Understanding social network support, composition, and structure among cancer caregivers.

OBJECTIVE: We examined the social network support, composition, and structure of pediatric cancer caregivers. METHODS: We used a self-report survey to collect egocentric social network data from 107 caregivers of pediatric cancer patients and calculated descriptive statistics to examine cancer-related support network composition, function, and structure. We then ran logistic regressions to examine the relationships between network characteristics and overall satisfaction with social support. RESULTS: Family members were the most common source of emotional support and logistical support, and health care providers were the most common source of informational support. Participants perceived the "most helpful" forms of support as being: (1) emotional support from family and health care providers; (2) informational support from health care providers and other cancer caregivers; and (3) logistical support from family. Overall, caregivers wished that 9.8% of their network ties had provided more support, with family members being the most common alter type to disappoint caregivers and offer less support than needed/expected. Caregivers who reported higher network disappointment (having network members who offered less support than needed/expected) were significantly less satisfied with emotional support than those with lower network disappointment (Odds Ratio = 0.18, p = 0.02), and caregivers with higher network disappointment were significantly less satisfied with logistical support compared to those with lower network disappointment (Odds Ratio = 0.14, p = 0.01). CONCLUSION: Our results show differences in the nature of social support provided by different types of network members. These findings have implications for tailoring social network interventions to improve caregiver and family outcomes.

An initial investigation of using smartphone-enabled micro-temporal data collection to increase acceptability, feasibility, and validity of research on cancer caregiving.

PURPOSE: Smartphone-enabled micro-temporal data collection has potential to increase reliability, validity, and feasibility of participant-reported data and is a promising strategy for pediatric oncology supportive care and quality-of-life research. Given the demands of pediatric cancer caregiving, we sought to understand the feasibility and acceptability of smartphone data collection that included short surveys administered daily for 14 days via text message link. METHODS: We recruited pediatric cancer caregivers, whose children (ages 0-18 years) were on active treatment, to complete a 14-day daily survey study via smartphone. We implemented our study procedures and examined feasibility through study enrollment rates, reasons for refusal, retention rates, number of reminders and number of completed surveys. We examined acceptability using caregiver ratings of survey length, burden, and ease of completion on a smartphone. RESULTS: We recruited (N = 75) caregivers to the study and had an 84% enrollment rate. Reasons for declining participation included passive refusal (n = 13) and too busy (n = 1). The participant retention rate was 100% and compliance with daily survey completion was 99%. Most surveys were completed following two prompts and took participants 5 minutes or less to complete. Caregivers rated the surveys as easy to complete, low burden, and just right in length. CONCLUSION: A daily self-report, using a brief (≤5 minutes) survey administered on a smartphone via text message prompt, is a feasible and acceptable method. Future research should extend these findings to understand the generalizability across pediatric cancer caregiving contexts.

Behavioral parenting skills as a novel target for improving medication adherence in young children: Feasibility and acceptability of the CareMeds intervention.

In pediatric cancer care, medication non-adherence is a significant driver of avoidable suffering and death. There is a lack of interventions designed for families of young children, where patient medication refusal/avoidance is a common barrier to adherence. We developed the CareMeds intervention which focuses on caregiver skills training to help young children take medicine calmly and without use of restraint techniques. The goal of this preliminary study was to assess the acceptability and feasibility of the CareMeds intervention. Caregivers of pediatric cancer patients (ages 2-10) whose children were on a home-based oral medication regimen were recruited to participate. Feasibility was examined through study enrollment and retention rates as well as reasons for refusal and drop out. Acceptability was evaluated through usability of and engagement with intervention components and an acceptability questionnaire. Feasibility: We recruited N = 9 caregivers to participate in this intervention pilot study and had a 75% enrollment rate. Reasons for declining included scheduling concerns (n = 2) and lack of interest (n = 1). The participant retention rate was 100% with 100% adherence to intervention sessions. Acceptability: Parents rated the sessions and resource materials as acceptable and reported frequent use of skills taught in the intervention. The CareMeds intervention is an acceptable and feasible strategy for caregivers of pediatric cancer patients and warrants future research to examine the efficacy of behavioral parenting skills interventions to improve medication adherence in young children.

A preliminary test of a brief intervention to lessen young adults' cannabis use: Episode-level smartphone data highlights the role of protective behavioral strategies and exercise.

