Reducing suicidal ideation in African American adolescents: A randomized controlled clinical trial.

OBJECTIVE: Suicide rates among African American adolescents have increased exponentially in recent years. The socioecological stressors that can increase suicide risk for African American adolescents, in conjunction with unique suicide risk manifestations within this group, require culturally sensitive preventive interventions. This study examines the efficacy of the Adapted-Coping With Stress course (A-CWS), a culturally tailored preventive intervention, to reduce suicidal ideation in African American adolescents, utilizing a randomized controlled design. METHOD: Participants included 410 ninth-grade students in a large Midwestern city; most students identified as Black/African American. Participants were randomly assigned to either the A-CWS intervention or standard care control condition. All participants were assessed at baseline, immediately postintervention, and 6 and 12 months postintervention. RESULTS: Treatment effects were examined using latent growth models comparing suicidal ideation trajectories in control and intervention conditions. Analyses were conducted using both intention-to-treat and treatment-as-received samples (i.e., intervention condition participants who attended at least 80% of sessions). In both intention-to-treat and treatment-as-received analyses, there was a significant treatment effect: Individuals in the A-CWS intervention condition with higher baseline ideation evidenced a superior reduction in suicidal ideation over the course of the study, relative to their counterparts in the standard care control condition. CONCLUSION: Findings indicate that the A-CWS preventive intervention is efficacious in reducing suicidal ideation among African American adolescents with higher levels of baseline suicidal ideation and that effects sustain over time, with the strongest effect evidenced 12 months postintervention. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Opioid Use Disorder Stigma and Support for Harm Reduction in Rural Counties.

Background: The opioid crisis is a public health emergency in the United States, particularly in rural Pennsylvania. Stigma in rural communities is a treatment barrier and impacts harm reduction programming availability.Objectives: The current study utilized an observational, cross-sectional design to examine latent subgroups of stigma and differences in support for harm reduction strategies (i.e., safe injection facilities, syringe services programs, fentanyl test strips, Naloxone distribution). Participants included rural Pennsylvanians (n = 252), taken from a statewide survey of opioid use disorder (OUD) stigma. Participants reported OUD public stigma (i.e., attitudes/perceptions about OUD, willingness to engage with individuals with OUD) and support for harm reduction strategies.Results: Latent class analysis identified 4 stigma classes: 1) high stigma (HS), 2) high judgment/low stigmatizing behavior (HJ/LB), 3) high stigmatizing behavior/low stigmatizing attitude (HB/LA), and 4) low stigma (LS). ANCOVAs identified subgroup differences in harm reduction support. The HS group indicated less support for safe injection sites, syringe services programs, and fentanyl test strips, compared to the HB/LA and LS groups. The HS group indicated less support for Naloxone distribution compared to the HJ/LB, HB/LA, and LS groups. Lastly, the HJ/LB group indicated less support for each program compared to the LS group.Conclusions/Importance: Findings highlight that OUD stigma profiles differ across rural Pennsylvania and are associated with varying support for harm reduction strategies. Individuals with less stigma report more support for harm reduction strategies. Interventions to implement harm reduction strategies should consider varying levels of stigma and use a targeted approach to inform implementation and messaging strategies.

Longitudinal patterns and predictors of suicidal ideation in African American adolescents.

Suicide rates among African American adolescents have increased dramatically. Suicidal ideation is associated with both suicide attempts and completions, thus understanding ideation patterns and predictors in African American adolescents is critical to informing prevention efforts. This study recruited 160 African American ninth grade students. Participants were those students randomized to the control condition of a randomized controlled preventive intervention. Of the 160 participants, 99 completed all assessment points and were included in latent transition analyses. We assessed participants four times: baseline then again at 6-, 12-, and 18-month postbaseline. Constructs of interest for this study included suicidal ideation, depression, hopelessness, and community violence exposure. A 2-class model (i.e., low ideation [LI] and high ideation [HI]) characterized ideation at each time point. A total of 86%-90% of participants were in the LI class in any given time point and 27.3% of participants were in the HI class at least once. Participants in the LI class tended to stay in that class, whereas those in the HI class often transitioned to the LI group. Depression and hopelessness, but not exposure to community violence, predicted HI class membership. Findings suggest that (a) most African American adolescents may experience suicide ideation at some point in time, (b) a concerning proportion of African American adolescents may experience high ideation, (c) high ideation is often time-limited, and (d) depression and hopelessness predict high ideation.

Social Support Coping for African American Adolescents: Effect of a Culturally Grounded Randomized Controlled Trial Intervention.

