Transitioning From an In-Person Intervention to Augmented Text Messaging During COVID-19 in Mexican Americans With Prediabetes: The Starr County Diabetes Prevention Randomized Clinical Trial.

PURPOSE: The purpose of the study was to explore the feasibility of using commonly available technology, such as text messaging, for diabetes prevention in rural Mexican American communities during COVID-19. METHODS: Participants were selected from a diabetes prevention study funded by the National Institutes of Health that, prior to COVID-19, involved in-person group intervention sessions. Participants were predominantly female adults born in Mexico and Spanish-speaking. A subsample (n = 140) was divided into 3 cohorts: (1) 50 who completed the initial in-person intervention prior to the COVID-19 research pause, (2) 60 who needed additional support sessions to complete the intervention and thus received 10 text messages with links to relevant online diabetes prevention videos (TM+), and (3) 30 who received enhanced usual care involving health guidance offered during data collection (control). Repeated measures analysis of covariance was used to evaluate cohort differences at 24 months post baseline. RESULTS: No significant cohort differences were found for depression, eating self-efficacy, alcohol intake, fat avoidance, or sedentary behaviors. Differences in A1C showed both in-person and TM+ cohorts having lower mean A1C levels (5.5%) than the control cohort (5.7%). The TM+ cohort had lower body mass index than other cohorts and a lower diabetes conversion rate (22.2%) compared to the control cohort (28%). Participants indicated preferences for in-person/TM+ combination interventions. The strongest positive feedback was for the TM+ intervention cooking demonstration videos. CONCLUSIONS: Augmented text messaging combined with in-person sessions had similar outcomes to the all in-person strategy and thus has the potential for expanding the reach of diabetes prevention to many Mexican American communities.

Sociodemographic and treatment-related determinants of recent substance use among adults with comorbid substance misuse and psychotic disorders discharged from substance use treatment.

INTRODUCTION: Rates of alcohol and illicit substance use are higher among persons with psychotic disorders relative to the general population. The adverse health and psychological effects of substance use behaviors disproportionately impact persons with psychotic disorders. Prior research has shown that persons with psychotic disorders experience increased difficulty in reducing substance use behaviors, and interventions targeting substance use behavior change among this population have demonstrated limited effectiveness. One reason for this is that little is known about the factors that influence substance use and behavior change among this population. To address these disparities, the present study investigated sociodemographic and treatment-related factors of substance use recurrence among persons with psychotic disorders who received substance use treatment services. METHODS: Data came from the 2015-2018 Treatment Episode Dataset-Discharges (TEDS-D). TEDS-D collects annual data on adolescent and adult discharges from state-certified substance use treatment centers in the United States. The study conducted all analyses with a subsample of 1956 adult discharges with a psychotic disorder who received services from an outpatient substance use treatment center for at least one month. χ2 tests of independence and multivariable logistic regression analyses were used to examine associations of sociodemographic and treatment-related characteristics with substance use recurrence while in treatment (α < 0.05 analyses). The study presents results from multivariable logistic regression models as adjusted odds ratios (AORs) with 95 % confidence intervals (CI). RESULTS: Those who were age 50 or older, were referred to treatment by the criminal justice system, and attended substance use self-help groups had lower odds of substance use recurrence while in treatment. Sex, educational attainment, employment status, living situation, type of substance use, and treatment history were not significantly associated with substance use recurrence. CONCLUSIONS: In designing treatment services, providers should consider whether focusing on sociodemographic, including cultural, factors can affect more positive substance use behavior change and other desired treatment outcomes among those with psychotic disorders and comorbid substance misuse. Further study is needed to identify these factors among specific subpopulations of those with psychotic disorders and substance misuse.

Practice Makes Perfect: MSW Students Reflect on Skill-Based Teaching Methods in Clinical Social Work Education.