Brief interventions are increasingly being used to help young adults to moderate their cannabis use. We conducted a randomized clinical trial of a brief (4 weekly sessions), in-person intervention that included a smartphone application that reinforced the use of protective behavioral strategies (PBSs) to lessen cannabis use. Young adults (N = 37; 24 men) who regularly used cannabis were randomized to 2 intervention conditions rooted in cognitive-behavioral therapy (CBT) and motivational enhancement therapy (MET). Along with learning CBT + MET strategies, participants in 1 of the conditions were instructed to engage in exercise. All participants used smartphone-based ecological momentary assessment to provide episode-level reports about use of cannabis and PBSs. Two multilevel structural equation models were run to test the study hypotheses that (a) cannabis use would be reduced over the course of the 6-month study, (b) reductions would be moderated by intervention condition, and (c) episode-level PBS use would predict episode-level cannabis use. Participants reduced their cannabis use by approximately 1 half of a standard joint per time point. The MET + CBT + Exercise condition reduced cannabis use to a greater degree than did the MET + CBT condition. With episode-level PBS use in the model, reductions in cannabis use were independent of intervention condition. Our findings suggest that young adults will engage with a smartphone app that serves as a component of an in-person intervention to moderate their cannabis use. Intervention content that promotes the use of PBSs and exercise facilitates reductions in cannabis use. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Effects of exercise on experimentally manipulated craving for cannabis: A preliminary study.

Cannabis is the most commonly used illicit drug in the United States, and craving for cannabis is related to cannabis use. Exercise has been demonstrated to reduce craving for substances. To examine the effects of exercise on cannabis craving, we conducted a 3-week within-subject crossover experiment. Young-adult men (n = 35) and women (n = 11), age 18-25 years (M = 20.76, SD = 1.68), who regularly (≥3 times per week) used cannabis participated in a cue exposure paradigm to stimulate craving. After each of three separate craving inductions, they completed a 10-min bout of exercise that varied in intensity (rest, moderate, vigorous). Craving was assessed before and after the induction, immediately following the exercise, and at three 10-min intervals (total of 30 min). Results of condition-specific, repeated measures analyses of variance showed nonsignificant reductions in immediate postexercise craving for the moderate and vigorous conditions. We used latent growth modeling to examine the trajectory of craving rebound during the 30 min following exercise and explored the effect of baseline weekly cannabis use in predicting craving rebound. Within 30 min postexercise, craving rebounded for both the moderate, F(3, 135) = 9.10, p < .01, and vigorous, F(3, 135) = 3.48, p < .05, conditions. We found that among cannabis users reporting larger quantities of typical weekly cannabis use, craving rebounded more quickly following vigorous than moderate exercise, b = 0.02, SE = 0.02, 95% confidence interval [0.00, 0.06]. The findings suggest that moderate exercise may be useful for reducing craving, particularly among those who use larger quantities of cannabis. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The effects of perceived quality on behavioral economic demand for marijuana: A web-based experiment.

BACKGROUND: Given the growing legalization of recreational marijuana use and related increase in its prevalence in the United States, it is important to understand marijuana's appeal. We used a behavioral economic (BE) approach to examine whether the reinforcing properties of marijuana, including "demand" for marijuana, varied as a function of its perceived quality. METHODS: Using an innovative, Web-based marijuana purchase task (MPT), a sample of 683 young-adult recreational marijuana users made hypothetical purchases of marijuana across three qualities (low, mid and high grade) at nine escalating prices per joint, ranging from $0/free to $20. RESULTS: We used nonlinear mixed effects modeling to conduct demand curve analyses, which produced separate demand indices (e.g., Pmax, elasticity) for each grade of marijuana. Consistent with previous research, as the price of marijuana increased, marijuana users reduced their purchasing. Demand also was sensitive to quality, with users willing to pay more for higher quality/grade marijuana. In regression analyses, demand indices accounted for significant variance in typical marijuana use. CONCLUSIONS: This study illustrates the value of applying BE theory to young adult marijuana use. It extends past research by examining how perceived quality affects demand for marijuana and provides support for the validity of a Web-based MPT to examine the appeal of marijuana. Our results have implications for policies to regulate marijuana use, including taxation based on the quality of different marijuana products.

A behavioral economic approach to assessing demand for marijuana.

In the United States, marijuana is the most commonly used illicit drug. Its prevalence is growing, particularly among young adults. Behavioral economic indices of the relative reinforcing efficacy (RRE) of substances have been used to examine the appeal of licit (e.g., alcohol) and illicit (e.g., heroin) drugs. The present study is the first to use an experimental, simulated purchasing task to examine the RRE of marijuana. Young-adult (M age = 21.64 years) recreational marijuana users (N = 59) completed a computerized marijuana purchasing task designed to generate demand curves and the related RRE indices (e.g., intensity of demand-purchases at lowest price; Omax-max. spent on marijuana; Pmax-price at which marijuana expenditure is max). Participants "purchased" high-grade marijuana across 16 escalating prices that ranged from $0/free to $160/joint. They also provided 2 weeks of real-time, ecological momentary assessment reports on their marijuana use. The purchasing task generated multiple RRE indices. Consistent with research on other substances, the demand for marijuana was inelastic at lower prices but became elastic at higher prices, suggesting that increases in the price of marijuana could lessen its use. In regression analyses, the intensity of demand, Omax, and Pmax, and elasticity each accounted for significant variance in real-time marijuana use. These results provide support for the validity of a simulated marijuana purchasing task to examine marijuana's reinforcing efficacy. This study highlights the value of applying a behavioral economic framework to young-adult marijuana use and has implications for prevention, treatment, and policies to regulate marijuana use.