The effect of the Adapted-Coping with Stress (A-CWS) intervention on social support coping was examined, using a randomized controlled trial design. The participants were 410 ninth-grade students (ages 14 to 16 years and mostly African American) living in low-resourced neighborhoods. Participants were randomly assigned 1:1 to either the A-CWS intervention or a standard care control condition. All participants were assessed at their schools before implementation of the intervention, at intervention completion, and again at 6- and 12-month post-intervention. Engagement in social support coping was examined in both intention-to-treat and treatment-as-received samples (i.e., intervention participants who attended at least 12 A-CWS treatment sessions and participants in the standard care control condition), using latent growth models. In intention-to-treat analyses, no significant treatment effects were identified. In treatment-as-received analyses, results revealed a significant association between social support coping and treatment condition; levels of social support coping decreased over time in the control condition, but they remained relatively stable in the treatment condition. The results indicate adequate intervention adherence and efficacy of the A-CWS to sustain social support coping within a sample of youth at high risk for stress exposure and associated disorders.Clinical Trial Registration: clinicaltrials.gov identifier: NCT0395445.

The Opioid Epidemic and the State of Stigma: A Pennsylvania Statewide Survey.

Background: The opioid epidemic is a public health crisis. Among initiatives surrounding treatment and prevention, opioid use disorder (OUD) stigma has emerged as a subject for intervention. Objectives: This study examines overall results and demographic differences of three subscales of a public stigma survey instrument: general attitudes, social distance, and treatment availability and effectiveness. Methods: A statewide sample of Pennsylvanian adults (N = 1033) completed an online survey about the opioid epidemic. Weighted percentage level of agreement was reported for each item. To determine significant differences in responding across demographic groups (gender, race, and urban/rural status), multiple one-way ANOVAs were analyzed. Significant differences in the level of agreement and disagreement (p < .05) were reported. Results: The majority of respondents agreed that the opioid epidemic is a problem and that anyone can become addicted to opioids; however, many Pennsylvanians still disagree that OUD is a medical disorder and continue to endorse social distance beliefs of people with OUD. Most participants agreed that there are effective treatments available, and that recovery was possible; however, a large portion of participants were unsure whether specific treatments are effective. Subscale mean differences were significant for gender and age. Conclusions/Importance: Findings highlight that stigmatized attitudes, behaviors, and beliefs about individuals who use opioids are still prevalent and that uncertainty remains about the effectiveness of OUD treatment. OUD interventions should use targeted messaging in order to impact the ongoing opioid crisis.

Suicide in African American Adolescents: Understanding Risk by Studying Resilience.

Historically, suicide rates for African American adolescents have been low, relative to rates for youth of other racial-ethnic backgrounds. Since 2001, however, suicide rates among African American adolescents have escalated: Suicide is now the third leading cause of death for African American adolescents. This disturbing trend warrants focused research on suicide etiology and manifestation in African American adolescents, along with culturally sensitive and effective prevention efforts. First, we revisit leading suicide theories and their relevance for African American adolescents. Next, we discuss health promotive and protective factors within the context of African American youth development. We also critique the current status of suicide risk assessment and prevention for African American adolescents. Then, we present a heuristic model of suicide risk and resilience for African American adolescents that considers their development within a hegemonic society. Finally, we recommend future directions for African American adolescent suicidology.

Patterns of Community Violence Exposure among African American Adolescents Living in Low-Resourced Urban Neighborhoods.

African American adolescents living in neighborhoods with concentrated economic disadvantage are disproportionately exposed to community violence. This study builds upon previous research and examines patterns, severity, and chronicity of violence exposure, within a sample of African American adolescents living in low-resourced, urban neighborhoods (n = 327). The influence of both individual- and contextual-level factors on community violence exposure (CVE) is examined. Data were collected across four time points at 6-month intervals. Latent transition analysis identified three patterns of CVE at each time point: low witnessing and low victimization (LW-LV), high witnessing and low victimization (HW-LV), and high witnessing and high victimization (HW-HV), as well as transitions between each class. Although a stable LW-LV class membership over time was the most prevalent pattern, most adolescents experienced some change in exposure. Nearly one-third of the participants were classified in the HW-HV group at some point in time. Analyses on individual- and contextual-level factors revealed that more depressive symptoms, community problems (e.g., drugs, graffiti, noise), or community resources (e.g., schools, parks, recreational facilities) were associated with an increased likelihood of experiencing high levels of violent victimization. Implications for intervention and prevention of CVE are discussed.

African American adolescent suicidal ideation and behavior: The role of racism and prevention.

Suicide is one of the most devastating, yet preventable, health disparities for African American adolescents. African American adolescent suicidal ideation and behavior may have different manifestations and risk factors relative to those of adolescents from other ethnic backgrounds that impact prevention efforts. For example, in addition to more common manifestations of suicidal ideation and behavior, African American youth may engage in violent or high-risk behaviors, use more lethal means, or report ideation at lower depression levels. The Adapted-Coping with Stress Course (A-CWS), an adaptation of Gregory Clarke and colleagues' Coping with Stress Course, was developed to address the cultural nuances of African American adolescents. The A-CWS is a 15-session cognitive-behavioral, group-based preventive intervention that aims to enhance adaptive coping skills and reduce suicidal ideation, by incorporating strategies that counter stressors associated with systemic racism that burden African American adolescents. This study evaluated the feasibility and acceptability of the A-CWS intervention, using a sample of predominantly African American ninth-grade students. Results indicated that the adolescents were very favorable and receptive to the A-CWS intervention and that the intervention could be conducted feasibly. The A-CWS intervention serves as a model to advance culturally-grounded, evidence-based preventive intervention, for an underserved sector of adolescents.

