Polysubstance use latent class membership in New Jersey: Association with prior overdoses, prior emergency department peer recovery engagement, and mental health diagnosis among participants in an opioid overdose recovery program.

Background: Epidemiological research has indicated higher polysubstance use among individuals who misuse opioids in the United States. Polysubstance use is also associated with multiple emergency department (ED) engagements in intervention services. Less is known about polysubstance use among individuals who use opioids or were engaged in an ED setting as part of an opioid recovery intervention program. Examining emerging patterns of polysubstance use among individuals who use opioids may help shape policy and practice around developing drug markets and social norms. The objective of this study was to understand subpopulations who demonstrated distinct patterns of polysubstance use among participants in an ED Opioid Overdose Recovery Program (OORP) in New Jersey. Method: This study investigated patterns of polysubstance use among participants in a New Jersey OORP using latent class analysis (LCA; N = 1690; 70.2% male; 84.7% White non-Hispanic; meanage = 35.72 ± 11.95). Multinomial logistic regression analyses examined latent class (LC) membership based on clinically relevant indicators. Results: Five latent classes were identified (Model fit: L2 = 33.76, BIC = 4482.69, AIC = 4245.01, and the bootstrap L2p-value =0.27; standard R2 value of 0.85). Multinomial logistic regression analyses showed that subgroups with the greatest odds of prior OORP engagement related to those participants in subgroups with heroin and polysubstance use. Conclusion: It is critical to examine the heterogeneity among people engaging in prescription opioid use and polysubstance use in the United States. This study represents an important contribution in identifying polysubstance use LC membership groups and associations with clinically relevant indicators among those engaged in an opioid recovery program. Results can be valuable in understanding the nature of the larger epidemic and how it can be addressed.

Measuring Youth Empowerment: An Item Response Theory Analysis of the Sociopolitical Control Scale for Youth.

Sociopolitical control (SPC) has been identified as a key element of the intrapersonal component of psychological empowerment. The Sociopolitical Control Scale (SPCS) is a widely used measure and has been modified for use among youth (SPCS-Y). In light of the emerging interest in SPC among youth within community-based research, this study applied item response theory (IRT) to examine the psychometric properties of the SPCS-Y and to explore a brief version. Data were collected between 2006 and 2013 from a convenience sample of high school students (N = 1,808), located in a midsized, economically disadvantaged urban community in the northeastern United States. Findings indicate that the two subscales, leadership competence, and policy control, were unidimensional and items functioned well. Most items functioned particularly well at low and moderate levels of the construct, but a few were able to capture higher levels of the construct. Based on our IRT analyses of the performance of items on the subscales, we selected items to create a brief version of the SPCS-Y (BSPCS-Y) and performed structural equation modeling for further examination. Results provide empirical evidence to support the reliability and validity of the SPCS-Y and suggest a brief version based on high-performing items is possible.

Measurement invariance of the Brief Sense of Community Scale across non-Hispanic, Black and Hispanic college students.

Ethnic-racial background may influence college students' psychological sense of community (PSOC). Thus, it is critical to examine whether this construct is conceptualized similarly between non-Hispanic, Black and Hispanic students. This study tested the measurement invariance of the Brief Sense of Community Scale (BSCS) across the two groups. We used data from a self-administered online survey provided to college students in 2016 in a Northeastern urban university (non-Hispanic, Black = 307; Hispanic = 409). We tested the measurement invariance of the BSCS using a series of nested multigroup confirmatory factor analyses with increasingly restrictive sets of parameters. Measurement invariance of the BSCS across non-Hispanic, Black and Hispanic college students was achieved. The BSCS successfully measures the multidimensionality of PSOC across the two groups in a college setting. Students' score on the BSCS is not biased by measurement invariance related to cultural influences. When using the BSCS, community psychologists and researchers can have confidence that the observed differences in PSOC across non-Hispanic, Black and Hispanic college students are attributable to true differences rather than a cultural understanding of the construct.

Participation in community organizing: Cross-sectional and longitudinal analyses of impacts on sociopolitical development.

