Polydrug Use Typologies of Regular Ecstasy Users Visiting Electronic Dance Music Events: A Latent Class Analysis.

INTRODUCTION: Polydrug use patterns among young adults using ecstasy vary, as well as their willingness to change them. Polydrug use patterns are likely associated with different adverse health outcomes. It is unknown whether polydrug use patterns of young adults who use ecstasy are similar in different countries. This study aims to identify and compare polydrug use patterns and willingness to change them of young adults that use ecstasy in the United Kingdom (UK) and the Netherlands (NL), two countries with a high prevalence of ecstasy use and a large electronic dance music (EDM) scene. METHODS: The data from the online cross-sectional Electronic Music Scene Survey were used in a latent class analysis. The binary indicators used in the estimation were past-year substance use of 21 different substances. The sample consisted of young adult ecstasy users that regularly visit EDM events (age 18-34). RESULTS: A total of 1,077 respondents from the UK (age M = 23.1) and 1,178 from the NL (age M = 23.7) that regularly visit EDM events were included in the analyses. In both countries, three polydrug use patterns of ecstasy users were identified based on Bayesian Information Criterion fit indices: a traditional polydrug use class (UK: 28%; NL: 40%), a stimulant and ketamine polydrug use class (UK: 48%; NL: 52%), and an extensive polydrug use class (UK: 24%; NL: 8%) characterized by substantial use of stimulants, depressant, and psychedelic substances. Overall, young adults that used ecstasy in the UK consumed 3,4-methylenedioxymeth-amphetamine (MDMA) more often as powder/crystalline and at higher dosages compared to young adults in the NL who preferred MDMA tablets. Regardless of polydrug class or country, most respondents indicated that they had the intention to reduce but not quit their use. CONCLUSION: In both countries, structurally similar polydrug use patterns among young adults that use ecstasy were found, while the use frequencies of individual substances and preferred MDMA form varied between the countries.

The effects of COVID-19 on child mental health: Biannual assessments up to April 2022 in a clinical and two general population samples.

Background: The COVID-19 pandemic has had an acute impact on child mental and social health, but long-term effects are still unclear. We examined how child mental health has developed since the start of the COVID-19 pandemic up to 2 years into the pandemic (April 2022). Methods: We included children (age 8-18) from two general population samples (N = 222-1333 per measurement and N = 2401-13,362 for pre-covid data) and one clinical sample receiving psychiatric care (N = 334-748). Behavioral questionnaire data were assessed five times from April 2020 till April 2022 and pre-pandemic data were available for both general population samples. We collected parent-reported data on internalizing and externalizing problems with the Brief Problem Monitor and self-reported data on Anxiety, Depressive symptoms, Sleep-related impairments, Anger, Global health, and Peer relations with the Patient-Reported Outcomes Measurement Information System (PROMIS®). Results: In all samples, parents reported overall increased internalizing problems, but no increases in externalizing problems, in their children. Children from the general population self-reported increased mental health problems from before to during the pandemic on all six PROMIS domains, with generally worst scores in April 2021, and scores improving toward April 2022 but not to pre-pandemic norms. Children from the clinical sample reported increased mental health problems throughout the pandemic, with generally worst scores in April 2021 or April 2022 and no improvement. We found evidence of minor age effects and no sex effects. Conclusions: Child mental health in the general population has deteriorated during the first phase of the COVID-19 pandemic, has improved since April 2021, but has not yet returned to pre-pandemic levels. Children in psychiatric care show worsening of mental health problems during the pandemic, which has not improved since. Changes in child mental health should be monitored comprehensively to inform health care and policy.

What Do Young Adults Expect from the Recreational Use of Ecstasy (3,4-Methylenedioxymethamphetamine/Molly)? A Latent Class Analysis of a Convenience Sample of Dutch Young Adults.