In the current focus-group study, we consider student experiences with and perceptions of teaching methods that involve practice observation, demonstration, and performance assessment and feedback (i.e., skill-based teaching methods). Focus groups included masters of social work students (N = 40) from six universities in the United States. Students were, on average, 34 years of age (range 21 to 58) with 75% female, 20% male, and two non-binary students. Students identified as White (50%), Latinx/Latine (20%), Black (12.5%), and multi-racial (12.2%). A framework-guided content analysis was used, and revealed four broad themes: 1) classroom-based opportunities for practice observation and feedback, 2) field-based opportunities for practice observation and feedback, 3) other methods such as standardized patient simulations and computer simulations, and 4) attitudes about these methods. Experiences with these methods were quite diverse with classroom-based role plays being the most common. Attitudes were generally positive, though lack of authenticity and performance anxiety were perceived as drawbacks. Student reflections on their experiences yielded several teaching recommendations specific to preparation, the nature of the simulated client role, and feedback.

Acculturation, Dietary Behaviors, and Macronutrient Intake Among Mexican Americans With Prediabetes: The Starr County Diabetes Prevention Initiative.

PURPOSE: The purpose of the study was to examine the influences of sex and acculturation on dietary behaviors, macronutrient intake, and dietary quality in participants enrolled in a diabetes prevention initiative in Starr County, Texas. METHODS: Baseline data from the Starr County diabetes prevention study (N = 300) were analyzed-acculturation (country of origin, years in Starr County, language and food preferences), depressive symptoms (Patient Health Questionnaire-9), healthy eating self-efficacy (Weight Efficacy Lifestyle Questionnaire-Short Form), diet quality (USDA Healthy Eating Index), fat avoidance (Fat Avoidance Scale, Spanish version), and macronutrients. Descriptive statistics and univariate analysis of covariance were used to examine differences based on acculturation, controlling for sex. RESULTS: Participants were predominantly female (73%) and, on average, 51 years of age. Language and food preferences favored Spanish language and Hispanic foods, respectively. The majority (71%) was born in Mexico but had resided in Starr County for 33 years, on average. Depressive symptoms were moderate, and eating self-efficacy scores suggested low confidence in making healthy food choices, particularly for saturated fats. Spanish language preference was associated with worse dietary habits. The mean dietary quality score was lower than the national average (54 vs 59 nationally); females had slightly higher dietary quality than males and a higher mean fat avoidance score, although differences were not clinically significant. Intakes of carbohydrate, saturated fats, and cholesterol were higher than recommended daily allowances. CONCLUSIONS: The overall preference for speaking Spanish and the influence of language on dietary intake should inform future dietary interventions. Accommodating cultural norms and food preferences remain major challenges to improving dietary quality among the diverse Hispanic ethnic groups.

Processes of change in preventing alcohol-exposed pregnancy: Replication of a mediation analysis.

OBJECTIVE: Further test mechanisms of the CHOICES intervention by replicating analyses of the experiential and behavioral processes of change (POC) for alcohol and for contraception as mediators of the intervention for reducing risk of alcohol-exposed pregnancy (AEP) using data from a more recent trial, CHOICES Plus (CP). METHOD: As in the prior study, replication models examined indirect paths from intervention to experiential POC for alcohol at 3 months, to behavioral POC at 9 months, to risky drinking and risk of AEP at 9 months and experiential POC for contraception at 3 months, to behavioral POC at 9 months, and to ineffective contraception and risk of AEP at 9 months. To test the temporal relationship, additional models examined the indirect path from behavioral POC for alcohol and POC for contraception at 3 months, to the experiential POC at 9 months, and to risk of AEP at 9 months. A final model tested the mediation of experiential and behavioral POC assessed at 3 months. RESULTS: There was an indirect effect of the intervention on risky drinking (total indirect effect = -.13, 95% confidence interval [CI] [-.32, -.02]) but not AEP via the alcohol POC. There was an indirect effect of the intervention on ineffective contraception (total indirect effect = -.27, 95% CI [-.55, -.07]) and AEP (total indirect effect = -.22, 95% CI [-.46, -.06]) via the contraception POC. CONCLUSIONS: This study completely replicated the prior indirect effects of the CHOICES intervention on the targeted risk behaviors through the experiential and behavioral POC for each behavior. Findings support the utility of the POC for informing health behavior change interventions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Reasons and obstacles for changing risky drinking behavior among Latinas at risk of an alcohol-exposed pregnancy.