This article reports cross-sectional (Study 1) and longitudinal (Study 2) results from analyses of civic behaviors and attitudes among two groups: participants in grassroots community organizing in five US cities and a geographically balanced sample of their neighbors, many of whom were participating with other types of voluntary organizations (e.g., neighborhood-based or school-based groups). This analytic approach allowed for tests of differences between groups, differences within groups over time, and interactions between groups and time on indicators of sociopolitical development including civic behaviors, psychological sense of community, and the emotional and cognitive components of psychological empowerment. Results showed that community organizing, as a particular type of mediating institution, cultivates sociopolitical development by elevating psychological empowerment and civic engagement over time.

Psychometric properties of a Recovery Empowerment Scale: Testing emotional, cognitive, behavioral, and relational domains.

Psychological empowerment (PE) is a multidimensional construct comprised of emotional, cognitive, behavioral, and relational domains. Although context-specific measures of PE exist, no study to date has introduced and tested a measure of the construct that captures all four domains for both women and men in recovery from substance misuse. Furthermore, research has largely neglected the relational dimension, particularly in studies involving people in recovery. In this study, we tested a measure of PE among a diverse sample (n = 200) of people in recovery who participated in a program designed to expand access to medications for opioid use disorder in the northeastern United States. Factor analysis results supported the hypothesized four-factor structure of the scale, and dimensions of PE were found to be associated in expected ways with measures of quality of life, self-reported health, and depression. Implications of the study are described and directions for future research discussed.

Youth Cognitive Empowerment: Development and Evaluation of an Instrument.

Psychological empowerment (PE) is a multicomponent construct that involves the mechanisms through which people and groups gain control over their lives and environments. Psychological empowerment has previously been operationalized using measures of sociopolitical control among young people, with findings indicating links between PE and other positive developmental outcomes. Sociopolitical control, however, is only an indicator for the emotional component of PE. Research has largely neglected the cognitive component of PE, particularly in studies of younger people. In fact, few studies to date have presented and empirically tested measurement instruments for the cognitive component of PE among youth. In this study, we adapted a measure, which previously had been validated and used among adults, for use among young people and tested it in a sample of high school students (53% female, 75% Hispanic) in an urban school in the northeastern U.S. Confirmatory factor analyses were used to assess the hypothesized three-factor structure of cognitive empowerment, and the measure was examined for association with the construct of social justice orientation. Results indicate an adequate fit for the second-order factor, and an expected relationship with the related construct.

Critical Hopefulness Among Urban High School Students.

Psychological empowerment encompasses several key aspects of youth civic and sociopolitical development. Most research has focused on psychological empowerment's emotional component, which entails learned hopefulness about one's own ability to participate in and lead community change efforts. Fewer studies have assessed critical awareness of how social power operates-psychological empowerment's cognitive component. The confluence of these two components has been termed critical hopefulness. A complex relationship exists between these two components, and previous research has found relatively small proportions of participants reporting both high levels of critical awareness and simultaneously high levels of hopefulness about their ability to exert influence in the sociopolitical domain. The current study of urban high school students in the Northeastern U.S. (n = 389; 53.5% female) investigates heterogeneity according to these two components of psychological empowerment. Latent class cluster analyses were conducted and seven distinct groups of participants emerged. Students identifying as Hispanic/Latinx were more likely to be classified into a profile group exhibiting critical hopefulness. Differences were observed between psychological empowerment profile groups on self-reported levels of psychological sense of community, civic engagement, and social justice orientation. Furthermore, a larger proportion of this overall sample was classified into groups that exhibited critical hopefulness than in a previous study of adults. These findings provide useful insights for efforts to engage young people in civic life and to promote sociopolitical development.

Assessing Community Participation: Comparing Self-Reported Participation Data with Organizational Attendance Records.

How well do self-reported levels of community and organizational participation align with recorded acts of community and organizational participation? This study explores this question among participants in social action community organizing initiatives by comparing responses on a community participation scale designed to retrospectively assess community participation (T1, n = 482; T2, n = 220) with individual participants' attendance records in various social action organizing activities over two 1-year periods. By testing the self-reported measure's overall and item-by-item association with documented participation in various types of organizing activities, we find that the self-report measure is positively, but weakly correlated with actual participation levels in community organizing activities. Moreover, associations between self-report and recorded acts of participation differ by types of activity. Examining this unique source of data raises important questions about how community participation is conceptualized and measured in our field. Implications are explored for theory and measurement of participation in community and organizational contexts.