Peer Victimization Exposure and Subsequent Substance Use in Early Adolescence: The Role of Sleep Problems.

While sleep problems are positively associated with both peer victimization and substance use, previous studies largely have ignored the indirect role sleep problems may play in this association. This three-wave longitudinal study aimed to determine whether sleep problems might link peer victimization to subsequent substance use. Participants were 986 youth (53.7% female, Mage = 12.32 [SD = 0.54 years], 55.6% White, 24.4% Latinx, 22.8% African American/Black, 11.1% Multiracial/Multiethnic, 13.4% Asian/Pacific Islander, and 6.4% Native American) from three U.S. public middle schools. A structural equation model controlling for multiple potential confounds revealed an indirect effect of peer victimization on substance use through sleep problems. Multiple group analyses indicated that the indirect effect was larger for females than for males. Effects did not differ across school socioeconomic level. The results provide further support to include peer victimization when considering factors that may influence adolescent sleep issues and subsequent substance use.

Expanding Collective Efficacy Theory to Reduce Violence Among African American Adolescents.

Community violence is a complex phenomenon, and many theories have been put forth to explain the causes of community violence and disparities in community violence across neighborhoods. One notable theory, collective efficacy theory (CET), posits that collective efficacy (i.e., a neighborhood's social cohesion and informal social control) mediates the association between concentrated disadvantage and community violence. As CET theorizes an inverse feedback loop between collective efficacy and community violence, collective efficacy could mitigate the link between neighborhood disadvantage and community violence. The current study examines the reciprocal association between collective efficacy and community violence exposure using data from 604 low-resourced, urban African American ninth-grade students from a large Midwestern city. Data were collected at 6-month intervals over 2 years. Significant cross-sectional associations were found between each of the collective efficacy constructs (social cohesion and informal social control) and community violence exposure, although no significant longitudinal cross-lagged associations were found. There were positive cross-sectional associations between (a) collective efficacy and community violence exposure and (b) informal social control and community violence exposure; however, the association between social cohesion and community violence exposure was negative. Associations between overall collective efficacy, as well as its subscales, and community violence exposure were consistent with hypothesized directions for social cohesion, but not for collective efficacy or informal social control. Findings support the use of collective efficacy as two constructs, rather than a single construct as proposed by Sampson et al. Implications for expanding original assumptions of CET are discussed.

Culturally Grounded Stress Reduction and Suicide Prevention for African American Adolescents.

Suicide is an often-overlooked manifestation of violence among African American youth that has become more prevalent in the last two decades. This article reports on the process used to culturally adapt a cognitive-behavioral coping with stress prevention intervention for African American adolescents. We implemented this adapted school-based suicide prevention intervention with 758 African American 9th, 10th and 11th grade students at four high schools in a large Midwestern city. The findings presented are preliminary. The adolescents in this sample endorsed high levels of suicide risk, with females endorsing significantly more suicide risk than males. Those receiving the prevention intervention evidenced an 86% relative suicide risk reduction, compared to the standard care control participants. The presented model of adaptation and resulting culturally-grounded suicide prevention intervention significantly reduced suicide risk among African American adolescents. Clinical, research and policy implications are discussed.

Family Dynamics May Influence an Individual's Substance Use Abstinence Self-Efficacy.

BACKGROUND: Previous work on substance use suggests the influence of family dynamics on emotion regulation. OBJECTIVE: The present study examined the role of family in substance use recovery. It is of importance to examine whether conflict with various family members influences an individual's abstinence self-efficacy. METHODS: We examined individual abstinence self-efficacy scores and lifetime conflict with mother, father, and siblings in a sample of 200 women who had been justice involved. RESULTS: We found that conflict with mother was the best predictor of abstinence self-efficacy compared to conflict with father and conflict with siblings. Individuals who indicated having conflict with mother over their lifetime had lower confidence that they could abstain from use in potentially emotionally triggering situations. CONCLUSIONS/IMPORTANCE: These findings suggest that family dynamics, specifically lifetime conflict with mother, do play a role in an individual's confidence to regulate emotions in high-risk relapse situations without turning to substances. Limitations include using abstinence self-efficacy as a proxy for emotion regulation and not directly measuring emotion regulation. Examining family relationships may be especially important in the treatment of women in recovery from substance use.

Housing and abstinence self-efficacy in formerly incarcerated individuals.

To avoid recidivism, formerly-incarcerated individuals must successfully navigate barriers to re-entry, including finding adequate housing and avoiding substance use. This study examined the role that time in diverse housing situations affect abstinence self-efficacy in formerly-incarcerated individuals. Formerly-incarcerated individuals were surveyed about previous housing situations and abstinence self-efficacy after release from prison or inpatient substance use treatment. Models were estimated with both days spent in different housing situations in the past 180 and past 30 days. More time spent in recovery situations was associated with increased abstinence self-efficacy, while more time spent in precarious situations was associated with decreased abstinence self-efficacy.