Investigating for Whom Brief Substance Use Interventions Are Most Effective: An Individual Participant Data Meta-analysis.

Prior research suggests that brief interventions (BIs) for alcohol and other drug use may vary in effectiveness across patient sociodemographic factors. The objective of this individual participant data (IPD) meta-analysis was to explore for whom BIs delivered in general healthcare settings are more or less effective. We examined variability in BI effects by patient age, sex, employment, education, relationship status, and baseline severity of substance use using a two-stage IPD meta-analysis approach. All trials included in a parent aggregate data meta-analysis (k = 116) were invited to contribute IPD, and 29 trials provided patient-level data (12,074 participants). Among females, BIs led to significant reductions in binge alcohol consumption ([Formula: see text] = 0.09, 95% CI [0.03, 0.14]), frequency of alcohol consumption ([Formula: see text] = 0.10, 95% CI [0.03, 0.17]), and alcohol-related consequences ([Formula: see text] = 0.16, 95% CI [0.08, 0.25]), as well as greater substance use treatment utilization ([Formula: see text] = 0.25, 95% CI [0.21, 0.30]). BIs yielded larger reductions in frequency of alcohol consumption at 3-month follow-up for individuals with less than a high school level education ([Formula: see text] = 0.16, 95% CI [0.09, 0.22]). Given evidence demonstrating modest BI effects on alcohol use and mixed or null findings for BI effects on other drug use, BI research should continue to investigate potential drivers of effect magnitude and variation.  PROTOCOL REGISTRATION DETAILS: The protocol for this review was pre-registered in PROSPERO #CRD42018086832 and the analysis plan was pre-registered in OSF: osf.io/m48g6.

Differences in the age-varying association of school belonging with socioemotional flourishing among minority and non-minority college and university students.

Objective: This study aimed to assess the age-varying prevalence of and association between school belonging and flourishing among sexual or gender minority (SGM) and racial or ethnic minority (REM) students compared with non-minority students in the U.S. college setting. Participants: Data were drawn from a 2017-2018 national survey of U.S. college and university students ages 18-26. Method: Data were examined using varying-coefficients models to estimate the relation of school belonging and flourishing across ages 18-26. Results: SGM students (n = 6,718) and REM students (n = 10,539) reported significantly lower belonging and flourishing than cisgender heterosexual students (n = 19,492) and white students (n = 16,444), respectively, at several age points. The association of belonging with flourishing was significantly greater for SGM students than for cisgender heterosexual students across all ages. Conclusions: Findings of this study underline the important role of school belonging in socioemotional flourishing for SGM young adults.

Using Machine Learning to Identify and Investigate Moderators of Alcohol Use Intervention Effects in Meta-Analyses.

AIMS: To illustrate a machine learning-based approach for identifying and investigating moderators of alcohol use intervention effects in aggregate-data meta-analysis. METHODS: We illustrated the machine learning technique of random forest modeling using data from an ongoing meta-analysis of brief substance use interventions implemented in general healthcare settings. A subset of 40 trials testing brief alcohol interventions (BAIs) was used; these trials provided 344 estimates of post-intervention effects on participants' alcohol use as well as data on 20 potential moderators of intervention effects. These candidate moderators included characteristics of trial methodology and implementation, intervention design and participant samples. RESULTS: The best-fitting random forest model identified 10 important moderators from the pool of 20 candidate moderators. Meta-regression utilizing the selected moderators found that inclusion of prescriptive advice in a BAI session significantly moderated BAI effects on alcohol use. Observed effects were also significantly moderated by several methodological characteristics of trials, including the type of comparison group used, the overall level of attrition and the strategy used to address missing data. In a meta-regression model that included all candidate moderators, fewer coefficients were found to be significant, indicating that the use of a preliminary data reduction technique to identify only important moderators for inclusion in final analyses may have yielded improved statistical power to detect moderation. CONCLUSIONS: Machine learning methods can be valuable tools for clarifying the influence of trial, intervention and sample characteristics on alcohol use intervention effects, in particular when numerous candidate moderators are available.