Analytical Problems and Suggestions in the Analysis of Behavioral Economic Demand Curves.

Behavioral economic demand curves (Hursh, Raslear, Shurtleff, Bauman, & Simmons, 1988) are innovative approaches to characterize the relationships between consumption of a substance and its price. In this article, we investigate common analytical issues in the use of behavioral economic demand curves, which can cause inconsistent interpretations of demand curves, and then we provide methodological suggestions to address those analytical issues. We first demonstrate that log transformation with different added values for handling zeros changes model parameter estimates dramatically. Second, demand curves are often analyzed using an overparameterized model that results in an inefficient use of the available data and a lack of assessment of the variability among individuals. To address these issues, we apply a nonlinear mixed effects model based on multivariate error structures that has not been used previously to analyze behavioral economic demand curves in the literature. We also propose analytical formulas for the relevant standard errors of derived values such as P max, O max, and elasticity. The proposed model stabilizes the derived values regardless of using different added increments and provides substantially smaller standard errors. We illustrate the data analysis procedure using data from a relative reinforcement efficacy study of simulated marijuana purchasing.

A beverage-specific measure of expectancies for malt liquor: development and initial testing.

Malt liquor (ML) is a unique, high alcohol content beverage marketed to encourage heavy drinking. We developed the Malt Liquor Expectancy Questionnaire (MLEQ), a beverage-specific measure of alcohol expectancies, and examined its association with typical weekly ML use, typical weekly alcohol use, and alcohol problems. Forty positive and 40 negative expectancy items were administered to a sample of 639 young adults who regularly consumed ML. Exploratory and confirmatory factor analyses led to the development of the 30-item MLEQ. The MLEQ consists of two positive (i.e., Social Facilitation and Enjoyment, Enhanced Sexuality) and two negative factors (i.e., Aggression and Negative Consequences; Impairment and Physical Symptoms) that possess good internal consistency, test-retest reliability, and convergent validity. The psychometrically sound MLEQ contributes to the limited research on beverage-specific expectancies and heavy drinking.

Validation of the revised Problems Assessment for Substance Using Psychiatric Patients.

This study assessed the factor structure, internal consistency, test-retest reliability, and construct validity of the Problems Assessment for Substance Using Psychiatric Patients (PASUPP; Carey, Roberts, Kivlahan, Carey, & Neal, 2004) with a sample of 278 men and women seeking outpatient dual-diagnosis treatment. All participants were diagnosed with a current AUD and schizophrenia and/or bipolar disorder. Initial confirmatory factor analysis did not support the 1-factor model for the 50-item measure found by Carey and colleagues. Instead, exploratory factor analysis yielded a shorter (27-item) scale with four distinct, yet related factors (Physical Problems, Aggression, Social and Financial Consequences, and Psychological Problems). The factor-based scales had good internal consistency (α=.77-.81) and 1-week test-retest reliability (r=.67-.73). The revised PASUPP (PASUPP-R) was associated with measures of psychiatric symptoms/adjustment, substance use/dependence, and another measure of substance use problems, providing evidence for convergent validity. Subgroup comparisons suggested few demographic differences on the PASUPP-R, but differential patterns of problems endorsement emerged as a function of mental health and substance use diagnosis. Overall, this study provides preliminary evidence for the psychometric soundness of the PASUPP-R as a measure of problems experienced by persons with co-occurring psychiatric and substance use disorders.

Predicting post-treatment-initiation alcohol use among patients with severe mental illness and alcohol use disorders.

Few investigators studying alcohol abuse among individuals with a severe mental illness (SMI) have examined predictors of posttreatment alcohol outcomes. In the present study, a multivariate approach based on a theoretical model was used to study the relationship between psychosocial factors and post-treatment-initiation alcohol use. Predictors of alcohol use outcomes were examined in 278 individuals diagnosed with a current schizophrenia-spectrum or bipolar disorder and an alcohol use disorder (AUD). At 6-months follow-up, 144 of 228 available participants (63%) had good clinical outcomes. The results of structural equation modeling indicated that type of pretreatment residential setting was directly related to treatment, with participants who lived in supervised settings (41%) reporting significantly more days of treatment (beta = .34, p < .001). In addition, participants with more psychiatric symptoms, as assessed with the Brief Symptom Inventory and Structured Clinical Interview for the Positive and Negative Syndrome Scale, reported significantly fewer treatment days (beta = -.20, p < .001). Number of days that participants attended treatment was indirectly associated with alcohol use outcomes and was mediated by use of alcohol-specific coping skills, such that more frequent use of such skills was associated with less post-treatment-initiation alcohol use (beta = -.34, p < .001). This study emphasizes the favorable prognosis for alcohol outcomes among treated individuals with SMI and AUD and the importance of psychosocial interventions, particularly those that result in better alcohol-specific coping skills.