INTRODUCTION: This study offers insights into Dutch young people's expected social and personal consequences of ecstasy use. Substance use expectancies are assumed to be an essential component in explaining substance use behaviour and, therefore, the development of effective substance use prevention and treatment strategies. METHOD: Dutch young adults with an online interest in drug-related social media posts were targeted with an online survey about their use of alcohol and drugs. This resulted in a convenience sample (N = 4182, 73.4% female, Mage = 21.11), of which 35.5% had used ecstasy at least once in their life and 29.3% had used ecstasy last year. Latent class analyses were used to identify subgroups based on both positive and negative expectancies of ecstasy use. Cross-class differences were examined using multinomial logistic regression. RESULTS: This study yielded four distinct classes: only negative expectancies (13.6%), high positive and negative expectancies (23.5%), low to moderate positive and negative expectancies (20.6%), and mostly positive expectancies (22.4%). These classes differed significantly in lifetime experience with ecstasy use, intention to use ecstasy, perception of harmfulness and availability, and social norms regarding the use of ecstasy. CONCLUSION: Findings show that ecstasy use expectancies can be used to create meaningful classes of users and non-users, and that these classes are different enough to warrant varied prevention approaches. Expectancies young people have regarding the use of ecstasy are associated with various ecstasy use-related variables and should be taken into consideration when developing and implementing preventive interventions.

Augmented reality as a novel approach for addiction treatment: development of a smoking cessation app.

OBJECTIVE: Augmented reality (AR) is a rapidly developing technology that has substantial potential as a novel approach for addiction treatment, including tobacco use. AR can facilitate the delivery of cue exposure therapy (CET) such that individuals can experience the treatment in their natural environments as viewed via a smartphone screen, addressing the limited generalizbility of extinction learning. Previously, our team developed a basic AR app for smoking cessation and demonstrated the necessary mechanisms for CET. Specifically, we showed that the AR smoking cues, compared to neutral cues, elicited substantial cue reactivity (i.e. increased urge) and that repeated exposure to the AR smoking cues reduced urge (i.e. extinction) in a laboratory setting. Here we report the next step in the systematic development of the AR app, in which we assessed the usability and acceptability of the app among daily smokers in their natural environments. METHOD: Daily smokers (N = 23, 78.3% female, Mean Age = 43.4, Mean Cigarettes/Day = 14.9), not actively quitting, were instructed to use the AR app in locations and situations where they smoke (e.g. home, bar) at least 5 times per day over one week. The study is registered in clinicaltrials.gov (NCT04101422). RESULTS: Results indicated high usability and acceptability. Most of the participants (73.9%) used the AR app on at least 5 days. Participants found the AR cues realistic and well-integrated in their natural environments. The AR app was perceived as easy to use (Mean = 4.1/5) and learn (mean of 2 days to learn). Overall satisfaction with the app was also high. Secondary analyses found that 56.5% reported reduced smoking, with an average 26% reduction in cigarettes per day at follow-up. CONCLUSIONS: These findings set the stage for a randomized controlled trial testing the AR app as an adjuvant therapy for treating tobacco dependence, with potential applicability to other substances. KEY MESSAGEThis study found that the augmented reality (AR) smartphone application that utlized cue exposure treatment for smoking cessation was perceived as easy to use and learn in the natural, day-to-day environment of daily smokers. Findings set the stage for a larger clinical trial testing the AR app as an adjuvant therapy for treating tobacco dependence, with potential applicability to other addictive behaviors.

The effectiveness of a web-based Dutch parenting program to prevent overweight in children 9-13 years of age: Results of a two-armed cluster randomized controlled trial.

INTRODUCTION: Although parental support is an important component in programs designed to prevent overweight in children, current programs pay remarkably little attention to the role of parenting. We therefore developed a web-based parenting program entitled "Making a healthy deal with your child". This e-learning program can be incorporated into existing overweight prevention programs. The aim of this study was to determine the effectiveness of this e-learning program. MATERIALS AND METHODS: The effectiveness was examined in a two-armed cluster randomized controlled trial. The participants were 475 parent-child dyads of children 9-13 years of age in the Netherlands who participated in an existing schoolclass-based overweight prevention program. At the school grade level, parents were randomly assigned to either the intervention or the control condition. Measurements were taken from both parents and children at baseline, and 5 and 12 months after baseline. Primary outcomes included the child's dietary and sedentary behavior, and level of physical activity. Secondary outcomes included general parenting style, specific parenting practices, and parental self-efficacy. Linear mixed effects models and generalized linear mixed effects models were conducted in R. RESULTS: Intention-to-treat analyses and completers only revealed no significant effects between the intervention and control condition on energy balance-related behaviors of the child and parenting skills after correction for multiple testing. The parents' mean satisfaction with the e-learning program (on a 10-point scale) was 7.0±1.1. CONCLUSIONS: Although parents were generally satisfied with the parenting program, following this program had no significant beneficial effects regarding the children's energy balance-related behaviors or the parenting skills compared to the control condition. This program may be more beneficial if used by high-risk groups (e.g. parents of children with unhealthy energy balance-related behaviors and/or with overweight) compared to the general population, warranting further study.