Effects of brief substance use interventions delivered in general medical settings: a systematic review and meta-analysis.

AIMS: To estimate effects of brief substance use interventions delivered in general medical settings. METHODS: A systematic review and meta-analysis of randomized trials conducted since 1990 of brief substance use interventions in patients of any age or severity level recruited in general medical settings. Primary outcomes were any measure of substance use or substance-related consequences (indexed with Hedges' g and risk ratios). Mixed-effects meta-regressions were used to estimate overall effects and predictors of effect variability. Analyses were conducted separately by brief intervention (BI) target substance: alcohol only or drugs. FINDINGS: A total of 116 trials (64 439 participants) were identified; 111 (62 263 participants) provided effect size data and were included in the meta-analysis. Drug-targeted BIs yielded significant small improvements in multiple drug/mixed substance use (Hedges' g (g¯ ) = 0.08; 95% CI = 0.002, 0.15), but after adjusting for multiple comparisons, they did not produce significant effects on cannabis use ( g¯ = 0.06; 95% CI = 0.001, 0.12), alcohol use ( g¯ = 0.08; 95% CI = -0.0003, 0.17), or consequences ( g¯ = 0.05; 95% CI = 0.01, 0.10). Drug-targeted BIs yielded larger improvements in multiple drug/mixed substance use when delivered by a general practitioner ( g¯ = 0.19; 95% CI = 0.187, 0.193). Alcohol-targeted BIs yielded small beneficial effects on alcohol use ( g¯ = 0.12; 95% CI 0.08, 0.16), but no evidence of an effect on consequences ( g¯ = 0.05; 95% CI = -0.04, 0.13). However, alcohol-targeted BIs only had beneficial effects on alcohol use when delivered in general medical settings (g¯ = 0.17; 95% CI = 0.10, 0.24); the findings were inconclusive for those delivered in emergency department/trauma centers ( g¯ = 0.05; 95% CI = 0.00, 0.10). CONCLUSIONS: When delivered in general medical settings, alcohol-targeted brief interventions may produce small beneficial reductions in drinking (equivalent to a reduction in 1 drinking day per month). There is limited evidence regarding the effects of drug-targeted brief interventions on drug use.

Factors associated with frequency of gender identity nonaffirmation microaggressions among transgender persons.

Gender-based victimisation (GBV) is commonly experienced by transgender individuals, and can include physical or sexual violence; social, workplace, or housing discrimination; or family or social rejection. In addition to overt forms of GBV, transgender individuals experience gender identity-related microaggressions: subtle, frequently-occurring aversive events that convey nonaffirmation or rejection of an individual's gender identity. The degree to which a transgender individual is socially perceived as the gender with which they identify, sometimes referred to as passing, as well as sociodemographic factors such as annual income and race/ethnicity, have been previously linked with experiencing overt GBV. This study aimed to quantitatively assess whether self-rated degree of passing, age, annual income and being a person of colour were associated with the frequency with which transgender individuals experience less overt identity-related victimisation in the form of gender nonaffirmation microaggressions. Among an age-diverse sample of US adolescent and adult transgender persons (n = 224) who responded to 14 situational prompts of nonaffirmation microaggressions, adolescents experienced the highest average weekly frequency of nonaffirmation microaggressions (M = 2.16, SD = 1.48). Factors significantly associated with increased average weekly frequency of nonaffirmation microaggressions included lower degree of passing and lower income, while older age was associated with lower frequency of microaggressions.

Sexual Assault and Co-Occurrence of Mental Health Outcomes Among Cisgender Female, Cisgender Male, and Gender Minority U.S. College Students.