This study examined reasons and obstacles for changing risky alcohol use behavior among Latina adults at risk of an alcohol-exposed pregnancy. Using qualitative methods, data from CHOICES Plus intervention sessions of Latinas (N = 59) were analyzed. Reasons for wanting to change risky alcohol use centered on health, parenting, interpersonal conflict, control, and risk of harm. Obstacles included social obstacles, belief that drinking was not risky, and drinking to manage mood. Differences were found across level of acculturation. Knowledge about salient motives and obstacles is critical to addressing the needs and strengths of Latinas at risk of an alcohol-exposed pregnancy.

The effects of gender and country of origin on acculturation, psychological factors, lifestyle factors, and diabetes-related physiological outcomes among Mexican Americans: The Starr County diabetes prevention initiative.

OBJECTIVES: Examine acculturation and psychological, lifestyle, and physiological factors based on gender and country of origin (U.S. vs. Mexico). METHODS: Baseline data from the Starr County diabetes prevention study (N = 300) were analyzed - acculturation (language), psychological factors (depression), lifestyle factors (sedentary behaviors), and diabetes-related physiological outcomes (insulin resistance). MANOVA and linear regression were used to examine variable relationships based on gender and country of origin and identify predictors of depression and insulin resistance. RESULTS: Participants were: predominantly female (73%); 51 years of age, on average; born in Mexico (71%); and Spanish-speaking. Individuals spent 11 of their waking hours (range = 0-18 h) in sedentary activities. Compared to females, more males spoke English and reported fewer hours in sedentary activities. Compared to participants born in Mexico, those born in the U.S. were more likely to: speak English; report depressive symptoms; and exhibit elevated BMI and insulin resistance rates. Two distinct models significantly predicted depression (R2 = 14.5%) and insulin resistance (R2 = 26.8%), with acculturation-language entering into both models. DISCUSSION: Significant gender and country-of-origin differences were found. Future research on diabetes prevention should examine other Hispanic subgroups and strategies for addressing individual differences, while employing cost-effective group interventions that incorporate these differences and reach more at-risk individuals.

Facilitating treatment initiation and reproductive care postpartum to prevent substance-exposed pregnancies: A randomized bayesian pilot trial.

BACKGROUND: For non-treatment-seeking women who use substances during pregnancy, immediately postpartum may be an optimum time for intervention. Our study tested a novel, brief, hospital-initiated, adaptive motivational interviewing plus acceptance and commitment therapy (MIACT) intervention to facilitate treatment initiation and reproductive planning postpartum among mothers who used substances during pregnancy. METHODS: Mothers (N = 64) with an infant admitted to a neonatal intensive care unit were enrolled if they or their infant tested positive for an illicit substance at delivery or had a documented positive drug screen during pregnancy. A parallel group, randomized controlled design assigned participants to MIACT or conventional care (CC), with assessments at week 2 and 4 during treatment and follow-up at 2 and 6 months post treatment. Bayesian generalized linear modeling was used to evaluate outcomes as a function of treatment. RESULTS: Results indicated that during treatment the MIACT group demonstrated an 84% probability of benefit relative to CC with regard to initiating treatment (RR=1.5), however the effect was not seen at follow-up. MIACT was also associated with an increased probability of attending a postpartum obstetrics visit (RR=1.4), and receiving contraception during treatment and at both follow-ups, with posterior probabilities of 96% or higher and relative risks ranging from 1.5 to 5.1 at varying timepoints. Substance use rates for the MIACT versus CC were higher at follow-up. CONCLUSIONS: Brief, hospital-initiated interventions can assist postpartum mothers who use substances to enter treatment and obtain contraception in order to reduce future substance-exposed pregnancies.

Postresidency Impact of Alcohol and Drug Screening and Intervention Training.