The Need for a Data Ecosystem for Youth Mental Health in The Netherlands.

The Netherlands is missing nationally representative data on child and adolescent mental health, e.g., on prevalence, course, and consequences of psychological disorders and mental health care utilization. Researchers and policy makers also lack a basic data infrastructure that is necessary to provide timely and reliable data crucial for benchmarking and informed decision making. In this article, we describe the necessity for a clear and well-organized overview of data on youth mental health and mental health care. We look back on three key moments in time to illustrate the breadth of the desire for data. Barriers in collecting structured, national data on a frequent basis are discussed, and several recommendations are provided of what is needed to move towards a data ecosystem that can help us to track the development and mental well-being of all children and youth and the impact of the care they receive.

Development of a Dynamically Tailored mHealth Intervention (What Do You Drink) to Reduce Excessive Drinking Among Dutch Lower-Educated Students: User-Centered Design Approach.

BACKGROUND: The high prevalence and adverse consequences of excessive drinking among lower-educated adolescents and young adults are public concerns in the Netherlands. Evidence-based alcohol prevention programs targeting adolescents and young adults with a low educational background are sparse. OBJECTIVE: This study aimed to describe the planned process for the theory- and evidence-based development, implementation, and evaluation of a dynamically tailored mobile alcohol intervention, entitled What Do You Drink (WDYD), aimed at lower-educated students from secondary vocational education and training (Middelbaar Beroepsonderwijs in Dutch). METHODS: We used intervention mapping as the framework for the systematic development of WDYD. It consists of the following six steps: assessing needs (step 1), formulating intervention objectives (step 2), translating theoretical methods into practical applications (step 3), integrating these into a coherent program (step 4), anticipating future implementation and adoption (step 5), and developing an evaluation plan (step 6). RESULTS: Reducing excessive drinking among Dutch lower-educated students aged 16 to 24 years was defined as the desired behavioral outcome and subdivided into the following five program objectives: make the decision to reduce drinking, set realistic drinking goals, use effective strategies to achieve drinking goals, monitor own drinking behavior, and evaluate own drinking behavior and adjust goals. Risk awareness, motivation, social norms, and self-efficacy were identified as the most important and changeable individual determinants related to excessive drinking and, therefore, were incorporated into WDYD. Dynamic tailoring was selected as the basic intervention method for changing these determinants. A user-centered design strategy was used to enhance the fit of the intervention to the needs of students. The intervention was developed in 4 iterations, and the prototypes were subsequently tested with the students and refined. This resulted in a completely automated, standalone native app in which students received dynamically tailored feedback regarding their alcohol use and goal achievement via multiple sessions within 17 weeks based on diary data assessing their alcohol consumption, motivation, confidence, and mood. A randomized controlled trial with ecological momentary assessments will be used to examine the effects, use, and acceptability of the intervention. CONCLUSIONS: The use of intervention mapping led to the development of an innovative, evidence-based intervention to reduce excessive alcohol consumption among lower-educated Dutch adolescents and young adults. Developing an intervention based on theory and empirical evidence enables researchers and program planners to identify and retain effective intervention elements and to translate the intervention to new populations and settings. This is important, as black boxes, or poorly described interventions, have long been a criticism of the eHealth field, and effective intervention elements across mobile health alcohol interventions are still largely unknown. TRIAL REGISTRATION: Netherlands Trial Registry NTR6619; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6619.

