from the National Longitudinal Survey of Youth 1997 cohort (N = 3889), we conducted sequential multivariate linear regression analyses to investigate the influences of macro-level and family-level sociocultural contextual factors in youth (region of country, urbanicity, race/ethnicity, year of birth, household composition, mother's education, and mother's age at first birth) and early menarche, a marker of early pubertal development, on women's educational attainment after age 24. RESULTS: Pubertal timing and all sociocultural factors in youth, other than year of birth, predicted women's lifetime educational attainment in bivariate models. Family factors had the strongest associations. When family factors were added to multivariate models, geographic region in youth, and pubertal timing were no longer significant. CONCLUSION: Our findings provide additional evidence that family factors should be considered when developing comprehensive and inclusive interventions in childhood and adolescence to promote lifetime educational attainment among girls.

Assessing the effects of Families for Safe Dates, a family-based teen dating abuse prevention program.

PURPOSE: To examine the effects of a family-based teen dating abuse prevention program, Families for Safe Dates, primarily on outcomes related to testing the conceptual underpinnings of the program including (1) factors motivating and facilitating caregiver engagement in teen dating abuse prevention activities, and 2) risk factors for teen dating abuse, and secondarily on dating abuse behaviors. METHODS: Families were recruited nationwide using listed telephone numbers. Caregivers and teens completed baseline and 3-month follow-up telephone interviews (n = 324). Families randomly allocated to treatment condition received the Families for Safe Dates program including six mailed activity booklets followed-up by health educator telephone calls. RESULTS: There were significant (<.05) treatment effects in hypothesized directions on most of the factors motivating and facilitating caregiver engagement in teen dating abuse prevention activities including caregiver perceived severity of dating abuse, response efficacy for preventing dating abuse, self-efficacy for talking about dating abuse, knowledge of dating abuse, acceptance of dating abuse, communication skills with the teen, and belief in the importance of involvement in their male (but not female) teen's dating. The latter effect was the only one moderated by sex of the teen. The targeted risk factor affected by the program was teen acceptance of dating abuse. Treatment was also significantly associated with less physical dating abuse victimization. CONCLUSIONS: Modifications to the program are warranted, but overall, the findings are very favorable for the first family-based teen dating abuse prevention program to be evaluated.

What's the 411? Assessing the feasibility of providing African American adolescents with HIV/AIDS prevention education in a faith-based setting.

This study examines African American faith based leaders' attitudes and beliefs about providing HIV prevention education and services to adolescents. Using a convenience sample, we identified priority adolescent health issues, attitudes about abstinence messages, and willingness to provide and participate in HIV prevention. Leaders identified drugs, gangs, alcohol, sex, and pregnancy as priority health issues affecting youth in their institutions. Leaders' strongly preferred to emphasize abstinence messages. Although leaders were willing to provide youth with health education, they were not willing to discuss specific behaviors associated with HIV transmission. African American churches provide a venue to reach African American youth; however, there are limitations to relying on faith-based HIV prevention services. HIV prevention education should continue to be supplemented via parents, schools, and public health agencies.

Correlates of HIV-related risk behaviors in African American adolescents from substance-using families: patterns of adolescent-level factors associated with sexual experience and substance use.

PURPOSE: To examine adolescent-level correlates of HIV-related risk behaviors among urban African American adolescents whose mothers use crack cocaine. METHODS: Interviews were conducted with 208 African American adolescents (aged 12-17 years) to assess psychosocial, behavioral, and perceived environment correlates of HIV-related risk behavior. Adolescents were children of community-recruited African American women not currently in drug treatment who reported crack cocaine use (in last 6 months). Bivariate and multivariate regression models were used to evaluate associations among adolescent-level factors, sexual experience, and substance use. RESULTS: Of the adolescents, 30% reported being sexually experienced, and 23% reported alcohol or drug use in the past month. Older age and lower school satisfaction were associated with both sexual experience and substance use, but no other factors were associated with both risk behaviors. Male gender, current substance use, high HIV/AIDS knowledge, and high risk perception were associated with being sexual experienced. Sexual experience and lower expectations for future life outcomes were associated with substance use. A general pattern of protective factors related to attitudes about future goals, help-seeking behavior, and positive feelings about school emerged for substance use. CONCLUSIONS: These results suggest that the patterns of adolescent-level risk and protective factors for sexual experience and substance use may be unique in African American adolescents from substance-abusing families. Instead of an increase in problem behaviors associated with using substances, protective factors were evident, suggesting these adolescents may have resiliency for dealing with environmental stressors related to substance use. Implications for HIV prevention programs involving mentoring and goal development are discussed.

Children of African-American mothers who use crack cocaine: parenting influences on youth substance use.

OBJECTIVE: To examine relationships between parenting behaviors, parent-child relationship, and moderating effects of age on youth substance use among a community sample of African-American mothers who use crack cocaine and their children (12-17 years). METHODS: Maternal-child dyads (n = 208) were recruited through street outreach and snowball sampling and completed interviews about substance use and parenting. RESULTS: Regression analyses found significant main effects of youth age, family conflict, warmth, and disapproval of youth substance use on children's substance use. Age x Parenting interactions were significant for conflict and disapproval. Higher family conflict increased older youths' risk, while higher perceived maternal disapproval protected against substance use for older youth. CONCLUSIONS: Family influences may offer risk and protective effects for adolescent children of maternal drug users. Outreach and family-focused interventions that address family conflict and communication of disapproval of substance use may help reduce intergenerational risk transmission. However, longitudinal research with comprehensive parenting assessments is needed.

Unhealthy weight control behaviors and MDMA (Ecstasy) use among adolescent females.

PURPOSE: To estimate the prevalence of past year laxative use or vomiting weight control behaviors among adolescent females in the general population and to examine the relationship between these behaviors and substance use among adolescent females, with a specific focus on past year 3-4 methylenedioxymethamphetamine (MDMA) ("Ecstasy") use. METHODS: Secondary analyses were conducted using a nationally representative sample of females aged 12 to 17 years (n = 4292) from the 2001 National Household Survey on Drug Abuse (NHSDA). Logistic regression was used to examine bivariate relationships between past year laxative use or vomiting weight control behaviors and substance use and the multivariate relationship between unhealthy weight control behaviors and Ecstasy use. RESULTS: Approximately 10% of adolescent females had used laxatives or vomited to lose weight in the past year. Adolescent females who had used laxatives or vomited to lose weight in the past year were more likely than those who had not to have used substances during the past year, including Ecstasy, inhalants, nonmedical psychotherapeutics, marijuana, cigarettes, and alcohol. After controlling for demographics and other substance use, past year laxative use or vomiting weight control behaviors were positively associated with past year Ecstasy use (OR = 1.81; 95% CI = 1.05, 3.14; p = 0.04). CONCLUSION: Laxative use or vomiting weight control behaviors are a significant problem among the general population of adolescent females and are related to an increased risk of Ecstasy use.