BACKGROUND AND OBJECTIVES: Many residency programs provide alcohol and drug screening, brief intervention (BI), and referral to treatment (SBIRT) training, hoping to impact residents' future practice activities. Little is known about postresidency use of these skills. This study assesses postresidency impact of SBIRT training. METHODS: Over 3 years, physicians who participated in SBIRT training in four residency programs were recruited for follow-up. Participants chose between a paper and online questionnaire 12-24 months after graduation; participants received $20 gift cards. We first analyzed postresidency responses only (n=74), then compared pre- and posttraining results of those completing both surveys (n=50). RESULTS: Of 182 enrolled graduates, 74 (41%) completed questionnaires. In paired comparisons to their pretraining responses, graduates increased endorsement of statements that BIs can reduce risky use and reduced endorsement of statements that they do not have adequate training or time to address patients' alcohol use, or that discussing alcohol use with patients is uncomfortable. While most barriers to providing interventions were endorsed less frequently by SBIRT-trained clinicians in postresidency surveys, ongoing concerns included poor reimbursement, little time, low success rates, and some discomfort with interventions. Seventy percent of graduates felt motivational interviewing techniques created stronger doctor-patient relationships; 16% reported colleagues in their practices had increased SBIRT activities after they joined the practice. CONCLUSIONS: SBIRT trainees reported high levels of SBIRT activity 12-24 months after graduation and increased SBIRT activities by their colleagues. While some barriers remain, residency training appears to be a promising approach for disseminating SBIRT into clinical practice.

Alcohol use and problems among Latinas at risk of an alcohol-exposed pregnancy: The role of acculturation and interpersonal factors.

Path analysis was used to examine the role of acculturation, helping relationships, partner status, age, and education on heavy drinking and alcohol problems among 119 Latina adults at risk of an alcohol-exposed pregnancy (AEP). Greater acculturation was positively related to more helping relationships and heavy drinking, and there was an indirect positive relationship between acculturation and alcohol problems. There was also a positive relationship between helping relationships and alcohol problems, and a negative relationship between helping relationships and being partnered. Knowledge of the mechanisms by which acculturation and interpersonal factors influence behavior change can inform potential targets for intervention among Latinas with AEP risk.

Randomized Trial of Screening and Brief Intervention to Reduce Injury and Substance Abuse in an urban Level I Trauma Center.

BACKGROUND: The TIP (Traumatic Injury Prevention) Project evaluated the impact on post-injury drug use of two brief motivational interventions compared to brief advice (BA) among injured patients who use drugs. METHOD: Three-group, single blind, randomized controlled trial in a Level 1Trauma Center enrolled 395 admitted patients with drug positive toxicology screen or verbal report of drug use in the previous 30 days. 34% were Hispanic, 45% non-Hispanic White, 16% non-Hispanic Black. 88% smoked marijuana, 28% used cocaine and 11% prescription opioids. Brief Advice (BA) provided advice to abstain from drugs, educational materials and referral to community resources. Brief Motivational Intervention (BMI) additionally included a 30-45 minute session, with assessment feedback, based on motivational interviewing. BMI + B included a telephone booster 4-weeks post-intervention. Drug use as measured by percent days abstinent and total abstinence, derived from the Timeline Follow back was the primary outcome. RESULTS: A significant reduction from baseline was observed at 3, 6, and 12 months in the primary outcomes of any drug use (excluding alcohol); cannabis and cocaine, the most frequently used drugs, were analyzed individually. There were no between group differences or group X time interactions. Similarly, there were no between groups differences on secondary outcomes including perceived health status, re-injury, arrest, incarceration, alcohol and drug treatment, employment, AA attendance, homelessness, physical abuse, and problems associated with alcohol and drug use. CONCLUSIONS: The study does not support use of these enhanced motivational interventions over brief advice for trauma patients with a positive screen for drug use.

Alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Girls and Women.