A randomized controlled trial of a multi-dose bystander intervention program using peer education theater.

This article reports findings from a longitudinal, experimental evaluation of a peer education theater program, Students Challenging Realities and Educating Against Myths (SCREAM) Theater. This study examines the impact of SCREAM Theater on a range of bystander-related outcomes (i.e. bystander intentions, bystander efficacy, perception of friend norms and bystander behaviors) in situations involving sexual violence and whether there was a differential impact of the program by participant sex. First-year college students completed three waves of surveys (pretest, first post-test and second post-test). All participants received one dose of the intervention during summer orientation after the pretest. After the first post-test, participants were randomly assigned to receive two additional doses, or to a control condition, in which they received no additional doses. Students in both one- and three-dose groups reported a number of positive increases. Overall, an intent-to-treat analysis (n = 1390) indicated three doses of the intervention during the first semester of college resulted in better outcomes than the one-time intervention during summer orientation alone. Although both male and female students' scores increased during the study period, female students consistently scored higher than male students on each outcome. The findings suggest that peer education theater holds promise for bystander intervention education on college campuses.

Predicting Bystander Behavior to Prevent Sexual Assault on College Campuses: The Role of Self-Efficacy and Intent.

Bystander intervention has been increasingly applied to prevent sexual violence on college campuses. Its underlying theory assumes unidirectional relationships between variables, predicting that bystander behaviors (i.e., actions taken to intervene in sexual violence situations) will be influenced by bystander intentions (BI; i.e., likelihood to intervene in the future), which in turn will be affected by bystander efficacy (BE; i.e., confidence to intervene). One question for theory is whether a reciprocal relationship exists between BI and BE. We used structural equation modeling (SEM) with longitudinal data to test unidirectional and reciprocal causal relations between BI and BE. Participants (n = 1390) were students at a northeastern US university. Four models were examined using SEM: (1) a baseline model with autoregressive paths; (2) a model with autoregressive effects and BI predicting future BE; (3) a model with autoregressive effects and BE predicting future BI; and, (4) a fully cross-lagged model. Results indicated that reciprocal causality was found to occur between BI and BE. In addition, a final model demonstrated indirect effects of a bystander intervention program on bystander behaviors through both BI and BE at different time points. Implications for theory and practice are described, and directions for future research discussed.

Empowerment theory: clarifying the nature of higher-order multidimensional constructs.

Development of empowerment theory has focused on defining the construct at different levels of analysis, presenting new frameworks or dimensions, and explaining relationships between empowerment-related processes and outcomes. Less studied, and less conceptually developed, is the nature of empowerment as a higher-order multidimensional construct. One critical issue is whether empowerment is conceptualized as a superordinate construct (i.e., empowerment is manifested by its dimensions), an aggregate construct (i.e., empowerment is formed by its dimensions), or rather as a set of distinct constructs. To date, researchers have presented superordinate models without careful consideration of the relationships between dimensions and the higher-order construct of empowerment. Empirical studies can yield very different results, however, depending on the conceptualization of a construct. This paper represents the first attempt to address this issue systematically in empowerment theory. It is argued that superordinate models of empowerment are misspecified and research that tests alternative models at different levels of analysis is needed to advance theory, research, and practice in this area. Recommendations for future work are discussed.

Measuring relational and intrapersonal empowerment: testing instrument validity in a former soviet country with a secular muslim culture.

Research and evaluation studies measuring the construct of empowerment within international community development and human rights initiatives are rare due to a lack of validated measures appropriate for the cultural context. This study represents an initial effort to develop and test the Brief Azerbaijani Empowerment Scale (BAES), an instrument designed to assess relational and intrapersonal components of psychological empowerment among adult community residents (n = 350) in Azerbaijan, a former Soviet country with a predominantly Muslim culture. Exploratory factor analysis was used to examine the underlying dimensionality of the BAES, and path analysis was used to examine relationships between subscales of the BAES and a set of conceptually relevant variables (i.e., alienation, sense of community, and involvement in community organizations). Findings supported the reliability and validity of the BAES, which may be useful to future efforts to develop more comprehensive measures of intrapersonal and relational empowerment. Implications for future research and practice are discussed.