A Game-Based School Program for Mental Health Literacy and Stigma on Depression (Moving Stories): Cluster Randomized Controlled Trial.

BACKGROUND: Depressive symptoms are highly prevalent among adolescents in Western countries. However, although treatment for depressive symptoms is available, many adolescents do not seek help when they need it. Important barriers to help-seeking among adolescents include low mental health literacy and high stigma. Therefore, we have developed a game-based school program, Moving Stories, which combines mental health literacy training for depression with contact with someone with lived experience both in the digital and nondigital world. OBJECTIVE: The aim of this study is to conduct a first test of the effectiveness of the newly developed game-based program, Moving Stories, using a cluster randomized controlled trial. METHODS: A total of 185 adolescents participated, divided over 10 classes from 4 schools. Half of the classes were randomly selected to follow the Moving Stories program, whereas the other half were in the control group, where no intervention was provided. The adolescents filled out digital questionnaires at 4 time points, with questions on mental health literacy, stigma, depressive symptoms, and the program itself (before the program, after the program, 3-month follow-up, and 6-month follow-up). Using R (R Foundation for Statistical Computing), we ran linear mixed-effects models for all continuous outcome variables and generalized linear mixed-effects models for all binary outcome variables. RESULTS: Compared with the control group, participants in the Moving Stories group improved after the program in personal stigma (b=-0.53, 95% CI -1.02 to -0.03; t179.16=-2.08; P=.04). Effects on personal stigma lasted over time (3-month follow-up: b=-0.57, 95% CI -1.11 to -0.03; t174.39=-2.07; P=.04). Most adolescents in the Moving Stories group participated in the introduction (97/99, 98%) and contact session (93/99, 94%), played the game for 4 or 5 days (83/99, 83%), and indicated that they would recommend the game to their peers (90/98, 92%). CONCLUSIONS: The results of this study show the potential of Moving Stories as a stigma reduction program. With changes in the program to improve its effects on mental health literacy, Moving Stories could be implemented in schools to improve help-seeking in adolescents and reduce the negative consequences and burden of depressive symptoms. TRIAL REGISTRATION: Dutch Trial Register NTR7033; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7033. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/11255.

Augmented reality for extinction of cue-provoked urges to smoke: Proof of concept.

OBJECTIVE: Cue-exposure therapy (CET) aims to extinguish conditioned cue reactivity (CR) to aid in smoking cessation. A key disadvantage of extant CET is its limited ability to generalize extinction to the real world. Our team developed a set of augmented reality smoking-related and neutral cues that can appear in real-time in smokers' natural environments as viewed through a smartphone screen. Prior to deployment as a clinical tool, the present study tested the ability of AR smoking cues to extinguish CR in a controlled laboratory study with an AR smartphone application developed for this project. We hypothesized that daily smokers who completed a single session of cue exposure with AR smoking cues (extinction condition) would demonstrate lower cue-provoked urge to smoke at posttest compared to those who viewed AR neutral cues (control condition). METHOD: Daily smokers (N = 129, 46.5% female, Mage = 47.6, Mcigarettes/day = 19.1) in acute abstinence were randomized to either the extinction or control condition comprising 28 AR trials. RESULTS: As hypothesized, we found a Time × Condition interaction indicating that posttest urge ratings were lower in the extinction condition than in the control condition (p = .034). A secondary hypothesis that participants in the extinction condition would show a longer latency to smoke when provided a cigarette was not supported. CONCLUSIONS: These laboratory findings provide evidence supporting the potential clinical efficacy of AR cues for cue-exposure trials, setting the stage for testing in smokers' naturalistic environments. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Latent Classes of Substance Use in Young Adults - A Systematic Review.