Females ages 12 and older are the fastest growing segment of alcohol consumers in the United States, with the past decade showing a 16% increase in alcohol use per 12-month period and a 58% increase in high-risk drinking (i.e., > 3 drinks in a day and/or > 7 drinks in a week) per 12-month period. The increase in alcohol use and risk drinking poses unique and serious consequences for women. Women have a more rapid progression to alcohol-related problems and alcohol use disorders (AUD) than men, and if pregnant, women can potentially expose the fetus to alcohol. Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based, integrated public health approach used to identify and address risky alcohol use among women in a variety of health and social service settings. This article presents the current status of SBIRT among girls ages 12 and older, women of childbearing age, and older women. Screening instruments, brief interventions, and implementation issues specific to women of all ages are described. Through this review of the current literature, care providers can determine best practices for the prevention and treatment of risk drinking in women of all ages presenting in health care settings.

Reducing Tobacco Smoke Exposure in High-Risk Infants: A Randomized, Controlled Trial.

OBJECTIVE: To evaluate a hospital-initiated intervention to reduce tobacco smoke exposure in infants in the neonatal intensive care unit. STUDY DESIGN: A randomized, controlled trial compared motivational interviewing plus financial incentives with conventional care on infant urine cotinine at 1 and 4 months' follow-up. Mothers of infants in the neonatal intensive care unit (N = 360) who reported a smoker living in the home were enrolled. Motivational interviewing sessions were delivered in both the hospital and the home. Financial incentives followed session attendance and negative infant cotinine tests postdischarge. RESULTS: The intervention effect on infant cotinine was not significant, except among mothers who reported high baseline readiness/ability to protect their infant (P ≤ .01) and mothers who completed the study within 6 months postdischarge (per protocol; P ≤ .05). Fewer mothers in the motivational interviewing plus financial incentives condition were smoking postdischarge (P ≤ .01). More mothers in the motivational interviewing plus financial incentives group reported a total home and car smoking ban at follow-up (P ≤ .05). CONCLUSIONS: Motivational interviewing combined with financial incentives reduced infant tobacco smoke exposure in a subset of women who were ready/able to protect their infant. The intervention also resulted in less maternal smoking postpartum. More robust interventions that include maternal and partner/household smoking cessation are likely needed to reduce the costly effects of tobacco smoke exposure on children and their families. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01726062.

CHOICES-TEEN: Reducing Substance-Exposed Pregnancy and HIV among Juvenile Justice Adolescent Females.

OBJECTIVE: The feasibility and acceptability of CHOICES-TEEN - a 3-session intervention to reduce overlapping risks of alcohol-exposed pregnancy (AEP), tobacco-exposed pregnancy (TEP) and HIV - was assessed among females in the juvenile justice system. METHODS: Females 14-17 on community probation in Houston, Texas were eligible if presenting with aforementioned health risks. Outcome measures - obtained at one- and three-months post baseline - included the Timeline Followback, Client Satisfaction Questionnaire-8, session completion/checklists, Working Alliance Inventory-Short, and open-ended questions. Twenty-two participants enrolled (82% Hispanic/Latina; mean age=16). RESULTS: The results suggest strong acceptability and feasibility with high client satisfaction and client/therapist ratings, 91% session completion, and positive open-ended responses. All youth were at risk at baseline, with the following proportions at reduced risk at follow-up: AEP (90% 1-month; 71.4% at 3-months; TEP (77% of smokers (n=17) at reduced risk at 1-month; 50% at 3-months); and HIV (52.4% 1-month; 28.6% at 3-months).

The Efficacy of Technology-Based Interventions for Alcohol and Illicit Drug Use Among Women of Childbearing Age: A Systematic Review and Meta-Analysis.