Factors affecting agreement between severely mentally ill alcohol abusers' and collaterals' reports of alcohol and other substance abuse.

This study examined subject-collateral reports of alcohol use among a sample of 167 dually diagnosed individuals seeking outpatient treatment at a community mental health clinic. All subjects met Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) criteria for a schizophrenia-spectrum or bipolar disorder and for alcohol abuse or dependence. Subjects were recruited within 2 weeks of treatment entry and completed measures of cognitive functioning, alcohol dependence severity, psychiatric symptoms, and quantity and frequency of substance use over the previous 60 days using the Timeline Follow-Back interview (L. C. Sobell & M. B. Sobell, 1996). They also provided a urine sample, which was screened for recent drug use. Collateral interviews were conducted by phone and included an assessment of the subject's alcohol and drug use over the same 60-day period. Collaterals also reported their confidence in the accuracy of their reports. Overall, the results indicated generally poor subject-collateral agreement. However, subject-collateral agreement appeared better for those individuals (n = 97) with negative urine drug screens. The most consistent predictor of subject-collateral discrepancy scores was subjects' recent drug use. Recommendations for enhancing the validity of self-reports of substance use in a severely mentally ill population are discussed.

Young-adult malt liquor drinkers: prediction of alcohol problems and marijuana use.

Malt liquor (ML) is a cheap, high alcohol content beverage that is marketed to appeal to young adults. Findings from the few published studies of ML use suggest that it may be associated with excessive drinking, alcohol problems, and the use of illicit drugs. The authors conducted separate hierarchical multiple regressions to examine the role of ML use and psychosocial variables (e.g., personality, ML motives) in alcohol-related problems and marijuana use. Demographic characteristics served as controls. The sample consisted of 639 (456 men, 183 women) young adults (M = 22.9 years, SD = 4.2) who regularly (> or =40 oz/week) consumed ML. ML use significantly and positively predicted alcohol problems, ML-specific problems, and marijuana use, above and beyond their associations with typical alcohol use. Marijuana was the illicit drug of choice, and 46% reported concurrent use of marijuana and ML. Those who concurrently used ML and marijuana began drinking at a younger age and reported more substance use (particularly marijuana) and more alcohol-related problems than did non-concurrent users. These results suggest that ML use may represent a risk for alcohol problems and marijuana use.

Do individuals with a severe mental illness experience greater alcohol and drug-related problems? A test of the supersensitivity hypothesis.

The supersensitivity hypothesis posits that individuals with a severe mental illness (i.e., schizophrenia and bipolar disorder; SMI) are more likely to be diagnosed with a substance abuse as opposed to a substance dependence diagnosis, and experience greater negative consequences associated with substance use at lower levels of consumption, as compared with non-SMI substance abusers. This is the first known study to test this hypothesis with a control group of non-SMI substance abusing individuals. Forty-two individuals with only a substance use disorder (SUD-only) and 53 dually diagnosed individuals (DD) were compared on measures of substance use, alcohol and drug dependence, negative consequences, substance use outcome expectancies, and motivation for change. A third group of SMI-only individuals (i.e., no SUD; n=35) were also recruited and all three groups were compared on psychological symptoms. Substance use, negative consequences, substance use outcome expectancies, motivation for change, and severity of alcohol and drug dependence were not found to differ significantly between the DD and SUD-only groups. However, the DD group had significantly greater levels of psychological symptoms, as compared with the SMI-only and SUD-only groups. Overall, this study does not provide support for the supersensitivity hypothesis.

It does the job: Young adults discuss their malt liquor consumption.

Young adult men and women (N=53) who regularly consume malt liquor (i.e., 40 oz/week) participated in 10 semi-structured focus groups. Group transcripts were analyzed using a multilevel process that focused on recurring themes across multiple groups. Commonly identified themes encompassed positive and negative qualities of malt liquor as well as contexts in which malt liquor was consumed. Some of the themes were corroborated by quantitative data on drinking behavior and other variables. The focus groups were designed to explore the unique characteristics of malt liquor (low price, high alcohol content, large volume packaging) that enhance consumption patterns and increase risk for excessive alcohol use. The combination of qualitative and quantitative data provides a unique and useful perspective for identifying issues for future research on malt liquor consumption.