The relaxation zone: Initial analysis of stress management services for university students.

Objective: We evaluated the Relaxation Zone (RZ), a room with "relaxation stations" designed to reduce stress in college students. Participants: Participants (N = 994) were enrolled during the 2019 calendar year. Most participants were female (62.8%), freshmen (59.3%), and African American (44.9%). Methods: Students visiting the RZ completed a brief pretest and posttest that measured self-reported stress. Results: Paired sample t-tests across class groups (e.g., freshman, sophomore) revealed a significant reduction in stress from pretest (Mpooled = 6.0) to posttest (Mpooled = 4.5), with medium to large effect sizes (Cohen's d ranging from 0.53 to 0.88) during their first visit. For students having at least two visits (N = 348), an exploratory dose-response analysis demonstrated that an optimal dose of self-guided relaxation ranged from two to eight visits. Conclusions: These findings provide initial evidence that programs like the RZ can reduce student stress within a few visits.

Using wearable technology to detect prescription opioid self-administration.

ABSTRACT: Appropriate monitoring of opioid use in patients with pain conditions is paramount, yet it remains a very challenging task. The current work examined the use of a wearable sensor to detect self-administration of opioids after dental surgery using machine learning. Participants were recruited from an oral and maxillofacial surgery clinic. Participants were 46 adult patients (26 female) receiving opioids after dental surgery. Participants wore Empatica E4 sensors during the period they self-administered opioids. The E4 collected physiological parameters including accelerometer x-, y-, and z-axes, heart rate, and electrodermal activity. Four machine learning models provided validation accuracies greater than 80%, but the bagged-tree model provided the highest combination of validation accuracy (83.7%) and area under the receiver operating characteristic curve (0.92). The trained model had a validation sensitivity of 82%, a specificity of 85%, a positive predictive value of 85%, and a negative predictive value of 83%. A subsequent test of the trained model on withheld data had a sensitivity of 81%, a specificity of 88%, a positive predictive value of 87%, and a negative predictive value of 82%. Results from training and testing model of machine learning indicated that opioid self-administration could be identified with reasonable accuracy, leading to considerable possibilities of the use of wearable technology to advance prevention and treatment.

Effect of short-term prescription opioids on DNA methylation of the OPRM1 promoter.

BACKGROUND: A long-term opioid use has been associated with hypermethylation of the opioid receptor mu 1 (OPRM1) promoter. Very little is currently known about the early epigenetic response to therapeutic opioids. Here, we examine whether we can detect DNA methylation changes associated with a few days' use of prescribed opioids. Genome-wide DNA methylation was assayed in a cohort of 33 opioid-naïve participants who underwent standard dental surgery followed by opioid self-administration. Saliva samples were collected before surgery (visit 1), and at two postsurgery visits at 2.7 ± 1.5 days (visit 2), and 39 ± 10 days (visit 3) after the discontinuation of opioid analgesics. RESULTS: The perioperative methylome underwent significant changes over the three visits that were primarily due to postoperative inflammatory response and cell heterogeneity. To specifically examine the effect of opioids, we started with a candidate gene approach and evaluated 10 CpGs located in the OPRM1 promoter. There was a significant cross-sectional variability in opioid use, and for participants who self-administered the prescribed drugs, the total dosage ranged from 5-210 morphine milligram equivalent (MME). Participants were categorized by cumulative dosage into three groups: < 25 MME, 25-90 MME, and ≥ 90 MME. Using mixed-effects modeling, 4 CpGs had significant positive associations with opioid dose at two-tailed p value < 0.05, and overall, 9 of the 10 OPRM1 promoter CpGs showed the predicted higher methylation in the higher dose groups relative to the lowest dose group. After adjustment for age, cellular heterogeneity, and past tobacco use, the promoter mean methylation also had positive associations with cumulative MME (regression coefficient = 0.0002, one-tailed p value = 0.02) and duration of opioid use (regression coefficient = 0.003, one-tailed p value = 0.001), but this effect was significant only for visit 3. A preliminary epigenome-wide association study identified a significant CpG in the promoter of the RAS-related signaling gene, RASL10A, that may be predictive of opioid dosage. CONCLUSION: The present study provides evidence that the hypermethylation of the OPRM1 promoter is in response to opioid use and that epigenetic differences in OPRM1 and other sites are associated with a short-term use of therapeutic opioids.