BACKGROUND: Alcohol and illicit drug use is prevalent among women of childbearing age and may lead to higher risk for substance-exposed pregnancy and related health consequences for both women and their offspring. Technology-based interventions (TBIs) are increasingly used to prevent or reduce substance use among women of childbearing age. The efficacy of these approaches, however, is unclear. This review critically reviewed existing research evidence from randomized controlled trials (RCTs) on the efficacy of TBIs in preventing and reducing alcohol and illicit drug use among childbearing-aged women. METHODS: Seven electronic databases were searched to identify eligible studies. Two reviewers independently screened studies, extracted data, and assessed risks of bias. Robust variance estimation in meta-regression was used to estimate effect sizes and conduct moderator analyses. RESULTS: Fifteen RCTs including 3,488 participants were included in the systematic review. Meta-analysis results based on 13 RCTs suggest that TBIs were efficacious relative to control conditions in preventing and reducing substance use among women of childbearing age (d = 0.19, 95% CI = 0.02, 0.35). Preliminary moderator analysis results suggest that the efficacy of TBIs might not vary by participant age, race/ethnicity, the type of technology used, or whether a virtual health assistant was used. TBIs' efficacy in terms of specific substance use types (alcohol use and illicit drug use) or control types (inactive control and active controls) was inconclusive, due to the limited number of studies in each category. CONCLUSIONS: This systematic review and meta-analysis found evidence of TBIs' efficacy in reducing alcohol and illicit drug use among women of childbearing age. Implications for future research and practice are discussed.

The Role of Acculturation and Alcohol Problems on Frequency of Cannabis Use Among Latinas at Risk of an Alcohol-Exposed Pregnancy.

Background: Along with alcohol, cannabis is one of the most commonly used substances among women of childbearing age. Recent studies indicate detrimental effects of prenatal cannabis use. Because many women use these substances before realizing they are pregnant, these serious health consequences for women and their offspring are of great concern. Despite the recent upsurge in cannabis use, little is known about individual and sociocultural factors that may contribute to risk of a cannabis-exposed pregnancy, particularly among Latinas of child-bearing age also at risk of an alcohol-exposed pregnancy (AEP). Objectives: Examine the relationships of acculturation, alcohol use, alcohol problems, and psychological distress with frequency of cannabis use among adult Latinas at risk of an AEP. Methods: The hypothesized model included 76 Latinas and was analyzed using path analysis. The study used baseline data from a randomized controlled trial of an intervention targeting risky drinking and tobacco use among women at risk of an AEP in primary care clinics. Results: Greater acculturation was associated with more frequent cannabis use and greater psychological distress. There was a positive indirect relationship between acculturation and alcohol use and alcohol problems through psychological distress. Greater alcohol problems were associated with more frequent cannabis use. Greater psychological distress and alcohol use were indirectly related to more frequent cannabis use through alcohol problems. Conclusions: Findings underscore the critical role of acculturation and alcohol-related problems in cannabis use frequency and have relevant implications for preventive efforts addressing cannabis use among Latinas at risk of an AEP.

Profiles of behavior change constructs for reducing alcohol use in women at risk of an alcohol-exposed pregnancy.

Using data from Project CHOICES, a randomized controlled trial to test an intervention to prevent alcohol-exposed pregnancies, this study examined process of change profiles composed of Transtheoretical Model of Change (TTM) constructs for alcohol. The primary purpose was to identify a profile of TTM variables associated with reduced drinking. Participants (n = 570) were women at risk of an alcohol-exposed pregnancy recruited from high risk settings. Profile analyses compared end-of-treatment (i.e., 3 months postintake) TTM construct mean profiles for women who reduced drinking to below NIAAA-defined risk levels1 (changers) with women who continued to drink at risk levels (nonchangers) at the 9-month follow-up. TTM construct profiles included experiential and behavioral processes of change, pros and cons for change, confidence to reduce drinking, and temptation to drink above risk levels. Results revealed a parallelism effect or interaction (p < .001) in the end-of-treatment TTM construct profiles for the changers versus the nonchangers at the 9-month follow-up. Changers reported greater pros (p < .001) and lower cons for change (p = .012), greater confidence (p = .030), lower temptation (p < .001) and greater use of the experiential (p < .001) and behavioral processes of change (p < .001). A larger percentage of the women from the CHOICES intervention were in the end-of-treatment profile of the changers (48%) compared with the control condition (39%; p = .042). Interventions can potentially be enhanced by clinicians' understanding what successful change "looks like" for specific clients in terms of their process use, decisional balance, and self-efficacy, allowing for tailored interventions targeted to each client's specific strengths and deficits. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Changing multiple health risk behaviors in CHOICES.