Peer Recovery Specialists and Referrals to Treatment: Clinical Correlates Among Patients of an Opioid Overdose Recovery Program in New Jersey.

BACKGROUND: Peer recovery programs increase recovery support and treatment engagement among individuals with opioid use disorder. Peer recovery specialists (PRS) are critical in the cascade of care of treating addiction and related conditions. Work remains to help identify the benefits of PRS, particularly time spent with a PRS as a clinical indicator associated with referral to substance use treatment services. Gaps in the literature do not consider the nested hierarchical intercorrelations of opioid recovery data within multiple emergency departments. PURPOSE: The current study examined demographic and clinical correlates with referral to substance use treatment services including prior engagement within an opioid overdose recovery program, mental health diagnosis, the number of naloxone administrations, prior overdoses, and hospital-level variability of PRS time associated with treatment referrals. METHOD: This study used data collected by providers among patients who engaged in an opioid overdose recovery program. Data were collected between January 2016 and September 2020. Generalized linear mixed effect multilevel regression analyses tested the associations on clinical referral to substance use services. RESULTS: A total of 5655 patients participated in the study (male: 68.91%; age: mean = 37.75 ± 12.43; White non-Hispanic: 62.48%). Significant individual-level associations were identified between demographic and clinical variables and referral to substance use treatment services. At the hospital level, recovery specialist time spent with the patient also showed a positive and significant association with referral to substance use treatment services. CONCLUSION: The cross-level interaction effect displayed that any period of time spent with PRS played an important role for those patients with a greater number of prior overdoses on referral to treatment. Results provide important information on the role of PRS in the cascade of care, as well as the time spent with those in this role for both individuals with varying number of prior overdoses.

The influence of participation, gender and organizational sense of community on psychological empowerment: the moderating effects of income.

This study explored the influence of participation, gender and organizational sense of community (SOC) on both the intrapersonal and interactional components of psychological empowerment (PE). Participants were residents (n = 562) involved in community organizing efforts in five U.S. communities. Measures of participation and SOC were tailored to community organization contexts. SOC assessed three dimensions: (1) connection of members to the organization; (2) perceptions about the organization as a bridge to other groups and organizations in the broader community; and (3) bond or attachment to the community at large. Income (low, middle and high-income) was tested as a moderator of these relationships. Results showed significant moderating effects of income on the relationship between participation, gender and SOC on both components of PE. Participation was positively related with intrapersonal empowerment across income levels, but positively related with interactional empowerment only for low-income individuals. Gender was only associated with intrapersonal empowerment, and only for low-income individuals. SOC, as expressed through bridging to the broader community, was positively related with interactional PE for all income levels, but with intrapersonal PE for only low and middle-income individuals. In contrast, member connection to the organization was not related to interactional empowerment and significantly related to intrapersonal empowerment only for individuals with higher income. The importance of participation, gender and SOC for different types of empowerment and the impact of income on the SOC-empowerment relationship are discussed.

Examining tobacco outlet concentration in New Jersey: does income and ethnicity matter?

This study examined the geographic association between tobacco outlet density and the demographic indicators of median household income and percentage of Hispanic residents in New Jersey. Tobacco outlet density was assessed by examining all tobacco retailers licensed in 2004 in New Jersey, and demographic variables were based on the 2000 United States Census. Results indicated that the percentage of Hispanic residents and median household income were both salient predictors of tobacco outlet density. We also observed that income level moderated the relationship between the percentage of Hispanics residents and tobacco outlet density. Implications for environmentally based tobacco prevention and control initiatives are discussed.

Tobacco outlet density and demographics: a geographically weighted regression analysis.

Previous studies have indicated that tobacco outlets seem to be clustered in low-income minority neighborhoods. This study utilized a cross-sectional design to examine the relationships among minority status, median household income, population density, commercial land use, and location of tobacco outlets at the census tract level in Polk County, Iowa. Using geographically weighted regression, this study re-examines one previously carried out in the same location by Schneider et al. (Prevention Science 6: 319-325, 2005). Contrary to that and some other previous studies, this research found no relationship between tobacco outlet density and percent Hispanic, and found a negative relationship with regard to two variables-that of being African American and median household income. Positive significant relationships were found with population density and land use.