A randomized pilot program to reduce opioid use following dental surgery and increase safe medication return.

Research indicates that increased cumulative exposure (duration of administration and strength of dose) is associated with long-term opioid use. Because dentists represent some of the highest opioid prescribing medical professionals in the US, dental practices offer a critical site for intervention. The current study used a randomized clinical trial design to examine the efficacy of an opioid misuse prevention program (OMPP), presented as a brief intervention immediately prior to dental extraction surgery. The OMPP provided educational counseling about risks and appropriate use of opioid medication, as well as 28 tablets of ibuprofen (200 mg) and 28 tablets of acetaminophen (500 mg) for weaning off opioid medication. This was compared with a Treatment as Usual (TAU) control condition. Participants were individuals presenting for surgery who were eligible for opioid medication (N = 76). Follow up assessment was conducted at 1 week following surgery, with 4 individuals refusing follow up or not prescribed opioid. Intent to treat analysis indicated a non-significant treatment group effect (N = 72, Beta = 0.16, p = .0835), such that the OMPP group self-reported less opioid use (in morphine milligram equivalents, MMEs) than the TAU group (37.94 vs. 47.79, effect size d = 0.42). Sensitivity analysis, excluding individuals with complications following surgery (n = 6) indicated a significant treatment group effect (N = 66, Beta = 0.24, p = .0259), such that the OMPP group self-reported significantly less MMEs than the TAU group (29.74 vs. 43.59, effect size d = 0.56). Results indicate that a 10-minute intervention and provision of non-narcotic pain medications may reduce the amount of self-administered opioid medication following dental surgery.

Adverse childhood experiences predict opioid relapse during treatment among rural adults.

Adverse childhood experiences (ACE) are a public health concern and strong predictor of substance abuse, but no studies to date have explored the association between ACE and opioid relapse during medication-assisted treatment. Using an observational design, we examined this relationship using archived medical records of 87 patients who attended opioid use disorder treatment (buprenorphine-naloxone and group counseling) at a rural medical clinic. All variables were collected from medical files. ACE scores were derived from a 10-item screening questionnaire administered at intake, a regular procedure for this clinic. The primary outcome was opioid relapse observed at each visit, as indicated by self-reported opioid use, positive urine drug screen for opioids, or prescription drug database results for opioid acquisition. The sample was 100% Caucasian and 75% male. A total of 2052 visit observations from the 87 patients were extracted from the medical records. Patients had an average of 23.6 (SD = 22) treatment visits. Opioid relapse occurred in 54% of patients. Results indicated that for every unit increase in ACE score, there was an increase of 17% in the odds of relapse (95% CI: 1.05-1.30, p = .005). Additionally, each treatment visit was associated with a 2% reduction in the odds of opioid relapse (95% CI: 0.97-0.99, p = .008). We conclude that ACE may increase the risk for poor response to buprenorphine-naloxone treatment due to high rates of opioid relapse during the first treatment visits. However, consistent adherence to treatment is likely to reduce the odds of opioid relapse.

Fit & quit: An efficacy trial of two behavioral post-cessation weight gain interventions.

While smoking cessation leads to significant improvements in both mortality and morbidity, post-cessation weight gain partially attenuates this benefit. Even though post-cessation weight gain is small (4.7 kg on average), it is a stated reason to delay cessation attempts and is associated with smoking relapse. Fit & Quit is a randomized, controlled efficacy trial that aims to examine the ability of a weight stability intervention and a weight loss intervention to reduce post-cessation weight gain. For this purpose, Fit & Quit will randomize participants to three conditions: (a) Small Changes, a weight gain prevention intervention; (b) Look AHEAD Intensive Lifestyle Intervention; and (c) a lower-intensity bibliotherapy intervention. All conditions will receive a highly efficacious behavioral (i.e., rate reduction skills, motivational interviewing) and pharmacological (i.e., varenicline) smoking cessation program. A total of 400 participants will be recruited and randomized to the three interventions. Participants will be recruited in waves, with 10 waves of approximately 40 participants per wave. The primary outcomes of this study include post-cessation weight gain and cessation status at 12-month follow-up. Fit & Quit will integrate and adapt the strongest evidence-based interventions available for weight management and smoking cessation. Fit & Quit is highly innovative in the areas of the target population, study design, and use of technology. For these reasons, we expect that Fit & Quit will make a significant public health contribution to curtailing the important cessation barrier of post-cessation weight gain.