Multiple health behavior change (MHBC) intervention trials to date have only considered behaviors that were directly targeted. Research has yet to consider how untargeted behaviors can affect change in behaviors directly targeted by an intervention or how changes in targeted behaviors might lead to changes in other, untargeted behaviors. This study addresses these gaps with a secondary analysis of change in risk drinking (targeted behavior) and smoking (behavior that was not addressed) in the efficacy trial of CHOICES, an intervention for the prevention of alcohol-exposed pregnancies. Measures included the Timeline Followback for daily alcohol consumption and questions about smoking behavior. Participants were women of childbearing age who were at risk of alcohol-exposed pregnancy at baseline. Baseline smokers were less likely to change their drinking behavior than baseline non-smokers at nine months (n = 579) with Odds Ratio (OR) of 0.681 (95% CI = 0.471-0.985); 41.1% of smokers vs 50.6% of non-smokers reduced drinking to below risk levels (<5 drinks/day and < 8 drinks per week). Meanwhile, smokers who had changed their drinking behavior were more likely than smokers who had not changed their drinking behavior to have also quit smoking at nine months (OR = 2.769; 95% CI = 1.533-5.000); 19.5% vs. 8.1%, respectively. Together, these findings suggest a natural tendency towards change of multiple related behaviors and indicate that while the presence of unaddressed risk behaviors may make a targeted behavior change more difficult, change in one behavior may facilitate change in related behaviors, even when they are not addressed.

The Starr County Border Health Initiative: Focus Groups on Diabetes Prevention in Mexican Americans.

Purpose The purpose of the study was to conduct focus groups with Mexican Americans in an impoverished rural community on the Texas-Mexico border to identify current barriers to adopting healthier lifestyles and to obtain recommendations for diabetes prevention. Methods Three separate 2-hour focus groups were led by an experienced bilingual Mexican American moderator. Interviews included questions about cultural factors and barriers that influence lifestyle behaviors, aspects of previous diabetes self-management interventions that were helpful for motivating behavioral change, and recommendations for diabetes prevention. Results Twenty-seven participants attended a focus group session; each session involved 7 to 12 informants. Individuals were diagnosed with prediabetes or type 2 diabetes mellitus; most were female, foreign born, and Spanish speaking. Interviews documented the cultural importance of food. Informants raised priority issues for diabetes prevention, including the need to learn how to prepare healthier foods and track caloric intake. Major barriers to healthier lifestyles included high costs of healthy foods, fatigue from busy schedules and working multiple jobs, a cultural view that exercise is a waste of valuable time, and fear of deportation. Conclusions Cultural influences and barriers to implementing healthy lifestyles should be assessed regularly and strategies implemented to overcome them. Such factors may change as environmental, sociocultural, and political environments change.

Associated factors of readiness to change in young adult risky drinkers.

BACKGROUND: Readiness to change alcohol use has been associated with a number of predictors including emotional distress, drinking severity, and consequence severity, as well as with static demographic factors such as gender and race/ethnicity. OBJECTIVE: To examine the relationships among these variables and readiness to change alcohol use in young adults. METHODS: Structural equation modeling was used to test pathways of readiness to change in 1,256 young adult patients (78% male/22% female) ages 18-29 who were provided screening, brief intervention and referral to treatment (SBIRT) as part of a Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Capacity Expansion Project. RESULTS: The strongest relationships were between emotional distress, drinking severity, and consequence severity with readiness to change. Results indicated that participants with more severe alcohol problems demonstrated higher levels of readiness to change alcohol use and therefore, may be more amenable to behavior change. Additionally, females, Hispanic/Latino, and Black non-Hispanic (Black) participants demonstrated higher levels of readiness to change when compared to other groups. CONCLUSION: These results lend support to the concept that young adults are using alcohol to modulate their emotions. Furthermore, resultant severity of consequences from drinking may play an important role in their readiness to change risky drinking. This may be especially true for females, who reported greater emotional distress, and for Hispanic/Latinos and Blacks, who reported greater drinking severity with greater emotional distress. Caregivers may be better equipped to address young adult alcohol use with this added understanding.