Background: This systematic review provides an overview of studies on latent classes related to the substance use among young adults (18-25 years). Identifying these classes helps to detect high-risk groups, setting a base for selective prevention.Methods: This systematic literature review included peer-reviewed studies (published up to February, 2021) that identified latent classes and investigated predictors of latent classes relating to the use of marijuana, alcohol and/or other substances within samples of young adults.Results: Twenty studies (sample sizes N = 171 to N = 21945) met the inclusion criteria. 14 studies identified 'low-level engagers', 'light alcohol and tobacco use', 'heavy alcohol and tobacco use' and 'heavy use/polysubstance use' classes. Four studies differentiated within the 'heavy/polysubstance' class and found 'traditional clubdrugs', 'hallucinogens' and 'wide-range illicit drugs' classes. Male gender and white race predicted membership of the 'heavy use/polysubstance use' class consistently across studies. Other predictors of polysubstance use that were consistent across studies were peer substance use, depressive symptoms, parental drinking and participating in an honor society.Conclusions: The investigated predictors of class membership provide insight into social settings and characteristics that predict heavy use or polysubstance use. They can contribute to the development of effective prevention interventions by allowing for a more targeted approach.

The degree of consistency of applying parental dietary and sedentary behavior rules as indicators for overweight in children: a cross-sectional study.

BACKGROUND: Review studies increasingly emphasize the importance of the role of parenting in interventions for preventing overweight in children. The aim of this study was to examine typologies regarding how consistently parents apply energy-balance related behavior rules, and the association between these typologies and socio-demographic characteristics, energy balance-related behaviors among school age children, and the prevalence of being overweight. METHODS: For this cross-sectional study, we had access to a database managed by a Municipal Health Service Department in the Netherlands. In total, 4,865 parents with children 4-12 years of age participated in this survey and completed a standardized questionnaire. Parents classified their consistency of applying rules as "strict", "indulgent", or "no rules". Typologies were identified using latent class analyses. We used regression analyses to examine how the typologies differed with respect to the covariates socio-demographic characteristics, children's energy balance-related behaviors, and weight status. RESULTS: We identified four stable, distinct parental typologies with respect to applying dietary and sedentary behavior rules. Overall, we found that parents who apply "overall strict EBRB rules" had the highest level of education and that their children practiced healthier behaviors compared to the children of parents in the other three classes. In addition, we found that parents who apply "indulgent dietary rules and no sedentary rules" had the lowest level of education and the highest percentage of non-Caucasians; in addition, their children 8-12 years of age had the highest likelihood of being overweight compared to children of parents with "no dietary rules". CONCLUSIONS: Parents' consistency in applying rules regarding dietary and sedentary behaviors was associated with parents' level of education and ethnic background, as well as with children's dietary and sedentary behaviors and their likelihood of becoming overweight. Our results may contribute to helping make healthcare professionals aware that children of parents who do not apply sedentary behavior rules are more likely to become overweight, as well as the importance of encouraging parents to apply strict dietary and sedentary behavior rules. These results can serve as a starting point for developing effective strategies to prevent overweight among children.

A school-based program to prevent depressive symptoms and strengthen well-being among pre-vocational students (Happy Lessons): protocol for a cluster randomized controlled trial and implementation study.

BACKGROUND: Depression is one of the leading causes of illness and disability among young people. In the Netherlands, one in twelve Dutch adolescents has experienced depression in the last 12 months. Pre-vocational students are at higher risk for elevated depressive symptoms. Effective interventions, especially for this risk group, are therefore needed to prevent the onset of depression or mitigate the adverse long-term effects of depression. The aim of this study is to examine the effectiveness and implementation of a school-based program Happy Lessons (HL), that aims to prevent depression and promote well-being among pre-vocational students. METHODS: A cluster randomized controlled trial (RCT) with students randomized to HL or to care as usual will be conducted. Pre-vocational students in their first or second year (aged 12 to 14) will participate in the study. Subjects in both conditions will complete assessments at baseline and at 3- and 6-months follow-up. The primary outcome will be depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CES-D) at 6-months follow-up. Secondary outcomes are well-being using the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) and life satisfaction (Cantril Ladder) measured at 6-months follow-up. Alongside the trial, an implementation study will be conducted to evaluate the implementation of HL, using both quantitative and qualitative methods (interviews, survey, and classroom observations). DISCUSSION: The results from both the RCT and implementation study will contribute to the limited evidence base on effective school-based interventions for the prevention of depression and promotion of well-being among pre-vocational adolescents. In addition, insights from the implementation study will aid identifying factors relevant for optimizing the future implementation and scale-up of HL to other schools and contexts. TRIAL REGISTRATION: This study was registered on 20 September 2021 in the Dutch Trial Register ( NL9732 ).