Perceived Needs of Veterans Transitioning from the Military to Civilian Life.

Despite existing separation services provided by the military, many transitioning to civilian life report continued or even worsening issues, including anger outbursts, PTSD, sustained substance use, and strained family relationships. Further, only 61% of the 1,906,754 veterans separated since 2002 participate in the VA health care system after separation, indicating that at least three quarters of a million veterans are not captured by research conducted in VA systems. The current study (N = 90) examined the perceived needs of veterans transitioning from the military to civilian life, assessed issues that prevent these individuals from participating in VA health care upon separation, and captured veteran recommendations to improve existing separation services, either prior to or after the transition to civilian life. Veterans identified several needs, including improved access to care, mental health and substance use counseling, and preparedness for adjustment and economical/financial issues. Implications for both care and policy are discussed.

Smoking Cessation for Those Pursuing Recovery from Substance Use Disorders.

This article summarizes the literature regarding the similar biopsychosocial mechanisms of tobacco use and alcohol and substance use disorders, and the evidence for and against the provision of tobacco cessation for those in treatment for alcohol and substance use disorders. The practicality of treatment, focusing on methods, timing, and breadth of intervention strategies, are also presented. Common methodologies that may be used across tobacco use and alcohol and substance use disorder to prevent lapse and relapse are discussed. Physicians can and should adhere to the policy that tobacco use is a common and dangerous comorbid condition that demands concomitant treatment.

Planning a Change Easily (PACE): A randomized controlled trial for smokers who are not ready to quit.

Smoking cessation programs are efficacious and have been validated to assist the 10% to 30% of smokers who are ready to quit in the next 30 days. While the majority of smokers want to quit smoking in the future, only 69% are planning to quit within the next year. Planning a Change Easily (PACE) is a nation-wide, telephone-based comparative effectiveness, randomized controlled trial for smokers not ready to quit (SNRTQ). This project, as well as its intervention components, outcomes, and hypotheses are discussed. This study will compare the effectiveness of four intervention conditions that could potentially help SNRTQ to quit smoking: Brief Advice, Motivational Interviewing, Rate Reduction, and Motivational Interviewing plus Rate Reduction combined. Rate Reduction conditions will include the provision of nicotine replacement therapy in the form of gum. Approximately 840 participants will be recruited and randomized to the four intervention conditions. The main outcomes for this study include self-report prolonged and point prevalence abstinence with biochemical verification of cessation. Secondary outcomes include quit attempts, cost-per-quit, and cost-effectiveness analyses. Informed by evidenced-based interventions, strong clinical guidelines, and economic analysis, PACE has the potential for significant public health impact. Results could readily be disseminated and translated to tobacco quitlines, which are present in all 50 states and are offered free to the public.

Substance Use and Psychological Distress Before and After the Military to Civilian Transition.