PURPOSE: The aim of this study was to examine the co-occurrence of mental health (depression, anxiety, nonsuicidal self-injury, and suicide ideation) and substance use outcomes among cisgender female, cisgender male, and gender minority college students exposed to sexual assault (SA). METHODS: Data were drawn from a 2018 U.S. national survey of college student well-being (N = 50,438). Inverse propensity-weighted three-step latent class analysis was used to examine co-occurrence of outcomes while adjusting for 31 potential confounders of the relation between SA and outcome classes. RESULTS: Four latent classes were identified for cisgender female and male participants and two for gender minority participants, reflecting a range from low to high risk of co-occurring outcomes. SA was associated with significantly and substantially increased odds (odds ratio: 2.03-3.64) of membership to the highest-risk outcome class compared with the lowest-risk class across gender identity subgroups. CONCLUSIONS: SA in the college setting is associated with substantially increased odds of co-occurring depression, anxiety, nonsuicidal self-injury, and suicide ideation, regardless of gender identity.

Positive Youth Development in Croatia: School and Family Factors Associated With Mental Health of Croatian Adolescents.

INTRODUCTION: A framework for understanding the interrelationship of individual and environmental factors that influence adolescent health and well-being, as well as opportunities for policy-level interventions, is known as Positive Youth Development (PYD). The current study represents one of the largest studies of Croatian adolescents to date, and aimed to examine associations between school and family factors linked to PYD, and mental health outcomes experienced by Croatian youth. METHODS: A multi-site survey study was conducted among adolescents (N = 9,655) residing in the five most populous cities in Croatia, with the aim of examining cross-sectional associations of family and school factors with adolescent mental health. The mean age of participants was 16.3 years (SD = 1.2), and 52.5% of participants were female. School and family factors included school attachment, school commitment, family communication, and family satisfaction. Depression, anxiety, and stress were assessed as outcomes. Multigroup structural equation modeling (SEM) was used to examine relations of interest among female and male adolescents. RESULTS: Among school factors, increased school attachment was found to be significantly associated with reduced depression, anxiety, and stress for female adolescents, and with decreased depression and stress for male adolescents. Increased school commitment was significantly associated with decreased depression and anxiety for female adolescents; conversely, an increase in school commitment was associated with an increase in anxiety and stress for male adolescents. Increases in family communication were significantly associated with reduced depression, anxiety, and stress only for male adolescents, while increased family satisfaction was significantly associated with reduced depression, anxiety, and stress for female adolescents and with decreased depression and stress for male adolescents. CONCLUSION: Findings suggest that interventions for mental health promotion and prevention of internalizing problems should address both school and family contexts, and may be more effective when accounting for differing developmental experiences of female and male adolescents.

Meta-analytic approaches for examining complexity and heterogeneity in studies of adolescent development.

INTRODUCTION: In the field of adolescent development, meta-analysis offers valuable tools for synthesizing and assessing cumulative research evidence on the effectiveness of programs, practices, and policies intended to promote healthy adolescent development. When examining the impact of a program implemented across multiple primary studies, variation is often observed in the methodological attributes of those primary studies, such as their implementation methods, program components, participant characteristics, outcome measurement, and the systems in which programs are deployed. Differences in methodological attributes of primary studies represented in a meta-analysis, referred to as complexity, can yield variation in true effects across primary studies, which is described as heterogeneity. METHODS: We discuss heterogeneity as a parameter of interest in meta-analysis, introducing and demonstrating both graphical and statistical methods for evaluating the magnitude and impact of heterogeneity. We discuss approaches for presenting characteristics of heterogeneity in meta-analytic findings, and methods for identifying and statistically controlling for aspects of methodological complexity that may contribute to variation in effects across primary studies. RESULTS: Topics and methods related to assessing and explaining heterogeneity were contextualized in the field of adolescent development using a sample of primary studies from a large meta-analysis examining the effectiveness of brief alcohol interventions for youth. We highlighted approaches currently underutilized in the field and provided R code for key methods to broaden their use. CONCLUSIONS: By discussing various heterogeneity statistics, visualizations, and explanatory methods, this article provides the applied developmental researcher a foundational understanding of complexity and heterogeneity in meta-analysis.

Life lost due to premature deaths in New South Wales, Australia.