Why adolescents engage in early alcohol use: A study of drinking motives.

Shortly after young adolescents initiate alcohol use, we investigated whether (1) drinking motives are associated with current alcohol use and binge drinking, (2) motives predict these alcohol outcomes 6 months later, and (3) alcohol outcomes predict motives 6 months later. Data on adolescents' drinking motives and alcohol use were drawn from a Dutch longitudinal 7-wave family study at the timepoint of alcohol use initiation (t0, N = 210, 51.4% male, Mage = 14.01 SD = 1.02) and 6 months later (t1, n = 88). Logistic and linear regressions were conducted. Results indicated that young adolescents mainly drink for social and enhancement motives rather than coping and conformity motives. Shortly after alcohol initiation, social motives were associated with alcohol use at t0 (OR = 1.52), enhancement motives with binge drinking at t0 (OR = 2.35), and coping motives with binge drinking at t0 (OR = 2.62) and at t1 (OR = 3.00). Conformity motives were inversely associated with binge drinking at t0 (OR = 0.42). Binge drinking predicted coping motives at t1 (B = 0.71, SE = -0.35), but no other associations among alcohol use, binge drinking, and drinking motives at t1 were found. Conclusively, this study shows that young adolescents drink to enjoy parties and to get drunk (social and enhancement motives) rather than to fit in (conformity motives). The study also indicates that shortly after alcohol initiation, alcohol to cope represents a reciprocal risk factor for binge drinking that may persist in the future, thus pointing to the importance of drinking motives for drinking behaviors among young adolescents. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Investigating the association between smoking, environmental tobacco smoke exposure and reward-related brain activity in adolescent experimental smokers.

Reduced anticipatory reward-related activity, especially in the ventral striatum (VS), may underly adolescent vulnerability to develop nicotine dependence. It remains unclear whether nicotine uptake caused by environmental tobacco smoke (ETS) exposure, known to be associated with future smoking, might prompt similar changes in the brain's reward system, rendering adolescents vulnerable for development of nicotine dependence. To address this question, we tested whether current ETS exposure and monthly smoking are associated with VS hypoactivity for non-drug rewards in experimental smoking adolescents. One-hundred adolescents performed a monetary incentive delay task while brain activity was measured using fMRI. To test the hypothesized relationship, we used a variety of approaches: (1) a whole-brain voxel-wise approach, (2) an region-of-interest approach in the VS using frequentist and Bayesian statistics and (3) a small volume voxel-wise approach across the complete striatum. The results converged in revealing no significant relationships between monthly smoking, ETS exposure and reward-related brain activation across the brain or in the (ventral) striatum specifically. However, Bayesian statistics showed only anecdotal evidence for the null hypothesis in the VS, providing limited insight into the (non-)existence of the hypothesized relationship. Based on these results, we speculate that blunted VS reward-related activity might only occur after relatively high levels of exposure or might be associated with more long term effects of smoking. Future studies would benefit from even larger sample sizes to reliably distinguish between the null and alternative models, as well as more objective measures of (environmental) smoking via using devices such as silicone wristbands.

Implementation of a proactive referral tool for child healthcare professionals to encourage and facilitate parental smoking cessation in the Netherlands: a mixed-methods study.