The role of empowerment in youth development: a study of sociopolitical control as mediator of ecological systems' influence on developmental outcomes.

Empowerment has become an influential concept and theoretical framework for social policy and practice. Still, relatively little is known about the roles that empowerment plays in the ecology of human development, particularly among young people. This article reports results of a study of psychological empowerment among young people, using data from 629 high school students (65.8% female; 96.5% non-white). Using a path analysis, we examined the role of perceived sociopolitical control--an indicator of the intrapersonal component of psychological empowerment--as a mediator between ecological support systems and developmental outcomes. Findings confirmed that social support in family, peer, and school settings, and family cohesion positively predict self-esteem and perceived school importance, which, in turn, have protective effects on psychological symptoms, violent behaviors and substance use. Sociopolitical control was found to mediate the relationships between ecological supports and risk factors and developmental outcomes, leading to the conclusion that perceived efficacy in the sociopolitical domain, and youth empowerment, more generally, should be considered as core elements of the ecology of human development. Policy and practice aimed at promoting positive developmental outcomes and preventing risk behaviors should take their relationship to sociopolitical control into account.

Testing Relationships Between Racial-Ethnic Identity, Racial-Ethnic Discrimination, and Substance Misuse Among Black and Latinx Older Adults in a Nationally Representative Sample.

Older adults (aged 55+) comprise a rapidly growing population both in number and racial-ethnic diversity. In recent years, substance misuse prevalence among older adults has increased and is expected to continue rising, highlighting the need to understand risk and protective factors in this population. Using nationally representative data, this study examines the association of racial-ethnic identity and racial-ethnic discrimination with alcohol and illicit drug use among Black and Latinx older adults, and whether racial-ethnic identity moderates the relationship between discrimination and substance misuse. Findings show that among Latinx older adults discrimination is associated with increased substance misuse, and higher ethnic identity is associated with decreased illicit drug use. Higher racial-ethnic identity buffers the effects of discrimination on illicit drug use for Latinx, but not for Black respondents. Findings of this study highlight the complex associations between racial-ethnic identity, discrimination, and substance misuse, varying across racial-ethnic group, age, context, and other factors.

Social Isolation Profiles and Older Adult Substance Use: A Latent Profile Analysis.

OBJECTIVES: The aim of this study was to determine substance use among older adults based upon their social isolation and loneliness profiles. METHODS: Data were derived from the New Jersey Older Adult Survey on Drug Use and Health. Latent profile analysis (LPA) was used to determine the profiles of older adults (N = 801) based on 5 dimensions of social isolation and loneliness. Logistic and generalized ordered logistic regressions were conducted to assess the relationship between the latent profiles and substance use. RESULTS: LPA identified 5 social isolation/loneliness profiles. The "connected and active" group had the lowest odds of cigarette use. The "alone but not lonely" group had the highest odds of cigarette use, alcohol use, and high-risk drinking. The "alone and lonely" group had the highest odds of nonmedical drug use. DISCUSSION: In working with older adults who are using substances, it is important to inquire about their social isolation and loneliness. Cognitive behavioral therapy for the "alone and lonely" group may be beneficial, as it has been deemed effective in reducing loneliness and enhancing social networks.

Knowledge of Predatory Practices within the Substance Use Disorder Treatment Industry: Development of a Measurement Instrument.

The increase in predatory practices in the substance use disorder treatment industry calls for the development of measures to assess individuals' knowledge about these practices. METHODS: This study describes the development of the Knowledge of Predatory Practices Scale (KPPS), a newly developed measure designed to assess the knowledge of predatory practices within the substance use disorder treatment industry. An exploratory factor analysis was conducted to determine the factor structure of this measure. RESULTS: The final 11-item KPPS consisted of two factors-knowledge about general predatory practices (9 items) and knowledge about unethical practices (2 items). Overall, these factors explained 61.75% of the total variance. The Cronbach's alpha for the KPPS was 0.81. CONCLUSIONS: The KPPS is a reliable measure of knowledge of predatory practices within the substance use disorder treatment industry and can be used as a measurement tool to educate individuals seeking help for their loved ones who are misusing substances.