Background: Those currently serving in the military constitute a vulnerable population given their high-risk status for substance use, and population data suggest that veterans continue to engage in significant substance use long after their military service ends. Recent research suggests that the separation transition from active duty to civilian life may be critical in terms of the future functioning of the veteran. Methods: We sought to explore substance use prevalence, as well as potential emotional distress among veterans by retrospectively assessing substance use during active duty and following separation to examine possible changes in use over this period. This study assessed substance use and emotional distress in veterans (N = 80; 90% male) across the military to civilian transition. Findings: Repeated measures tests indicated that endorsement of alcohol use, cigarette use, and prescription drug misuse was similar during active duty and post-separation, and marijuana and hard drug use endorsement increased significantly in the 6-mo period post-separation. Further, comorbid use of different substances was common. Active duty levels of anxiety/depression and aggressive feelings were maintained from active duty to post-separation, and feeling alone and military-based trauma symptoms increased significantly. Finally, participants indicated that only a minority of the veterans they knew were doing emotionally well or did not have alcohol/substance use issues. Discussion: These findings indicate a clear need for substance use and psychological intervention availability before and after transition to enable veterans to transition to civilian life effectively. Based on the many issues at work during the transition process, programs may do well to focus more specifically on identification of problems and raising awareness, rather than awaiting more severe issues in the future. Validation of the difficulties of the separation transition, veterans' feelings of isolation, and the importance of veteran community support may help newly transitioning veterans find advocates who may help them navigate existing assistance programs.

Physician Intervention for Improving Tobacco Control Among Parents Who Use Tobacco.

Research has demonstrated that parents who smoke are often inadvertent sources of their children's first cigarettes. Teaching parents to restrict their tobacco may give pediatricians another method for helping parents who are not ready to quit smoking. This purpose of this study was to determine the feasibility of a program training pediatricians to discuss tobacco control with smoking parents and to examine changes in parents' tobacco control after the physician intervention. One month after the intervention by pediatricians, parents reported significantly improved tobacco control. They were more likely to count their packs and cigarettes and to keep their tobacco products at work and on their person. Parents reported restricting household control of adult smoking, and children were exposed to significantly less secondhand smoke. These results showed that it is possible to integrate advice about tobacco control into a busy pediatric practice and to improve parents' restrictions of their tobacco products.

Smoking and Smoking Increase in Caregivers of Alzheimer's Patients.

PURPOSE OF THE STUDY: The relationship between stress and smoking has been established, but there is little research on the effects of stress and coping on smoking in caregivers of Alzheimer's disease patients. This study examines how caregiver stressors and coping resources explain smoking status and recent smoking increase. DESIGN AND METHODS: Data were obtained from the Resources for Enhancing Alzheimer's Caregivers Health (REACH II) study. Analyses identified differences between caregiver smokers and nonsmokers and between caregiver smokers who reported a recent smoking increase and those who did not. Variables that were significantly different between the groups were examined in two logistic regression analyses to explain smoking status and smoking increase. RESULTS: Of 642 caregivers, nearly 40% reported smoking and 25% of smokers reported recent increase in smoking. Younger caregivers were more likely to report smoking. Explanatory variables for smoking increase were being Caucasian or African-American, higher depression scores, and less caregiving skills. IMPLICATIONS: This study demonstrates that smoking among caregivers is a valid public health concern. Further investigation of ways that explanatory variables affect smoking status and increase in caregivers, and incorporation of smoking cessation strategies that address depression and low caregiving skills, seem warranted in future caregiver interventions.

Craving effect of smoking cues in smoking and antismoking stimuli in light smokers.

Cue-reactivity models may be able to inform light and intermittent smoking patterns not yet explained by withdrawal models. For instance, smoking cues in smoking and antismoking advertisements may elicit cravings in smokers at equal rates, which may promote smoking maintenance. Moreover, smoking has been associated with impulsivity, but has not been explored in light and intermittent smokers (LITS). Aims of this study included the assessment of the impact of smoking and antismoking advertisements on post-exposure cravings in LITS and assessment of impulsivity as a moderator between cue exposure and cravings. Data from 155 LITS were analyzed. Participants were exposed to one of three stimuli conditions (i.e., smoking, antismoking, and neutral) and completed measures of demographics, tobacco use and history, impulsivity, and cravings. Univariate analysis demonstrated that smoking stimuli produced higher cravings relative to antismoking and neutral stimuli, whereas no differences between antismoking and neutral stimuli were observed. Impulsivity did not moderate the relationship between stimuli condition and cravings. Implications stemming from these findings include the further regulation of smoking advertisements and future exploration of smoking and smoking cessation in the context of cue-reactivity.