BACKGROUND: Recently, the parent-tailored telephone based smoking cessation counseling program 'Smoke-free Parents' was shown to be effective in helping parents to quit smoking. To implement this program in child healthcare settings in the Netherlands, the research team developed a proactive referral tool to refer parents to Smoke-free Parents. The aim of the present implementation study was to explore the facilitators, barriers, and suggestions for improvement in the implementation of this referral tool. METHODS: Child healthcare professionals (N = 68) were recruited via multiple strategies (e.g., social media, mailings, and word of mouth among healthcare professionals) and invited to complete two online (quantitative and qualitative) questionnaires and to participate in a telephone semi-structured qualitative interview between April 2017 and February 2019. In total, 65 child healthcare professionals were included in the analyses. After inductive coding, thematic analyses were performed on the qualitative data. Descriptive analyses were performed on the quantitative data. RESULTS: The data from both questionnaires and the telephone interview revealed that the majority of the child healthcare professionals (92.3 % female; average years of working as a healthcare professional: 23.0) found the Smoke-free Parents referral tool accessible and convenient to use. Yet there were several barriers that limited their use of the tool. The data revealed that one of the main barriers that healthcare professionals experienced was parental resistance to smoking cessation assistance. In addition, healthcare professionals noted that they experienced tension when motivating parents to quit smoking, as they were not the parent's, but the child's healthcare provider. Additionally, healthcare professionals reported being concerned about the lack of information about the costs of Smoke-free Parents, which limited professionals referring parents to the service. CONCLUSIONS: Although healthcare professionals reported rather positive experiences with the Smoke-free Parents referral tool, the use of the tool was limited due to barriers. To increase the impact of the Smoke-free Parents telephone-based smoking cessation counseling program via child healthcare settings, it is important to overcome these barriers. Suggestions for improvement in the implementation of the referral tool in child healthcare settings are discussed.

Program uptake of a parent-tailored telephone smoking cessation counselling: An examination of recruitment approaches.

INTRODUCTION: Recently, a Dutch proactive parent-tailored telephone smoking cessation counselling program, Smoke-free Parents (SFP), was demonstrated to be effective in helping parents to quit smoking. This study aimed to examine the program's uptake and the costs of two recruitment approaches (i.e. healthcare vs mass media) for SFP. In addition, parent's barriers to participating in SFP and the characteristics of participating parents were assessed. METHODS: As part of an effectiveness-implementation hybrid trial, 402 smoking parents were recruited via healthcare settings and mass media for an informal, proactive, and free phone call with a smoking cessation counsellor about SFP (the Netherlands, September 2016 - September 2018). Parents were asked whether they wanted to participate in SFP. If parents refused, reasons for decline and additional information (e.g. educational level) were collected. RESULTS: Results revealed that 26.4% of the recruited parents participated in SFP. Although the program uptake of parents recruited via mass media was slightly, but not significantly, higher than via healthcare (27.3% vs 26.8%, p=0.92), the healthcare approach resulted in lower costs per participant (€99.62 vs €205.72). Smoking cessation counsellors were unable to reach almost one-third (32.7%) of the parents after they had agreed to be called about SFP. CONCLUSIONS: The present study showed that more than a quarter of all recruited parents participated in SFP and that the mass media approach and healthcare approach can be used to recruit parents for SFP. To increase the number of parents participating in SFP, it is important to overcome the identified barriers that prevent parents from participating.

Environmental Tobacco Smoke Exposure and Brain Functioning Associated with Smoking Cue-Reactivity and Inhibitory Control in Nonsmoking Adolescents.

INTRODUCTION: Despite its well-established negative effects, environmental tobacco smoke (ETS) exposure remains highly prevalent worldwide. ETS exposure is associated with a wide range of physical and mental health-related problems among youth, including an increased likelihood to develop nicotine dependence. Up till now, neurocognitive effects of ETS exposure are largely unknown, while such effects could explain the role of ETS exposure in the development of nicotine dependence. Therefore, this preregistered study investigated the role of current ETS exposure in brain functioning associated with smoking cue-reactivity and inhibitory control. METHOD: Concurrent with functional magnetic resonance imaging, nonsmoking adolescents aged 14-18 years (N = 51) performed a smoking cue-reactivity task, assessing brain functioning to smoking cues, and a Go/NoGo task measuring inhibitory control. ETS exposure was measured using a self-report questionnaire and biochemically verified. RESULTS: No significant associations were observed between current ETS exposure and brain functioning associated with smoking cue-reactivity and inhibitory control. CONCLUSION: These findings suggest that low-to-moderate levels of current ETS exposure are not associated with increased salience of smoking cues or deficits in inhibitory control in nonsmoking adolescents. Longitudinal research is needed to further clarify the exact effect of lifetime ETS exposure on brain functioning, as well as research focusing on the effects of higher levels of ETS exposure.

Longitudinal bidirectional associations between internalizing mental disorders and cardiometabolic disorders in the general adult population.