This study attempts to measure premature mortality, in addition to overall death rates, in order to provide more information that can be used to develop and monitor health programmes that are aimed at reducing premature (often preventable) mortality in New South Wales (NSW), Australia. Premature years of potential life lost (PYPLL) and valued years of potential life lost methods are applied for mortality data in NSW from 1990 to 2002. Variations in these measures for 2001 are studied further in terms of age, sex, urban/rural residence, and socio-economic status. PYPLL rates for all leading causes of death have declined. It is shown that the average male to female ratio of PYPLLs is highest for accidents, injury and poisoning (3.4:1) followed by mental disorders (2.7:1) and cardiovascular diseases (2.6:1). Although fewer women than men die of cardiovascular diseases, there is a greater proportionate importance of cerebrovascular mortality among women. In order to further reduce premature deaths, programs are required to improve the health of people living in lower socio-economic status areas, especially in rural NSW. Targeted regional or community level programs are required to reduce avoidable deaths due to accidents, injury and poisoning occasioned by motor vehicle accidents, poisoning and suicide among young adults.

Trends in percutaneous coronary interventions in new South Wales, Australia.

This is the first detailed study on percutaneous coronary intervention (PCI) in New South Wales (NSW), Australia. Hospital data for PCIs carried out between 1 July 1990 and 30 June 2002 are analysed. The study explores trends in PCI rates by selected socio-demographic factors, the utilisation of angioplasties vis-a-vis stents, emergency admissions, and selected coexisting conditions which determine the disease status of PCI patients. Logistic regression models are used to study the medical conditions that require both PCI and coronary artery bypass graft (CABG). The PCI rate has grown rapidly at 12.1% per annum, with a particularly rapid increase for persons aged 75+. The rate of multiple stent utilisation increased at 4.6% per annum. Pacific-born and Middle-Eastern-born patients are more than twice as likely as the Australian-born to have diabetes. Factors affecting failure of PCI requiring CABG include perforation and multi-vessel disease. PCI services in public hospitals need to be increased to facilitate the availability of these procedures to all segments of the population, as do targeted community-level programmes to educate high-risk groups in the control of heart diseases.

Family background, schooling and childlessness in Australia.

Using data from Wave 1 of the Household Income and Labour Dynamics in Australia (HILDA) survey, this paper analyses the extent to which childlessness among Australian women aged 40-54 years varies according to the size and type of family in which they were brought up, and the level and type of schooling they had. Multilevel logistic analysis shows that having been educated in a non-government school, having stayed at school to year 12, having a small number of siblings, at age 14 having a father who was either dead or absent, at age 14 having a father who was employed in a professional occupation, or being a migrant from North or West Europe, North America, East Asia or South-East Asia, all are significantly associated with higher rates of childlessness among women in the 40-54 years age range. The effects of these early lifecourse variables on marital and socioeconomic status in later life, and hence on childlessness, are also considered. The implications of the findings for fertility trends and for Australia's public debate are discussed.

Discontinuation of contraceptive use in Ghana.

Using data from the Ghana Demographic and Health Survey 1998, this paper analyzed the duration of use of a contraceptive method and the reasons for its non-use given by former users of contraception. The results showed that the duration of use tended to be short, particularly so for the use of condom and withdrawal. Injectable contraceptives and periodic abstinence tended to be used for relatively long periods. After type of method, a woman's age and residence (urban or rural) were the most significant predictors of duration of use. The reasons for not currently using contraception given by significant numbers of former users of pill and injectable contraceptives should concern service providers and educators.

Effect of wealth on marital fertility in Sri Lanka.

This study examines the effect of household wealth on marital fertility in Sri Lanka. Data on type of dwelling, availability of vehicles, and electrical equipment in households were combined with estimates of 'typical' rupee values of various elements to generate an index of their wealth. Differentials in value of the wealth indices among sociodemographic subgroups of population are also described. The results of the study showed that, after controlling for other variables, higher levels of household wealth were associated with lower fertility. There were also significant effects of participation of female labour force, ethnicity, age-at-marriage, and parity on current fertility. However, after controlling for wealth and other explanatory variables, the effect of female education was not significant. If the model were to remain constant over time, raising levels of wealth would reduce marital fertility in Sri Lanka.