PURPOSE: This prospective population-based study investigated whether having any internalizing mental disorder (INT) was associated with the presence and onset of any cardiometabolic disorder (CM) at 3-year follow-up; and vice versa. Furthermore, we examined whether observed associations differed when using longer time intervals of respectively 6 and 9 years. METHODS: Data were used from the four waves (baseline and 3-, 6- and 9-year follow-up) of the Netherlands Mental Health Survey and Incidence Study-2, a prospective study of a representative cohort of adults. At each wave, the presence and first onset of INT (i.e. any mood or anxiety disorder) were assessed with the Composite International Diagnostic Interview 3.0; the presence and onset of CM (i.e. hypertension, diabetes, heart disease, and stroke) were based on self-report. Multilevel logistic autoregressive models were controlled for previous-wave INT and CM, respectively, and sociodemographic, clinical, and lifestyle covariates. RESULTS: Having any INT predicted both the presence (OR 1.28, p = 0.029) and the onset (OR 1.46, p = 0.003) of any CM at the next wave (3-year intervals). Having any CM was not significantly related to the presence of any INT at 3-year follow-up, while its association with the first onset of any INT reached borderline significance (OR 1.64, p = 0.06), but only when examining 6-year intervals. CONCLUSIONS: Our findings indicate that INTs increase the risk of both the presence and the onset of CMs in the short term, while CMs may increase the likelihood of the first onset of INTs in the longer term. Further research is needed to better understand the mechanisms underlying the observed associations.

Duration of anxiety disorder and its associated risk indicators: Results of a longitudinal study of the general population.

BACKGROUND: Data on episode duration of anxiety disorders are required for informing patients and for disease management, but such data from population studies are lacking. METHODS: Three-year longitudinal data were used from the Netherlands Mental Health Survey and Incidence Study-2, a psychiatric epidemiological cohort study among the general adult population (N = 6646). Respondents with a new (first or recurrent) anxiety disorder were selected (n = 158). DSM-IV diagnoses were assessed with the Composite International Diagnostic Interview; the Life Chart Interview assessed episode duration and recovery rates. RESULTS: Among those with anxiety disorder, median episode duration was 7.5 months and mean duration was 15.2 months. 38.8% had not recovered at 12 months and 30.1% not at 36 months. Longer duration was associated with older age, not having a paid job, higher neuroticism, more physical disorders, and worse physical functioning. CONCLUSIONS: Also, in the general population, anxiety disorder has a rather chronic course. After 12 months the cumulative recovery rate flattened. To prevent and manage chronicity, timely treatment, and chronic disease management are required. The risk indicators found may help to identify individuals with an anxiety disorder at risk for chronicity.

The Effectiveness of Smoking Cessation Interventions Tailored to Smoking Parents of Children Aged 0-18 Years: A Meta-Analysis.

INTRODUCTION: A meta-analysis was conducted to examine the effectiveness of smoking cessation interventions tailored to parents of children aged 0-18 years. METHODS: A systematic search was carried out in PsycInfo, Embase, and PubMed in March 2020. A manual search of the reference lists of the included studies and systematic reviews related to the topic was also performed. Two authors independently screened the studies based on the following inclusion criteria: (1) effect studies with control groups that examine smoking cessation interventions tailored to parents of children (0-18 years), and (2) full-text original articles written in English and published between January 1990 and February 2020. In total, 18 studies were included in the analyses. The TiDieR checklist and the Cochrane Risk of Bias Tool 2.0 were used to extract data and to assess the risk of bias. Consensus among authors was reached at each stage. RESULTS: Random-effects meta-analyses were performed. With a total number of 8,560 parents, the pooled relative risk was 1.62 (95% CI 1.38-1.90; p < 0.00001), showing a modest effect of the interventions on smoking cessation. Overall, 13.1% of the parents in the intervention conditions reported abstinence versus 8.4% of the parents in the control conditions. DISCUSSION/CONCLUSION: Smoking cessation interventions tailored to parents are modestly effective. To increase the effectiveness and the impact of these interventions in terms of controlling tobacco use and public health, it is crucial for further research to explore how these interventions can be improved.